Biomedical subjects
Publications and source records attributed to J R Varma.
Bacterial endocarditis is a preventable disease in most patients. It is a potentially fatal disease if left untreated. This article addresses issues related to bacterial endocarditis prophylaxis as related to lower gastrointestinal endoscopy and the recommendations of the American Heart Association.
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Bowel bypass surgery, which involves shortening the small bowel to about 45 cm, is a modality of treatment for morbid obesity. Although this procedure is not routinely performed today, patients with complications from this procedure are still seen by physicians. The case of a patient who had bowel bypass surgery and experienced subsequent complications is discussed.
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Colonic polyps commonly occur in all age groups and are of varied significance depending on the type of polyp and the symptoms manifested. There is some debate in the medical literature regarding the appropriate clinical management of polyps and the follow-up of patients after polypectomy. This discussion addresses the significance of colon polyps, including their etiology, histology, complications, detection, and management.
A mail survey of 430 participants in a 2-day course on flexible sigmoidoscopy presented over the past 6 years was conducted to determine the extent to which flexible sigmoidoscopy was subsequently utilized in physician practice. Eighty percent of respondents performed the procedure in their practices on a regular basis. Two-thirds of the patients underwent sigmoidoscopy for screening. The course in flexible sigmoidoscopy appears to potentiate the motivation of primary care physicians to incorporate complete colorectal cancer screening in their practice.
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Early detection of colorectal cancer, followed by surgical excision, can effect a cure in 50% of patients. The flexible fiberoptic sigmoidoscope enables identification of lesions in the premalignant or early malignant stages. Its use is cost-effective in any practice that includes more than 200 to 300 patients over age 50, and the procedure is well accepted by patients. Available options for learning the technique are listed, along with their approximate fees. The author explores all considerations pertinent to instituting this screening procedure and suggests the best way to introduce sigmoidoscopy into the established office routine.
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The frequency of colorectal cancer increased during the first half of the twentieth century, but for the last four decades, it appears to have stabilized. Today, the average American has a 5 percent probability of developing colorectal cancer during a 70-year life span. The majority of cases occur in persons aged greater than 50 years; the incidence increases up to age 75 years, after which there is a decline. Etiology is unknown; however, environment, genetics, and carcinogens have been implicated. Genetic relations of skin tags, colon polyps, and colon cancer are a matter of ongoing research. If such relations could be established, it could provide clinicians with a possible additional marker for persons at increased risk of colorectal adenoma and adenocarcinoma. Two cases are presented with a brief review of the literature.
Colorectal cancer is commonly found in adults aged greater than 50 years. The peak frequency occurs in the 6th to 7th decades and gradually declines in the 8th decade. This cancer is very unusual in young adults, the occurrence ranging from 1 to 17 percent of all cases of colon cancer. The prognosis for this disease in the young adult is reported to be unfavorable. This may be due to delayed diagnoses and a higher frequency of mucin-producing tumors and advanced stage of the disease. This article presents a case report and review of the literature and alerts the primary care physician to the possibility of serious disease in young adults who may present with protracted abdominal symptoms. Age should not be a barrier in the application of diagnostic tools. The duration and degree of symptoms should prompt early investigation.
This case report and literature review is presented to alert primary care physicians performing flexible sigmoidoscopy and limited colonoscopy to the malignant potential of even diminutive polyps. The term "polyp" refers to any circumscribed mass of tissue that arises from mucosa and protrudes into the lumen of the gastrointestinal tract. The significance of this lesion in the rectum and colon is its propensity for malignant change. Although small polyps in the region of the rectum tend to be hyperplastic and those more proximal tend to be adenomas with a significant malignant potential, there is no way to distinguish them visually; hence, all need to be biopsied. The following case report shows the necessity of identifying neoplastic lesions within diminutive polyps (less than 1 cm). Standard biopsy technique usually removes these lesions; nevertheless, when histology confirms the presence of adenoma or carcinoma, the patient requires additional evaluation of the entire large intestine and more frequent follow-up examinations.