PubMed Health⌕ Search

Biomedical subjects

James M Church

Publications and source records attributed to James M Church.

25 records · Page 2Linked to original sources
PubMed2003

An unusual complication after hyaluronate-based bioresorbable membrane (Seprafilm) application.

Recent developments in adhesion prevention have led to the introduction of a sodium hyaluranate-based bioresorbable membrane into clinical practice. Its application has been regarded as safe and efficient. We present three cases of postoperative acute aseptic peritonitis without an obvious etiology, which might have been related to this bioresorbable membrane during recent surgery. Surgeons should be aware of this kind of a complication that might be attributed to this product.

Acute Disease↗
PubMed2002

Course and follow-up of solitary Peutz-Jeghers polyps: a case series.

BACKGROUND AND AIMS: Peutz-Jeghers syndrome (PJS) is a rare, autosomal-dominant disease characterized by hamartomatous polyps of the alimentary tract, hyperpigmentation of the skin, and family history of PJS. Rarely, solitary Peutz-Jeghers polyps (PJP) arise in patients without other features of PJS. PATIENTS AND METHODS: We reviewed eight patients since 1979 with solitary PJP, six men and two women. RESULTS: The average age at diagnosis was higher (56+/-13 years) than that of PJS patients in the literature. Polyps were found in the sigmoid colon ( n=4), cecum ( n=1), stomach ( n=1), and duodenum ( n=2). The colonic polyps were diagnosed and removed endoscopically. Indications for colonoscopy included routine screening ( n=4) or rectal bleeding ( n=1). The duodenal and gastric polyps were diagnosed and removed during gastroduodenoscopic examinations, which were performed for nonspecific dyspepsia ( n=2) or gastrointestinal bleeding ( n=1). The median size was 20 mm (range 2 mm-25 mm). Patients were followed for a median of 11.5 years (range 3-22) without another PJP or cancer. Three patients died of causes unrelated to PJP. Five patients are alive and polyp free. CONCLUSION: Solitary PJP do not carry a risk of gastrointestinal cancer and are not an indication for specific high-risk screening.

Adult↗
PubMed2002

Teenagers with familial adenomatous polyposis: what is their risk for colorectal cancer?

PURPOSE: Familial adenomatous polyposis is a general growth disorder caused by highly penetrant germline mutations in the tumor suppressor gene APC. The major manifestation of these mutations is colorectal adenomatous polyposis, which, if untreated, leads to early development of colorectal cancer. To prevent this from happening, endoscopic screening of at-risk family members begins early in the second decade of life. Patients with adenomas are offered surgery sometime in that decade. There is a concern about the risk of cancer in teenagers if such surgery is deferred. We conducted this study to investigate that risk. METHODS: A brief survey was sent by facsimile or mail to all familial adenomatous polyposis registries affiliated with the Leeds Castle Polyposis Group. This questionnaire asked for the number of teenage or younger patients in the registry diagnosed with invasive colorectal carcinoma. Other questions addressed the stages and treatment of the tumors and the outcome of their treatment. Patients with carcinoma-in-situ or intramucosal carcinoma were excluded. RESULTS: Replies were received from 26 of 52 registries, but not all questions were answered by all registries. There were 14 patients identified as having invasive colorectal cancer younger than 20 years, the youngest of whom was 9 and the oldest 19. Two patients had two cancers each. Three patients were diagnosed at surgery, and seven were diagnosed when they presented with symptoms. Of the 13 cancers that had staging information, 8 were T1N0M0; 1 was T2N0M0; 2 were TxN1M0; 1 was T3N0M0; and 1 was TxNxM1. Only one patient died of their colorectal cancer. CONCLUSION: Cancer occurs rarely in familial adenomatous polyposis patients younger than 20 years, and only 1 case was reported younger than 15 years. Surgery for colorectal polyposis usually can be deferred safely until at least the age of 15, unless suspicious lesions are found.

Adenomatous Polyposis Coli↗
PubMed2002

Functional outcome, quality of life, and complications after ileal pouch-anal anastomosis in selected septuagenarians.

PURPOSE: Concerns about morbidity and functional outcome have lead some authors to suggest that ileal pouch-anal anastomosis should not be performed in older patients. This article evaluates the outcome of selected septuagenarians undergoing ileal pouch-anal anastomosis at this institution. METHODS: Seventeen of 1,911 patients undergoing ileal pouch-anal anastomosis for ulcerative colitis were older than the age of 70 at the time of surgery. Functional outcome, quality of life, and manometric data were assessed prospectively, whereas complications were assessed by chart review. RESULTS: There was one mortality related to sepsis after small-bowel obstruction and one reoperation at 18 months for pelvic abscess. Minor complications occurred in five patients. Median (interquartile range) quality of life and health and levels of energy and happiness (scored out of 10) were 9 (7-10), 9 (7-10), 8 (5-10), and 9.5 (7-10), respectively. Medical Outcomes Study Short Form 36 quality of life scores were not different from those for the healthy population older than 65 years. There was complete continence in 38 percent, rare incontinence in 12 percent, and some incontinence in 50 percent. Nobody was usually or always incontinent. Overall, 82 percent would undergo pouch surgery again, and 89 percent would recommend it to others. CONCLUSIONS: Ileal pouch-anal anastomosis is an acceptable surgical option for selected healthy, motivated septuagenarians with ulcerative colitis who are eager to preserve fecal continence.

Aged↗
PubMed2002

Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective.

BACKGROUND: Colonic spasm can interfere with colonoscopy by hindering insertion of the colonoscope and by making polypectomy difficult, painful, and dangerous. Methods for dealing with colonic spasm include waiting for it to subside and administration of antispasmodic agents such as glucagon or hyoscyamine. Glucagon is expensive and hyoscyamine has side effects. This study evaluated an inexpensive technique, warm water irrigation, for overcoming colonic spasm during colonoscopy. METHODS: A prospective, randomized, controlled trial in a consecutive series of patients was conducted to compare warm water irrigation for relaxation of spasm with standard examination techniques. Patients in whom the sigmoid colon had been resected were excluded. In the test group, water from the hot water tap at approximately body temperature was instilled into the colon by means of the accessory channel of the colonoscope with a 30 mL syringe. Any irrigation, either for removal of stool or control of spasm, was performed with warm water in the test group and water at room temperature in the control group. After each colonoscopy, the level of pain experienced by the patient was recorded with a linear analog scale. RESULTS: Sixty-nine patients were randomized. The groups were similar with respect to gender distribution, age, and degree of spasm. There was no difference between groups for insertion time, total duration of colonoscopy, dose of midazolam administered, or frequency of severe spasm. Patients who had warm water irrigation had significantly less discomfort than control patients (median 2.0, interquartile range: 1-4 on a 10 point linear analog scale, vs. 4.0, interquartile range: 2-5). CONCLUSIONS: Although glucagon and hyoscyamine remain options for treatment of colonic spasm, the results of this study suggest that warm water is also effective. It has no side effects and costs practically nothing.

Aged↗
PubMed2002

Portal vein thrombi after restorative proctocolectomy.

BACKGROUND: Restorative proctocolectomy (RP) has been the surgical procedure of choice for surgical management of mucosal ulcerative colitis since 1978. This study was undertaken to investigate the clinical presentation and implications of portal vein thrombi (PVT). METHODS: We reviewed all patients undergoing RP in our institution in the 4 years from January 1997 to December 2000. As the diagnosis of PVT was made on computed tomography (CT) scan in all cases, we confined our incidence estimate to those patients having an abdominal CT scan postoperatively. All scans were reviewed by an experienced radiologist. Patient demographics, symptoms, and clinical course were recorded. RESULTS: A total of 702 patients underwent RP, of whom 94 had a CT scan within the postoperative period. PVT was diagnosed in 42 of the 94 patients (45%). PVT was diagnosed at initial reading of the scan in 11 patients, and on review in 31. The indications for CT scan included abdominal pain, fever, leukocytosis, and delayed bowel function. Septic complications of RP caused these symptoms and signs in 45 patients, 20 of whom had PVT. Twenty-two patients were found to have had PVT without evidence of any septic source. CONCLUSION: PVT can be found in a high proportion of patients undergoing abdominal CT scan after RP. It is often associated with pain, fever, nausea vomiting, tenderness, and leukocytosis. This study shows that PVT subtle enough to go undiagnosed has no serious consequences, even when not treated. Also, patients treated with anticoagulation recover completely.

Adult↗