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Biomedical subjects

A E Kark

Publications and source records attributed to A E Kark.

At least 73 records · Page 4Linked to original sources
PubMed1977

Studies on a case of suppurative thyroiditis.

A patient with suppurative thyroiditis due to infection with Escherichia coli is described. Serial studies of thyroid function were performed. Before the abscess was drained there was no uptake of radio-iodine by the thyroid and there was some spillage of iodinated compounds from the gland. Post-operatively circulating thyroid hormone concentrations declined but were restored at four weeks. Thyroid uptake of radio-iodine was re-established two weeks after operation but there was little secretion of thyroxine at this time. Four weeks after operation the uptake of radio-iodine was greater than normal and thyroxine was being secreted. These changes in thyroid function were not associated with any significant rise in the plasma thyrotrophin concentration.

Aged↗
PubMed1975

Crohn's disease of the colon. II. Controversial aspects of hemorrhage, anemia and rectal involvement in granulomatous disease involving the colon.

In 160 cases with granulomatous colitis or ileocolitis, blood was found in the stool in 72 or 45%. Massive bleeding occurred in four patients (25%); overt bleeding in 51 (32%) and occult bleeding, repeated guaiac positive stools, in 17 (11%). Thus, clinically obvious bleeding occurred in about one patient in three. Of the four patients with massive hemorrhage one required subtotal colectomy, one right hemicolectomy and the other two were controlled by medical measures including blood transfusion. In each of the surgical cases, the massive bleeding originated in the region of the cecum. An additional patient, not in the series, required proctectomy as a life-saving measure following subtotal colectomy. Clinically obvious rectal bleeding in Crohn's colitis is approximately ten times as frequent as in regional enteritis but only one-third as frequent as in ulcerative colitis. There was no correlation between rectal bleeding and rectal involvement determined radiologically or by signoidoscopy, in the whole series but there was a strong association in the small group of Crohn's colitis with rectal involvement (86% with bleeding) and a significantly greater proportion of patients with colitis with rectal involvement and hemorrhage (P smaller than 0.02). Anemia is common in both groups but in Crohn's colitis it is almost always, 75%, associated with rectal blood loss, whereas in ileocolitis this association is much less marked, 40%, indicating other important causes of anemia when there is small bowel disease. The bleeding patient with Crohn's colitis should be managed medically initially. Uncontrollable, continuous, or massive hemorrhage may require angiography and early surgical intervention.

Adolescent↗
PubMed1975

Transcervical thymectomy in myasthenia gravis.

Since 1967, transcervical thymectomy has been the procedure of choice for all patients with nonthymomatous myasthenia gravis and a selected group of patients with thymomatous myasthenia gravis operated upon at the Mount Sinai Hospital. A total of 180 transcervical thymectomies have been performed. In 12 patients, a pre-existing tracheostomy was present. Morbidity was minimal, limited to three instances of bleeding, five of pneumothorax, one of self-limited chylothorax, and one wound infection. One postoperative death from an unrelated cause occurred in 1967. The postoperative course has been smoother and the management of the myasthenia gravis considerably easier than those following transthoracic approaches. Consequently, routine elective tracheostomy at the time of thymectomy has been abandoned. The average period of hospitalization does not exceed one week. As a result of the minimal risk involved, indications for thymectomy now include all patients with generalized myasthenia gravis, and the procedure is performed earlier in the course of disease. Postoperative electromyographic findings show immediate improvement in the majority of patients operated upon during the first year in which symptoms occur. Transcervical thymectomy arrests the progress of the disease, decreases the mortality rate, and has long term results equal to those of transthoracic approaches. Earlier remissions, fewer germinal centers, and a smaller number of thymomas were noted in patients operated upon early in the course of the disease. A decrease in neoplasms outside the thymus gland and in neonatal myasthenia gravis was also noted following thymectomy.

Breast Neoplasms↗
PubMed1975

Crohn's disease of the colon. III. Toxic dilatation of the colon in Crohn's colitis.

In a group of 160 patients with Crohn's disease involving the colon, there were seven patients with toxic dilatation, four with granulomatous colitis and three with ileocolitis, all successfully treated without mortality. This complications is more common than previously recognized in Crohn's colitis. In Crohn's disease, toxic dilatation is less likely to proceed to perforation of the bowel, because of the nature of the pathology and is more likely to respond to conservative measures: intubation, with decompression, corticotropin, steroids and high-dose antibiotic administration. Although patients do recover from this life-threatening complication with conservative management, the majority of patients, if not all, will ultimately come to surgical excision of the colon. If surgery is mandatory, it should be carried out early, rather than late, in the patient who is failing to respond to medical therapy, certainly before the development of perforation, massive hemorrhage, or gram negative sepsis with shock. The surgical therapy will depend upon the state of the bowel at laparotomy. Thus, an intact bowel in a young patient, would favor subtotal colectomy or proctocolectomy; a sealed perforation, a diverting ileostomy with skin level colostomy decompression as suggested by Turnbull and a free perforation, the minimum adequate procedure which will tide the patient over the early postoperative period. Diverting ileostomy alone has been effective in two of our patients but should be avoided in ulcerative colitis. The critically ill patient with the ominous finding of "disintegrating colitis" and multiple leaks, will require nothing less than total radical excision of the diseased bowel in the hope of immediate salvage.

Adrenocorticotropic Hormone↗