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Biomedical subjects

S J Boley

Publications and source records attributed to S J Boley.

At least 19 recordsLinked to original sources
PubMed1992

Laparoscopic cholecystectomy in teenagers.

The positive experience with laparoscopic cholecystectomy (LC) in the adult surgical community encouraged us to perform LC in our last nine adolescent patients requiring cholecystectomy. There were no operative or postoperative complications, and the average hospital stay was less than 3 days. All the teenagers resumed their normal activities 1 week after surgery and were pleased with the small operative scars. Once the technique has been mastered and adequate experience gained with the new instrumentation, laparoscopic cholecystectomy would seem to offer many advantages in the teenage patient.

Acute Disease↗
PubMed1992

Anatomy of the splanchnic circulation.

The blood supply to the intestines is a complex one, including branches of the three main splanchnic arteries as well as a vast collateral circulation. The variant anatomy and collateral pathways are described, based on anatomic dissections and angiographic studies, to focus attention on anatomically based explanations for clinical entities.

Humans↗
PubMed1992

Aggressive approach to acute mesenteric ischemia.

An aggressive diagnostic and therapeutic approach to acute mesenteric ischemia can dramatically lower the mortality of this lethal disease. The cornerstones of this approach are the earlier and more liberal use of angiography and the use of intra-arterial infusions of vasodilators in the treatment of both nonocclusive and occlusive mesenteric ischemia.

Algorithms↗
PubMed1992

Mesenteric venous thrombosis.

Mesenteric venous occlusion produces a spectrum of clinical presentations, the most common of which is the acute onset of abdominal pain with progressive signs and symptoms of bowel infarction. This acute form of mesenteric venous thrombosis, compared with other forms of acute mesenteric infarction, occurs in younger patients, typically has a more indolent and nonspecific course, involves shorter segments of bowel, and has a lower mortality rate. In contradistinction to our recommended therapy in other forms of acute mesenteric infarction, immediate anticoagulation is indicated for mesenteric venous thrombosis. Second-look operations are used, as in other forms of acute mesenteric infarction, whenever portions of bowel of questionable viability are not resected at the primary operation. Chronic mesenteric venous thrombosis may produce no symptoms or may cause gastrointestinal bleeding from portal hypertension. Newer imaging techniques have increased the ability to diagnose and define the extent of all forms of mesenteric venous thrombosis and have added to the therapeutic options available to manage them.

Animals↗
PubMed1992

Colonic ischemia.

Our understanding of ischemia and the importance of this disease in the elderly have increased dramatically over the past 30 years. Moreover, the number of patients found to have colonic ischemia can be expected to increase over the next several decades as that portion of our population older than 65 years grows and the many forms of ischemic injury to the colon are better appreciated. Earlier diagnosis should follow the wider use of colonoscopy, and recognition of the ischemic nature of the varied disease manifestations and identification of patients at high risk for this disease should result in better management.

Aged↗
PubMed1992

Acute mesenteric ischemia: an aggressive diagnostic and therapeutic approach. 1991 Roussel Lecture.

The incidence of acute mesenteric ischemia (AMI) has increased substantially over the last few decades. Death rates of 70% to 90% have been reported for traditional methods of diagnosis and therapy. Use of an aggressive radiologic, pharmacologic and surgical approach has decreased the mortality and morbidity associated with AMI. The cornerstones of management are prompt diagnosis by the earlier and more liberal use of angiography and the incorporation of intra-arterial papaverine in the treatment of both occlusive and nonocclusive AMI. Widespread adoption of this protocol in patients at risk might improve the overall results of treatment of AMI.

Acute Disease↗
PubMed1991

Colonic ischemia complicating immunotherapy with interleukin-2 and interferon-alpha.

Colonic ischemia (CI) is a rare complication of high-dose interleukin-2 (IL-2) immunotherapy. This complication occurred in three of 141 patients (2.1%) with metastatic cancer treated with high-dose IL-2 therapy; CI only developed in patients receiving interferon-alpha (IFN) with IL-2 (three of 21, 14%) compared with none of 120 in those patients receiving IL-2 alone (P equals 0.0009). Severe diarrhea (greater than or equal to 7 bowel movements/day) also was significantly more common in patients receiving IFN with IL-2 (six of 21, 29%) than in those receiving IL-2 alone (three of 120, 2.5%, P equals 0.001) and preceded the clinical diagnosis of CI in all three patients. Three of nine patients with severe diarrhea had CI. Hematochezia occurred in four patients, all of whom received IFN with IL-2; three had CI, and the other patient had nonspecific colitis. Differences in vasopressor use did not explain the increased risk of CI in patients receiving IFN; those receiving IFN with IL-2 required phenylephrine less often than patients receiving IL-2 alone (P equals 0.01). The administration of lymphokine-activated killer (LAK) cells had no significant effect on the incidence of CI, severe diarrhea, peritonitis, or vasopressor use; two of three patients with CI, however, had their ischemic episode within 24 hours after the last of three LAK cell infusions. In conclusion, CI is an unusual complication of high-dose IL-2 and IFN immunotherapy. In patients receiving such combination therapy, severe diarrhea is a risk factor for the subsequent occurrence of CI.

Carcinoma, Renal Cell↗
PubMed1991

The irreducible ovary: a true emergency.

The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls. Fifteen girls (4%) had irreducible ovaries present at the time of operation and in 4 of the 15 (27%) the ovary was twisted and infarcted. Two of the 4 girls were known to have an irreducible ovary prior to the day of operation--1 was noted 2 months earlier and 1 was noted 1 month earlier. At the time of the initial diagnosis, neither patient had physical findings of vascular compromise of the ovary. In the other two girls, evidence of an infarcted ovary was present when the hernia was first diagnosed and an emergency operation was performed. A 27% incidence of torsion and strangulation of irreducible ovaries appears to be high, but reports of strangulated ovaries have been reported in 2% to 33% of other series. The normal anatomy is altered when an ovary is trapped in a hernia sac, and these changes make torsion more likely. Although an irreducible ovary is not at great risk of compression of its blood supply, this report identifies a significant risk of torsion. This risk warrants treating the asymptomatic irreducible ovary as any other incarcerated hernia--as a true emergency.

Emergencies↗
PubMed1991

A new provocative test for chronic mesenteric ischemia.

A new provocative test for chronic mesenteric ischemia is described, based upon the demonstration of a fall in the intramural pH of the small bowel after introduction of a test meal into the stomach. Intramural pH (pHI) is determined indirectly by tonometry, utilizing a tonometer passed per os. Postoperative assessment of revascularization procedures is also possible by the same technique. Application of the test in an 84-yr-old woman showed good correlation between a preoperative fall in jejunal intramural pH and abdominal pain, and the absence of a fall postoperatively after successful revascularization.

Aged↗
PubMed1990

Ischemic diseases of the bowel.

The ischemic bowel diseases are a heterogeneous group of disorders usually seen in elderly individuals. They represent ischemic damage to different portions of the bowel and therefore produce a variety of clinical syndromes and outcomes. Proper diagnosis and management of patients with ischemic bowel disease require vigilance on the part of the physician and a willingness to embark on an aggressive plan of diagnosis and management in the appropriate setting.

Age Factors↗
PubMed1989

Idiopathic intestinal perforations in the newborn: an increasingly common entity.

Between 1982 and 1987 seven neonates ranging in age from 24 hours to 1 week were treated for idiopathic intestinal perforations at the Montefiore Medical Center, Albert Einstein College of Medicine. Four of the infants were born prematurely; three were full term. Five were being treated in an intensive care nursery when the perforation was diagnosed. All infants whose perforations were due to necrotizing enterocolitis, appendicitis, Hirschsprung's disease, meconium ileus, intestinal atresias, or drug therapy are excluded from the series. None of the infants had associated anomalies. The sites of the perforations were as follows: two in the jejunum, two in the ileum, one in the cecum, and two in the transverse colon. Six of the perforations were on the antimesenteric aspect of the bowel; one was on the mesenteric aspect. The sizes of the perforations ranged from pinhole to 1 cm in diameter. All the infants did well. Pathologic examination of the resected specimens failed to reveal an etiology for the perforations. There were no cases of duplication or muscular hypoplasia. We believe the etiology of this condition may be ischemic necrosis, secondary to a localized vascular accident in the wall of the affected viscus, but we do not have a good explanation for the upsurge in cases we are seeing.

Colonic Diseases↗
PubMed1987

Hemodynamic basis of the pain of chronic mesenteric ischemia.

Tonometry, a new technique to indirectly assess intestinal blood flow, was used to determine the hemodynamic changes produced by a simulated meal in animals with a fixed, decreased splanchnic blood flow. In experiments on 14 dogs, celiac artery and superior mesenteric artery blood flow was maintained at 50 percent of normal flow by occluders and flow probes, and tonometers were placed in the stomach and small bowel to measure intramural pH, a metabolic marker of intestinal perfusion. Intramural pH was determined at 100 percent and 50 percent splanchnic blood flow, at 50 percent flow after instillation of cream into the stomach, and again when cream was placed into the small bowel. Intestinal intramural pH decreased significantly when blood flow was decreased to 50 percent, as expected, but decreased significantly again when cream was placed in the stomach. The hemodynamic explanation of the decrease when cream was placed in the stomach is a steal from the intestinal to the gastric circulation stimulated by food in the stomach. Such a steal could explain the temporal nature of the pain experienced by patients with chronic mesenteric ischemia.

Animals↗
PubMed1986

Sigmoid volvulus in elderly patients.

We reviewed the records of 51 patients over 65 years of age admitted for an initial episode of sigmoid volvulus, and adequate information about their subsequent course was obtained in 92 percent. Nonoperative reduction of the initial volvulus was attempted in 43 patients and was successful in 39 (91 percent). Eleven patients required emergency operations, with a mortality rate of 36 percent. Six patients had elective resections with no deaths. Thirty-three patients, 32 after nonoperative reduction of a volvulus and 1 after operative reduction, were discharged without definitive treatment. Twenty-three of the 33 patients (70 percent) managed by expectant observation had one or more episodes of recurrent volvulus. Five of the 23 patients died from the recurrence without operation, and 16 were operated on either emergently (3 patients) or electively (13 patients) after nonoperative reduction. The mortality rate related to recurrent volvulus or its treatment in the 33 patients observed was 21 percent. The mortality rate for 18 elective resections (6 for initial volvulus and 12 for recurrent volvulus) was 5.6 percent. After successful nonoperative reduction of a sigmoid volvulus in elderly patients, maximal survival is achieved by early elective resection. Age alone is not an adequate reason for adopting a nonoperative approach.

Aged↗