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Biomedical subjects

B H Sullivan

Publications and source records attributed to B H Sullivan.

At least 19 recordsLinked to original sources
PubMed1985

Surveillance for colonic carcinoma in ulcerative colitis.

To evaluate the efficacy of surveillance colonoscopy with biopsy for the detection of high-grade dysplasia (HGD) or colonic carcinoma in patients with chronic ulcerative colitis, we undertook a retrospective review of 248 patients who underwent 370 examinations (mean duration of disease 12 yr). High-grade dysplasia or carcinoma was found in 24 examinations in 16 patients, with a mean duration of disease of 16 yr. There were 15 patients with HGD. Nine patients had HGD alone, 6 had HGD and carcinoma, and 1 had carcinoma without HGD. The overall incidence of HGD was 6%. Dysplasia-associated lesions or mass were the most consistent indicators of carcinoma, the combination being present in four instances. Of the 7 patients with cancer, 6 were recognized by colonoscopy, and 1 patient with negative visual endoscopic findings was discovered using surveillance biopsies. The conclusions of this study are that dysplasia is a reliable histopathologic marker and correlates with the presence of cancer in chronic ulcerative colitis; the absence of dysplasia correlates with the absence of cancer. The presence of dysplasia-associated lesions or mass with HGD is the strongest indication for operation. This study supports the use of surveillance colonoscopy in managing high-risk ulcerative colitis patients.

Adolescent↗
PubMed1981

A linkage study of HLA and inherited adenocarcinoma of the colon.

A kindred with the familial cancer syndrome is reported in which every confirmed affected member of the pedigree had at least one primary carcinoma of the colon. The average age at which cancer appeared was 38 years, and multiple primary neoplasm occurred in 23% of the cancer patients. Transmission of the cancer trait is consistent with an autosomal dominant mode of inheritance. Colonoscopy eliminated the presence of any unsuspected cancers in family members at risk. HLA typing was done, and by direct typing or inference, data were available on 66 living and deceased individuals. There were four informative matings in the kindred, the offspring of which showed only three crossovers of a possible 17. The lod score totaled 1.06 at a recombination fraction of 0.20. The need for cooperative efforts of many investigators in HLA linkage studies is emphasized, along with the potential value of such an approach.

Adenocarcinoma↗
PubMed1980

Colonoscopy in the diagnosis of unexplained rectal bleeding.

Three hundred six patients with unexplained rectal bleeding were examined by colonoscopy. Significant lesions were found in 30% including polyps having a diameter of 0.5 cm or larger in 14%, carcinoma in 8%, and a small number of patients with inflammatory bowel disease, vascular formations, and radiation colitis. Colonoscopic findings in a large subgroup of patients with diverticulosis established by barium enema did not differ significantly from those of the group as a whole. Significant lesions were also identified in 22% of small subsets of patients with occult bleeding or unexplained melena.

Adenoma↗
PubMed1980

Endoscopic retrograde pancreatography in the evaluation of trauma to the pancreas.

Pancreatic injury is an unusual but serious complication of abdominal trauma. A high index of suspicion is required, as results of routine laboratory tests and physical examination can be misleading. Complications following injury to the body and tail may be particularly indolent in their presentation. Endoscopic retrograde pancreatography allows accurate localization of the site of pancreatic duct disruption and facilitates appropriate surgical management.

Abdominal Injuries↗
PubMed1980

Endoscopic sphincterotomy and removal of gallstones.

Endoscopic sphincterotomy was attempted in 23 patients. The procedure was successful in 22 patients. Sphincterotomy was not successful in one patient due to the technical inability selectively to cannulate the common bile duct. The indications for sphincterotomy were retained common duct stones after cholecystectomy in 12 patients, recurrent common duct stones after cholecystectomy in nine patients and common bile duct stones with the gallbladder intact in two patients who were prohibitive operative risks. Calculi were completely cleared in 17 of 23 patients at the time of discharge from the hospital following sphincterotomy and ultimately in 19 of 23. There were no complications in 21 of 22 sphincterotomies, although one older patient died of persistent septicemia. A second patient was symptomatically improved but had persistent calculi and died of cardiac causes five months after sphincterotomy. One patient was treated with chenodeoxycholic acid for persistent calculi in the common bile duct after sphincterotomy. Endoscopic sphincterotomy is an effective alternative to conventional surgical procedures for removal of stones of the common bile duct.

Adult↗
PubMed1980

Endoscopic surveillance for cancer in chronic ulcerative colitis.

Severe epithelial dysplasia in multiple colonscopic biopsy specimens may held identify those patients with chronic ulcerating colitis (CUC) at highest risk for developing colonic cancer. This retrospective analysis of 75 patients with longstanding CUC studied by colonoscopy and biopsy disclosed 11 patients with cancer. Four of these cancers were detected by surveillance colonoscopy and seven were detected by diagnostic colonoscopy. There was a high correlation between the presence of dysplasia and cancer in the patients. Cancer was found in five of seven patients who underwent operation after colonoscopic biopsies showed severe dysplasia. No cancers were found at operation in 15 patients whose colonoscopic biopsy specimens were free of dysplasia. Dysplasia can be consistently identified. A reviewing pathologist agreed with the initial biopsy diagnosis in 59 of 64 cases (92%) and with the colectomy diagnosis in 18 of 21 (86%). Colonscopy with multiple biopsy specimens is a valuable surveillance technic. Patients without dysplasia on biopsy should have continued surveillance.

Adult↗
PubMed1979

Aortoduodenal fistula: endoscopic diagnosis.

Aortoduodenal fistula has been reported as a complication in up to 4% of aortic aneurysm repairs, presenting as gastrointestinal bleeding of varying severity. Mortality of patients not operated on approaches 100%, and preoperative diagnosis is extremely difficult. In this report five cases are described in which the diagnosis was established endoscopically, and the literature regarding the pathophysiology and natural history of this entity is reviewed.

Aged↗
PubMed1976

Endoscopic retrograde pancreatography: analysis of the normal pancreatogram.

Thirty-five pancreatograms were selected from 62 which were obtained during endoscopic cannulation of the papilla of Vater with retrograde injection of radiopaque medium. Pancreatograms were selected on the basis of the quality of the study and on the absence of any clinically demonstrable pancreatic disease. Measurements were made of the main pancreatic duct (MPD) in the head, body, and tail, as well as the length of the duct. Although there is a wide range of normal, practical reference figures for the diameters of the main duct in the head, body, and tail are 3, 2 and 1 mm, respectively. The length averages 15.4 cm. No correlation was found between the measurements and the body surface area, age, or sex of the patient. Comparisons are made with other autopsy and endoscopic studies, and attention is focused on the salient anatomic features, including normal points of narrowing of the duct, the accessory pancreatic duct (APD), and the main pancreatic duct branches (MPDB).

Cholangiography↗
PubMed1976

Endoscopic features of gastroduodenal Crohn's disease.

The clinical, roentgenographic and endoscopic findings in 14 patients with Crohn's disease of the stomach and/or duodenum are described. To date, this is the largest series of endoscopic findings of Crohn's disease of gastroduodenal region. The endoscopic findings include (1) mucosal nodularity or "cobblestoned" mucosa; (2) multiple aphthous-like ulcerations and/or linear ulcerations; (3) thickening of the antral folds; (4) antral narrowing with evidence of hypoperistalsis; (5) duodenal strictures. The diagnosis of gastric duodenal Crohn's disease is achieved by combining recognition of clinical features and roentgenographic and endoscopic features. The endoscopic features correlate well with the roentgenographic findings in our 14 patients. Tissue for histological diagnosis of Crohn's disease of the gastroduodenal area is rarely obtained by endoscopic biopsy, but peroral suction biopsy specimens may increase the rate of histological confirmation.

Adolescent↗
PubMed1975

Endoscopic pancreatography: its value in preoperative and postoperative assessment of pancreatic disease.

Examples of the use of endoscopic pancreatography in the preoperative evaluation and postoperative follow-up study of patients with pancreatic disease are presented and discussed. Six cases selected from a total experience of forty-eight patients have been summarized. The direct role of pancreatography in the management of these cases is cited. There is a small but definite risk to the procedure. With increased use of endoscopic pancreatography, it is hoped that earlier diagnoses of a variety of pancreatic diseases will be obtained which will permit more accurate medical and surgical therapy.

Adult↗
PubMed1975

Neurogenic tumors of the small intestine. Review of the literature and report of a case with endoscopic removal.

Epigastric pain and melena prompted the study of a woman with cutaneous neurofibromatosis (von Recklinghausen's disease). Roentgenographic and endoscopic examination demonstrated an ulcerated polypoid neurilemoma of the duodenum. It was removed by endoscopic electrosurgery. Neurogenic tumors of the intestine are rare, but should be considered in the differential diagnosis when patients with multiple café au lait spots or cutaneous neurofibromatosis manifest epigastric pain, gastrointestinal bleeding, or intestinal obstruction. Endoscopic polypectomy may offer a low risk method of treatment for sutably located bleeding neurogenic tumors of the stomach or duodenum.

Diagnosis, Differential↗