PubMed Health⌕ Search

Biomedical subjects

W A Koltun

Publications and source records attributed to W A Koltun.

10 recordsLinked to original sources
PubMed1991

Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis.

This study retrospectively evaluated 288 patients who had undergone ileal pouch-anal anastomosis to determine the incidence of perineal complications and to relate these findings to the pathologic diagnosis, with the goal of specifically clarifying the appropriate surgical management of patients with indeterminate colitis. Of these 288 patients, 235 patients (82 percent) had a diagnosis of chronic ulcerative colitis, 18 patients (6 percent) had indeterminate colitis, 6 patients (2 percent) had Crohn's disease, and 29 patients (10 percent) had familial polyposis. All complications occurred at least 6 months after closure of the stoma and required operative therapy. Of 18 patients with indeterminate colitis, 9 patients experienced complications (50 percent) vs. 8 of 235 patients with chronic ulcerative colitis (3 percent), a highly significant difference (P less 0.001). Furthermore, the risk of eventual ileostomy because of perineal complications was 0.4 percent in patients with chronic ulcerative colitis vs. 28 percent in patients with indeterminate colitis (P less than 0.001). We conclude that a diagnosis of indeterminate colitis predisposes the patient undergoing ileal pouch-anal anastomosis to perineal complications, with a resultant high chance of reservoir loss. Ileal pouch-anal anastomosis should be considered with caution in the patient with a diagnosis of indeterminate colitis.

Abscess↗
PubMed1991

Incarceration of colonoscope in an inguinal hernia. "Pulley" technique of removal.

Because of its relative safety, colonoscopy has become an accepted diagnostic and therapeutic procedure in the evaluation of patients with colorectal disorders. Many unusual complications of colonoscopy have been described, but only anecdotal reports of hernial incarceration have been published. We present a case of a right-sided hernial incarceration of the colonoscope that would not permit reduction of the hernia nor removal of the instrument by conventional means. The mechanism of incarceration, which dictates the size of hernia at risk for incarceration, is explained. The "pulley" technique, which was used to remove the instrument without surgical intervention, is described.

Aged↗
PubMed1991

Gastric duplication cyst. Endoscopic presentation as an ulcerated antral mass.

A case of a 53-year-old man who presented with epigastric pain and weight loss is described. Endoscopy showed a smooth antral mass with what appeared to be a central overlying ulcer. Computerized tomography and upper gastrointestinal series confirmed the presence of a gastric mass. Laparotomy and local resection showed a gastric duplication comprised of two cysts, one with communication to the stomach lumen. Gastric duplication is a rare entity, especially in the adult. Though generally benign, local ulceration or fistula formation can cause symptoms and may suggest a more malignant process that warrants investigation.

Cysts↗
PubMed1987

Thrombolysis in the treatment of peripheral arterial vascular occlusions.

The efficacy of thrombolytic agents in the management of peripheral arterial disease remains unclear. We reviewed our experience with 64 consecutive episodes of limb-threatening graft or native vessel occlusions. The overall success rate was 59%, with a major complication/mortality rate of 28%. Thrombolytic therapy in patients with occluded vascular grafts required identification of a causative lesion and subsequent adjunctive management with percutaneous transluminal angioplasty or surgery for sustained patency (64%). In contrast, approximately 70% of native vessel occlusions maintained patency whether a causative lesion was identified and corrected or not. Patients who failed thrombolytic therapy had a worse prognosis overall, with 38% undergoing primary amputation, although patients with reconstructable occlusions still had a 64% salvage rate at six months. The review demonstrated that thrombolytic therapy continues to be a useful adjunct in treating the patient with peripheral vascular occlusion, although a significant risk of major complications persists. Patients with graft occlusions successfully treated with thrombolysis require correction of any precipitating lesions for long-term limb salvage, while careful management of patients failing thrombolysis can still achieve significant limb salvage in selected cases.

Aged↗
PubMed1987

Metabolic aspects of small bowel transplantation in inbred rats.

An inbred rat model of small bowel transplantation was used to study the metabolic consequences of systemic venous drainage of the graft. Lewis rats received either Lewis (isograft) or Lewis X Brown Norway F1 (allograft) small bowel grafts. Venous drainage of the isografts was to either the portal vein or the inferior vena cava. Allograft recipients underwent systemic venous drainage and were treated with a 4-week course of tapering cyclosporine. Ammonia levels in systemically drained isografts (108 +/- 5 microM/100 ml) were more than twice those in portally drained isografts (38 +/- 3, P less than 0.001), while amino acid analysis showed significant elevations in glycine, serine, asparagine, histidine, phenylalanine, and tyrosine. Ammonia levels decreased and amino acid alterations were generally corrected when animals were fed a modified protein diet low in aromatic and high in branched chain amino acids. Recipients of both systemically and portally drained isografts grew normally, while weight gain in allograft recipients was impaired. We conclude that systemic venous drainage of small bowel grafts results in altered ammonia and amino acid levels that resemble those found in models of hepatic encephalopathy; these changes can be significantly ameliorated by dietary modification; and the compromised growth seen in systemically drained allografted animals results from chronic rejection and/or cyclosporine rather than the partial porto-systemic shunt.

Amino Acids↗
PubMed1985

The effect of anti-interleukin-2 receptor monoclonal antibody on allograft rejection.

During immune response to an allograft, activated T cells express a number of cell surface activation antigens, among them the membrane receptor for the lymphokine interleukin 2 (IL-2). As the IL-2 receptor is not present on resting T cells, it offers an attractive target for potentially specific immunosuppressive therapy. The rat monoclonal antibody M7/20, which binds to the murine IL-2 receptor, was studied for its effect on allograft survival in two H-2-incompatible strain combinations in inbred mice. Treatment with M7/20 for 10 days markedly prolonged survival of vascularized, heterotopic heart allografts in both strain combinations, with indefinite graft survival in 50% of recipients. The same treatment significantly prolonged skin allograft survival in one of the two combinations. The results support the important role of the IL-2 receptor in the mechanism of graft rejection and confirm its suitability as a target for immunosuppressive therapy in transplantation.

Animals↗
PubMed1977

Decrease in neostriatal blood flow after D-amphetamine administration or electrical stimulation of the substantia nigra.

Local blood flow was measured in the caudate nuclei and, in some cases, other areas of rat and monkey brain by the hydrogen clearance technique. Resting values for caudate blood flow in the rat were similar to those reported elsewhere, i.e., 69 +/- 4 ml/min/100 g in the caudate. Administering D-amphetamine sulfate (0.5 mg/kg, i.p.) to rats reduced caudate flow by a maximum of about 33% after 30 min; this effect could be blocked by pretreatment with haloperidol (5.0 mg/kg, i.p.), a drug that blocks dopamine receptors. D-Amphetamine sulfate (1.5 mg/kg) also reduced caudate but not cortical blood flow in unanesthetized monkeys. Electrical stimulation of the pars compacta of the substantia nigra reduced ipsilateral caudate flow by about 25% without affecting flow in the contralateral caudate. This effect varied with the frequency and intensity of stimulation. These studies suggest that the intraparenchymal release of brain dopamine may modify intraparenchymal (local) blood flow.

Animals↗