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L B Weinstock

Publications and source records attributed to L B Weinstock.

At least 19 recordsLinked to original sources
PubMed2001

Jaundice caused by a clinically undetectable T-cell lymphoma infiltrating the sphincter of Oddi.

Malignant lymphoma rarely presents with jaundice. We describe a patient who had a unique etiology for painless jaundice, dilated ducts, and a normal ampulla of Vater. A Whipple's procedure was performed for the suspicion of pancreatic cancer, and initial pathological review detected only mild focal chronic pancreatitis. Seven months later, the patient developed ascites, retroperitoneal mass, and splenomegaly caused by a T-cell lymphoma. Reevaluation of the Whipple's specimen revealed previously unrecognized microscopic infiltration and fibrosis of the sphincter of Oddi by atypical T-lymphocytes. Obstructive jaundice caused by a clinically undetectable primary duodenal T-cell lymphoma has not been previously reported and is contrasted with other causes of jaundice associated with malignant lymphoma and ampullary lesions.

Aged↗
PubMed1999

Transverse colon diverticulitis: successful nonoperative management in four patients. Report of four cases.

PURPOSE: Diverticulitis of the transverse colon is a rare disorder and is often confused with other conditions. Previously reported cases of transverse colon diverticulitis were diagnosed and treated by surgical exploration. Four cases are presented that were successfully managed with a nonsurgical approach. METHODS AND RESULTS: Review of the literature in English disclosed 31 cases of transverse colon diverticulitis. The clinical characteristics and management of these patients are reviewed and compared with the current series of patients. The utility of computerized tomography in the diagnosis of diverticulitis is discussed. CONCLUSIONS: Medical therapy with bowel rest and antibiotics is appropriate for transverse colon diverticulitis when free perforation and peritoneal signs are absent and the inflammation is contained, as shown by computerized tomography. Operative exploration should be reserved for patients with diffuse peritonitis or those where perforated colon cancer cannot be excluded.

Adult↗
PubMed1999

Laparoscopic removal of an Angelchik prosthesis.

The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.

Aged↗
PubMed1999

Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases.

BACKGROUND AND STUDY AIMS: Endoscopic extraction is the standard method of treating esophageal food bolus obstructions. The efficacy, efficiency, and safety of various techniques used over a 12-year period were evaluated. PATIENTS AND METHODS: Seventy-five procedures with soft food bolus obstruction were analyzed. If endoscopic extraction failed, or it was determined that alternative techniques would be effective, food was pushed into the stomach by: a) the endoscope tip, with or without a guide wire; or b) the wire-guided Savary dilators. The duration of the procedures included therapeutic Savary dilation (in 61 of 75 cases). RESULTS: Food bolus obstruction was associated with peptic strictures (69%), Schatzki's rings (19%), and tight fundoplications (3 %). No narrowing was seen in 9%. Extraction, scope push and Savary push methods were successful in seven of 16, 48 of 48, and 20 of 20 attempts, respectively. The mean duration, including stricture dilation (+/- 1 standard deviation), for the extraction, scope push and Savary push procedures were 32 (+/- 17), 18 (+/- 14) and 27 (+/- 15) mm, respectively. No cases of perforation, hemorrhage, oxygen desaturation, aspiration, or pneumonia occurred. CONCLUSIONS: Management of esophageal food bolus obstructions by modified push methods and esophageal dilation in the same session appears to be effective, efficient and safe. The methods employed should be individualized for each patient. Push methods require experience and judgment.

Adolescent↗
PubMed1998

Colonic chicken skin mucosa: an endoscopic and histological abnormality adjacent to colonic neoplasms.

OBJECTIVES: We recently described an endoscopic finding of pale yellow-speckled mucosa adjacent to colonic neoplasms. This resembled the appearance of chicken skin and was named chicken skin mucosa (CSM). CSM differs from previously reported gastrointestinal xanthelasmas in that this entity always occurs in association with colonic neoplasms. The prevalence, endoscopic characteristics, clinical significance, and possible etiology were investigated. METHODS: Eight hundred fifty-two consecutive colonoscopies were prospectively evaluated for the presence of CSM associated with either cancer or adenomas > or = 1 cm. Electron microscopy and histopathology using hemotoxylin and eosin, mucicarmine, and oil red O stains were performed. Twelve consecutive colon cancer resection specimens were prospectively examined to determine the presence of histologic CSM. RESULTS: CSM was adjacent to eight of 10 distal colorectal cancers, one of four proximal colon cancers, 16 of 42 distal adenomas, and three of 44 proximal adenomas. Four of seven resected distal cancers demonstrated histological evidence of CSM. Biopsies of the CSM revealed that lipid-filled macrophages in the lamina propria were responsible for this endoscopic appearance. Electron microscopy showed that the surface epithelial cells had small intestine-like microvilli. CSM was not seen with other colonic conditions and was not associated with the laxative preparation. In four instances, identification of the CSM alerted the endoscopist to the presence of polyps in locations difficult to visualize. CONCLUSIONS: CSM is an endoscopic entity that occurs as a result of fat accumulation in macrophages in the lamina propria of the mucosa adjacent to colonic neoplasms. Small intestine-like microvilli were present in CSM and the pathophysiological implications remain to be elucidated.

Adenoma↗
PubMed1997

Long-term safety of India ink tattoos in the colon.

BACKGROUND: When the India ink tattoo is used as a guide for follow-up examinations, the tattoo may remain in the colon for the remainder of that patient's life. This raises the question of the long-term safety of India ink tattoos. The long-term clinical and histologic consequences of the tattoo have not been studied in a large group of patients. METHODS: Biopsy specimens were taken from all tattoo marks encountered during postpolypectomy surveillance colonoscopy in 55 patients. Seventeen of these patients were followed serially with two biopsies in 16 patients and three biopsies in 1 patient. A total of 74 biopsy specimens were obtained from tattoos that had been placed an average of 36 months prior to biopsy (range 1.5 to 117 months). RESULTS: There were no clinical complications such as infection, fever, or abdominal pain in any of the 55 patients. There were no endoscopic abnormalities on or adjacent to the tattoos. There were no histologic changes seen at the tattoo sites in 48 patients, mild chronic inflammation in 6 patients, and hyperplastic change in 1 patient. There were no neoplastic changes of the mucosa overlying the tattoo. CONCLUSIONS: Small-volume India ink tattooing of the colon appears to remain endoscopically identifiable over a long term and to be safe based on histologic analysis of sequential biopsies.

Adult↗
PubMed1995

Diffuse microscopic angiodysplasia--a previously unreported variant of angiodysplasia. Report of a case.

PURPOSE: The entity of diffuse microscopic angiodysplasia is described, and a patient with severe gastrointestinal hemorrhage because of this submucosal source of bleeding is reported. METHOD: Case records of a patient with severe gastrointestinal hemorrhage were reviewed, and histologic findings were compared with colonoscopic and operative findings. The patient received 51 units of packed red blood cells over 3.5 months and remained undiagnosed, despite an exhaustive evaluation, until autopsy. RESULTS: Ectatic veins, venules, and capillaries were present within the submucosa in virtually every section of the small and large intestine examined (79 of 86 sections). Histologic evidence of bleeding from these submucosal vessels was identified in three sites (colon, jejunum, and ileum). The absence of endoscopically visible lesions was explained by findings that vessels did not traverse the muscularis mucosa and that mucosal depth was normal. This case of diffuse microscopic angiodysplasia, therefore, represents a unique variant, because the vascular findings were so diffuse and the mucosa remained histologically and endoscopically uninvolved, despite severe bleeding. CONCLUSION: Gastrointestinal bleeding from angiodysplasia is generally assumed to arise from endoscopically recognizable vascular ectasia within the mucosa. Thus, this case helps provide an explanation for some cases in which occult or massive bleeding is assumed to be secondary to angiodysplasia, even when endoscopic verification is not possible. Recognition of this disease process may require segmental resection or deep biopsy of endoscopically normal intestine.

Aged↗
PubMed1989

Accuracy of abbreviated manometry in detecting esophageal motility abnormalities.

We determined whether an abbreviated motility study that is commonly employed in clinical esophageal manometrics was as accurate as an extended manometric evaluation in detecting abnormalities in the esophageal body. One hundred patients underwent both abbreviated (stationary catheter, 10 wet swallows) and extended manometries (stepwise catheter withdrawal, 62 +/- 1 wet swallows). Classification by the two techniques was identical in 83 patients. Abbreviated manometry failed to recognize nine abnormal motility patterns. The abbreviated method was least accurate in the identification of intermittent and focal motility abnormalities (sensitivity = 0.50). Misclassifications were related to catheter position and not solely to differences in the total number of swallows. Of the individual wave parameters measured by each method, detection of multipeaked contraction waves was the most discrepant (R = 0.59). These findings indicate that abbreviated esophageal manometry is reasonably well correlated with a more extended method in detecting esophageal motility disorders and, because of its relative simplicity, appears appropriate for use in clinical practice. Errors related to stationary recording port positions may interfere with the overall accuracy of the abbreviated technique.

Deglutition↗
PubMed1987

Recurrent abdominal pain as the sole manifestation of hereditary angioedema in multiple family members.

This paper describes a previously unreported finding of abdominal pain as the only lifelong manifestation of hereditary angioedema in multiple family members. This diagnosis was obscured by the absence of cutaneous, oropharyngeal, and respiratory involvement. Barium studies performed during painful attacks showed transient intestinal wall edema which, along with abnormalities in the C4 level and C1 esterase inhibitor activity, confirmed the diagnosis. It is important that hereditary angioedema be recognized in its various forms so that invasive procedures can be avoided and prophylactic therapy can be administered.

Abdomen↗
PubMed1987

Esophageal physiology: normal and abnormal motor function.

The physiological controls of esophageal motor function are complex. Despite the relatively simple-appearing contraction waves of the esophagus compared with other gastrointestinal organs, the fascinating interaction of the CNS with the nerve cells in the esophagus itself has delayed complete understanding of esophageal peristalsis. The list of recognized modulating influences, particularly on the smooth muscle components, continues to expand. Although there are many studies concerning normal esophageal motor function, the pathophysiological mechanisms of motor dysfunction in many of the common motility disorders remain obscure.

Central Nervous System Diseases↗