Search PubMed⌕ Search

Biomedical subjects

A M Zfass

Publications and source records attributed to A M Zfass.

At least 19 recordsLinked to original sources
PubMed1999

Recurrent acute pancreatitis caused by a gastric duplication communicating with an aberrant pancreas.

A 24-year-old female patient who had suffered from recurrent bouts of acute pancreatitis for over 3 years was found on endoscopic retrograde cholangiopancreatography to have an aberrant pancreatic duct that terminated in a cyst. An aberrant lobe of pancreas had been discovered at exploratory laparotomy 3 years previously and was left untreated. Excision of the aberrant lobe of pancreas and accompanying gastric duplication cyst was curative. This case illustrates the importance of obtaining endoscopic retrograde cholangiopancreatography in all young individuals with recurrent pancreatitis to detect this rare, but curable, cause of pancreatitis.

Acute Disease↗
PubMed1998

Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects.

PURPOSE: To determine prospectively the clinical applications and diagnostic accuracy of half-Fourier rapid acquisition with relaxation enhancement (RARE) magnetic resonance (MR) cholangiopancreatography (MRCP) in a large patient population. MATERIALS AND METHODS: Breath-hold, heavily T2-weighted half-Fourier RARE MRCP was performed in 265 patients with suspected pancreaticobiliary disease and in 35 control patients without symptoms or signs referrable to the biliary tract or pancreatic duct. MRCP findings were correlated with those at direct cholangiography, pathologic examination, cross-sectional imaging, and clinical follow-up. RESULTS: Diagnostic MRCP examinations were obtained in 299 (99.7%) subjects. MRCP yielded an accuracy of 100% in determining the presence of pancreaticobiliary disease, the presence and level of biliary obstruction, and obstruction due to bile duct calculi. The accuracy of MRCP and MR imaging in determining the presence and level of malignant obstruction was 98.2%. MRCP obviated endoscopic retrograde cholangiopancreatography (ERCP) by excluding choledocholithiasis in patients with acute pancreatitis (n = 13) and nonspecific abdominal pain (n = 82). In patients with sclerosing cholangitis and acquired immunodeficiency syndrome cholangiopathy, MRCP depicted the biliary tract as clearly as did ERCP (n = 9). After failed ERCP, MRCP delineated the pancreaticobiliary tract and helped determine therapeutic options (n = 27). CONCLUSION: Half-Fourier RARE MRCP enables accurate evaluation of pancreaticobiliary disease and obviates ERCP in some patients.

Adolescent↗
PubMed1998

Magnetic resonance cholangiopancreatography: a new technique for evaluating the biliary tract and pancreatic duct.

Magnetic resonance cholangiopancreatography (MRCP) represents a new development in MR technology that provides a noninvasive accurate means of evaluating the biliary tree and pancreatic duct. Recent technical refinements that allow for imaging of the entire biliary tree and pancreatic duct in 18 seconds make this examination easily performed even in critically ill patients. The clinical applications of MRCP are illustrated in a variety of scenarios that include choledocholithiasis, malignant obstruction, incomplete/failed endoscopic retrograde cholangiopancreatographies (ERCPs), postsurgical alterations of the biliary tract and gastrointestinal tract such as biliary-enteric anastomoses, intrahepatic bile duct pathology such as sclerosing cholangitis and AIDS cholangiopathy, chronic pancreatitis, congenital anomalies of the biliary tract and pancreatic duct, and gallbladder pathology.

Bile Duct Diseases↗
PubMed1997

Laparoscopic Nissen fundoplication for severe gastroesophageal reflux disease: pros and cons.

The advent of the laparoscopic approach to Nissen fundoplication has led to a resurgence in enthusiasm for the surgical treatment of gastroesophageal reflux disease (GERD). However, controversy exists as to which subgroups of GERD patients are best treated surgically. The relative success of treatment with medical and surgical intervention in terms of both symptom control and objective resolution of esophageal injury must be weighed against the relative costs of each therapeutic strategy in both the short and long term, given that GERD tends to be a lifelong disorder. The following is the transcribed text of a debate held at the Medical College of Virginia as part of a continuing medical education program in which the statement "Laparoscopic antireflux surgery is superior to medical treatment for severe gastroesophageal reflux disease" was contested. Representatives from the departments of surgery and gastroenterology provided arguments supporting their respective sides of this issue. The purpose was not to promote polarization in treatment selection, but to review the available data in a forum that could promote development of a rational algorithm for clinical decision-making in patients with GERD who might benefit from antireflux surgery. Final comments from the authors are provided in an attempt to synthesize the arguments into a reasonable strategy for individual case management.

Decision Making↗
PubMed1996

Gallstone pancreatitis: an update.

Gallstone pancreatitis is one of the more prevalent causes of pancreatitis. It accounts for more than two thirds of the cases of acute pancreatitis worldwide and 25 to 45% of the cases in the United States. Furthermore, it is one of the most important treatable causes of pancreatitis. These two important features of the disease make its recognition and proper management critical. Key to recognition and proper management of gallstone pancreatitis is understanding that this disease can exist in three different forms. It can exist as impacted gallstone pancreatitis, as nonimpacted gallstone pancreatitis, or as sludge-related pancreatitis. Each of these forms of the disease will have some unique features relating to their pathogenesis, diagnosis, and treatment. This update focuses on "take-home" features that will allow (1) clinical differentiation between the three forms of the disease and (2) understanding the unique features that relate to their pathogenesis, diagnosis, and management.

Cholelithiasis↗
PubMed1996

Small flat adenoma: important in colon carcinogenesis?

The risk for development of colonic carcinoma increases with increasing size of the polyp. Endoscopists have focused attention on large polyps. Small flat adenomas are sessile polyps that measure less than 1 cm; they are nearly flat, and they have a slight depression in the center. They have a high incidence of cancer in situ. Adenomatous polyps follow the adenoma-carcinoma sequence. Small flat adenomas do not appear to follow this sequence, but they may be precursors of so called de novo colonic carcinoma. The genetics of small flat adenomas are not fully elucidated. Small flat adenomas may not be identified during standard colonoscopy due to the small size of the lesion. Chromoendoscopy may increase the rate of detection.

Adenoma↗
PubMed1993

Pharmacological control of gastric acid secretion.

Gastric acid produced by the parietal cells has a significant role in a variety of gastrointestinal diseases, such as duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. We address acid production by the parietal cell and the pharmacological means to control gastric acid secretion. The physiology of parietal cell acid secretion is reviewed. The role of acid-suppressive therapy with histamine H2 antagonists and omeprazole in duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease is discussed. Pharmacology, side-effect profile, and dosage requirements of the histamine H2 antagonists and omeprazole are outlined.

Depression, Chemical↗
PubMed1993

Nonsteroidal antiinflammatory drug-induced gastroduodenal lesions: prophylaxis and treatment.

Nonsteroidal antiinflammatory drugs (NSAIDs) are one of the most commonly prescribed agents, especially for elderly patients. These drugs frequently produce mucosal petechiae and erosions in the stomach and duodenum, but these conditions are rarely of clinical significance. NSAIDs, however, cause considerable morbidity and mortality due to their ability to cause gastric and duodenal ulcers. NSAID-induced ulcers are most likely to develop in elderly women receiving multiple NSAIDs for prolonged periods. NSAIDs injure gastric and duodenal mucosa by both a topical and a systemic effect. The latter is responsible for the pathogenesis of NSAID-associated ulcers. These ulcers are particularly prone to perforation and hemorrhage. Both complications frequently occur in asymptomatic long-term users of NSAIDs. H2 antagonists prevent NSAID-related duodenal ulcers but are not effective for prevention of gastric ulcers. Misoprostol is the only agent proven to decrease the risk of gastric ulcers in patients receiving NSAIDs. Both H2 antagonists and omeprazole are highly effective for the treatment of established duodenal ulcers in patients receiving NSAIDs. H2 antagonists also heal gastric ulcers in these patients but at slower rates than in patients not receiving NSAIDs. The existing literature is reviewed, and guidelines for prophylaxis against NSAID-induced ulcers and treatment of established ulcers are provided.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Stapled ileoanal anastomosis for ulcerative colitis and familial polyposis without a temporary diverting ileostomy.

Between March 1989 and August 1990, we performed 21 stapled J pouch ileonal procedures (20 ulcerative colitis [UC], 1 familial polyposis [FP]) without an ileostomy in 19, of whom 13 were taking prednisone and eight underwent semi-emergent surgery for uncontrollable bleeding. During the same time, an additional four patients required a standard ileonal procedure. The results of anal manometry and clinical function were compared to 25 patients who had previously undergone mucosal stripping and a sutured J pouch ileoanal anastomoses with a temporary diverting ileostomy between October 1982 and August 1990. During this same time period, an additional 19 patients underwent an anti-peristaltic reversed J pouch and 18 an S pouch, for a total of 83 ileoanal procedures. The reversed J pouch had a lower stool frequency than a standard J pouch but had an unacceptable incidence of complications and problems with pouch emptying. The S pouch had a stool frequency similar to the standard J pouch but provided greater length in patients with a short mesentery. Stapled J pouch ileoanal patients had a better (p less than 0.02) maximum and sphincter resting pressure (46 +/- 11 versus 34 +/- 12 mmHg), fewer (p less than 0.05) night-time accidents (22% versus 68%), daytime (17% versus 55%) or night-time (28 versus 61%) spotting, or use of a protective pad at night (11% versus 42%) than nonstapled J pouch ileoanal patients. Stool frequency was similar in the two groups. All but one UC patient had residual disease at the anastomosis. Anal mucosa between the dentate line and stapled anastomosis was 1.8 +/- 1.3 cm (range, 0 to 3.5 cm). Complications in the nonstapled J pouch group included 4 pouches excised (2 for complications, 2 for excessive stool frequency), 1 pelvic abscess, 2 stenosis requiring dilation under anesthesia, 1 enterocutaneous fistula after ileostomy closure, 1 ileostomy site hernia, and 2 small bowel obstructions. Of the 65 patients who underwent ileostomy closure in the entire series, 8 (12%) developed a complication requiring surgical intervention. Complications in the stapled group included 1 anastomotic leak, 1 pouch leak, and 1 pelvic abscess. Patients were managed successfully with drainage (all 3) and diverting ileostomy (1). One patient developed stenosis requiring dilation under anesthesia. The stapled J pouch ileoanal anastomosis is a simpler, safer procedure with less tension than a standard handsewn J pouch but leaves a very small cuff of residual disease. It provides significantly better stool control and may obviate the need for an ileostomy with its complications.

Anal Canal↗
PubMed1990

A prospective assessment of the Garren-Edwards Gastric Bubble and bariatric surgery in the treatment of morbid obesity.

Morbid obesity is a serious medical hazard, and effective alternatives to surgery have been unsuccessful. In 1985, the Garren-Edwards Gastric Bubble (GEGB) was offered as an adjunct to dietary and behavioral therapy for weight loss treatment. The safety and efficacy of the GEGB were compared with bariatric surgery, the current standard for the treatment of morbid obesity. Fifty-seven patients received GEGB and 77 underwent bariatric surgery. GEGB patients were divided into two groups: those who attended group therapy and those who did not. This study showed that bariatric surgery was far more effective in reducing excess body weight during a 12-month period compared with the GEGB plus group therapy and the GEGB alone. The morbidity from bariatric surgery was greater than in the GEGB-treated groups, while the cost for uncomplicated cases for a year's treatment was comparable. It is concluded that the GEGB does not offer an effective alternative to bariatric surgery in the treatment of morbid obesity.

Adult↗
PubMed1987

The impact of an educational workshop on colorectal screening practices.

Since its establishment in 1983, the Virginia Colorectal Cancer Control Project has emphasized the importance of routine screening of asymptomatic adults for colorectal cancer. This has been accomplished through educational workshops that are offered to primary care physicians. These workshops provide didactic information on current concepts in screening and individualized instruction on the use of the flexible sigmoidoscope. Eleven workshops have been conducted since the fall of 1984. During the spring of 1986, a survey was mailed to workshop participants to determine whether changes had occurred in their screening practices. A total of 115 physicians responded to the survey. Prior to the workshop, 86 physicians performed the digital rectal examination; now 100 do. Prior to the workshop, 68 physicians performed the fecal occult blood test; now 89 do. Prior to the workshop, 34 physicians used a flexible scope; now 71 do. Participants found the workshop to be extremely effective in providing individualized instruction.

Colorectal Neoplasms↗
PubMed1987

Small intestinal motility: normal and abnormal function.

This review outlines the properties and function of intestinal smooth muscle and the mechanisms that underlie contraction and relaxation. Both tonic and phasic (rhythmic) contraction are mediated by an increase in intracellular calcium. Phasic contraction is paced electrically by rhythmic changes in membrane potential (slow waves) which, upon reaching a threshold, lead to opening of membrane calcium channels and the entry of calcium into muscle cells; this inwardly directed calcium current or spike initiates a cascade of events resulting in contraction. Slow waves and spike potentials and, thus, phasic contraction, are influenced by neurotransmitters, hormones, and drugs. In circular muscle, these agents can also increase calcium by releasing it from intracellular stores, thus inducing tonic contraction. Ingestion of food initiates peristaltic propulsive activity which, in its rhythm, is superimposed on spontaneous phasic activity. The peristaltic reflex consists of two successive phases: relation of circular muscle distal to the distending bolus (descending relaxation) and contraction proximal to the bolus (ascending contraction). In-between meals, a different, slower pattern of muscle activity prevails, known as the migrating motor complex, which helps to maintain the lumen of the intestine free of contents. Improved understanding of normal muscle function is beginning to reflect itself in improved management of patients with motility disorders.

Eating↗
PubMed1986

Colorectal cancer. A blueprint for disease control through screening by primary care physicians.

The Virginia Colorectal Cancer Control Project is a statewide effort to reduce morbidity and mortality from colorectal cancer by stimulating the adoption of screening and early detection practices by primary care physicians. The project emphasizes use of the three-day fecal occult blood test, digital rectal examination, and endoscopy. Recruitment strategies included personal contact, newsletters, journal articles, and screening workshops. Of the 33 318 patients screened over 26 months, positive fecal occult blood test reactions were recorded in 3.3% of asymptomatic patients and in 14.8% of symptomatic patients. Polyps were found in 149 and cancer was diagnosed in 94 patients of whom one third were asymptomatic. Eighty percent of the latter had Dukes' A and B lesions, 12% had Dukes' C lesions, and 8% had Dukes' D lesions. In contrast, only 36% of the symptomatic cancers were Dukes' A and B lesions, and 69% were Dukes' C and D lesions. These results suggest that primary care physicians can be effective in the screening and detection of precancerous polyps and early-staged colorectal cancers.

Colonic Neoplasms↗