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Biomedical subjects

F A Farraye

Publications and source records attributed to F A Farraye.

At least 19 recordsLinked to original sources
PubMed1999

A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy.

OBJECTIVES: To determine whether an enhanced compliance program (ECP) improves patient compliance with bismuth subsalicylate, metronidazole, and tetracycline hydrochloride (BMT) triple therapy for the treatment of Helicobacter pylori infection and to identify factors that affect compliance with therapy. DESIGN: A randomized controlled trial conducted in 4 staff-model health centers of a health maintenance organization in Massachusetts. PATIENTS AND METHODS: A total of 125 patients 18 years of age or older with peptic ulcer disease or dyspepsia whose clinicians prescribed BMT triple therapy for 14 days were randomized to a control group or to the ECP group. The ECP group received medication counseling (written and oral) from a pharmacist, along with a medication calendar and a minipillbox, as well as a follow-up telephone call after initiation of therapy. Compliance was assessed by a pill count, and factors affecting adherence to the regimen were identified by patients' reports. RESULTS: There was no statistically significant difference between the 2 groups in the number of patients taking more than 60% of the medications (89% of the control group vs 95% of the ECP group; P>.30). However, there was a statistically significant difference in the number of patients taking more than 90% of the medications (67% of the control group vs 89% of the ECP group; P<.01). An intention-to-treat analysis confirmed these results. The most frequently reported adverse effect was gastrointestinal intolerance. Other factors reported to affect compliance included the frequency of dosing and the number of pills. CONCLUSIONS: These findings suggest that although adverse effects were common, most patients were able to complete 60% or more of the 2-week regimen. An ECP further improved the percentage of medications taken.

Adult↗
PubMed1999

Screening for colorectal cancer with flexible sigmoidoscopy by nonphysician endoscopists.

PURPOSE: Screening with sigmoidoscopy reduces the risk of death from colorectal cancer. Only 30% of eligible patients have undergone sigmoidoscopy, in part because of a limited supply of endoscopists. We evaluated the performance and safety of screening sigmoidoscopic examinations by trained nonphysician endoscopists in comparison with board-certified gastroenterologists. SUBJECTS AND METHODS: Asymptomatic patients 50 years or older without evidence of fecal occult blood and no personal history or family history of a first-degree relative with colorectal cancer under age 55 years were offered sigmoidoscopy. All examinations were performed either by a gastroenterologist or a trained nonphysician endoscopist at a staff model health maintenance organization. Outcomes included the depth of examination, number and histology of polyps, and complications. RESULTS: Nonphysicians performed 2,323 sigmoidoscopic examinations, and physicians performed 1,378 examinations. The mean (+/-SD) depth of sigmoidoscopy examinations performed by nonphysicians was 52 +/- 10 cm compared with 55 +/- 9 cm (P <0.001) in physicians. Nonphysicians detected neoplastic polyps in a greater proportion of patients (7.8%) than physicians (5.8%), but this difference was not significant after adjusting for differences in the age, sex, and family history of the patients (P = 0.35). No major complications occurred. The cost per examination, including the nonphysician training cost, was lower for nonphysicians ($186 per examination) than for physicians ($283 per examination). CONCLUSIONS: Appropriately trained nonphysicians may be capable of performing safe and effective screening for colorectal cancer with flexible sigmoidoscopy. An increased use of nonphysicians to perform sigmoidoscopy may increase the availability and reduce the cost of the procedure.

Aged↗
PubMed1999

Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis.

BACKGROUND & AIMS: Chronic ulcerative colitis (CUC)-associated adenoma-like DALMs (dysplasia-associated lesions or masses) pose a difficult clinical problem to both gastroenterologists and pathologists because they are difficult to distinguish endoscopically and pathologically from sporadic adenomas that develop coincidentally in patients with CUC. The aim of this study was to evaluate the outcome of CUC patients with an adenoma-like DALM treated conservatively and to compare the findings with CUC patients with a coincidental sporadic adenoma. METHODS: Clinical, endoscopic, and pathological features and outcome of 24 CUC patients with an adenoma-like DALM were compared with those of 10 CUC patients with a coincidental sporadic adenoma and 49 non-CUC (control) patients with a sporadic adenoma. Patients were followed up for a mean of 42.4 and 41.2 months for the 2 CUC groups, respectively, and 37.0 months for the non-CUC controls by endoscopic surveillance. RESULTS: Of the 24 CUC patients with adenoma-like DALMs (male/female ratio, 14/10; mean age, 61.5 years; mean duration of colitis, 10.4 years), 14 (58%) developed further adenoma-like DALMs within the follow-up interval. Only 1 patient (4%) developed an isolated focus of low-grade dysplasia, and none developed adenocarcinoma. Five of 10 (50%) CUC patients with sporadic adenomas developed further adenomas, and none of the patients in this group developed either dysplasia or adenocarcinoma. Of the 49 non-CUC control patients, 39% developed further adenomas. CONCLUSIONS: CUC patients who develop an adenoma-like DALM that endoscopically and histologically resembles a sporadic adenoma, regardless of its location (either within or outside areas of documented colitis), may be treated with polypectomy and endoscopic surveillance because of its relatively benign course.

Adenoma↗
PubMed1998

Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy?

BACKGROUND: There is controversy over whether patients who have a small tubular adenoma on screening flexible sigmoidoscopy should undergo colonoscopic examination of the proximal colon. OBJECTIVE: To prospectively determine the prevalence of advanced polyps in the proximal colon among patients who have small adenomas on screening sigmoidoscopy. DESIGN: Prospective cohort study. SETTING: A health maintenance organization and a Veterans Affairs medical center. PATIENTS: Asymptomatic patients older than 50 years of age who had no risk factors for colon cancer and underwent sigmoidoscopy. INTERVENTION: At the time of sigmoidoscopy, all polyps were biopsied and characterized. All patients with distal adenomas were offered colonoscopy. MEASUREMENTS: The size and histology of polyps identified by sigmoidoscopy and colonoscopy were noted. Polyps were considered advanced if they were larger than 10 mm or were tubulovillous, villous, or malignant. The prevalence of advanced proximal polyps was determined, and patients were stratified by the size and number of distal polyps found by sigmoidoscopy. RESULTS: Among 4490 patients who underwent sigmoidoscopy, a neoplastic lesion was detected in 401 (8.9%) and colonoscopy was done in 301 (75%). Of 90 patients with a single tubular adenoma 1 to 5 mm in diameter in the distal colon, 0% (95% CI, 0.0% to 4.0%) had an advanced proximal polyp compared with 5.4% (CI, 2.4% to 10.4%) of those who had multiple distal polyps 1 to 5 mm or 6 to 10 mm in diameter and 7.9% (CI, 2.6% to 17.6%) of those who had advanced distal polyps (P = 0.013 for trend). The low-risk group with a single tubular adenoma 1 to 5 mm in diameter represented 44% of all patients with distal adenomas or cancers found at flexible sigmoidoscopy. CONCLUSIONS: Among patients undergoing screening sigmoidoscopy, those with single tubular adenomas of 5 mm or less had a low prevalence of advanced proximal polyps. These patients may not benefit from colonoscopy.

Adenoma↗
PubMed1996

Peristomal hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic, suppurative, and cicatricial cutaneous disease with clinical manifestations including inflammatory lesions and nodules, abscesses, and sinus tracts. We describe an unusual case of peristomal lesions that may represent hidradenitis suppurativa. Peristomal hidradenitis suppurativa has not been previously reported. This unusual complication demonstrates the need for a thorough patient history to identify any systemic disease that may contribute to peristomal skin problems.

Crohn Disease↗
PubMed1996

Toothpick ingestion as a cause of acute and chronic duodenal inflammation.

Toothpicks are a common cause of foreign body ingestion. We present two patients with duodenal inflammation secondary to toothpick ingestion. In the first patient, there was acute onset of severe abdominal pain, with findings on computed tomography consistent with marked duodenal inflammation. Endoscopy revealed a toothpick embedded in the wall of the duodenum with associated ulceration. In the second patient, 4 months of chronic abdominal pain was evaluated by upper endoscopy which revealed a toothpick embedded in a 1-cm ulcer found in the third portion of the duodenum. Both patients denied memory of ingestion of the toothpicks. Endoscopic removal of the toothpicks resulted in rapid relief of symptoms.

Abdominal Pain↗
PubMed1996

Intraductal mucin-hypersecreting neoplasm "mucinous ductal ectasia": endoscopic recognition and management.

OBJECTIVES: Intraductal mucin-hypersecreting neoplasm (IMHN), also termed mucinous ductal ectasia, is a rare disorder of the pancreas characterized by distension of the pancreatic duct with mucus. This study attempted to clarify the clinical, radiographic, histological, and treatment approaches to this entity. METHODS: The medical records, radiological imaging studies, and pathology specimens of eight patients with IMHN seen during a 3-yr period were reviewed. The diagnosis of IMHN was established by findings during ERCP, which included mucin plugging of the papilla, mucin extrusion from the papillary orifice after intraductal injection of contrast medium, mucinous filling defects in the main pancreatic duct, and dilated main and branch pancreatic ducts in the absence of obstructing ductal strictures. RESULTS: All patients presented with an initial clinical diagnosis of acute or chronic pancreatitis, suspected cystic neoplasm, or biliary obstruction. Noninvasive imaging studies such as transabdominal ultrasonography or CT and laboratory evaluation did not seem to help in defining the disease. Five patients underwent Whipple resection; pathology included papillary ductal hyperplasia in one, dysplastic mucinous epithelium in two, and mucinous cystadenocarcinoma in two. All five patients had associated histological evidence of chronic pancreatitis. All patients are alive and well after 21-53 months without evidence of residual disease. CONCLUSIONS: IMHN has a wide spectrum of clinical, radiological, and histological features. The indolent biologic behavior and favorable prognosis of IMHN suggest that it is one of the most curable forms of pancreatic malignancy.

Adult↗