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M J Stamos

Publications and source records attributed to M J Stamos.

15 recordsLinked to original sources
PubMed2001

Initial nonoperative management for periappendiceal abscess.

PURPOSE: Our goal was to compare initial operative and nonoperative management for periappendiceal abscess complicating appendicitis. METHODS: This study is a retrospective review of 155 consecutive patients with appendicitis complicated by periappendiceal abscess treated between 1992 and 1998. Eighty-eight patients were treated initially nonoperatively, and 67 patients were treated operatively. All patients had localized abdominal tenderness and either computed tomography or intraoperative documentation of an abscess. RESULTS: Our patient population consisted of 107 males and 48 females, with an average age of 33 (range, 16-75) years. Age, gender, comorbidity, white blood cell count, temperature, and heart rate did not differ significantly between groups. For the initial nonoperative management group, the failure rate was 5.8 percent and the appendicitis recurrence rate was 8 percent after a mean follow-up of 36 weeks. The response to treatment of the initial nonoperative group and the initial operative group was compared by length of stay (9 +/- 5 days vs. 9 +/- 3 days; P = not significant), days until white blood cell count normalized (3.8 +/- 4 days vs. 3.1 +/- 3 days; P = not significant), days until temperature normalized (3.2 +/- 3 days vs. 3.1 +/- 2 days; P = not significant), and days until a regular diet was tolerated (4.7 +/- 4 days vs. 4.6 +/- 3 days; P = not significant). Complication rate was significantly lower in the nonoperative group (17 vs. 36 percent; P = 0.008). CONCLUSIONS: Initial nonoperative management of appendicitis complicated by periappendiceal abscess is safe and effective. Patients undergoing initial nonoperative management have a lower rate of complications, but they are at risk for recurrent appendicitis.

Abscess↗
PubMed2000

Patterns of recurrence in anal canal carcinoma.

HYPOTHESIS: The initial modality of treatment of anal canal carcinoma (ACC) influences the pattern of recurrence of disease. DESIGN: A retrospective analysis comparing patterns of recurrence in patients with ACC undergoing either surgery or chemoradiotherapy as their initial therapeutic intervention. Anal margin cancers and adenocarcinomas were excluded. SETTING: A university-affiliated urban medical center. PATIENTS: Eighty-one patients were given a diagnosis of ACC between February 1, 1952, and December 31, 1998. Fifty-one (63%) of the patients initially underwent surgery: abdominoperineal resection in 38 patients (75%) and local excision in 13 patients (25%). Chemoradiotherapy was the initial therapeutic intervention in 30 patients (37%). MAIN OUTCOME MEASURES: The patterns of recurrence (local vs distant disease) and survival were compared between the group that underwent palliative surgery (hereafter referred to as the surgical group) and the group that received chemoradiotherapy (hereafter referred to as the chemoradiotherapy group). RESULTS: The mean follow-up was 40 months. Local recurrence occurred in 7 patients (14%) in the surgical group vs 7 patients (23%) in the chemoradiotherapy group (P =.46). Using Kaplan-Meier actuarial analysis, local recurrence rates for the surgical and chemoradiotherapy groups at 1 year were 0% and 6%, respectively (P =.32), and at 5 years were 17% and 36%, respectively (P =.02). The average (+/-SD) time to local recurrence in the surgical group was 23 +/- 0.7 months and for the chemoradiotherapy group 16 +/- 2.9 months (P =.27). Five (71%) of the 7 patients with local recurrences in the chemoradiotherapy group underwent salvage abdominoperineal resection with 100% disease-free survival at a mean follow-up of 35 months. When patients presenting with metastatic disease were excluded, distant recurrences developed in 7 patients (16%) in the surgical group and 2 (7%) in the chemoradiotherapy group (P =.31). Actuarial 5-year distant recurrence rates for the surgical and chemoradiotherapy groups were 26% and 19%, respectively (P =.65). Five-year survival was 42% in the surgical group and 74% in the chemoradiotherapy group (P =.01). CONCLUSION: There was a higher rate of local recurrence in patients with ACC treated with chemoradiotherapy vs surgical resection as the initial therapeutic intervention. However, when this occurred, abdominoperineal resection was effective salvage therapy and was associated with a 100% disease-free survival at 3 years. Therefore, chemoradiotherapy is justified as the initial treatment for ACC and has an overall 5-year survival that is significantly higher than that attained with initial surgical treatment.

Adult↗
PubMed2000

Nonoperative management of perforated appendicitis without periappendiceal mass.

BACKGROUND: Initial nonoperative treatment for patients with periappendiceal mass has been shown to be safe and effective. Our goal was to evaluate the safety and efficacy of initial nonoperative management for perforated appendicitis not accompanied by a palpable mass. METHODS: The study population consisted of 77 patients with appendicitis treated initially nonoperatively between 1992 and 1998. All had localized abdominal tenderness and computed tomography findings of abscess or phlegmon. None had a palpable abdominal mass. Outcome parameters evaluated were rate of failure, complication, and recurrence. RESULTS: There were 49 males and 28 females with a mean age of 35 years (range 16 to 75). Initial nonoperative management was successful in 95% of patients. Complications occurred in 12% of patients. Recurrent appendicitis developed in 6.5% of patients after an average follow-up of 30 weeks. CONCLUSIONS: Perforated appendicitis patients with localized abdominal tenderness and abscess or phlegmon can safely and effectively be treated in an initial nonoperative fashion.

Abdominal Abscess↗
PubMed2000

Surgical management of gastrointestinal bleeding.

Severe gastrointestinal bleeding has historically been a clinical problem primarily under the purview of the general surgeon. Diagnostic advances made as the result of newer technologies, such as fiberoptic and video endoscopy, selective visceral arteriography, and nuclear scintigraphy, have permitted more accurate and targeted operations. More importantly, they have led to safe, effective nonoperative therapeutic interventions that have obviated the need for surgery in many patients. Today, most gastrointestinal bleeding episodes are initially managed by endoscopic or angiographic control measures. Such interventions are often definitive in obtaining hemostasis. Even temporary cessation or attenuation of massive bleeding in an unstable patient permits a safer, more controlled operative procedure by allowing an adequate period of preoperative resuscitation. Despite the less frequent need for surgical intervention, traditional operative approaches, such as suture ligation, lesion or organ excision, vagotomy, portasystemic anastomosis, and devascularization procedures, continue to be life-saving in many instances. The proliferation of laparoscopic surgery has fostered the application of minimally invasive techniques to highly selected patients with gastrointestinal bleeding. Intraoperative endoscopy has greatly facilitated the accuracy of laparoscopic surgery by endoscopic localization of bleeding lesions requiring excision. It is anticipated that the evolving technologies pertinent to the diagnosis and management of gastrointestinal bleeding will continue to promote collaboration and cooperation between gastroenterologists, radiologists, and surgeons.

Clinical Trials as Topic↗
PubMed2000

A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis.

Laparoscopic sigmoid colectomy (LSC) for diverticular disease accounts for a limited number of laparoscopic colon cases performed nationally because of the technical challenge it presents. Our objective was to determine the feasibility and impact of the laparoscopic approach in elective sigmoid colectomy for diverticular disease and to compare these results with those of the open approach. Twenty elective laparoscopic sigmoid colectomies (LSCs) were performed for diverticulitis between April 1992 and July 1999 at a university-affiliated urban hospital. A case-control study was performed comparing LCS with a matched control group of conventional open sigmoidectomies. Fourteen of 20 sigmoidectomies were successfully completed laparoscopically. The mean operative time for LSC was similar to that for open sigmoid colectomy (251 vs 243 minutes). There was earlier return to oral intake in the LSC group (1 vs 5 days; P < 0.001). The mean length of stay was significantly shorter (P = 0.029) in LSC (4.8 days) versus open sigmoid colectomy (7.8 days). Conversion to open sigmoidectomy extended hospital stay to 8.16 days. The overall complication rate was 10 per cent in both groups. We conclude that LSC can be performed effectively and with a low complication rate for diverticular disease. LSC provides the benefit of quicker return of bowel function and shorter hospitalization.

Adult↗
PubMed1999

Computed tomography scanning for the diagnosis of perforated appendicitis.

The optimal initial treatment for perforated appendicitis may be nonoperative. For this reason it is important to be able to reliably distinguish between acute and perforated appendicitis. CT scanning has been shown to be highly accurate for the diagnosis of appendicitis, but it has not been specifically evaluated for perforated appendicitis. Our objective was to evaluate CT for the diagnosis of perforated appendicitis. Our study population comprised 84 patients who underwent appendectomy between 1993 and 1997 and who had CT scanning performed preoperatively. Medical records were reviewed retrospectively. CT scans were reviewed in a blinded fashion. CT findings were correlated with pathologic and clinical factors. Sixteen patients with acute appendicitis, 59 patients with gangrenous or perforated appendicitis, and 9 patients with normal appendices or other diagnoses were evaluated. For patients with pathologic documentation of appendicitis, CT findings that independently predict perforation or gangrene included abscess (P<0.001), phlegmon (P<0.001), extraluminal gas (P = 0.01), and terminal ileal wall thickening (P = 0.03). CT findings of an abscess, extraluminal gas, or phlegmon have a sensitivity of 92 per cent, specificity of 88 per cent, positive predictive value of 96 per cent, and negative predictive value of 74 per cent for perforated or gangrenous appendicitis. We conclude that CT can reliably distinguish between acute and perforated appendicitis.

Acute Disease↗
PubMed1998

Perforated appendicitis: is it truly a surgical urgency?

Advanced perforated appendicitis with localized findings has classically been treated with either operative therapy or with percutaneous drainage. The role of nonoperative therapy followed by interval appendectomy (IA) remains controversial. We assessed the safety and efficacy of conservative management for perforated appendicitis in a 5-year review of patients treated conservatively for perforated appendicitis with localized abscess or phlegmon. Patients were treated initially with intravenous antibiotics, and CT-guided drainage was used only if the patient failed to improve after 48 to 72 hours. Patients still not improving underwent appendectomy. Patients responding to conservative therapy were recommended IA in 6 to 12 weeks. Sixty-six patients with 54 abscesses and 10 phlegmons were treated. Fifty-one patients (92%) improved without surgery. Only 58 per cent of the abscesses required percutaneous drainage. The mean length of stay for conservative therapy was 7.6 days. Forty-one patients underwent IA with a 10 per cent morbidity and a mean length of stay of 1.4 days. Conservative management of appendicitis with localized perforation or phlegmon is safe and effective. Percutaneous drainage is frequently not required. IA is associated with low morbidity without prolonged hospitalization.

Abscess↗
PubMed1998

Colonic stents in colorectal obstruction.

Obstruction is the presenting symptom of colorectal cancer in up to 40 per cent of patients. Benign strictures and other neoplasms including lymphoma and gynecologic tumors occur as well. Emergent operative therapy is often suboptimal and associated with significant morbidity and mortality. Our objective was to review our experience with stent placement for colonic obstruction. Seven patients underwent stent placement for a total of eight procedures. There were three patients with unresectable colorectal cancer, two patients with metastatic gynecologic cancer, one patient with rectal lymphoma, and one patient with metastatic cancer of unknown primary. All colonic stents were Wallstents placed by the same endoscopist under fluoroscopic and endoscopic guidance. Stents were successfully placed in all patients without complication. One patient underwent placement of two stents in succession for a long stenosis. Six of seven patients (86%) had resolution of the obstruction and return of bowel function. Five of seven were tolerating a diet within 24 hours. One patient's mental status did not allow for oral intake. Four patients were discharged within 48 hours. Two patients died within the same hospitalization as a result of metastatic disease. One patient was found to have multilevel disease requiring stoma placement. There was no morbidity or mortality associated with stent placement, and 86 per cent of patients had palliation of the obstruction. We conclude that colonic stent placement is a safe and effective therapy for colorectal obstruction at this institution.

Colorectal Neoplasms↗
PubMed1996

Alternatives in therapy for low rectal cancer.

Rectal cancer affects 40,000 people annually in the United States. Traditionally, operative therapy has involved abdominoperineal resection. This procedure results in a permanent colostomy and carries a high incidence of impotence and urinary retention. Because of improvements in operative techniques, perioperative care, and adjuvant tumor therapy, less invasive local techniques of tumor resection have become excellent options.

Algorithms↗
PubMed1994

Appendiceal mass: conservative therapy followed by interval laparoscopic appendectomy.

BACKGROUND: Current therapy of patients with appendiceal abscess or phlegmon is in evolution. Controversial areas include initial conservative therapy, drainage of periappendiceal abscesses, and the role of interval appendectomy. OBJECTIVE: To evaluate the safety and efficacy of conservative therapy and of interval laparoscopic appendectomy (ILA). PATIENTS AND METHODS: Patients with signs and symptoms of acute appendicitis and a palpable right lower quadrant mass were included. Abscess/phlegmon was documented with ultrasound or computerized tomography. After initial therapy with antibiotics, patients were discharged to home. ILA was performed 6 to 12 weeks later. RESULTS: Twelve patients were included. Four patients had phlegmonous appendicitis and eight had an abscess, but only four had percutaneous drainage. All patients improved without surgical exploration and were subjected to ILA. ILA was successful in 11 of 12 patients; a median hospital postoperative stay of 1 day was required, and no perioperative morbidity was encountered. All patients returned to routine activities within 2 weeks of surgery. CONCLUSIONS: 1) Initial conservative management of patients with appendiceal abscess/phlegmon is prudent, safe, and effective. 2) Interval laparoscopic appendectomy can be performed safely and effectively.

Abscess↗
PubMed1992

Three-dimensional transrectal ultrasound: preliminary patient evaluation.

Transrectal ultrasound is uniquely useful in diagnosing and localizing the extent of lower colon and rectal disease. This paper reports the preliminary evaluation of three-dimensional intraluminal ultrasound imaging of normal and diseased rectal segments. The three-dimensional reconstructions were produced using a computerized PC based image analysis system which aligns ultrasound images to produce the three-dimensional images. A unique perspective for displaying both normal and pathologic anatomy is achieved using this new technology and the method has promising diagnostic and therapeutic potentials.

Crohn Disease↗
PubMedDate not supplied

Can perforated appendicitis Be diagnosed preoperatively based on admission factors?

The optimal initial treatment for selected patients with perforated appendicitis may be nonoperative. For this reason it is important to be able to diagnose perforated appendicitis preoperatively. The purpose of this study was to determine the accuracy of diagnosing perforated appendicitis using only admission factors. The study population was comprised of 366 adult patients who underwent appendectomy for presumed appendicitis during 1997. Admission factors associated with perforated appendicitis were determined using univariate and multivariate analyses. These variables were then used to formulate a rule for the diagnosis of perforated appendicitis. Sensitivity and specificity were calculated for this rule. The admission factors analyzed were sex, race, age, days of pain, temperature, heart rate, symptoms, physical examination findings, and laboratory findings. Multivariate regression analysis revealed days of pain, temperature, and localized tenderness outside the right lower quadrant to be significant (P <0.05). Using two or more days of pain, a temperature of >/=101 F (38.3 C), or localized tenderness outside the right lower quadrant as criteria to indicate perforation, we achieved a sensitivity of 86% and a specificity of 58% for distinguishing perforated from nonperforated appendicitis. We concluded that (1) perforated appendicitis cannot reliably be distinguished from nonperforated appendicitis based on admission factors, and (2) two or more days of pain, localized tenderness outside the right lower quadrant, and a temperature of >/=101 F (38.3 C) define a group of patients with appendicitis who have a high incidence of perforation.

Adolescent↗