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Biomedical subjects

S B Benjamin

Publications and source records attributed to S B Benjamin.

At least 73 records · Page 4Linked to original sources
PubMed1987

Esophageal malignancy: imaging results and complications of combined endoscopic-radiologic palliation.

Fifty-one patients with advanced cancer of the esophagus underwent 191 endoscopic palliative procedures, including bouginage, laser therapy, bipolar electrocoagulation, and stent placement. In three patients free perforations developed; these were treated immediately and no sequelae developed. Perforations confined within the tumor mass were diagnosed with CT in two patients and did not require treatment. Methods of endoscopic palliation are discussed with reference to the radiologic studies and techniques. The radiologist must evaluate tumor topography and esophageal wall thickness with computed tomography and esophagography to aid in the choice of palliative therapy. Knowledge of each technique and its risks by the radiologist is essential for useful consultation with the endoscopist before, during, and after the procedure.

Adenocarcinoma↗
PubMed1987

Metoclopramide response in patients with progressive systemic sclerosis. Effect on esophageal and gastric motility abnormalities.

Twelve patients with progressive systemic sclerosis (four with CREST [calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia] variant) underwent systematic evaluation to assess the esophagogastric effects of metoclopramide hydrochloride in this patient population. Esophageal manometry, esophageal radionuclide scintigraphy, solid-phase gastric emptying, and 24-hour esophageal pH monitoring were performed in all patients with and without metoclopramide. Metoclopramide improved lower esophageal sphincter pressure and reduced the gastric emptying delay and gastroesophageal reflux in most patients but had a less consistent effect improving esophageal transit or esophageal body pressures. Metoclopramide should be strongly considered in the pharmacologic approach to the gastroesophageal reflux-related complications of this disease.

Adult↗
PubMed1986

Evaluation of the Angelchik antireflux prosthesis using a model for esophageal reflux in rhesus monkeys.

Minimal data are available about the Angelchik antireflux prosthesis although it has been inserted in more than 14,000 patients. The present animal study was designed to evaluate the effectiveness and mechanism of action of this prosthesis. A reproducible model of esophageal reflux in primates was created using a double myotomy. Lower esophageal sphincter (LES) pressure and reflux score were improved significantly in animals by insertion of an Angelchik antireflux prosthesis, a modified antireflux prosthesis, or a Nissen fundoplication. Manometrically determined LES length was increased after insertion of an Angelchik antireflux prosthesis but not by a Nissen fundoplication or sham operation. Complications after insertion of the modified prosthesis included intraluminal erosion, fibrous stricture, and slippage of the device over the stomach.

Animals↗
PubMed1986

Radiology of the nutcracker esophagus.

We prospectively evaluated 22 patients with manometrically proven "nutcracker esophagus" (high amplitude peristaltic contractions). All patients were symptomatic with angina-like chest pain, dysphagia, or both. Patients underwent barium esophagram with video-recording of the images. Video tapes were reviewed independently by a gastrointestinal radiologist who was unaware of the patients' manometric diagnoses. The video-esophagram was normal in 12 of 22 (55%) patients. Eight of 22 (36%) had dysmotility: either diffuse spasm (9%) or tertiary contractions (27%) (Fig. 2). A hiatal hernia was the only abnormality in two patients. Although the presence of diffuse spasm or tertiary contractions may suggest the presence of the underlying motor disorder in patients with nutcracker esophagus, we conclude that the "barium swallow" lacks sufficient sensitivity to screen adequately for this disorder in patients with atypical angina or dysphagia.

Adult↗
PubMed1986

Extra-esophageal complications of gastroesophageal reflux.

Gastroesophageal reflux is precisely defined as physiologic reflux, symptomatic esophageal reflux (SGER), and gastroesophageal reflux (GERD). GERD defines diseases related to the movement of gastric contents into the esophagus, hypopharynx, and lungs. The spectrum of disease known to be causally related to reflux is increasing now that the technology to prove these associations is available. Clinicians should be aware of the potential relationship between reflux and extra esophageal diseases.

Gastroesophageal Reflux↗
PubMed1986

Gastric tuberculosis: a manifestation of acquired immunodeficiency syndrome.

A Haitian man with acquired immunodeficiency syndrome (AIDS), fever, malaise, and diarrhea is described. A computed tomographic (CT) scan showed a retrogastric mass with an associated ulcer. An upper gastrointestinal tract study showed an ulcer with both benign and malignant features. Endoscopy revealed a malignant-appearing ulcer, but cultures and histologic examinations of surgical biopsy specimens indicated gastric tuberculosis. The relationship between tuberculosis and AIDS is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Acetaminophen hepatotoxicity in alcoholics. A therapeutic misadventure.

We have treated 6 chronic alcoholics and identified an additional 19 reported in the literature who developed severe hepatotoxicity from acetaminophen taken in apparently moderate doses. The clinical disease in these 25 patients had a characteristic pattern: mild to moderate jaundice; mild to severe coagulopathy; and strikingly abnormal aminotransferase levels, values inconsistent with either acute alcoholic hepatitis or viral hepatitis. The possible causes for the injury from ostensibly nontoxic drug levels appear to be either the induction by chronic alcohol intake of the cytochrome P-450 system responsible for converting acetaminophen to a toxic metabolite, or the effect of alcoholism and the associated malnutrition in reducing the glutathione concentration, responsible normally for preventing hepatotoxicity by conjugation with the toxic metabolite. The research data pertaining to the apparent enhanced toxicity from chronic alcoholism are reviewed. Despite the low frequency of ethanol-potentiated acetaminophen hepatotoxicity, alcoholics should be cautioned about the use of acetaminophen while they persist in heavy consumption of alcohol.

Acetaminophen↗
PubMed1986

Systematic esophageal evaluation of patients with noncardiac chest pain.

We prospectively studied 73 patients with angina-like chest pain severe enough to warrant admission to a coronary care unit over a five-month period. Thirty-four patients (47%) were found to have coronary artery disease as the cause of their symptoms, based on exercise testing, stress radionuclide imaging, or cardiac catheterization. The remaining 39 patients had normal cardiac findings and then underwent videoesophagography, radionuclide esophageal transit study, and esophageal manometry. Thirty-three of the 39 underwent acid perfusion testing (modified Bernstein's test). The findings at esophageal manometry were abnormal in 29 (74%) of 39. Manometric diagnoses were "nutcracker esophagus" in 17 (59%), nonspecific esophageal motility disorders in nine (31%), diffuse esophageal spasm in two (7%), and achalasia in one (3%). Bernstein's test reproduced symptoms in only 12%. The sensitivity of videoesophagography in detecting esophageal motility disorders was 66%, and that of radionuclide esophageal transit was 79%. The positive predictive values were 86% and 85%, respectively.

Adult↗
PubMed1986

Abnormal esophageal pressures in reflux esophagitis: cause or effect?

Thirteen patients with gastroesophageal reflux disease underwent esophageal manometric evaluation during acute exacerbations and disease remission to evaluate lower esophageal sphincter and peristaltic pressure in response to treatment. No change was noted in lower esophageal sphincter pressure (15.2 +/- 2.6 mg versus 14.3 +/- 1.8 mm Hg) or peristaltic pressure (64.1 +/- 6.9 versus 62.1 +/- 7/8 mm Hg) with remission while both lower esophageal sphincter pressure and distal amplitude were lower in reflux patients than controls (p less than 0.05). Short-term treatment resulting in endoscopic and symptom improvement of gastroesophageal reflux disease does not appear to improve lower esophageal sphincter and peristaltic pressure.

Adult↗
PubMed1986

Cholestatic hepatic injury related to warfarin exposure.

Despite the widespread use of oral anticoagulants derived from 4-hydroxycoumarin, there have been only a small number of well-defined cases of hepatotoxicity. We report a well-defined case of cholestasis following exposure to warfarin sodium (Coumadin). Inadvertent rechallenge reproduced the syndrome. Cholestasis may occur in response to exposure to derivations of 4-hydroxycoumarin.

Aged↗
PubMed1985

Iatrogenic sclerosing cholangitis following hepatic arterial chemotherapy infusion.

A case of common hepatic duct stricture secondary to hepatic artery chemotherapy infusion is described. CT and endoscopic retrograde cholangiopancreatography (ERCP) may be used in concert to differentiate this entity from other causes of jaundice--namely, hepatic replacement by tumor, porta hepatis adenopathy, and chemotherapy hepatotoxicity.

Adenocarcinoma↗
PubMed1984

Esophageal bougienage in symptomatic patients with the nutcracker esophagus. A primary esophageal motility disorder.

A wide variety of therapies have been suggested for patients with painful esophageal motility disorders. In a prospective, double-blind, cross-over clinical trial, we evaluated the effectiveness of mercury bougienage ("placebo," 24 F; "therapeutic," 54 F) in eight symptomatic patients with the nutcracker esophagus (NE). There were no significant differences between the placebo or therapeutic dilators in relation to chest pain, dysphagia, lower esophageal sphincter pressure, or amplitude. Chest pain scores after completion of this trial were significantly lower than baseline scores, irrespective of the sequence of dilators used. No subjective or objective improvement could be demonstrated when "therapeutic bougienage" was compared with "placebo bougienage" in patients with the NE. The improvement in symptoms at the completion of the study may result from the close physician-patient interaction, suggesting that this may be more important than the actual size of the bougie.

Adult↗
PubMed1984

Histologic evaluation of chronic gastroesophageal reflux. An evaluation of biopsy methods and diagnostic criteria.

Controversy exists regarding the appropriate method for biopsy confirmation of esophageal reflux injury. We have compared endoscopic pinch biopsy (PB) with endoscopically directed Rubin tube suction biopsy (SB) in 40 patients with symptomatic gastroesophageal reflux disease (GERD). Utilizing a plastic tube attached alongside the endoscope, SB at specific sites in the esophagus can be easily obtained. Suction biopsy was rated superior to PB for adequacy of tissue, ability to make an interpretation, and certainty in diagnosis. These differences were most pronounced in patients with endoscopic grades 0 and 1 + esophagitis in which 59% of PBs were uninterpretable compared to 23% of SBs. The passage of the Rubin tube was easily done and could be performed repeatedly. Six of 40 patients (15%) developed substernal chest discomfort in the 24 hr following SB. We conclude that SB is the most appropriate way to evaluate histologic changes related to reflux injury and that this method is mandatory in symptomatic patients with minimal endoscopic evidence of esophagitis (0-1 +).

Adult↗