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Biomedical subjects

N W Pearlman

Publications and source records attributed to N W Pearlman.

At least 19 recordsLinked to original sources
PubMed1992

Papillomavirus found in anorectal squamous carcinoma, not in colon adenocarcinoma.

We used polymerase chain reaction DNA amplification methods for the detection and typing of genital human papillomaviruses in paraffin-embedded tissue sections of five patients with anorectal squamous cell carcinoma and 22 patients with colonic adenocarcinoma. The cases were further tested by in situ hybridization with biotin-labeled probes specific for human papillomavirus types 6/11, 16/18, and 31/33/35. By polymerase chain reaction, human papillomavirus DNA was demonstrated in all of the cases of anorectal squamous cell carcinoma and in none of the cases of colonic adenocarcinoma for which analyzable DNA was available. Tumor cell nuclei stained for human papillomavirus DNA by in situ hybridization in four of the five cases of squamous cell carcinoma and in none of the cases of colonic adenocarcinoma. We conclude that human papillomavirus types usually associated with malignant transformation are uniformly present in anorectal squamous cell carcinoma but are absent from adenocarcinoma of the colon.

Adenocarcinoma↗
PubMed1992

A case-control study of late recurrence of malignant melanoma.

Late recurrence of malignant melanoma is uncommon but appears to be a growing problem. It is unclear whether late recurrence has a better prognosis than early recurrence. Since the answer may influence treatment, we compared recurrence sites and subsequent survival in 35 patients with disease-free intervals of 72 to 240 months (median: 127 months) with 35 case-controls who had relapse at 4 to 56 months (median: 26.7 months). The distribution of recurrence sites in early relapse was 66% in regional nodes or soft tissue and 34% in distant soft tissue or viscera. In late relapse, this distribution was 49% in regional nodes or soft tissue and 51% in distant soft tissue or viscera (no significant differences). Median survival for patients with early and late recurrences in regional nodes or soft tissue was 26 and 44 months, respectively (no significant differences); 5-year survival was 27% and 33%, respectively (no significant differences). Median survival was similar for early or late relapse in distant soft tissue or viscera (8 and 10 months, respectively), as was 5-year survival (0% and 6%, respectively). These results suggest that the metastatic pattern and survival after recurrence are similar for patients with early and late recurring melanoma.

Case-Control Studies↗
PubMed1991

A prospective study of incisional time, blood loss, pain, and healing with carbon dioxide laser, scalpel, and electrosurgery.

Carbon dioxide laser incisions are reported to be less painful, less bloody, and less prone to seroma formation and to heal better than scalpel or electrosurgical incisions. We compared all three modalities in a prospective randomized study of cholecystectomy incisions. Time required for the incision and incisional blood loss was less with electrosurgery than with the carbon dioxide laser or scalpel. Postoperative pain and wound healing, however, were the same for all three techniques. The carbon dioxide laser appears to offer no advantage over conventional means of making a standard incision.

Adult↗
PubMed1991

The next step.

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Curriculum↗
PubMed1991

Decision for surgical management of perforation following endoscopic sphincterotomy.

Duodenal perforation resulting from endoscopic sphincterotomy (ES) is a serious complication with a high mortality. Diagnosis is often problematic and the optimum treatment is controversial. Eight proven perforations occurred following 441 ES at University of Colorado Hospital, a rate of 1.8 per cent. Physical and laboratory findings were of little diagnostic value, whereas plain abdominal radiographs showed evidence of perforation in 86 per cent. All patients were operated on promptly after diagnosis of perforation. Delay in diagnosis of perforation beyond 24 hours in six patients was associated with a high morbidity and two deaths. Analysis of published series confirmed that delay in diagnosis and delay in operation after perforation were associated with a higher mortality rate than early diagnosis with or without operation. We recommend operative intervention in all patients with clinical evidence of perforation following ES.

Adult↗
PubMed1990

Resident training.

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Clinical Competence↗
PubMed1990

Continent ileocolonic urinary reservoirs for filling and lining the post-exenteration pelvis.

Pelvic exenteration has a high complication rate due, in large part, to the extensive raw surfaces and dead space it creates. Numerous techniques have been used to control this space and line these surfaces, but none, to date, has proven to be a reliable solution. We investigated the use of continent ileocolonic urinary reservoirs as a new "flap" to fill and line the pelvis in 17 patients, and found that our historical complication rate of 44% for pelvic exenteration was reduced to 18%. These reservoirs appear to be an improved method of managing the post-exenteration pelvis.

Adult↗
PubMed1989

Extended resection of fixed rectal cancer.

Between 1980 and 1987, we operated on 23 patients (16 men and 7 women) with fixed rectal cancer. Two patients had primary tumours. Twenty-one patients had recurrent disease (anterior resection, 8; abdominoperineal resection, 13). Eighteen patients had prior irradiation (40 Gy to 120 Gy). Resection was possible in 20 patients (16 for cure and 4 for palliation). Operations included extended proctectomy (n = 4), standard pelvic exenteration (n = 4), and sacropelvic exenteration (n = 12). One (5%) patient died postoperatively and five (25%) others had significant postoperative complications. With a follow-up time of 1 to 48+ months (median, 18 months), nine patients are dead of disease (operative death included), four are living with disease, two are dead free of disease, and eight (50% of those undergoing curative resection) are living free of disease. The results suggest that resection of fixed rectal cancer is feasible in many patients and of potential long-term benefit to approximately 50% of those in whom curative resection is possible.

Adenocarcinoma↗
PubMed1989

Endoscopic cholangiography and stone removal prior to cholecystectomy. A more cost-effective approach than operative duct exploration?

Would economic benefit result from performing endoscopic cholangiography and removal of common bile duct stones prior to cholecystectomy in patients who are suspected preoperatively of having choledocholithiasis? In this study, 173 patients had cholecystectomy and 30 (17%) had common bile duct exploration. Records of these patients were reviewed as were those of 31 patients who had only endoscopic cholangiography and endoscopic stone removal. Cost estimates were based on local charges. Cholecystectomy with common bile duct exploration was $6730 more per patient than cholecystectomy alone. Endoscopic cholangiography and endoscopic stone removal was 87% successful in removing duct stones. Had endoscopic cholangiography and endoscopic stone removal been performed preoperatively in patients undergoing cholecystectomy who had suspected choledocholithiasis, 21 of 30 common bile duct explorations could theoretically have been eliminated. This would have saved $85,526 or $2851 per patient undergoing common bile duct exploration. Our analysis suggests that patients who require cholecystectomy and have suspected choledocholithiasis may be treated more cost-effectively by performing endoscopic cholangiography and endoscopic stone removal immediately prior to cholecystectomy than by cholecystectomy and operative common bile duct exploration.

Adolescent↗
PubMed1989

A good offense.

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Endocrine System Diseases↗
PubMed1988

Accuracy and cost of needle localization breast biopsy.

The success and cost of needle localization biopsy (NLB) performed with local anesthesia in an outpatient procedure room (81 biopsies, group 1) or under general anesthesia in an operating room (36 biopsies, group 2) were compared in a longitudinal study. Only 78% of operations in group 1 successfully removed the target breast lesion; definite failure occurred in 17%, and results were indeterminate in 5%. Among lesions sought by group 2 procedures, 92% of lesions were removed successfully, 5% were missed, and 3% were indeterminate. The incidence of carcinoma in breast specimens was 17% in group 1 and 22% in group 2. Wound infection occurred after 6% of group 1 biopsies. The total cost of NLB was $775 in group 1 and $1960 in group 2. The difference in cost represented by the use of general anesthesia was $1260. The added expense of NLB done in an operating room under general anesthesia can be justified by a high rate of success in removing the breast lesion, by patient comfort, and by technical ease.

Adult↗
PubMed1988

Laser probe coagulation of bleeding canine ulcers.

A nonlight-transmitting contact laser probe was used to treat acutely bleeding gastric ulcers in heparinized dogs. Thirty-five treated ulcers responded with complete hemostasis following 21-92 seconds (mean, 32 seconds) application per ulcer. Ten control ulcers left untreated bled for 5-30 minutes (mean, 11 minutes). Hemostasis was maintained at treated sites for the entire observation period (60 minutes). Perforations did not occur, and there was no evidence of full thickness injury. Histological assessment confirmed a limited (0.2-0.5 mm) zone of coagulation injury. The laser probe is effective for control of acute bleeding in this canine ulcer model.

Animals↗
PubMed1988

Primary upper aerodigestive tract manifestations of gastroesophageal reflux.

Chronic hoarseness, chronic sore throat, "lump in the throat," or cervical pain with swallowing were the primary complaints in 25 (6.6%) of 379 patients undergoing esophagoscopy for gastroesophageal reflux at the Denver Veterans Administration Medical Center between 1981 and 1985. In 18 (72%) of the 25 patients, these were the only reflux symptoms. Surgery was required to control symptoms in nine (36%) patients with upper aerodigestive tract complaints, versus 52 (15%) of 354 patients with more typical reflux symptoms (z = 2.77, p less than 0.01). Surgery was also necessary more often in patients with chronic hoarseness or sore throat (seven of 15) than in those with "lump in the throat" or cervical pain with swallowing (two of 10). These findings suggest reflux does cause otherwise unexplained upper aerodigestive tract symptoms, and that surgery may be required more often to control these symptoms than is the case in patients with more typical symptoms of reflux.

Adult↗
PubMed1987

Pelvic and sacropelvic exenteration for locally advanced or recurrent anorectal cancer.

Postirradiation "fixed" anorectal tumors are often considered incurable. Since 1980, we have carried out 12 pelvic and seven sacropelvic exenterations for this problem (adenocarcinoma, 18; squamous cancer, one). Nine tumors were primary; ten were recurrent (five after an anterior resection and five after an abdominoperineal resection). Prior irradiation ranged from 3000 to 12,000 rad (30 to 120 Gy). Four patients had synchronous distant metastases; three died of disease (one with local recurrence), and the fourth patient has been living with disease (distant metastasis). Fifteen patients (four with B2 tumors and 11 with Astler-Coller C2 disease) had no extrapelvic disease. One patient died of postoperative complications; two others died free of disease. Three of the 15 patients died of disease (all with local recurrence), and one has been living with disease (local recurrence). Eight (53%) of 15 patients have been living free of disease 12+ to 53+ months. The results suggest that many patients with fixed postirradiation anorectal tumors may be salvaged by aggressive surgery.

Aged↗
PubMed1986

Acid and gastrin levels following pyloric-preserving pancreaticoduodenectomy.

Acid and gastrin production after pyloric-preserving pancreaticoduodenectomy was evaluated in six patients. Five patients had low-normal basal and stimulated acid output; the sixth patient was achlorhydric. Fasting gastrin levels were less than 90 to 105 pg/mL (normal range) in five patients, three of whom had stimulated gastrin levels that remained below this range. Two patients had stimulated gastrin levels of 510 pg/mL and 205 pg/mL, respectively, within 15 minutes of eating; however, both levels returned to normal by 120 minutes' time. The sixth patient had mildly elevated fasting (105 pg/mL) and stimulated gastrin levels (160 to 200 pg/mL) throughout the test period. The results suggest that pyloric-preserving pancreaticoduodenectomy does not lead to either gastric hyperacidity or persistent hypergastrinemia.

Achlorhydria↗
PubMed1986

Simplified endoscopic placement of nasoenteral feeding tubes.

A technique for expeditious and safe placement of nasoenteric feeding tubes under direct vision is described. Adult patients undergo feeding tube placement with intravenous sedation and topical anesthesia. Endoscopic tube placement requires an average of 10 min and eliminates many risks associated with blind passage.

Endoscopy↗