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Biomedical subjects

R C Kurtz

Publications and source records attributed to R C Kurtz.

At least 19 recordsLinked to original sources
PubMed1992

Acute pancreatitis from intussusception of a gastric polyp in a patient with Gardner's syndrome.

Gastric polyps in Gardner's syndrome are usually benign small fundic gland neoplasms with little clinical significance. We report a case of gastroduodenal intussusception secondary to a large benign gastric polyp in a 44-year-old woman with Gardner's syndrome who presented with acute pancreatitis. The intussuscepted polyp caused obstruction of the ampulla of Vater with subsequent acute pancreatitis.

Acute Disease↗
PubMed1991

A new syndrome: ascites, hyperbilirubinemia, and hypoalbuminemia after biochemical modulation of fluorouracil with N-phosphonacetyl-L-aspartate (PALA)

OBJECTIVE: To report a new syndrome of ascites, hyperbilirubinemia, and hypoalbuminemia after treatment with N-phosphonacetyl-L-aspartate (PALA) and fluorouracil for metastatic colorectal cancer. DESIGN: Retrospective analysis. SETTING: Regional cancer treatment center. PATIENTS: Forty-four previously untreated patients with metastatic colorectal cancer in a phase I-II trial of PALA-fluorouracil. MEASUREMENTS AND MAIN RESULTS: One or more transient hepatic abnormalities frequently occurred in 15 of the 17 responding patients. Within the first 10 weeks of treatment, 5 patients developed ascites, 12 had a decrease in the serum albumin level, 6 developed bilirubin elevations, and 7 had transaminase elevations, all in the presence of a complete or partial tumor response. Prolongations of the prothrombin time and elevations of serum glucose levels were also seen. CONCLUSIONS: An unusual syndrome of ascites, hyperbilirubinemia, and hypoalbuminemia is associated with a PALA-fluorouracil regimen. These abnormalities, which may be related to decreased hepatic protein synthesis, occurred more often in patients whose tumor was responding to chemotherapy. Clinicians must recognize that in patients undergoing chemotherapy with these agents, ascites and elevated liver function tests may be secondary to drug administration and are not necessarily due to disease progression.

Aged↗
PubMed1991

Reviewing graduate medical education programs: a cancer center experience. Members of the Graduate Training Committee.

The Graduate Training Committee at Memorial Sloan-Kettering Cancer Center developed procedures for comprehensively reviewing the 32 graduate training programs at our institution. The methods used to carry out this review, the problems encountered, and the results of this review are presented. As this type of program review is now mandated by the Accreditation Council for Graduate Medical Education (ACGME), our method and experience should prove useful to other institutions planning a similar review process.

Cancer Care Facilities↗
PubMed1990

Gastrointestinal cancer in the elderly.

The older patient population, aged 70 years and greater, represent a large proportion of patients diagnosed with gastrointestinal malignancies. Surgery remains the mainstay of treatment for these malignancy sites. Chronologic age alone should not determine the extent of surgical or medical management. The authors describe those aspects of gastrointestinal cancer detection and therapy that are unique to the aging population.

Age Factors↗
PubMed1988

Ogilvie's syndrome. Successful management without colonoscopy.

We reviewed the clinical presentation, management, and outcome of 25 patients with Ogilvie's syndrome (acute colonic pseudoobstruction) at Memorial Sloan-Kettering Cancer Center from 1982 through 1985. All patients had cancer and severe associated medical problems. Abdominal x-rays uniformly showed cecal distension ranging between 9 and 18 cm. Twenty-four of the 25 patients were treated with conservative nonendoscopic management. One patient had an exploratory laparotomy for prophylactic cecostomy after only one day of conservative therapy. Of the 24 patients treated conservatively, 23 (96%) improved by both clinical and radiologic criteria in a mean of 3.0 days. The remaining patient died of multisystem failure not related to the acute colonic pseudoobstruction. Colonoscopic decompression was not attempted in any of the 25 patients. There were no colonic perforations, and there were no pseudoobstruction-related deaths. This study questions the need for early endoscopic or surgical treatment in cancer patients with acute colonic pseudoobstruction.

Colonic Pseudo-Obstruction↗
PubMed1987

Upper gastrointestinal neoplasia in familial polyposis.

Upper gastrointestinal (UGI) endoscopy was performed in 41 asymptomatic American patients with familial polyposis to assess the prevalence of gastric and duodenal polyps and to characterize their pathological features. Eighteen patients (44%) had UGI endoscopic abnormalities. Six patients had both gastric and duodenal lesions. Eight patients had only gastric polyps, and four had duodenal polyps only. The presence of other extracolonic expressions of polyposis had a suggestive but statistically insignificant correlation with UGI polyps. Patients with familial polyposis and duodenal adenomatous polyps are at high risk for the development of periampullary cancer; screening and identification of these individuals is recommended.

Adenomatous Polyposis Coli↗
PubMed1987

Multiple primary malignant tumors.

Members of colon cancer-prone nonpolyposis families who had multiple primary malignant tumors were analyzed to determine the frequencies, locations, and stages of their cancers, and the duration of their survival. Colon cancers tended to be more proximal, were in a less advanced stage than in the general population, and in a majority of instances were associated with colonic adenomas. The multiple primary malignant tumors were more common in women, and occurred at a younger age than in the general population. Six or more multiple primary malignant tumors occurred in each of 4 patients. All patients survived for more than 10 yr after the diagnosis of the first cancer. Extracolonic cancers were most frequent in the breast and endometrium.

Actuarial Analysis↗
PubMed1986

Cholesonographic characteristics of cystic duct metastasis causing acute acalculous cholecystitis: case report.

A variety of epithelial malignancies are capable of metastasizing to the bile ducts and gall bladder in a fashion distinct from concurrent spread to the liver. Ultrasonography has proved useful in evaluating obstructive jaundice in this setting and, in the case described, accurately diagnosed acute acalculous cholecystitis caused by a solitary metastasis from carcinoma of the breast to the cystic duct. Exploratory laparotomy confirmed the accuracy of this preoperative diagnosis.

Adenocarcinoma↗
PubMed1986

Cryptosporidiosis. Case report in a health team worker.

Cryptosporidium is a coccidial protozoan of the intestinal tract; cryptosporidiosis in veterinarians has been reported as a cause of diarrhea. It has also been reported as a cause of diarrhea in marrow transplant recipients. Cryptosporidiosis has gained attention recently because of its occurrence in patients with the acquired immune deficiency syndrome (AIDS). A healthy intensive care unit nurse who acquired cryptosporidiosis from a bone marrow transplant recipient with diarrhea caused by cryptosporidiosis is described. Results of laboratory examination, including T lymphocyte subsets, were normal. She was treated with bed rest and a liquid diet and her symptoms completely resolved after 15 days. Health care workers should be aware that cryptosporidiosis can be transmitted to them from patients and should follow precautions to avoid acquiring the disease.

Adult↗
PubMed1986

Severe gastroduodenal ulcerations complicating hepatic artery infusion chemotherapy for metastatic colon cancer.

Patients receiving continuous hepatic artery infusion chemotherapy (HAIC) with 5-fluoro-2'-deoxyuridine for colorectal carcinoma metastatic to the liver frequently complain of nonspecific abdominal discomfort. To determine the etiology of these symptoms we performed upper gastrointestinal endoscopy on symptomatic patients during the course of HAIC. Among 40 patients receiving HAIC of 5-fluoro-2'-deoxyuridine, 21 (53%) developed epigastric pain. They all had upper gastrointestinal endoscopy and 19 were found to have gastroduodenal ulcerations and or erosions. In two patients the infusion catheter eroded into the duodenum. The pathogenesis of the mucosal disease is not clear, but because symptoms responded to discontinuation of HAIC but not to therapy with cimetidine, a direct toxic effect of chemotherapy is postulated. We conclude that patients who complain of upper gastrointestinal symptoms while receiving continuous HAIC with 5-fluoro-2'-deoxyuridine should be investigated for the development of gastroduodenal ulcerations and erosions and that chemotherapy should be withheld if such lesions are found.

Acute Disease↗
PubMed1985

Malabsorption and mucosal abnormalities of the small intestine in the acquired immunodeficiency syndrome.

Diarrhea and weight loss may accompany the acquired immunodeficiency syndrome. We studied 30 patients with the syndrome, 20 of whom had diarrhea and weight loss and 10 of whom did not. Patients with identifiable enteric infections or small intestinal Kaposi's sarcoma were excluded. Malabsorption was common in the patients with diarrhea and weight loss, as shown by abnormal D-xylose and 14C-glycerol-tripalmitin absorption tests. In these patients, duodenal biopsy specimens showed a histiocytic infiltrate containing numerous acid-fast organisms in 5 and a mild-moderate chronic inflammation in 13. In asymptomatic patients, duodenal biopsy specimens were normal in 6 and showed chronic inflammation in 4. These results suggest that malabsorption is common in patients with the acquired immunodeficiency syndrome with chronic diarrhea and may contribute to their weight loss.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Comparison of flexible sigmoidoscopy with other diagnostic techniques in the diagnosis of rectocolon neoplasia.

Flexible sigmoidoscopy was compared to rigid sigmoidoscopy in the detection of colorectal neoplasia in a select group of patients. A distance of 30 cm or greater was obtained by flexible sigmoidoscopy in 94% of patients and a distance of 50 cm or greater in 46% of patients. A significant number of cancers and adenomas detected by flexible sigmoidoscopy were not detected by rigid sigmoidoscopy. Flexible sigmoidoscopy was tolerated better than rigid sigmoidoscopy but required twice the time. Flexible sigmoidoscopy could be combined with air-contrast barium enema the same day with the one preparation and did not interfere with the x-ray examination. All cancers and a significant number of adenomas detected subsequently on colonoscopy were detected by the combination of flexible sigmoidoscopy and air-contrast barium enema. Although the combination of flexible sigmoidoscopy and air-contrast barium enema is not adequate for thorough diagnostic evaluation of patients with a positive screening test, it may be of value in other select clinical situations. Flexible sigmoidoscopy has the potential for higher yield and better patient tolerance as compared to rigid sigmoidoscopy. This warrants further evaluation.

Adenoma↗