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Biomedical subjects

T T Nostrant

Publications and source records attributed to T T Nostrant.

70 records · Page 4Linked to original sources
PubMed1984

Clinical manifestations of hereditary hemorrhagic telangiectasia.

Sixty-four patients with symptomatic hereditary hemorrhagic telangiectasia were retrospectively studied in order to determine the true incidence of clinical manifestations in this disease. This select group had a significantly higher incidence of gastrointestinal hemorrhage and pulmonary arteriovenous fistula formation than has been previously reported. Data are presented regarding the course and severity of nasal and gastrointestinal hemorrhage, the use of endoscopy for diagnosis, the incidence of associated neurological, cardiac, and hepatic disease, and mortality.

Adolescent↗
PubMed1984

Intraoperative fiberoptic endoscopy.

Conventional endoscopy is an indispensable tool in the diagnosis and management of many patients with gastrointestinal disease. Intraoperative use of the fiberoptic endoscope permits direct visualization of the mucosal surface, eliminating the need for enterotomy in many cases. Over a 4.5-year period, 32 patients underwent gastrointestinal endoscopy during laparotomy for a wide variety of surgical problems. In 15 cases, obscure or unknown sites of upper and lower gastrointestinal bleeding were localized. Replacement of percutaneously placed biliary drainage tubes was facilitated in four cases. In three patients artifactual lesions suggested by gastrointestinal (GI) contrast studies were excluded with intraoperative endoscopy at the time of exploratory laparotomy, and in four cases, retained foreign bodies were recovered easily without the need for enterotomy. In six additional patients intraoperative endoscopy was used to localize nonpalpable colon polyps or to determine the extent of mucosal ulceration. The average time for an intraoperative fiberoptic endoscopic examination was 20 minutes. No complications resulted from this technique. In summary, intraoperative fiberoptic endoscopy is of definite value in assessing selected patients with difficult GI surgical problems encountered during laparotomy. This technique enhances the surgeon's ability to identify and treat inaccessible and occult GI lesions.

Adult↗
PubMed1983

How good is screening for colorectal cancer?

Colorectal cancer is potentially preventable. Use of fecal occult blood testing, flexible sigmoidoscopy, and a combination of air-contrast barium enema examination and colonoscopy has proved to be a safe, relatively inexpensive approach to detecting colon cancer in its early stages, decreasing morbidity and increasing survival. Future work in secondary prevention of colon cancer should be aimed at standardized trials of fecal occult blood agents, thus optimizing the yield of localized lesions and decreasing the cost so that mass screening becomes possible. Major efforts should be aimed at educating physicians and the public alike. Primary prevention will deserve greater emphasis when specific risk factors pathogenetic of colon cancer are discovered.

Adenocarcinoma↗
PubMed1983

Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation.

Cecal perforation has been well established as a consequence of mechanical obstruction of the distal colon and has been estimated to occur in 1.5% to 7% of patients with colon obstruction. Perforation of the cecum also occurs in cases of nonobstructive colonic dilatation (NCD). Although the incidence is unknown, the mortality rate is nearly 50%. Over an eight-year period, 44 patients (mean age 59 years) underwent 52 colonoscopic examinations for presumed NCD. Twelve patients (27%) developed NCD while convalescing from a recent operation and 29 patients (66%) had major systemic disorders that preceded the development of NCD. Medical treatment for an average of 2.6 days was uniformly unsuccessful. Mean cecal diameter prior to colonoscopy was 12.8 cm (range 9.5 to 17 cm). Based on radiographic or clinical criteria, 38 patients (86%) were successfully decompressed on the initial colonoscopic examination; mean cecal diameter decreased to 8.7 cm (p less than 0.01). Perforation of the cecum during colonsocopy occurred in one patient (2%) who survived. Fourteen patients died; six deaths were attributed solely to the patient's who underwent operation. In summary, colonoscopy is a safe and effective therapeutic and diagnostic tool in cases of massive cecal dilatation. It should be considered before cecostomy in patients without radiographic evidence of pneumoperitoneum or clinical signs of peritoneal irritation.

Adult↗
PubMed1983

Treatment alternatives in renal failure and renal transplantation patients with nonobstructive colonic dilatation.

The incidence of nonobstructive colonic dilatation (NCD) is unknown, but the attendant mortality associated with perforation is nearly 50%. Patients with chronic renal failure and transplant recipients may manifest many of the conditions that have been implicated in the development of NCD. Mechanical obstruction and ischemic bowel disease must be eliminated as causes for colon dilatation. Over a four-year period eight patients (mean age 50 years) were treated for presumed NCD. Six patients with a mean cecal diameter of 12.8 cm were treated initially with colonoscopy. Five patients (83%) had successful endoscopic decompression; of the three remaining patients, one underwent urgent ileocolectomy for cecal ischemia after unsuccessful endoscopic decompression, a second (cecal diameter 13 cm) had a tube cecostomy performed as an initial procedure, and the third (cecal diameter 9 cm) was managed successfully with enemas and nasogastric suction. Two deaths occurred in the series (25%), but both were unrelated to colon distension. No complications of colonoscopy were observed. The sequelae of massive NCD (cecal ischemia, perforation, and protracted sepsis) are poorly tolerated in the immunocompromised patient. Conservative management may be employed in patients with a cecal diameter of 9 cm, but urgent diagnostic and therapeutic colonoscopy is recommended for patients with a cecal diameter of 12 cm or greater. Operative tube cecostomy may be necessary if colonoscopic decompression is unsuccessful or cannot be performed.

Adult↗
PubMed1983

Lethal pancreatitis.

Thirty-two patients died of pancreatitis and its complications over a 10-year period. Infection (bacteremia, fungemia, or pancreatic abscess) was the major cause of death in 80%. In the remaining 20%, refractory hypotension or respiratory failure were the lethal mechanisms. In only 78% of patients was the correct diagnosis made before death. Ninety-four percent of those who died did so during their first clinical episode of pancreatitis. Prophylactic antibiotics did not prevent the development of pancreatic abscesses and organisms resistant to the antibiotics used often became the primary pathogens. Certain prognostic factors reliably separated those who died from those who lived. Peritoneal lavage and dialysis may be helpful in both the early diagnosis and therapy of severe acute pancreatitis.

Abscess↗
PubMed1982

The histopathologic spectrum of acute self-limited colitis (acute infectious-type colitis).

Acute self-limited colitis (ASLC) is a self-limiting diarrheal illness which is often caused by known infectious agents (Campylobacter, Salmonella, and Shigella), but many cases are of unknown etiology. This report describes the histopathologic features of acute self-limited colitis as related to its natural history. The extent of inflammation and regeneration varies with the duration of the disease. In the peak activity stage (within 0-4 days of onset of bloody diarrhea) there is mucosal edema, cryptitis, crypt ulcers, and abscesses. At the time of resolution (within 6-9 days of onset of bloody diarrhea), regenerative features become apparent along with residual focal neutrophilic cryptitis. In the latter stages of resolution, along with some regenerative features, occasional crypts with transmigrating lymphocytes may be present. A rectal biopsy is diagnostic only in the early stages of the disease. Later in the course, the rectal biopsy from patients with ASLC may be nondiagnostic or may be confused with Crohn's disease due to the persistence of focal cryptitis. In our experience, the presence of crypt distortion and basal plasmacytosis are the two most useful criteria to differentiate chronic ulcerative colitis from ASLC.

Acute Disease↗
PubMed1981

Viral hepatitis.

Explore the source record for details and available documents.

Carrier State↗
PubMed1978

Acinar distribution of liver cell regeneration after selective zonal injury in the rat.

Liver cell regeneration after selective zonal injury induced by bromobenzene (acinar zone III damage) and allyl alcohol (acinar zone I damage) was examined in the context of the simple liver acinus. The zonal distribution of necrosis and inflammation was assessed by light microscopy and the volume fraction of necrosis was quantitated at the times of maximal damage. The acinar distribution of hepatocytic [6-3H]thymidine incorporation was determined autoradiographically at 24, 36, 48, 60, 72, and 96 hr after the administration of the toxicants. The mitotic index for each acinar zone was calculated at the time of peak thymidine incorporation after each drug and then at 12-hr intervals for the next 24 hr. Autoradiographic data indicated that the relative contributions of acinar zones II and III to [6-3H]thymidine incorporation were greater after zone III damage (bromobenze), whereas the relative contribution of acinar zone I was greater after allyl alcohol (zone I) damage. This was observed despite the greater degree of damage seem after bromobenzene than after allyl alcohol (volume fractions of necrosis were 26.4 and 10.1%, respectively). Moreover, the acinar distribution of mitosis indicated an increased centrizonal mitosis after centrizonal damage, and an increased periportal mitosis after periportal damage. Thus, the contribution of each acinar zone to liver cell regeneration depends on the acinar location of damage.

Allyl Compounds↗
PubMedDate not supplied

Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia.

The purpose of this study was to evaluate accuracy of dynamic gadolinium-enhanced MR angiography (MRA) of the celiac, superior, and inferior mesenteric arteries in patients with suspected mesenteric ischemia compared with catheter angiography or surgery. Sixty-five patients with suspected mesenteric ischemia underwent three-dimensional spoiled gradient-recalled acquisition in the steady state (GRASS) gadolinium-enhanced MRA. Correlative studies were performed on 14 patients, catheter angiography alone was performed on 12 patients, and surgery alone was performed on two patients. Six patients had mesenteric ischemia. In all patients, the celiac artery (CA) and superior mesenteric artery (SMA) were seen well enough to evaluate; however, the inferior mesenteric artery (IMA) could be evaluated in only 9 of the 14 patients. MRA showed severe stenosis (> 75%) or occlusion of the celiac axis in seven patients, of the SMA in six patients, and of the IMA in four patients. The overall sensitivity and specificity were 100% and 95%, respectively, compared with catheter angiography and surgery. The two errors were caused by overgrading the severity of IMA disease. Three-dimensional gadolinium-enhanced MRA can accurately demonstrate the origins of the CA and SMA and is useful in evaluation of patients with suspected mesenteric ischemia.

Adult↗
PubMedDate not supplied

Witzel pneumatic dilation for achalasia: safety and long-term efficacy.

Forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia. The Witzel pneumatic balloon dilator, unlike fluoroscopically placed dilators, is placed over a standard gastroscope allowing positioning and dilation under direct vision. We report our experience with the Witzel dilator in 45 patients with achalasia over a 5-year period. All patients had at least one major symptom score of 8 out of 10 for dysphagia and/or regurgitation before dilation. After Witzel dilation, symptomatic response was graded as excellent (score 0 to 2), good (score 3 to 5), fair (score 6 to 8), and poor (no improvement). Symptom response was assessed after 1 week, 1 month, 6 month, 1 year, and present. The mean period of follow-up was 25 months (range, 3 to 85 months). Passage of the balloon across the gastroesophageal junction was technically unsuccessful in three patients. Esophageal perforation occurred in two patients (4%) and transient chest pain greater than 2 days in three patients (7%). There was no bleeding or death. Symptomatic long-term improvement was excellent in 25 patients (63%), good in 6 patients (15%), fair in 4 patients (10%), and poor in 5 patients (12%). A repeat Witzel dilation was performed in five patients but resulted in good/excellent improvement in only one patient. We conclude that pneumatic dilation with the Witzel balloon is a safe, effective procedure for achalasia.

Adolescent↗
PubMedDate not supplied

Utility of a linear array ultrasound endoscope in the evaluation of suspected pancreatic disease.

Endoscopic ultrasonography (EUS) is currently being used to evaluate and stage pancreaticobiliary malignancies and neuroendocrine tumors, and to perform aspiration for cytologic diagnosis. There are currently two different commercially available EUS systems for clinical use. One system uses a mechanical radial sector scanner oriented in a plane perpendicular to the long axis of the endoscope, and the other uses an electronic convex scanner that is oriented in the long axis of the endoscope. The vast majority of the current literature reports experience using the radial scanning device in the evaluation of pancreaticobiliary abnormalities. We prospectively evaluated the linear probe as the sole instrument for EUS in 26 patients with suspected pancreatic disease. The results of the endoscopic ultrasound examination were compared with the results of surgery or long-term clinical follow-up. The sensitivity and specificity of linear array EUS for benign pancreatic disease were 93.8% and 88.2%, respectively. The sensitivity and specificity for malignant disease of the pancreas were 80.0% and 88.9%, respectively. The linear array echoendoscope, employed as the only instrument for evaluation of the pancreas, is accurate in the evaluation of pancreatic disease. The addition of EUS-guided pancreatic biopsy would be anticipated to improve the sensitivity of the linear array instrument for detecting malignancy.

Endoscopes↗
PubMedDate not supplied

Esophageal dilatation.

Esophageal dilatation as a treatment option in patients with both benign and malignant esophageal strictures is described. Types of dilators available, techniques of passage, complications, redilation rates, and comparative studies between dilating systems are reviewed. The use of proton pump inhibitors to reduce the rates of redilation is discussed in view of the natural history of benign esophageal strictures. Comparisons among blind passage, fluoroscopic guidance and endoscopically directed dilatation are made and discussed in relation to cost effectiveness. Brief mention of new dilating systems including wall stents and wall-tension-sensing systems are made. Achalasia treatment with pneumatic dilatation is described in detail and compared to medication and surgical myotomy options. New treatments, including botulinum toxin injection into the lower esophageal sphincter, are briefly mentioned.

Catheterization↗
PubMedDate not supplied

Esophageal reflux and dysmotility as the basis for persistent cervical symptoms.

To examine a possible esophageal basis for cervical symptoms, we studied 63 patients with persistent cervical complaints, 36 patients with gastroesophageal reflux but no cervical symptoms, and ten normal subjects. Patients were evaluated for a history of pyrosis and regurgitation and underwent otolaryngologic examination, barium esophagram, upper endoscopy, esophageal biopsy, standard esophageal manometrics, acid reflux testing, and Bernstein examination, as well as tests of esophageal dysmotility and acid clearance time before and after bethanechol (50 micrograms/kg, two doses). Standard diagnostic examinations usually were normal in patients with cervical symptoms. Pyrosis, regurgitation, and a positive Bernstein examination were uncommon in patients with cervical symptoms. This occurred despite frequent acid reflux (68%) and poor acid clearance (79%). Esophageal dysmotility also was common (63%). Patients with reflux but no cervical symptoms and normal subjects had a normal acid clearance time, and dysmotility was unusual (8%). We conclude that patients with cervical symptoms have diminished esophageal sensitivity despite frequent and long acid exposure. The pathophysiologic significance of this observation is discussed.

Esophagus↗