Biomedical subjects

Stephen H Leveson

Publications and source records attributed to Stephen H Leveson.

7 recordsLinked to original sources

PubMed2006

Laparoscopy-associated portal vein thrombosis: description of an evolving clinical syndrome.

Several cases of portal vein thrombosis following laparoscopic procedures have been reported over the past few years. To date, no formal description of this phenomenon has been provided. In this paper, we summarize and analyze the features of the 4 reported cases to date as well as a fifth case encountered at our institution. The probable causes of this complication include changes in coagulation status, splanchnic hemodynamics, and portal venous blood flow, all of which may be related to carbon dioxide absorption and increased intra-abdominal pressure. The recognition of this phenomenon and its management are discussed. A review of the relevant literature is provided.

Adult↗

PubMed2006

Nicorandil-associated para-stomal ulceration: Case series.

Nicorandil is a vasodilator used to control severe angina. It has been associated with oral and anal ulceration that resolves upon withdrawal of the drug. We report a series of four patients, all of whom were receiving nicorandil therapy and developed nonspecific para-stomal ulcerations of similar clinical and histological appearance. All ulcers healed on withdrawal of nicorandil with no relapse. To the best of our knowledge, nicorandil-associated para-stomal ulcers have not been reported before. It is imperative to be aware of this association to prevent the persistence of these extremely painful ulcerations, and to avoid unnecessary and inappropriate interventions with substantial morbidity in a group of high-risk patients.

Aged, 80 and over↗

PubMed2005

Fibrin glue in the treatment of pilonidal sinus: results of a pilot study.

INTRODUCTION: Pilonidal sinus is a common condition of uncertain etiology. There is no agreed best surgical treatment. Treatment of fistula-in-ano has been described with some success with fibrin tissue glue. The use of fibrin glue is investigated in this pilot study. METHODS: Six patients with chronic pilonidal sinus were treated with injection of fibrin tissue glue after curettage of the pits. RESULTS: There were no complications. Postoperative discomfort was minimal and early return to normal activities was possible. There was no recurrence of disease in five of six patients at one year. CONCLUSIONS: Fibrin tissue glue may be a possible novel treatment for pilonidal disease.

Adult↗

PubMed2005

Implications of pouchitis on the functional results following stapled restorative proctocolectomy.

PURPOSE: Pouchitis is the most frequent long-term complication of restorative proctocolectomy; its long-term consequences are inadequately described. This prospective study evaluates the effect of pouchitis on the functional results, general health perception, and patient satisfaction. METHODS: A total of 100 consecutive patients who underwent stapled restorative proctocolectomy for ulcerative colitis were divided into three groups: no pouchitis, acute pouch-itis and chronic pouchitis. Functional results, general health perception, and satisfaction of each group at the latest review were compared only when patients were not symptomatic of active pouchitis. RESULTS: Pouchitis occurred in 33 patients (17 acute and 16 chronic). There were no significant differences in the long-term functional results between the no pouchitis and acute pouchitis groups. Patients who experienced chronic pouchitis had a significant increase in bowel movements, looseness of stools, urgency, nocturnal seepage, perianal excoriation, and dietary restrictions (P < 0.05). They also had a worse perception of their general health (P < 0.05). Previous chronic pouchitis had no effect on continence, daytime soilage, or gas-feces discrimination. Most patients were satisfied, despite pouchitis, and would recommend the operation to someone else with ulcerative colitis. CONCLUSIONS: Acute pouchitis is easily treated and results in minimal functional consequences. Even in the absence of clinically active pouchitis, patients who had suffered from chronic pouchitis had poorer functional results and general health perception. This may overshadow the benefits of restorative proctocolectomy. This finding suggests that acute and chronic pouchitis are distinct disease entities and chronic pouchitis may represent a persistent condition that displays episodic symptomatic exacerbation.

Acute Disease↗

PubMed2005

Ileitis in ulcerative colitis: is it a backwash?

PURPOSE: This study aims to determine the incidence, demography, pathologic nature, and clinical significance of ileitis in ulcerative colitis patients who underwent restorative proctocolectomy. METHODS: A prospectively collected pouch database and the case notes of 100 consecutive patients who underwent restorative proctocolectomy for ulcerative colitis, under the care of a single surgeon, between 1988 and 2003 were reviewed. The original proctocolectomy specimens and pouch biopsies were reexamined and regraded blind, using the current diagnostic criteria. Patients were divided into two groups, those who had ileitis and those who had not. The demographic, clinical, and pathologic characteristics and the incidence of pouchitis of both groups were compared. RESULTS: Twenty-two patients had ileitis (22 percent). Compared with those with noninflamed ileum, patients with ileitis had a significantly shorter disease duration (P < 0.005), many of them presented or progressed to a fulminant state requiring acute surgical intervention (P < 0.01), had strong association with pancolitis and primary sclerosing cholangitis (P < 0.001), and had a higher incidence of subsequent development of pouchitis (P < 0.001). There was no correlation between the presence of ileitis and colitis severity. CONCLUSIONS: Ileitis in ulcerative colitis is not rare and does influence the prognosis, and the term "backw ash" is a misnomer. Ulcerative colitis with ileitis represents a distinct disease-specific subset of patients. Its true incidence and clinical significance can be determined only if detailed microscopic characterization of the terminal ileum is performed routinely in every patient with ulcerative colitis and the clinical outcome of these patients is audited prospectively.

Adolescent↗

PubMed2005

Spontaneous regression of peritoneal carcinomatosis from a rectal cancer.

Spontaneous regression of adult solid tumours is rare. Here, we present the case of a 51-year-old man who underwent a curative resection for an adenocarcinoma of the rectum in 1989. He remained well until 12 months after surgery when he developed a large-fixed mass proximal to the anastomosis, which was treated with radiotherapy but did not respond. Shortly after, he presented with intestinal obstruction caused by extensive intraperitoneal metastases. At laparotomy, a palliative entero-enterostomy and ileostomy were performed. Biopsies from the peritoneal lesions showed features typical of metastatic adenocarcinoma. The patient did not receive any additional therapy. However, his condition continued to improve; he remains disease free and well at present (May 2005). A review of the literature revealed two cases of spontaneous regression of peritoneal carcinomatosis secondary to a rectal cancer; we report the third case and discuss some of the reasons potentially responsible for the regression.

Adenocarcinoma↗

PubMed2004

Pouchitis-associated pyoderma gangrenosum following restorative proctocolectomy for ulcerative colitis.

A 43-year-old female with ulcerative colitis treated by proctocolectomy and ileal pouch--anal anastomosis developed acute pouchitis. Although no extra-intestinal manifestations were present before the surgical procedure, pyoderma gangrenosum developed concomitantly with the appearance of acute pouchitis. Both conditions completely resolved with oral metronidazole only. This is the first report of acute pouchitis-related pyoderma gangrenosum. This association suggests that pouchitis may represent a recurrent ulcerative colitis-like syndrome within the novel environment of the pouch.

Acute Disease↗