Biliary balloon dilation using a triple-lumen balloon catheter.
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Biomedical subjects
Publications and source records attributed to J Zinberg.
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Ceftriaxone, a third-generation cephalosporin, has been associated with the development of sludge or stones in the gallbladders of some patients treated with this medication. Such precipitates, which are usually reversible upon discontinuation of the drug, sometimes cause symptoms, have simulated acute cholecystitis, and have even led to cholecystectomy in some cases. We report the first known instance of biliary obstruction and secondary pancreatitis in association with reversible ceftriaxone-induced pseudolithiasis.
Olsalazine is a compound consisting of two 5-amino salicylate (5-ASA) molecules linked by an azo bond, which, administered orally, is split by colonic bacteria to liberate 5-ASA. It lacks the sulfapyridine moiety found in sulfasalazine. Using a specific protocol, we conducted a randomized, double-blind, placebo-controlled trial of olsalazine in patients with symptomatic ulcerative colitis. Inclusion criteria included mild to moderate disease with involvement of more than 15 cm of colon, visible blood in stools, and the discontinuation of all other medications prior to and during the study. Patients were given oral olsalazine 3.0 g/day or placebo for 4 wk. Patients were evaluated clinically, by laboratory analysis and by colonoscopic evaluation, at entry and at 4 wk. Additional clinical and laboratory evaluations were performed at 2 wk. Fifteen patients entered the study. Of the seven patients randomized to olsalazine, four (57%) improved clinically and by colonoscopic scoring, one showed no improvement in either, and two (29%) withdrew after developing severe watery diarrhea. Of the eight patients treated with placebo, two (25%) improved clinically but were without colonscopic improvement and six (75%) worsened, of whom four withdrew early because of worsening symptoms of colitis. Seven of eight placebo patients were then treated with olsalazine on an open basis. Of these seven, five (71%) improved clinically and colonoscopically and two (29%) withdrew because of severe watery diarrhea. Overall, of 14 patients treated with Olsalazine, nine (64%) improved, one showed no improvement, and four (29%) discontinued because of persistent watery diarrhea. No other serious side effects were noted. Minor side effects included transient diarrhea, flares of acne, and anxiety attacks which resolved despite continuation of the drug.
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A 92-year-old woman with a normal serum calcium level received cimetidine postoperatively. She became severely hypocalcemic and exhibited tetany, seizures, and impaired mental status. Her condition responded to intravenous diazepam, phenytoin sodium, and gluconate calcium. Normal serum calcium levels were maintained by calcium infusions until the cimetidine treatment was stopped. Cimetidine may have been responsible for the observed complications due to its effect on serum parathyroid hormone level.
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Twelve patients with anatomic anal stricture were treated with C-anoplasty in the past six years. Anal stricture was caused by previous hemorrhoidectomy in ten, fistulectomy in one, and fissurectomy in one. All patients had had conservative treatment from four to 22 years but failed to respond. Eleven patients obtained satisfactory results from C-anoplasty; one required three anal dilatations postoperatively because of restricture. C-anoplasty is advantageous because it extends the pedicle without compromising vascular supplies; suture-line tension can be controlled by extending the incision; and the size of the graft is easily adjustable to anal size.