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Biomedical subjects

R J Vender

Publications and source records attributed to R J Vender.

15 recordsLinked to original sources
PubMed2000

Overuse of acid-suppressive therapy in hospitalized patients.

OBJECTIVES: The aims of this study were 1) to determine the frequency of use and indications for prescription of acid-suppressive medications in hospitalized patients, and 2) to determine whether patients who are prescribed these medications for stress ulcer prophylaxis are prescribed them on hospital discharge. METHODS: The use of acid-suppressive medications (histamine-2 receptor antagonists, proton pump inhibitors, and barriers--specifically, famotidine, omeprazole, and sucralfate) was assessed in 226 patients admitted consecutively to a general medical nursing unit of an urban, community, teaching hospital. Chart review was undertaken to determine the type of medication used, timing of prescription, and indication for use. RESULTS: Of hospitalized patients, 54% were receiving acid-suppressive therapy. Histamine-2 receptor antagonists were used most frequently (62%). In all, 65% of prescriptions were not indicated as determined by consensus review. Among patients put on acid-suppressive therapy for ulcer prophylaxis, 55% were discharged on the therapy. CONCLUSIONS: There is significant overuse of acid-suppressive therapy in hospitalized patients. The problem of placing low-risk patients on ulcer prophylaxis unnecessarily is compounded by discharging these patients with the medication.

Antacids↗
PubMed1996

Primary lymphoma of the gallbladder; case report and review of the literature.

The term extranodal lymphoma refers to lymphoma arising in tissues other than lymph nodes or major lymphoid organs (1). The GI tract is commonly involved by lymphoma. Although lymphomas of the liver and the biliary tree are uncommon, they are well described in the literature. However, there are only nine cases of primary lymphoma of the gallbladder reported in the English literature. We report a patient with primary gallbladder lymphoma diagnosed preoperatively by ultrasound, with disease confined to the gallbladder on pathology specimens and radiological examination. His rapid disease progression to diffuse abdominal involvement in 6 wk points to the importance of a timely diagnosis. We postulate that delays in making the diagnosis may lead to the underdiagnosis of primary lymphoma of the gallbladder.

Gallbladder Neoplasms↗
PubMed1994

Antibiotic-associated hemorrhagic colitis.

Antibiotic-associated hemorrhagic colitis is an infrequently recognized, self-limited process that may be experienced by patients receiving oral penicillin derivatives, primarily for upper respiratory infections. Symptoms of diarrhea, abdominal tenderness, and ultimately bloody diarrhea occur within one week of antibiotic use. Resolution of symptoms typically occurs within three days of discontinuing the offending antibiotic. Previous reports have suggested a non-inflammatory process involving the right colon. We present four cases and review the literature with respect to presentation, diagnosis, course, and postulated pathophysiologic mechanisms. Our patients demonstrate a more heterogeneous population than previously noted. This disease can affect young and old, male and female, and can involve the entire colon. Active inflammation demonstrated by fecal leukocytes, peripheral leukocytosis, and an active inflammatory infiltrate on biopsy are reported.

Adult↗
PubMed1989

Mechanisms of nonsteroidal anti-inflammatory drug-induced gastric damage.

The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the gastric mucosa are well documented. The complex mechanisms of gastric damage, however, are not fully understood. This review examines current knowledge about the normal function of the gastric mucosal barrier; the role of prostaglandins in cytoprotection and repair; the mechanisms by which aspirin and other weak organic acids are absorbed by the stomach; and the subsequent cascade of events--including ion trapping and back diffusion of hydrogen ions--that leads to gastric erosion and bleeding. A hypothesis describing NSAIDs' dual insult on the stomach is advanced.

Animals↗
PubMed1986

Portal venous gas following a barium enema in a patient with Crohn's colitis. A benign finding.

Hepatic portal venous gas occurring during an air-contrast barium-enema examination in patients with inflammatory bowel disease is a benign finding. Patients with chronic ulcerative colitis have experienced some morbidity, while those with Crohn's colitis have not. It may not be necessary to treat all of these patients with antibiotics, especially asymptomatic patients with Crohn's colitis.

Adolescent↗
PubMed1983

Salmonella colitis presenting as a segmental colitis resembling Crohn's disease.

Salmonella species have recently been shown to involve the colon in a diffuse fashion resembling ulcerative colitis by radiographic and endoscopic appearance. We describe a case of Salmonella colitis in which the radiographic and colonoscopic features were focal ulcerations, mucosal edema, friability, and a loss of normal vascularity, an appearance resembling Crohn's disease. This is the first well-documented example of this clinical presentation.

Colitis↗
PubMed1983

Anomalous pancreatic ducts causing "pseudomass" of the pancreas.

Computerized axial tomography (CT scan) of the abdomen is a sensitive method for examining the pancreas. Its sensitivity, however, may lead to the discovery of small mass lesions which do not represent neoplastic or inflammatory lesions. We describe our experience with 21 patients in whom mass lesions seen by CT scan were proven by endoscopic retrograde pancreatography (ERCP) to represent anomalies of the pancreatic duct. We call such lesions "pseudomasses." Our findings support the need for opacification of the pancreatic duct system to rule out lesions arising from the duct whenever lesions of the pancreas are suspected on CT scan.

Adult↗
PubMed1982

Inflammatory bowel disease and pregnancy.

Inflammatory bowel disease (IBD) commonly affects women of childbearing age, leading to concerns about the effects of the disease on fertility and pregnancy, the effect of pregnancy on the disease, and the diagnosis and treatment of IBD in the pregnancy women. The literature regarding these issues is reviewed, and a representative case report is discussed. Ulcerative colitis has no effect on fertility. Crohn's disease appears to be associated with an increased risk of infertility. "Subfertility," a temporary inability to conceive associated with chronic disease activity, is perhaps a more suitable description. There have been no studies regarding infertility and males with IBD, although sulfasalazine has recently been reported to cause reversible infertility in men. Ulcerative colitis is not associated with a higher spontaneous abortion rate than the general population, although it is not clear whether certain subgroups of patients have a higher rate of abortion. A similar conclusion has been reached for Crohn's disease, although reported abortion rates of 10-25% are somewhat higher than the general population. Approximately 30-50% of pregnant women with ulcerative colitis have exacerbations during their pregnancy or postpartum, a figure that is applicable to Crohn's disease as well, and which is no different than a control population of nonpregnant women with IBD. Patients with active ulcerative colitis at conception have a higher incidence of disease exacerbation than those with quiescent disease. Postpartum recurrences are more frequent in Crohn's disease, occurring in up to 40% of patients, but respond to standard medical therapy. Women who have had an ileostomy for ulcerative colitis consistently and successfully carry pregnancy to term. There is no data regarding women who have had an ileostomy for Crohn's disease. The approach to the women with abdominal pain during pregnancy is reviewed, including the use of radiographic procedures. No amount of radiation exposure can be considered safe, but the judicious use of standard radiographic tests when considered necessary for the health of the mother appear to be associated with little risk for the fetus. The medial treatment of IBD during pregnancy is the same as that for the nonpregnant patient. Despite animal data to the contrary, the bulk of human data suggests that steroids, when used to treat a variety of conditions including IBD, pose little risk to the human fetus. Similarly, despite the theoretical risk of kernicterus, sulfasalazine appears to be a safe drug even when used during the third trimester of pregnancy.U

Abortion, Spontaneous↗
PubMed1979

The outlook after total colectomy in patients with Crohn's colitis and ulcerative colitis.

The postoperative recurrence rates for Crohn's colitis (CC) and ulcerative colitis (UC) have varied markedly in different medical centers. We have reviewed the reasons for this variation and present our own series of patients in a manner which allows comparison with previous studies. In our study: 1) Patients with CC had an overall recurrence rate of 38% after total colectomy. By actuarial statistics, this recurrence rate computes to 48% by 12 years after operation. 2) Patients with ileal disease, even if totally removed at operation, had a recurrence rate of 48% whereas those with no obvious ileal involvement had a recurrence rate of 18%. 3) When nonspecific criteria are used for recurrence, which we call "complication," as has been the case in several previous studies of CC, even patients with UC had a complication rate of 33%. Such complications both in UC and CC represent postoperative occurrence rather than ileal recurrence of the inflammatory process. 4) Patients with CC develop more postoperative complications than patients with UC, but for most of the time they were asymptomatic. In this series there were no patients with disease originally or almost entirely limited to the colon who became "intestinal cripples" as a result of recurrent disease. 5) Patients with short preoperative intervals had the highest recurrence rate, whereas patients with disease of the terminal ileum had the highest postoperative complication rate. 6) Patients with "superficial" CC had a low recurrence rate, probably because of a shorter follow-up than the other patients. There were no true recurrences in patients with UC.

Adult↗