Biomedical subjects

D P Otchy

Publications and source records attributed to D P Otchy.

11 recordsLinked to original sources

PubMed2000

Learning curve of transrectal ultrasound.

PURPOSE: Transrectal ultrasound is the most accurate means of assessing the degree of invasion for rectal neoplasms. A learning curve for performing and interpreting these studies exists, but it is unknown how long or steep it is. We reviewed our initial results with transrectal ultrasound to determine our accuracy and to define the learning curve. METHODS: All patients undergoing transrectal ultrasound during our initial 30 months of experience were included. Each patient was staged with transrectal ultrasound and, after resection, the histopathologic stage was compared with transrectal ultrasound staging. The accuracy of transrectal ultrasound was calculated at intervals as experience was gained. RESULTS: A total of 42 examinations were performed on 41 neoplasms in 41 patients. Comparison between transrectal ultrasound and the pathologic stage could be made in 36 studies. Overall accuracy of degree of wall invasion was 78 percent. Overstaging occurred with eight neoplasms, and one lesion was understaged. Accuracy of transrectal ultrasound staging improved with time: 58 percent of the initial 12 studies were staged correctly compared with 87.5 percent accuracy in the remaining 24 examinations (P = 0.048). CONCLUSION: A definite learning curve was apparent. We conclude that transrectal ultrasound is a relatively simple procedure to learn and, once a moderate degree of experience is gained, should be routinely incorporated into the evaluation of rectal neoplasms.

Adult↗

PubMed1998

Timing of computed tomography in acute diverticulitis.

PURPOSE: The purpose of this study was to evaluate the use and timing of computed tomography in the treatment of patients with acute left-sided diverticulitis. METHODS: We reviewed our four-year experience of 47 patients with the diagnosis of acute diverticulitis. We have evaluated the benefits of admission vs. delayed computed tomography in patients with this diagnosis. RESULTS: Of the 47 patients, 17 were diagnosed on clinical grounds alone, treated, and released. Thirty patients had their clinical diagnoses of diverticulitis evaluated with either computed tomographic scan (26) or laparotomy (4). Eleven of those 30 (36 percent) patients were found to have normal computed tomographic scans, indicating inaccurate clinical diagnosis, and all patients who underwent laparotomy had the pathologic diagnosis of diverticulitis. Six of the 47 patients had abscesses, but only 2 were identified at the time of admission. The remaining four abscesses were identified on delayed computed tomographic scans after failure of medical therapy. Thirty-seven hospital days were used by patients with inaccurate diagnoses before their computed tomographic scans. Analysis of cost revealed that a computed tomographic scan for all 47 patients would have cost less than the expense of admission for just the 11 patients who had normal computed tomographic scans. CONCLUSION: Routine admission computed tomographic scan for patients with acute diverticulitis leads to more accurate diagnosis, earlier identification of complications, and possible decreased hospital costs.

Acute Disease↗

PubMed1997

Ileoanal pouch in the active duty population: effect on military career.

UNLABELLED: Patients undergoing proctocolectomy with an ileal pouch-anal anastomosis (IPAA) are reported to have an improvement in lifestyle and are able to return to their previous occupation. We questioned whether this was also true of active duty military personnel who require this operation. The rigors of military service are unlike that of most civilian occupations. Soldiers must maintain a physical fitness regimen and remain eligible to deploy overseas. We reviewed our experience with IPAA to determine whether our active duty patients could return to full duty. METHODS: The charts of all patients undergoing IPAA since October 1990 were reviewed, and each patient was interviewed by telephone to elicit late complications not noted in their medical records and to inquire about their present bowel function. Patients were classified as active duty or nonactive duty. Active duty patients were queried as to whether they have remained on active duty, have required a permanent profile, have been promoted, or have been deployed overseas. If a military medical evaluation board had determined whether they were fit for duty, the findings of the board were reviewed. RESULTS: Thirty-four patients underwent an IPAA; 15 were active duty. Mean follow-up was 24 months. Indication for IPAA was ulcerative colitis in 76 percent of patients and familial adenomatous polyposis in 24 percent. J-Pouch was created in 88 percent of patients. Mean bowel movement frequency was seven per day, and 84 percent could defer a bowel movement for more than one hour. Leakage requiring a pad was reported by three patients (9 percent). Seven of 15 active duty patients (47 percent) remained on active duty, and 3 have been promoted. Of the eight patients who were evaluated by a medical evaluation board and were retired, only four were found unfit because of poor bowel function. Therefore, if it were not for other physical limitations, 11 of 15 (73 percent) active duty patients could have continued to serve. CONCLUSIONS: Barring other disqualifying illnesses, active duty soldiers can anticipate continuation of their military career following IPAA. Active duty soldiers, if motivated, can excel and maintain their status in the military.

Adolescent↗

PubMed1996

Metachronous colon cancer in persons who have had a large adenomatous polyp.

OBJECTIVE: To determine, among persons who have had a large colon polyp, the risk of subsequent colon cancer at a site distant from that polyp. METHODS: Follow-up was done for 226 persons at the Mayo Clinic who had had a > or = 1-cm polyp demonstrated on barium enema between 1965 and 1970 and for whom yearly colon surveillance examination was recommended. Information was collected from Mayo Clinic records and from contact with patients, physicians, and other hospitals regarding the results of surveillance examinations and the development of colon cancer. Colon surveillance was routinely done at the Mayo Clinic using the technique of single contrast barium enema with vigorous manual fluoroscopic examination and proctoscopy. The expected rate of colorectal cancer (CRC) was calculated based on previously published rates for this community. RESULTS: Patients received, on average, four colon examinations in addition to the examination that discovered the index polyp. During 2126 person-years of follow-up, 16 persons developed a colon cancer at a location other than the site of the index polyp, in comparison with 4.0 expected cases, for a standardized incidence ratio of 4.0 (95% CI,2.3, 6.4). The cancers were large (mean 4.5cm) at presentation, and eight of the 16 cancers had been preceded within 3 yr by at least one negative barium enema. CONCLUSIONS: The rate to develop colon cancer in persons who have had a large colon polyp es about 4 times the expected rate, suggesting that such persons should be considered for aggressive colonoscopic surveillance. The failure to detect early cancer or its precursors by surveillance barium enema is probably explained by inherent insensitivity of single contrast barium enema.

Adenomatous Polyps↗

PubMed1995

Does the avoidance of nasogastric decompression following elective abdominal colorectal surgery affect the incidence of incisional hernia? Results of a prospective, randomized trial.

PURPOSE: In a previous, prospective, randomized study of the use of nasogastric tubes in patients undergoing elective abdominal colorectal surgery, we found that patients who did not have nasogastric (NG) decompression postoperatively had a significantly higher rate of abdominal distention, nausea, and vomiting. Patients from that study have now been followed for a median duration of 5.3 years to evaluate whether this elevation in perioperative intra-abdominal pressure would subsequently lead to an increased incidence of incisional hernia. RESULTS: Of the 251 patients who received NG decompression, 8 (3.2 percent) developed incisional hernias compared with 15 (6.6 percent) of 229 patients who were not decompressed (P = 0.085). CONCLUSION: The increase in postoperative abdominal distention and vomiting that occurs in patients who do not receive NG decompression does not lead to a significantly increased incidence of incisional hernia. Furthermore, we continue to support avoidance of routine prophylactic postoperative nasogastric decompression in uncomplicated, elective abdominal colorectal surgery.

Colon↗

PubMed1993

Radiation injuries of the colon and rectum.

Approximately 5% to 10% of patients receiving abdominopelvic radiation therapy will develop a colon or rectal injury. Thorough evaluation of the patient to determine the extent of the injury and the presence of concomitant lesions and to rule out recurrent malignancy is urged. Many radiation complications can be managed with medical regimens. Although colostomy remains a valuable and frequently utilized mode of treatment, it is by no means the sole alternative when surgical intervention is required. Rectal resection with colorectal or coloanal anastomosis can be performed safely for some injuries involving the distal rectum. Surgery for irradiated bowel should be focused on minimizing dissection to minimize injuries and on providing healthy non-irradiated tissues to provide adequate blood supply to promote healing. Patients who have received abdominopelvic radiation are at greater risk of developing colorectal cancer, and cancer surveillance should be commenced 5 years after completion of therapy.

Colonic Diseases↗

PubMed1992

The importance of stabilizing the specimen taken at needle localized biopsy of the breast for microcalcifications.

The specimen from a needle localized biopsy of the breast must be compared with its roentgenogram to locate the area of microcalcification within the specimen. Any errors in aligning the specimen to its roentgenogram could result in failure to sample and microscopically examine the area of the microcalcifications. The results of the current study show the importance of maintaining the orientation and position of the specimen from the time the roentgenogram is taken until it is examined by the pathologist. Each of 45 consecutive specimens taken at biopsy were secured to a square of cardboard immediately after excision from the breast to maintain the orientation of the specimen during the process of roentgenography. The histologic findings of this group (group 2) were compared with the preceding 87 biopsies (group 1) in which no effort had been made to immobilize the specimen for a roentgenogram. The presence of microcalcifications was confirmed roentgenographically in all the specimens of each group. Histologic confirmation of the presence of microcalcifications was obtained in 42 of 45 specimens in group 2 and only 71 of 87 in group 1 (p = 0.035). Thirty-one per cent of specimens in group 2 contained a carcinoma compared with 10 per cent in group 1. We conclude that fixing the position of the specimen after excision improves the ability of the pathologist to locate the suspicious area of microcalcifications within the specimen. This may lead to an increase in the yield of these biopsies and the identification of occult carcinomas that might otherwise be missed.

Adult↗

PubMed1992

Properitoneal synthetic mesh repair of recurrent inguinal hernias.

Safe reconstruction of the inguinal floor is the goal of any operation for repair of groin herniation. Operating in the properitoneal space avoids dissection of the scarred cord, and the incidence of testicular complications is markedly lowered. This study reports our experience with placing synthetic mesh between the peritoneum and the deficient inguinal floor for the repair of recurrent hernias of the groin area. During a five year period, 84 men underwent repair of 100 recurrent inguinal hernias using the properitoneal approach. Fifty-four patients had repair of a unilateral recurrent hernia, 16 had repair of a bilateral recurrent hernia and 14 had repair of both a recurrent hernia and a contralateral primary hernia. Postoperative complications occurred in six patients. No testicular complications were observed. Postoperative follow-up study ranged from six months to five years. There were only three recurrent hernias after this repair. All occurred within the first six months postoperatively. The properitoneal approach for repair of recurrent groin hernias using prosthetic mesh safely creates a new "fascia transversalis" with a low rate of recurrence and effectively eliminates testicular complications.

Adult↗

PubMed1991

Multiple, giant fibroadenoma.

Multiple, giant fibroadenomas are histologic and clinical variants of "juvenile" or "giant" fibroadenomas. These tumors are rare and occur mainly in adolescent and young adult black females. The individual lesions are well encapsulated with a histologic pattern primarily of the "juvenile" type, although cases of the "adult" type have been reported. A high incidence of recurrence is noted upon local excision, although this may decrease as the patient becomes older. Management options include local excision with reconstruction, reduction mammoplasty, and simple mastectomy with reconstruction. A case is described of this condition with review of the literature.

Adenofibroma↗

PubMed1990

Effect of mass screening mammography on staging of carcinoma of the breast in women.

In 1980, our institution began a screening mammography program. A retrospective review was done to document whether or not implementation of this program significantly changed the method of discovery of carcinoma of the breast and the stage of carcinoma of the breast at presentation in the patients we studied. Women diagnosed with carcinoma of the breast during a three year period, prior to the institution of the screening program (group 1) were compared with a similar set of patients diagnosed after establishment of the program (group 2). There were 165 patients in group 1 and 181 in group 2. The vast majority of cancers for those in group 1, 84.2 per cent, were discovered at self-examination, as compared with 46.3 per cent for those in group 2. Forty-eight per cent of the cancers for those in group 2 were first discovered by mammography as compared with 6.1 per cent in group 1. There was no statistical difference in the number of patients presenting with stage O, III and IV disease. The percentage of patients presenting with stage I disease rose significantly after the establishment of the mammography program (16.4 per cent in group 1 to 41.5 per cent in group 2). Findings from this study confirm that a mammographic screening program can have a marked effect on lowering the stage of carcinoma of the breast at presentation. The current recommendations for screening mammography should be implemented. Doing so will result in earlier detection and improved survival in this group of patients.

Breast↗

PubMed1987

The malpositioned Greenfield filter: lessons learned.

It is essential that a malpositioned Greenfield filter be recognized as such immediately. Three of the 21 Greenfield filters inserted in the current study were malpositioned. One was placed in the right renal vein, one in the right common iliac vein, and another in the right inferior vena cava in a patient with caval duplication and left ileofemoral thrombosis. A review of the postprocedure radiographs was performed. It was found that two of the three malpositioned filters were at an appropriate vertebral level, and, therefore, this single criteria was inadequate to judge proper filter positioning. A more reliable parameter was the maximal diameter of the open legs of the filter. The mean diameter of the legs in the correctly positioned filters was 29.9 mm compared with 19.0 mm for the malpositioned filters. The authors recommend that the diameter of the filter legs be measured on all postprocedure radiographs. If this diameter is not 30 +/- 4 mm (two standard deviations), then malposition of the filter should be suspected, regardless of the vertebral level at which the filter lies.

Adult↗