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Biomedical subjects

L F Fenster

Publications and source records attributed to L F Fenster.

At least 19 recordsLinked to original sources
PubMed1998

Effect of surgery on health-related quality of life in patients with inflammatory bowel disease: a prospective study.

BACKGROUND: Health-related quality of life (HRQL) has increasingly become a factor in management decisions in patients with chronic diseases. OBJECTIVE: To measure the effect of surgical resection on quality of life in patients with inflammatory bowel disease (IBD). DESIGN: A consecutive series of patients undergoing surgery for IBD between June 1994 and December 1997 were prospectively investigated as a cohort outcomes study. PATIENTS: Data were obtained in 63 patients. The primary diagnoses were Crohn's disease (n = 36) and ulcerative colitis (n = 27). INTERVENTION: Patients with Crohn's disease underwent resection with or without stricturoplasty for intractable disease; all but 3 patients with ulcerative colitis underwent ileoanal anastomoses with ileoanal reservoir. MAIN OUTCOME MEASURE: Health status was measured using the Health Status Questionnaire preoperatively and every 3 months postoperatively. RESULTS: Preoperative measures of HRQL of the patients were low, with values well below the general population in all 8 scales of the Health Status Questionnaire. Postoperatively, HRQL measures improved significantly (P < .05) in both patients with Crohn's disease and those with ulcerative colitis, with scores equal to the general population in most scales. For example, average raw scores for general health in previously studied patient groups were 59 in patients with asthma, 55 in those with diabetes mellitus, 74 in the general population, and 54 and 73 preoperatively and postoperatively, respectively, in the present study. CONCLUSIONS: The results of this study confirm that HRQL scores are low in many patients with IBD referred for operation and HRQL scores improve postoperatively to levels comparable to those of the general population. We believe these data justify early surgical intervention in many patients with symptomatic IBD.

Adult↗
PubMed1995

What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature.

BACKGROUND: The increasing application of cholecystectomy has increased the need to assess the effects of cholecystectomy on presenting symptoms. PATIENTS AND METHODS: Three surgeon-derived and two patient-derived data forms were collected for each patient in a series of 225 laparoscopic cholecystectomies. RESULTS: Eighty-two percent of patients had documented gallstones preoperatively, 91% had biliary pain, and 77% had both biliary pain and documented gallstones prior to surgery. Fifteen percent of patients were believed to have acalculous cholecystitis. Eighty-two percent also had bothersome nonpain symptoms (gassiness, bloating, indigestion, fatty-food intolerance, and nausea). The cure rate for biliary colic was 82% if stones were documented preoperatively, and 52% when they were not (P = 0.002). Atypical pain was cured 80% of the time, and nonpain symptoms, 44% of the time. CONCLUSIONS: Most patients (82%) with biliary colic and gallstones have complete relief of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculous cholecystitis was only 52%. Nonpain symptoms were common preoperatively (82%) and were relieved in 44% of patients.

Abdominal Pain↗
PubMed1995

The dilemma of managing value.

"Value" is an elusive term, but talk of how to manage value raises the specter of chaos. Value is defined as a working equation involving appropriateness of care, quality of outcomes and service, and cost. One hypothesis is that purchasers and providers will ultimately recognize that the value of health care services provided is critical because value, properly managed, directly addresses the volatile issue of containing health care costs. But to achieve success in managing value, providers must initiate new strategies and transform organizational and clinical priorities and practices. As the contest intensifies between society's infinite demand for health care services and finite resources, the need to truly subscribe to the management of value will become ever more important. Those providing care will learn to appreciate that long-term success will depend on much more than mere cost cutting.

Cost Control↗
PubMed1993

Fulminant herpes hepatitis mimicking hepatic abscesses.

Fulminant hepatitis due to herpes simplex virus (HSV) in adults is a rare and deadly disease. We describe a 23-year-old woman with a 20-year history of Crohn's disease (CD) who was hospitalized with an acute febrile illness and diarrhea. A computed tomography (CT) scan of the abdomen demonstrated an intramural sigmoid colon abscess and multiple abscesses in the liver. Despite high-dose parenteral corticosteroids and broad-spectrum antibiotics, the patient remained acutely ill, with high fever and markedly elevated serum transaminase levels, but no jaundice. Sigmoid resection and wedge liver biopsy were performed at laparotomy. Histologic examination documented HSV-type intranuclear inclusions and inflammation with necrosis in both the sigmoid colon and liver specimens. The patient subsequently died despite parenteral acyclovir treatment. Although rare, fulminant hepatitis due to HSV simplex virus should be considered in the differential diagnosis of all patients with severe hepatitis. Of special note, the necrotizing liver lesions may be mistaken for pyogenic abscesses on CT scan.

Adult↗
PubMed1990

Reversal of chronic hepatic encephalopathy by colonic exclusion: poor correlation with blood GABA levels.

Previous studies have suggested that the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) is a key factor in the syndrome of portasystemic encephalopathy. We report the case of a patient with medically intractable portasytemic encephalopathy after portacaval shunt who had marked clinical improvement after creation of an end ileostomy. Plasma GABA and serum ammonia levels were measured before and after ileostomy. Although the clinical syndrome and the EEG improved markedly after the ileostomy, the plasma GABA levels remained markedly elevated. Preoperative and postoperative GABA levels were 865 and 633 pmol/ml, respectively (nl = 100-180 pmol/ml). Our findings confirm previous reports of the efficacy of colonic exclusion in patients with intractable portasystemic encephalopathy. However, our results conflict with the hypothesis that GABA itself is the key mediator of the syndrome.

Ammonia↗
PubMed1984

Reactive hepatopathy. Liver signs without primary liver disease.

"Reactive hepatopathy" is the term that defines a common clinical syndrome seen in seriously ill patients with disorders other than primary hepatobiliary disease. A variety of factors, including circulatory changes, metabolic stress, increased bilirubin formation, and especially uncontrolled sepsis, may lead to marked changes in parameters of liver function and frequently to frank jaundice. It is important for the practitioner to be aware of this syndrome and to avoid being distracted into spending undue time and resources in investigating the liver and biliary tree. Otherwise, there may be crucial delay in treating underlying abnormalities.

Alkaline Phosphatase↗
PubMed1982

Acute respiratory distress syndrome after peritoneovenous shunt.

A case is presented in which a fatal acute respiratory distress syndrome, associated with disseminated intravascular coagulation, developed immediately after the insertion of a peritoneovenous shunt for management of refractory ascites. The absence of left-sided heart failure or fluid overload was established by (a) lack of diuresis from intravenous furosemide; (b) repeatedly normal pulmonary wedge pressures; and (c) autopsy findings. The nature of the toxic effect of this patient's ascites upon the alveolar membrane remains obscure.

Acute Disease↗
PubMed1978

Cholangiographic abnormalities in patients with inflammatory bowel disease.

Twenty patients with inflammatory bowel disease, abnormal liver function tests and abnormal endoscopic retrograde cholangiograms were found to have a spectrum of abnormalities affecting the intra- and extrahepatic biliary trees. The intrahepatic systems were abnormal in all patients and demonstrated ductal stenosis, ectasia, decreased arborization and major duct obstruction. The extrahepatic systems were abnormal in 75 percent of cases with stenosis, diverticula formation and mural irregularity being the most frequent abnormalities. The value of endoscopic retrograde cholangiography in this patient group is to exclude extrahepatic obstruction, establish a nonoperative diagnosis, and assist in determining the method of treatment.

Adenoma, Bile Duct↗
PubMed1968

Liver disease.

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Adult↗