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S Friedland

Publications and source records attributed to S Friedland.

At least 19 recordsLinked to original sources
PubMed2006

Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope.

BACKGROUND: Caecal intubation is a necessary step in the complete endoscopic evaluation of the colon. Studies have estimated that experienced colonoscopists may fail to reach the caecum in up to 10% of cases. AIMS: To evaluate the utility of the double balloon enteroscope used for complete examination of the colon in patients with incomplete standard colonoscopy. PATIENTS: Twenty consecutive patients with incomplete colonoscopies within the Veterans Affairs Palo Alto Health Care System. Mean age of 66 years (S.D.+/-12 years, range 46-84), 16 men. METHODS: Prospective single-centre case series on the caecal intubation rate using standard double balloon enteroscope technique in patients with previous incomplete conventional colonoscopy. RESULTS: Use of the standard double balloon enteroscope technique permitted complete colonoscopy to be achieved in 95% of the patients (19/20). Seven patients (35%) had significant pathology beyond the extent of the prior incomplete colonoscopy. We performed endoscopic mucosal resection, polypectomy or biopsy. The mean time to reach the caecum was 28 min (S.D.+/-20 min, range 6-90 min). The sedation was similar to conventional colonoscopy. No complications occurred. CONCLUSIONS: The double balloon enteroscope technology and technique can be used to complete examination of the colon in patients who were referred because of incomplete standard colonoscopy.

Aged↗
PubMed2006

Absence of ischemia in telangiectasias of chronic radiation proctopathy.

BACKGROUND AND STUDY AIMS: It has been postulated that chronic radiation proctopathy, clinically manifested by hematochezia and by the appearance of multiple telangiectasias, is caused by ischemia. This theory is based on reports that appeared in the 1980s which described obliterative endarteritis in patients with chronic radiation-induced ulcers. However, bleeding from radiation proctopathy is typically successfully treated endoscopically by widespread tissue coagulation, and the complications that would be expected to occur if the tissue was ischemic, such as poor wound healing, generally do not arise. We therefore hypothesized that the ischemia theory is incorrect and that rectal capillary oxygen saturation is normal in patients with telangiectasias of chronic radiation proctopathy. PATIENTS AND METHODS: We developed a visible-light spectroscopy device that measures mucosal capillary hemoglobin oxygen saturation during endoscopy (having reported its operating characteristics previously). We prospectively studied 20 patients who had typical findings of multiple rectal telangiectasias, 1 - 20 years after undergoing external-beam irradiation for prostate or rectal carcinoma. We measured and compared the mucosal capillary oxygen saturations in the affected areas of the distal rectum and in endoscopically normal areas in the rectosigmoid colon. RESULTS: Mucosal oxygenation was normal in all 20 patients in affected areas (64 % - 80 %) and in unaffected areas (63 % - 75 %). The mean mucosal hemoglobin oxygen saturation was actually slightly higher in the affected areas of the rectum than in the uninvolved rectosigmoid colon (73 % vs. 69 %, P < 0.01). CONCLUSIONS: The common form of chronic radiation proctopathy, characterized by multiple telangiectasias without ulcers or strictures, is not associated with ongoing mucosal ischemia. This finding may explain why endoscopic treatment of this disorder, in which large areas of the mucosa are coagulated with argon plasma or other treatment modalities that cause widespread ulceration, does not typically result in complications from poor wound healing.

Aged↗
PubMed2002

Bedside scoring system to predict the risk of developing pancreatitis following ERCP.

BACKGROUND AND STUDY AIMS: Pancreatitis is the most common significant complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of the present study was to develop a simple scoring system that clinicians can use to predict the risk of post-ERCP pancreatitis. PATIENTS AND METHODS: We analyzed a prospectively assembled database of 1835 ERCP procedures at a single referral hospital. Multivariate logistic regression analysis was performed to identify risk factors for pancreatitis and determine their relative contributions. From these results, a scoring system was constructed. The performance of the scoring system was assessed on the entire procedure database and in selected subgroups. RESULTS: Multivariate analysis yielded four risk factors: pain during the procedure, cannulation of the pancreatic duct (PD), previous post-ERCP pancreatitis, and number of cannulation attempts. Based on the regression model, the scoring system was: 4 points for pain, 3 points for PD cannulation, 2 points for a history of post-ERCP pancreatitis, and 1 - 4 points depending on the number of cannulation attempts. A total score of 1 - 4 points was associated with a low risk of pancreatitis (< 2 %), while a score of 5 - 8 points had an intermediate risk (7 %), and a score of 9 or above had a high risk (28 %). CONCLUSIONS: This simple scoring system may enable clinicians to stratify patients into low-risk, medium-risk, and high-risk groups for the development of post-ERCP pancreatitis. In addition, when patients with suspected sphincter of Oddi dysfunction and patients who underwent minor papilla cannulation were analyzed separately, the scoring system was able to predict accurately the pancreatitis risk of these patients as well.

Adult↗
PubMed2001

Stenting the sigmoid colon in a terminally ill patient with prostate cancer.

Large bowel obstruction in the terminally ill patient can be difficult to manage. We describe a patient with sigmoid colon obstruction caused by metastatic prostate cancer in the pelvis who required hospitalization because of severe pain and obstructive symptoms. Treatment with an endoscopically placed self-expandable metal stent allowed the patient to have immediate resolution of symptoms and to receive hospice care at home.

Colonoscopy↗
PubMed1996

Disorders of affective and linguistic prosody in children after early unilateral brain damage.

Prosody is that quality of speech that imparts meaning by changes in intonation, pitch, and stress. The right hemisphere (RH) appears to be dominant for affective prosody in adults, while the left hemisphere (LH) mediates the more linguistic aspects of nonverbal communication. Few similar studies have been reported of individuals who suffered early unilateral brain damage, when brain reorganization or plasticity might be expected to play a role in ameliorating the adverse effects of focal brain damage. In this study, comprehension and expression of affective and linguistic prosody were tested in subjects with documented unilateral brain damage of pre- or perinatal onset and in matched controls. Both RH- and LH-lesion groups demonstrated difficulty on tasks involving expression of affective prosody, and on tests of linguistic prosody, compared with controls. Only the RH-lesion group was impaired on an affective comprehension task. The results indicate that even after very early unilateral brain damage, prosodic deficits may be present. However, only for affective comprehension does the side of the lesion appear to determine such deficits. The findings suggest that during brain development there is not clear brain lateralization for prosody and there may be bilateral representation for these skills during early development. There may be limitations to the ability of the developing brain to reorganize after early injury.

Adolescent↗
PubMed1996

Three-dimensional measurements of central serous chorioretinopathy using a scanning laser tomograph.

PURPOSE: To evaluate the topographic three-dimensional mapping of retinal elevation in central serous chorioretinopathy using the Heidelberg Retina Tomograph and to correlate the measured parameters with the fluorescein angiographic findings. METHODS: Seventy-six consecutive patients with central serous chorioretinopathy (63 men, 13 women), between 26 and 54 years of age, were examined to identify areas of neurosensory retinal detachment and fluorescein leakage. In areas of retinal detachment, the parameters measured were the area, volume, maximal height, and diameters of the retinal elevation, which were statistically analyzed, and the correlations between these parameters were evaluated. RESULTS: Mean +/- SD area of elevation was 9.6 +/- 5.22 mm2 (range, 2.7 to 21.5 mm2); mean volume was 1.16 +/- 1.3 mm3 (range, 0.11 to 4.73 mm3); mean maximal height was 238 +/- 108 microns (range, 97 to 450 microns); mean x-axis was 3.4 +/- 1.1 mm (range, 1.6 to 5.6 mm); and mean y-axis was 3.03 +/- 0.98 mm (range, 1.6 to 4.7 mm). Most of the retinal elevations were oval (the x-axis longer than the y-axis); the maximal height was in the geometric center in the smaller blebs and below the geometric center in the larger blebs. There were statistically significant correlations between area, volume, and height of the sensory elevation. No correlation was found between the location and the shape of leakage on fluorescein angiography and the Heidelberg Retina Tomograph measurements. CONCLUSIONS: Confocal laser tomography is potentially useful as a noninvasive diagnostic technique for quantitative measurements of the neurosensory retinal detachment in central serous chorioretinopathy.

Adult↗
PubMed1996

Luxury perfusion following anterior ischemic optic neuropathy.

We present five patients who developed luxury perfusion following anterior ischemic optic neuropathy in whom fluorescein angiography was misinterpreted as "capillary hemangioma" or neovascularization of the disc. In each case, the segment of disc hyperemia corresponded to a spared region of visual field. Luxury perfusion represents a reparative autoregulatory reaction to ischemia.

Aged↗
PubMed1995

Neuro-ophthalmic manifestations of meningocerebral inflammation from the limited form of Wegener's granulomatosis.

PURPOSE: Wegener's granulomatosis is classically a systemic necrotizing granulomatous vasculitis that involves the upper and lower respiratory tracts and kidneys. Ophthalmologic and neurologic manifestations are common. The limited form of Wegener's granulomatosis may have pathologic characteristics consistent with the disease but lacks the complete clinical triad. We studied the clinical, pathologic, laboratory, and radiologic findings of four patients with Wegener's granulomatosis so that others will recognize the disease, even when it occurs in its limited form. METHODS: From three clinical centers, a chart review disclosed four patients with neuro-ophthalmic findings and the limited form of Wegener's granulomatosis. RESULTS: Three men and one woman, ranging in age from 40 to 73 years, were studied. All four patients had ocular motor abnormalities (one with oculomotor and trochlear nerve palsies, one with oculomotor nerve palsy, one with trochlear and abducens nerve palsies, and one with horizontal gaze deviation) in addition to other cranial nerve and cerebral abnormalities. Neuroimaging showed prominent meningeal, as well as intraparenchymal, abnormalities. In all patients, results of antineutrophil cytoplasmic antibody tests were initially negative but in one patient were positive at a late stage of the disease. In all patients, results of a biopsy demonstrated necrotizing granulomatous inflammation consistent with Wegener's granulomatosis. CONCLUSIONS: Neuro-ophthalmic findings may be the earliest manifestations of the limited form of Wegener's granulomatosis. Extensive meningocerebral inflammation can occur before systemic involvement or laboratory confirmation. Early diagnosis by biopsy of affected tissues may facilitate appropriate treatment and prevent progression of the disease.

Adult↗
PubMed1995

Mesenchymal chondrosarcoma with secondary orbital invasion.

Orbital involvement with mesenchymal chondrosarcoma is rare. Until recently, despite the young age of the affected population, exenteration was the recommended management. We report a patient with orbital invasion by mesenchymal chondrosarcoma managed surgically without exenteration. Adjuvant chemotherapy and radiotherapy were administered. There is no evidence of local or distant tumor recurrence with 30 months of postoperative follow-up. This and other recent case reports suggest that exenteration may not be necessary for local tumor control of mesenchymal chondrosarcoma in the orbit.

Adolescent↗
PubMed1993

[Monocular blindness following blunt head trauma].

An uncommon, devastating complication of blunt head trauma is monocular blindness. We present a 40-year-old man who complained of visual loss in the right eye a few days after minor closed head trauma. Electrophysiologic study (VEP) proved severe damage to the right optic nerve, most probably due to transection of the nerve. Based on the assumption that optic nerve injury might be analogous to spinal cord injury, we used methylprednisolone: a loading dose of 30 mg/kg was followed 2 hours later by 15 mg/kg, which was then given every 6 hours for 48 hours. Surgical decompression of the bony optic canal was not performed. There are no good data to guide our decision-making. A prospective randomized trial is required to provide definitive management guidelines in this severe and dramatic injury.

Adult↗
PubMed1993

Handling punctate keratitis resulting from systemic cytarabine.

A young patient with acute myelogenous leukemia was treated with high-dose cytarabine (3.0 g/m2 every 12 hours). After five days of treatment, he developed severe photophobia and decreased visual acuity. On examination, progressive punctate keratitis was found. We discuss the mechanism of the cytarabine-induced corneal toxicity and the prophylactic use of topical corticosteroids.

Adult↗
PubMed1991

[Central retinal artery occlusion in a young man].

Central retinal artery occlusion (CRAO) is uncommon in those younger than 50. We present a 42-year-old man who complained of sudden loss of vision in the left eye. Fundus examination showed typical findings of CRAO. Extensive medical work up showed no evidence of diabetes or of cardiovascular, hematologic or collagen disease. However, a malignant tumor of the right testis was found, with metastases in the lung, retroperitoneal lymph nodes and brain. The right testis was resected and chemotherapy and brain irradiation resulted in remission during a follow-up of 2.5 years. The differential diagnosis of CRAO in younger patients is difficult. We believe that metastases from the primary tumor were the cause of CRAO in our patient. The possibility of malignancy with metastatic spread causing CRAO should be considered, particularly in relatively young patients with no other evidence of systemic disease.

Adult↗