Biomedical subjects

D E Beck

Publications and source records attributed to D E Beck.

At least 37 records · Page 2Linked to original sources

PubMed1996

Colon surveillance after colorectal cancer surgery.

PURPOSE: This study was performed to determine cost-effective colonoscopy guidelines for patients with prior colorectal adenocarcinoma. METHOD: A retrospective review was performed of patients who had been treated for colorectal adenocarcinoma and later underwent follow-up colonoscopy from 1984 to 1994. RESULTS: During this study period, 389 patients previously treated for colorectal adenocarcinoma underwent follow-up colonoscopy. All patients had perioperative colon evaluation for other neoplasms. Ages ranged from 26 to 89 (mean, 65.8) years, and 46.8 percent were female. Recurrent or metachronous cancer or a neoplastic polyp constituted a positive examination. Results of 389 first follow-up colonoscopies were compared with 259 second (66.6 percent), 165 third (42.4 percent), and 83 fourth (21.3 percent) follow-up examinations. Median interval between all colonoscopies was 13 months. Positive examination rates for the first two yearly examinations were 18.3 and 18.5 percent, respectively. Slightly lower, third-year and fourth-year positive examination rates were 16.4 and 14.5 percent, respectively. Four-year examinations yielded the following: first year--1 carcinoid, a new adenocarcinoma, and 100 polyps; second year--1 anastomotic recurrence and 68 polyps; third year --55 polyps; and fourth year--1 recurrent cancer and 17 polyps. CONCLUSIONS: These data suggest that 1) annual follow-up colonoscopy for two years after colorectal cancer surgery is beneficial for detecting recurrent and metachronous neoplasms and 2) the interval between subsequent examinations may be increased depending on the result of the most recent examination.

Adenocarcinoma↗

PubMed1996

Postpolypectomy colonic hemorrhage.

PURPOSE: This study was undertaken to evaluate the incidence, diagnostic methods, and treatment of hemorrhage occurring after colonoscopic polypectomy. METHODS: A retrospective chart review was conducted of 12,058 patients who underwent colonoscopy at an academic referral center between January 1989 and July 1993. Of these, 6,365 patients required polypectomies or biopsies. RESULTS: After these procedures, 13 patients (0.2 percent) developed lower gastrointestinal hemorrhage requiring hospitalization. All bleeding episodes occurred within 12 days of polypectomy or biopsy (mean = 8 days). Twelve patients (92 percent) underwent technetium-tagged red blood cell scintigraphy, which localized bleeding in four patients (31 percent). In the eight patients with normal scintigrams, hemorrhage did not recur, and no further evaluation was performed. Five patients (38 percent) underwent arteriography. Arteriogram was positive in two of four patients with positive scintigrams, and bleeding was controlled with selective vasopressin infusion. The fifth patient had arteriography without prior diagnostic studies because of massive hemorrhage; the bleeding site was identified and controlled with selective vasopressin infusion. Three patients had lower gastrointestinal endoscopy, with endoscopic identification of bleeding site in two patients, and endoscopic electrocautery controlled the bleeding in one patient. In the 13 patients with hemorrhage, cessation of bleeding occurred with intestinal rest and hydration in nine patients (69 percent), selective vasopressin infusion in three patients (23 percent), and endoscopic electrocautery in one patient (8 percent). Eight patients (62 percent) required blood transfusion with a mean of 4.8 units (excluding one patient on warfarin sodium who required 14 units of blood). No patient required surgical intervention. CONCLUSIONS: Incidence of hemorrhage after colonoscopic polypectomy or biopsy is low, and in our series, hemorrhage resolved without the need for surgical intervention. Management includes initial stabilization followed by diagnostic evaluation. Technetium-tagged red blood cell nuclear scintigraphy identifies ongoing bleeding and identifies patients in whom additional invasive procedures (arteriography lower gastrointestinal tract endoscopy) are warranted.

Colonic Polyps↗

PubMed1996

Perioperative steroid use in colorectal patients. Results of a survey.

PURPOSE: A survey was conducted to document current perioperative steroid use in colorectal patients. METHODS: A mail survey was sent to 1,400 members and fellows of The American Society of Colon and Rectal Surgeons. RESULTS: Three hundred seven questionnaires (21.9 percent) were returned. Twenty-four respondents had retired or lacked accurate data. The remaining 283 surgeons averaged 43.5 (range, 31-71) years in age and had been in practice an average of 11 (range, 1-39) years. Ninety-seven percent were certified by the American Board of Surgery, 87 percent by the American Board of Colon and Rectal Surgery, and 85 percent by both. Eighty-six percent of respondents manage the perioperative steroids and 85 percent manage the postoperative steroid taper of their patients. In patients receiving preoperative steroids, 84 percent of respondents administer 100 mg of hydrocortisone phosphate intravenously before surgery. The most common postoperative dosage (used by 62 percent) was 100 mg of hydrocortisone phosphate intravenously every eight hours, which was tapered to 50 mg intravenously every 8 to 12 hours. Most patients (49 percent) received 20 mg of prednisone per day when their oral intake was resumed. The most common taper regimen was a 5 mg reduction per week (61 percent of respondents). CONCLUSION: Despite lack of scientifically established requirements or proven physiologic guidelines, perioperative steroid use by colorectal surgeons appears relatively consistent.

Adult↗

PubMed1996

Colostomy closure. Ochsner Clinic experience.

PURPOSE: We retrospectively reviewed the records from our past five years of experience with colostomy closure at a large multispecialty hospital to determine postoperative morbidity. RESULTS: From March 1988 to April 1993, 46 patients underwent colostomy closure. Patients ranged in age from 24 to 87 (mean, 41.8) years, and 25 (54 percent) were women. Stomas had been created during emergency operations in 40 patients (87 percent); most operations (54 percent) were for complications of acute diverticulitis. Of the 46 procedures, 40 (87 percent) were end colostomies, and 6 were loop colostomies. Stomas were closed at a range of 11 to 1,357 days after creation (mean, 207 days; median, 116 days). Twenty-six patients (57 percent) underwent colostomy closure alone, and the remainder underwent additional procedures ranging from appendectomy to hepatic lobectomy. Duration of operations ranged from 1 to 9.5 (mean, 4.2) hours, and estimated blood loss averaged 400 ml. Overall hospital stay for closure was 6 to 62 (mean, 11.5) days. Inpatient complications occurred in 15 percent of patients, including congestive heart failure (2 percent), cerebrovascular accident (4 percent), pneumonia (2 percent), enterocutaneous fistula (2 percent), and pulmonary embolus with death (2 percent). The most common long-term complication was midline wound hernia, which occurred in 10 percent of surviving patients. Overall, complications occurred in 24 percent. CONCLUSIONS: Colostomy closure is a major operation; however, with good surgical judgement and technique, associated morbidity and mortality can be minimized.

Acute Disease↗

PubMed1996

Surgical excision of large rectal villous adenomas.

Large villous tumors occur most frequently in the rectosigmoid and have a significant incidence of harboring a malignancy. The presence or absence of malignancy may be determined only by complete excision. Presence of invasive carcinoma on pathologic examination requires surgical intervention appropriate for that diagnosis. Recurrence depends on the technique used for tumor removal. It is highest for fulguration and local excision and lowest for operations that excise all or part of the rectum. Because most recurrences can be managed with local measures and the risk of malignancy in recurrences is relatively low, the procedure with which the tumor can be completely excised with the least morbidity should be used. Local excision with or without mucosal closure should be used as first-line surgical therapy whenever possible. It should be possible to manage most tumors in the mid and low rectum with this technique. For larger tumors and those tumors more proximal, it may be necessary to use snare cautery in combination with local excision or fulguration. Alternately, for some proximal rectal lesions the two-scope technique mentioned earlier may allow local excision. For circumferential or near circumferential tumors in the low to mid rectum, circumferential mucosectomy should be used. It has been used successfully for tumors involving the entire rectum down to the dentate line. Although this technique has a low recurrence rate, the rate of incontinence associated with it precludes its use in smaller tumors that are amenable to local excision. Transanal endoscopic microsurgery described by Beuss et al can produce good results. The authors have no experience with this technique. However, because of its expense, the need for specialized training, and the infrequency with which other transanal techniques are insufficient, we fail to see a significant role for its use. If use of this technique becomes more widespread, additional data regarding its value will become available. Posterior approaches offer no advantage for removal of tumors that can be excised by transanal techniques. Most tumors that require partial or complete rectal excision should be amenable to anterior or low anterior resection. Low anterior resection is a less morbid procedure with which most surgeons have a fairly extensive experience. For extremely large tumors that extend to the dentate line, coloanal anastomosis is appropriate. The functional results are acceptable compared with the alternative of abdominoperineal resection. Abdominoperineal resection should be reserved for those patients with a diagnosis of invasive carcinoma in whom a lesser procedure would not constitute adequate treatment.

Adenoma, Villous↗

PubMed1996

Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.

BACKGROUND: Postoperative abdominal adhesions are associated with numerous complications, including small bowel obstruction, difficult and dangerous reoperations, and infertility. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) was developed to reduce formation of postoperative adhesions. The objectives of our prospective study were to assess the incidence of adhesions that recurred after a standardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions. STUDY DESIGN: Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy. Before abdominal closure, patients were randomly assigned to receive or not receive HA membrane placed under the midline incision. At ileostomy closure eight to 12 weeks later, laparoscopy was used to evaluate the incidence, extent, and severity of adhesion formation to the midline incision. RESULTS: Data were analyzed for 175 assessable patients. While only five (6 percent) of 90 control patients had no adhesions, 43 (51 percent) of 85 patients receiving HA membrane were free of adhesions (p < 0.00000000001). The mean percent of the incision length involved was 63 percent in the control group, significantly greater than the 23 percent observed in patients who received HA membrane (p < 0.001). Dense adhesions were observed in 52 (58 percent) of the 90 control patients, but in only 13 (15 percent) of the 85 receiving HA membrane (P < 0.0001). Comparison of the incidence of specific adverse events between the groups did not identify a difference (P > 0.05). CONCLUSIONS: This study represents the first controlled, prospective evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using standardized, direct peritoneal visualization. In this study, HA membrane was safe and significantly reduced the incidence, extent, and severity of postoperative abdominal adhesions.

Adenomatous Polyposis Coli↗

PubMed1995

Fecal seepage and soiling: a problem of rectal sensation.

PURPOSE: To determine the physiologic alteration resulting in fecal seepage and soiling, results of anorectal manometric testing were evaluated in patients with varying degrees of fecal incontinence. METHODS: Anal manometric studies performed on 170 patients with fecal incontinence were reviewed. Results of their studies, including mean resting pressure, maximum resting pressure, maximum squeezing pressure, minimum rectal sensory volume, and minimum volume at which reflex relaxation first occurs, were compared with those of 35 control group subjects with normal fecal continence. Manometric studies were performed using a four-channel, water-perfused catheter. Incontinent patients were divided into three groups based on presenting complaints: complete incontinence (incontinence of gas and liquid and solid stool), partial incontinence (incontinence of gas and liquid), and seepage and soiling (incontinence of small amounts of liquid and solid stool without immediate awareness). RESULTS: Resting pressures were significantly lower in complete incontinence, partial incontinence, and seepage and soiling groups than in the controls (P < 0.001). Resting pressures of the complete incontinence group were also significantly lower than those of the partial incontinence and seepage and soiling groups (P = 0.03). Squeezing pressures were lower for both the complete incontinence and partial incontinence groups than for those in the control group (P < 0.001) and in the seepage and soiling group, which did not differ significantly from controls. The minimum rectal sensory volume was greater in all incontinent groups than in controls (P < 0.001). Sensory volume of the seepage and soiling group was significantly greater than that of the complete incontinence and partial incontinence groups (P < 0.01). The difference between sensory volume and the volume producing reflex relaxation was greatest in the seepage and soiling group and differed from that of the partial incontinence and control groups. CONCLUSIONS: These findings suggest that the mechanism of incontinence is different in seepage and soiling patients and involves a dyssynergy of rectal sensation and anal relaxation. Patients with the pattern of seepage and soiling may be successfully treated with stool bulking agents (e.g., psyllium or bran).

Adolescent↗

PubMed1995

Colonoscopic follow-up of adenomas and colorectal cancer.

Increasing experience with colonoscopy has altered recommendations for the frequency of follow-up surveillance examinations for adenomatous polyps and colorectal cancer. Current recommendations include a follow-up colonoscopy at 1 year for patients with more than two adenomatous or highly suggestive polyps and after curative surgery for colorectal cancer. Other patients can safely receive a follow-up colonoscopy at longer intervals of 3 years. Published data and a review of the Ochsner Clinic experience are presented to support these recommendations.

Adenoma↗

PubMed1994

Combination therapy for epidermoid carcinoma of the anal canal.

PURPOSE: This study was designed to assess results of chemoradiation therapy for epidermoid carcinoma of the anal canal. METHODS: A retrospective review of records of the prospective database revealed 35 patients who had been diagnosed with anal canal carcinoma and treated with chemoradiotherapy at Wilford Hall USAF Medical Center (tertiary referral hospital) from 1981 to 1991. RESULTS: Patients ranged in age from 35 to 80 (mean, 59) years, and 63 percent were women. Primary tumors ranged from 1 to 8 cm in diameter (mean, 3 cm). The first six patients had an abdominoperineal resection (APR) after chemoradiotherapy, and no residual tumor was identified in the specimens. In the subsequent 29 patients who did not have APR, 5 had moderate problems with anal continence, and one required a diverting colostomy for incontinence. Follow-up ranged from 4 months to 12.9 years (mean, 5.2 years). There were two pelvic recurrences, and three patients developed distal metastasis. Eight patients died during follow-up, including three with recurrent or persistent disease. Five-year survival using life-table analysis was 89 percent. CONCLUSION: Long-term follow-up confirms that chemoradiation remains the preferred therapy for epidermoid carcinoma of the anal canal.

Adult↗

PubMed1994

Colorectal operative experience. Results of a survey.

PURPOSE: This study was designed to document the operative colorectal experience of members and fellows of The American Society of Colon and Rectal Surgeons. METHODS: A mail survey of 900 members and fellows of The American Society of Colon and Rectal Surgeons was conducted. RESULTS: One hundred eighty questionnaires (20 percent) were returned; however, 25 respondents had retired or lacked accurate operative data. The remaining 155 surgeons averaged 49 (range, 35-83) years in age and had been in practice an average of 14.7 (range, 2-51) years. The respondents performed a median of 135 and a mean of 177 anorectal procedures per year (range, 20-1,471) and a median of 67 and a mean of 79 abdominal colorectal procedures (range, 6-443). Operative hemorrhoidectomy was the most common anorectal procedure (median, 25; mean, 47/year), while partial colectomy was the most common abdominal procedure (median, 18; mean, 26). The number of anorectal procedures correlated directly with the respondents' time in practice, and the number of abdominal procedures peaked between the tenth and fifteenth years. CONCLUSION: Despite the limitations associated with this type of study, the information is useful in assessing practice patterns and experience level.

Adult↗

PubMed1994

Ulcerative colitis: surgical indications and alternatives.

Ulcerative colitis is a surgically curable mucosal disease of the colon and rectum. Optimal management of this chronic condition requires close coordination between the patient, surgeon, and primary care provider or gastroenterologist. Knowledge of surgical indications and the operative alternatives available helps to individualize therapy. Acute and chronic indications for surgery and the five surgical methods currently in use are described.

Anastomosis, Surgical↗

PubMed1993

Laparoscopic-assisted full-thickness endoscopic polypectomy.

PURPOSE: To describe the procedure for endoscopically removing sessile colonic polyps with laparoscopic assistance. METHODS: Technique description and retrospective review of experience. RESULTS: The technique has been used to successfully remove polypoid colonic lesions in three patients. CONCLUSIONS: Laparoscopic-assisted polypectomy allows complete excision of moderate-sized sessile polyps and may spare selected patients a colonic resection.

Animals↗

PubMed1993

Nonpalpable breast lesions: association of mammographic abnormalities with diagnosis after needle-directed biopsy.

We reviewed the experience with needle-directed breast biopsies (NDBB) in a military medical center. In 195 patients, 207 NDBBs were done; 49 of these biopsies (24%) rendered a diagnosis of malignancy. The majority of patients (78%) had invasive cancer; 44% of them were found to have associated malignant axillary adenopathy. Mammographic indications were examined; 65% of the biopsies were done for microcalcifications with or without an associated mass/density. Approximately one third of these lesions harbored malignancy or high-risk hyperplasia. Discrete nodular densities had a low rate of malignancy (7%), while spiculated/stellate masses proved almost uniformly to be invasive cancer. NDBB should be considered in all women with mammographic abnormalities. The associated risk of malignancy may vary depending on the specific mammographic appearance of the lesion. Unfortunately, a significant number of women may have relatively advanced malignancy when first seen, despite having nonpalpable disease.

Aged↗

PubMed1992

Simplified balloon expulsion test.

The balloon expulsion test is a simple and inexpensive method to evaluate a patient's ability to expel and retain stool. In conjunction with other methods, it assists in identifying patients with outlet obstruction or incontinence. A simplified method of performing a balloon expulsion test is described.

Colorectal Surgery↗

PubMed1992

Preliminary results of a prospective randomized study of Cooper's ligament versus Shouldice herniorrhaphy technique.

Surgeons have developed many methods for the repair of direct inguinal hernias. The Cooper's ligament (McVay) repair and the Shouldice repair are widely used techniques. To determine the recurrence rates with differing techniques performed in a surgery residency program, we conducted a prospective randomized study for elective adult direct inguinal herniorrhaphies. Three hundred and eight elective direct inguinal herniorrhaphies in 269 adult patients were performed by residents in general surgery supervised by staff surgeons. Patients had yearly follow-up physical examinations (compliance rate of 87 percent) during an average follow-up period of 36.4 months. The recurrence rate was 8.8 percent for the McVay repair and 6.6 percent for the Shouldice repair (not significant). Bilateral inguinal hernias (repaired six weeks apart) had a recurrence rate of 12.8 percent, while the recurrence rate for unilateral repairs was 5.6 percent (p = <0.05). We found no significant difference in recurrence rates between the McVay and Shouldice herniorrhaphy techniques. However, there was an increase in hernia recurrence with either technique when bilateral direct inguinal herniorrhaphies were performed.

Female↗

PubMed1991

A new oral lavage solution vs cathartics and enema method for preoperative colonic cleansing.

Sulfate free-electrolyte lavage solution is a new osmotically balanced electrolyte gut lavage solution for colon surgery that has been formulated for improved taste and reduced water and electrolyte changes. Sixty patients were prospectively randomized to receive a 1-day preparation with sulfate free-electrolyte lavage solution or a 3-day preparation using a clear liquid diet, cathartics, and enemas. The patient groups were similar in age, race, male-female ratio, and the types of colonic resections performed. Colonic cleansing was better with sulfate free-electrolyte lavage solution (100% vs 63% "good" to "excellent" cleansing). Patient tolerance evaluated by a questionnaire showed more overall discomfort with sulfate free-electrolyte lavage solution but no difference between the preparations in individual symptoms of fullness, cramping, nausea, or vomiting. One patient developed a low level of serum potassium after a cathartic and enema preparation, while there were no complications with sulfate free-electrolyte lavage solution. Patient taste questionnaires showed a slight preference for sulfate free-electrolyte lavage solution (53%) over a polyethylene glycol electrolyte lavage solution (47%). This study confirms that sulfate free-electrolyte lavage solution is a safe and effective method of preoperative colonic cleansing.

Administration, Oral↗

PubMed1990

Colonic leiomyoma--an unusual cause of gastrointestinal hemorrhage in childhood. Report of a case.

Leiomyomas of the intestine are rarely found in the pediatric population. The authors' review of the literature revealed only three colonic leiomyomas previously described. The authors present the first reported case of a child with lower gastrointestinal hemorrhage secondary to a colonic leiomyoma. Pathologic aspects of intestinal leiomyomas are discussed along with the difficulty in histologic differentiation from leiomyosarcomas. Wide resection is recommended for spindle cell neoplasms of the intestine owing to difficulty in differentiating benign from malignant tumors.

Child↗

PubMed1990

Current preoperative bowel cleansing methods. Results of a survey.

A mail survey of 300 members of The American Society of Colon and Rectal Surgeons (ASCRS) was conducted to document the current methods of bowel preparation in use. Two hundred six questionnaires (69 percent) were returned. The majority of respondents (104 or 51 percent) used cathartics and enemas as the primary method of mechanical bowel cleansing. Eighty-nine (43 percent) used a PEG lavage, eight (4 percent) used mannitol, and one physician used a saline lavage method. Almost all the responding surgeons believed that their method of preparation was well tolerated by patients, provided good cleansing, and was associated with few complications. Most patients were admitted one day before surgery. All respondents used perioperative antibiotics, with the most common pattern being a combination of oral and parenteral agents. Surgeons using PEG lavage did more colonic resections per month and were fewer years out of their residency. This current pattern of preoperative bowel preparation has changed from previous surveys.

Anti-Bacterial Agents↗