PubMed Health⌕ Search

Biomedical subjects

M E Glick

Publications and source records attributed to M E Glick.

15 recordsLinked to original sources
PubMed1994

Multiple large hyperplastic polyps of the colon coincident with adenocarcinoma.

Diminutive hyperplastic polyps are the most common non-neoplastic lesions of the colon. Typically, they are small (< 0.5 cm) sessile lesions, lack cellular atypia, and are found predominantly in the rectosigmoid region of the colon. Multiple large hyperplastic polyps (> 1 cm) are rare. Although the relationship between diminutive hyperplastic polyps and adenomatous polyps or carcinoma is controversial, even less data are available on the significance of large hyperplastic polyps. We report the case of a 56-yr-old man who was seen because of fatigue, anemia, and Hemoccult-positive stool. On air contrast barium enema study and colonoscopy, multiple polyps that were similar in appearance were found distributed symmetrically throughout the colon. However, histologic examination revealed 16 hyperplastic polyps 1-2 cm in size, multiple diminutive hyperplastic polyps, one adenomatous polyp, and one adenomatous polyp containing well-differentiated adenocarcinoma. Because multiple large hyperplastic polyps are rare, we suspect this entity may be distinct from diminutive hyperplastic polyps. In our patient, large hyperplastic polyps were distributed symmetrically throughout the colon and were associated with a synchronous carcinoma. Because large hyperplastic polyps may be coincident with adenomatous polyps and carcinoma of the colon, we recommend that patients found to have large hyperplastic polyps undergo removal of all polyps for histologic study.

Adenocarcinoma↗
PubMed1992

Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis.

The pathogenesis and treatment of epiphrenic diverticula remain controversial subjects. Most surgeons recommend esophagomyotomy in association with diverticulectomy in every patient. We believe that selective use of myotomy, based on manometry, should be used. From 1960 to 1990, 16 patients underwent surgical treatment for epiphrenic diverticulum at the Lahey Clinic Medical Center, Burlington, Mass. Six patients, three of whom underwent diverticulectomy alone and three who underwent an associated long myotomy, had the lower esophageal sphincter left intact; long-term results were good in all patients. The remaining 10 patients underwent myotomy of the lower esophageal sphincter. Reflux esophagitis developed in two of these patients who had a normal lower esophageal sphincter. Clinical results support the selective use of esophagomyotomy applied to areas of demonstrated dysmotility. A normal lower esophageal sphincter should be left intact to prevent reflux complications.

Academic Medical Centers↗
PubMed1992

Manometric and radiologic correlations in achalasia.

Achalasia is an esophageal motor disorder distinguished by clinical, radiologic, and manometric features. To evaluate the correlation among these features, we studied 109 achalasia patients. The four most common clinical complaints, the four most commonly encountered radiologic findings, and two manometric parameters were analyzed with a correlation matrix test and a multiple regression analysis. Significant correlation existed among symptoms of dysphagia, regurgitation, and weight loss. In contrast, chest pain inversely correlated with these symptoms. Dysphagia and weight loss significantly correlated with a bird-beak deformity but not with esophageal dilatation or a sigmoid esophagus. Moreover, no significant relationship between lower esophageal sphincter pressure and esophageal dilatation or sphincter pressure and sigmoid esophagus was found. However, in those patients with a resting lower esophageal sphincter pressure greater than 45 mm Hg, a reasonable correlation among clinical, radiologic, and manometric parameters did exist. In conclusion, although in a subset of patients with markedly increased lower esophageal sphincter pressure, a good correlation between clinical, radiologic, and manometric findings exists, such a correlation cannot be established in all of the achalasia patients; esophageal dilatation or a sigmoid esophagus may not be due to a hypertensive sphincter, and their presence must not necessarily be interpreted as an indication of severity of the disease; there is an inverse correlation between chest pain and symptoms of dysphagia, regurgitation, and weight loss; and finally, achalasia and hiatal hernia may coexist in 6% of the patients.

Adolescent↗
PubMed1991

Acid-provoked esophageal spasm as a cause of noncardiac chest pain.

A total of 394 patients with noncardiac chest pain underwent both basal esophageal manometry and combined esophageal motility and acid perfusion studies between 1986 and 1988. On basal esophageal manometry, 275 patients had a normal response, 64 patients had findings of high-amplitude peristalsis or "nut-cracker" esophagus, and 11 patients exhibited changes of diffuse esophageal spasm. Of the 275 patients who had normal findings on basal esophageal manometry, 90 patients (33%) had a positive response on combined esophageal motility and acid perfusion studies, that is, reproduction of chest pain with associated abnormal motility changes. The present study focuses on the 90 patients with acid-provoked esophageal spasm. On acid perfusion study, these 90 patients had a 46.2% rise in deglutition response and a 95% increase in duration compared with a 3.2% and a 4.3% change in values for the control group of healthy volunteers. Of the group with acid-induced spasm, 90.1% had excessive dysmotility changes (repetitive waves, multiple peaks, spontaneous or simultaneous contractions) compared with an incidence of 12.5% in the control group.

Adult↗
PubMed1987

Efficacy of sucralfate and cimetidine in protection of the human gastric mucosa against alcohol injury.

In order to study whether sucralfate or cimetidine may protect human gastric mucosa against alcohol injury, 28 healthy volunteers were pretreated with either: (1) placebo 1 g; (2) cimetidine (Tagamet) 300 mg; or (3) sucralfate (Carafate) 1 g. One hour later, 100 ml of 40 percent ethanol was sprayed directly on the gastric mucosa of the greater curvature during an endoscopic examination. Gastric mucosal changes were assessed by endoscopic appearance (according to grading scale) and by histology. In placebo-pretreated subjects, alcohol produced prominent mucosal damage (endoscopic score, 3.9 +/- 0.3, histologic score, 4.0 +/- 1.1 at 30 minutes). Cimetidine alkalinized gastric pH but did not prevent alcohol-induced damage (endoscopic score, 4.0 +/- 0.6; histologic score, 3.8 +/- 1.1, at 30 minutes). Sucralfate reduced endoscopic and histologic features of alcohol injury (endoscopic score, 1.8 +/- 0.6; histologic score, 1.8 +/- 1.1, at 30 minutes) without affecting gastric luminal pH. Reduction of alcohol-induced injury of the human gastric mucosa by sucralfate but not cimetidine demonstrates that effective protection of the gastric mucosa can be achieved without neutralization or inhibition of gastric acid secretion and points out another clinical application for sucralfate.

Adolescent↗
PubMed1986

Why have controlled trials failed to demonstrate a benefit of esophagogastroduodenoscopy in acute upper gastrointestinal bleeding? A probability model analysis.

Numerous prospective randomized trials have failed to demonstrate a benefit attributable to early diagnostic esophagogastroduodenoscopy (EGD) in acute upper gastrointestinal bleeding (UGIB). The clinical implications of these studies have received extensive editorial comment and analysis. We have employed a probability model to further analyze the reasons why these studies have failed to demonstrate an impact of EGD on UGIB. The clinical course of each bleeding lesion can be predicted from the literature. For each lesion, the mortality associated with early specific intervention afforded by an early specific diagnosis can be compared with the mortality of intervention delayed by applying EGD only to those patients who have a complicated course marked by continued bleeding or rebleeding. Using optimistic assumptions that would tend to overstate the impact of EGD, this analysis estimates the maximum decrease in overall mortality in any of these trials afforded by early diagnostic EGD to be 1.2% which would require randomization of over 5000 patients to demonstrate this benefit in a prospective trial.

Acute Disease↗
PubMed1986

The neurovisceral and electrodiagnostic evaluation of patients with thoracic spinal cord injury.

We studied nine patients with complete thoracic spinal cord injury in order to investigate distal electrophysiologic and end organ function. Studies included motor and sensory nerve conduction velocities, spinal and cortical somatosensory evoked responses, bulbocavernosus reflex responses, cystometry and colonic compliance, motor and myoelectrical activity. These studies confirmed an intact peripheral nervous system, as well as normal nerve root, cauda equina, conus medullaris and distal spinal cord function. Cystometry demonstrated decreased bladder capacity and inability to suppress detrusor contractions. Colonic compliance was greatly reduced, compared to control subjects. While basal colonic motor and myoelectrical activity was normal, these spinal cord injury patients failed to demonstrate the postprandial increase in colonic motor and myoelectric activity seen in normal subjects. These tests allow the clinician to define and document the extent of neuronal injury distal to a transverse myelopathy and to evaluate visceral end organ function.

Adult↗
PubMed1984

Colonic dysfunction in patients with thoracic spinal cord injury.

Severe constipation is a debilitating concomitant of complete traumatic thoracic spinal cord injury. In order to investigate the pathophysiology of this symptom, we studied colonic compliance, as well as motor and myoelectrical activity, in the fasting and postprandial states and after neostigmine stimulation in 9 patients with clinically and electrophysiologically documented complete thoracic spinal cord injury. Electrophysiologic studies, including nerve conduction velocities, cortical and spinal somatosensory-evoked responses, and bulbocavernosus reflex responses, as well as urinary bladder cystometry, documented normal peripheral somatosensory function, integrity of the distal spinal cord, conus medullaris and cauda equina, and interruption of the somatosensory and descending spinal pathways proximal to the cauda equina. These 9 patients with spinal cord injury demonstrated a decrease in colonic compliance compared with a control group (p less than 0.01). They failed to demonstrate the postprandial increase in colonic motor and myoelectrical activity observed in a control group (p less than 0.01), but did respond to neostigmine with an increase in both motor and myoelectrical activity (p less than 0.02), suggesting an intact myogenic component. In these patients, decreased colonic compliance and absent postprandial colonic motor and myoelectrical activity may be mediated by ablation of outflow from higher centers to the lower spinal cord and may be correlates of visceral neuropathy and severe constipation.

Adult↗
PubMed1983

Colonic compliance in patients with spinal cord injury.

While numerous communications have focused on urinary bladder dysfunction in the course of spinal cord injury, gastrointestinal disorders have received little attention. Abnormal bladder response to distention (automatic bladder) has been widely encountered among patients with complete thoracic spinal cord injury. To examine the similar concept in the colon, intracolonic pressure changes were measured in response to variable volumes of water introduced into the organ. Eight patients with complete spinal cord injury at the thoracic region (T6-T10) and 10 healthy volunteers were studied. Water was infused into the colon and intracolonic pressure was recorded using a rectilinear dynograph. The procedure was continued until the pressure reached 40mmHg or 2500ml of water had been administered. In spinal cord injury patients, the intracolonic pressure increased rapidly to a mean value of 35mmHg with as little as 300ml of water, whereas in normal controls this pressure was achieved only after 2200ml of water had been introduced into the colon. These findings indicate that the colon in patients with complete spinal cord injury of the thoracic region demonstrates an abnormal stretch response similar to that described in the bladder. This phenomenon could explain the frequent colonic symptoms experienced by these patients.

Adolescent↗
PubMed1982

Clinical course of esophageal stricture managed by bougienage.

To define the clinical course of patients with benign esophageal stricture treated with bougienage, we received the records of 76 patients undergoing dilatation. Patients with the diagnosis of scleroderma and those with previous hiatal hernia repair or gastric surgery were excluded. Initial evaluation included contrast study, esophagoscopy, and biopsy. Patients underwent a series of dilatations until a 44-Fr or larger bougie was passed. Patients were then instructed to return for recurrence of dysphagia. In this group, mean duration of follow-up from the first dilatation was 21.1 months. A total of 569 dilatations were performed with one major complication and no mortality. Benign esophageal stricture recurred in 65% of patients. After two or more recurrences, the likelihood of requiring an additional dilatation was 86--94% after each recurrence. The interval between required dilatations was variable; however, after 8 dilatations, it approximated once monthly. The shorter mean follow-up time of patients requiring a single dilatation (9.7 months) compared to those requiring multiple dilatations (28.8 months) suggests that the recurrence rates noted in this study are underestimations. In spite of high recurrence rates and short recurrence intervals, the low morbidity and absent mortality over long-term follow-up suggests that repeated bougienage is an effective modality for the management of benign esophageal stricture.

Adult↗
PubMed1982

Esophageal manometry: a benefit and cost analysis.

Esophageal manometric study has gained tremendous popularity over the past decade. However, the contribution of this diagnostic technology has not been critically evaluated. The purpose of this report is, therefore, to determine how frequently esophageal manometry alters the clinical diagnosis and treatment and to assess the cost of new information. The patients reviewed in this report consisted of 363 consecutive referrals. Each completed a questionnaire, had an esophagogram, and underwent an esophageal manometric study for the evaluation of dysphagia, heartburn, and/or chest pain of unexplained etiology. To determine the clinical contribution of manometry, diagnoses before and after the study were compared. On the basis of symptoms and radiologic data, specific clinical entities were diagnosed in 36 patients. Manometric study did not confirm the diagnosis of achalasia in four of the 27 patients referred with this diagnosis and resulted in 19 additional specific diagnoses. Manometry changed the course of treatment in 14 cases, eight additional patients with achalasia received treatment, and four false-positive patients were spared inappropriate treatment. Moreover, two patients with simultaneous esophageal motor disorder and chest pain were spared further investigation. It is concluded that esophageal manometry altered the clinical diagnosis in 6% and changed the course of treatment in 4% of the population studied. Esophageal manometry is beneficial in patients with chest pain, dysphagia, and those in whom diagnosis of achalasia is suspected, but is of little benefit in patients with chronic heartburn. Assuming the cost per study to be +250, the cost of the study was +3945 per alteration of diagnosis and +6482 per alteration of treatment.

Cost-Benefit Analysis↗
PubMed1982

Colonic dysfunction in multiple sclerosis.

Multiple sclerosis is a central nervous system disease frequently accompanied by urinary symptoms and severe constipation. In order to investigate the pathophysiology of these symptoms, we studied colonic motor and myoelectrical activity, as well as colonic volume-pressure relationships (colonometrograms) and have correlated these data with cystometry and electrophysiologic studies of the central and peripheral somatosensory nervous system. The study group consisted of 7 patients with advanced multiple sclerosis marked by symptoms and signs of somatic and visceral nervous system dysfunction including severe constipation. Ten normal volunteers served as control subjects. The multiple sclerosis group demonstrated electrophysiologic evidence of lesions in the somatosensory neuroaxis central to the lumbosacral spinal cord. Abnormal cystometrograms suggested visceral central nervous system dysfunction. Colonometrograms in the multiple sclerosis group demonstrated a more rapid pressure rise than in the control group (p less than 0.01). The multiple sclerosis group failed to demonstrate the postprandial increase in colonic motor and myoelectrical activity observed in the control group (p less than 0.01). Abnormal colonometrograms and absent postprandial colonic motor and myoelectric responses may be features of visceral neuropathy in patients with advanced multiple sclerosis and severe constipation.

Colon↗
PubMed1981

Dinitrochlorobenzene-induced colitis in the guinea-pig: studies of colonic lamina propria lymphocytes.

Dinitrochlorobenzene-induced colitis in guinea-pigs may be immunologically mediated: animals must be presensitised to dinitrochlorobenzene to develop colitis, sensitivity can be passively transferred by lymphocytes and the injury can be mitigated by immunosuppression. In this study, we examined lamina propria lymphocytes isolated from colons of animals with dinitrochlorobenzene-induced colitis, and appropriate controls. Lamina propria lymphocytes from colitis animals have a greater percentage of rabbit erythrocyte-rosetting cells (T cells) (20.1 +/- 3.0 vs 2.3 +/- 0.8, p less than .01) and a greater capacity to mediate mitogen-induced cellular cytotoxicity with phytohaemagglutinin than lamina propria lymphocytes from normal colon (% specific cytoxicity = 29.4 +/- 8.7 vs 5.0 +/- 4.5, P less than .005). There was no difference in the percentage of rosetting cells or cytotoxicity index of spleen or mesenteric lymph node lymphocytes between the colitis animals and controls. These data suggest that there are changes in the distribution and functional characteristics of lamina propria lymphocytes which correlate with mucosal cell injury in the dinitrochlorobenzene-colitis model.

Animals↗
PubMed1981

Proctitis and colitis following diversion of the fecal stream.

Inflammation limited to excluded segments of the colon was observed in 10 patients without prior inflammatory bowel disease who had undergone colostomy or ileostomy for various indications. With the exception of 1 patient who complained of mucoid rectal discharge, the patients were asymptomatic when the lesion was discovered; 2 others subsequently developed mild symptoms. The proctoscopic findings were similar in appearance to those of mild ulcerative colitis. In 8 of 10 patients the inflammatory changes were confined to the distal few centimeters of the rectum, while in the remaining 2 patients the entire excluded segment was affected. Microscopic alterations were focal and included crypt abscesses, epithelial cell degeneration, acute and chronic inflammation in the lamina propria, and regenerative changes in the crypts. The inflammation persisted for as long as 8 yr in the 5 patients who did not have restoration of intestinal continuity, but subsided in the 5 patients whose colostomies were closed. The prior as subsequent clinical courses of these patients, together with the focal, nonspecific microscopic features, strongly suggest that the inflammation in these patients resulted from diversion of the fecal stream and was not a recognized form of specific or idiopathic colitis. Diversion-related colitis must not be confused with other forms of inflammation since this may result in improper therapy and/or delay in treatment of the condition for which the fecal diversion was performed.

Adult↗