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Biomedical subjects

F J Tedesco

Publications and source records attributed to F J Tedesco.

At least 19 recordsLinked to original sources

[67Ga]citrate scintiscanning in active inflammatory bowel disease.

Twenty-five hospitalized patients were studied prospectively with [67Ga]citrate (GA) abdominal scintillation scanning in an attempt to define its role in the evaluation of patients with active inflammatory bowel disease (IBD). There were nine patients with ulcerative colitis (UC), seven with Crohn's disease (CD), and nine controls. In four patients, two with UC and two with CD, a tissue/plasma radioactivity ratio was obtained and compared to normals. All the UC patients had positive GA scans and only one of seven of the CD patients had a positive scan. There were no false positive scans. Scans performed after a 3- or 5-day delay were more accurate than 6-hr scans alone. Well-delineated colinic radioactivity 6 hr after injection which persists for 3 to 5 days indicates the presence of UC in patients with IBD, while a negative scan is more consistent with active CD. Colonic uptake at 6 hr which clears by 48 or 72 hr is not indicative of UC. This procedure aided in following the course of UC, delineating the extent of disease, and in differentiating active CD from an intraabdominal abscess. Tissues from UC patients had increased tissue/plasma ratioactivity ratios while tissues from CD patients had normal or decreased ratios which were consistent with the imaging data.

Adolescent

Therapy of antibiotic-associated pseudomembranous colitis.

Seven patients treated with oral cholestyramine for antibiotic-associated pseudomembranous colitis are reported. Response was variable with only one patient having a totally satisfactory clinical outcome. Five of seven patients had continued systemic signs with fever and leukocytosis throughout the course of cholestyramine. Two observations were relatively consistent. First, six of the seven patient had a decrease in the number of daily stools during therapy. Second, all patients showed persistence of the cytopathic toxin in stools obtained after three to seven days of cholestyramine therapy. Six patients who were subsequently treated with oral vancomycin had a prompt clinical improvement and clearance of the cytopathic toxin in the stool.

Aged

Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination.

Most investigators have stressed that the diagnosis of antibiotic associated pseudomembranous colitis is made by proctosigmoidoscopic examination. In our investigation, 6 patients with tissue culture evidence of a clostridial toxin in stools and either normal or only edematous rectal mucosa were studied with total colonoscopy. Five of six patients demonstrated pseudomembranes located in various areas of the colon at a time when the rectosigmoid area was uninvolved. This demonstrates the occurrence of antibiotic associated pseudomembranous colitis which can be missed by routine proctosigmoidoscopy. The incidence of rectal sparing in this disease remains undetermined. Further investigation to determine the occurrence of antibiotic colitis, response to different treatments, or sensitivity of tissue culture assays as a diagnostic aid in antibiotic associated pseudomembranous colitis must take this subgroup into account.

Ampicillin

Brucella-induced cholecystitis.

Acute cholecystitis is a rare complication of systemic brucellosis. This report details the occurrence of acute noncalculous cholecystitis in which Brucella suis was cultured from both the blood and the gallbladder. A discussion of the various diagnostic tests and the recommended therapy for brucellosis is included.

Acute Disease

Squamous cell carcinoma of the ascending colon.

A right-sided colon lesion appearing as a typical adenocarcinoma was biopsied and revealed squamous cell carcinoma. The etiologic possibilities include metastatic disease to the gastrointestinal tract (most likely from the lung in this case) and the very uncommon primary squamous cell carcinoma of the colon. The described features of both lesions are reviewed.

Carcinoma, Squamous Cell

Azulfidine- (sulfasalazine-) induced hepatic injury.

A patient with Azulfidine-related hepatotoxicity in which prompt recurrence of symptoms, fever skin rash, and laboratory evidence of hepatocellular injury occurred upon readministration of Azulfidine is reported. The clinical and biochemical features support the fact that this was an example of an acquired hypersensitivity reaction to Azulfidine.

Adolescent

Colonoscopic evaluation of rectal bleeding: a study of 304 patients.

We studied 258 patients with rectal bleeding and 46 patients with anemia and occult blood in the stool. All 304 patients had negative proctosigmoidoscopies, single-contrast barium studies that were negative or showed diverticula only, and colonoscopic evaluation. In the 258 patients, the overall incidence of finding significant lesions by colonoscopy was 41.5%. Twenty-nine patients (11.2%) had carcinoma and 17 patients (6.6%) had cecal telangiectasia. In the 46 patients, the overall incidence of finding significant lesions was 19.6%. Three patients with carcinoma were found in this group. A significant number of both benign and malignant lesions were detected by colonoscopy proximal to the splenic flexure. Colonoscopy should be done in patients with rectal bleeding or anemia and occult blood in the stool who have had negative proctosigmoidoscopies and single-contrast barium studies interpreted as normal or showing diverticula.

Adult

Effect of glucagon infusion on the renal clearance of amylase relative to creatinine.

Recent data seem to support a tubular defect as the mechanism of the elevated renal clearance of amylase relative to creatinine in acute pancreatitis. Glucagon has been proposed by some to be an important factor in this phenomenon. To examine the role of glucagon as this "tubular dysfunction factor", we investigated the effect of intravenously infused glucagon on the fractional excretion of amylase and the tubular handling of a low molecular weight protein, beta2 microglobulin, in normal, healthy volunteers. At glucagon levels far in excess of those seen in pancreatitis, the clearance ratio of beta2 microglobulin relative to creatinine increased, whereas the clearance ratio of amylase relative to creatinine did not increase above the normal range. The dissociation between beta2 microglobulin clearance and amylase clearance allows one to question the theory that tubular dysfunction is the mechanism of the elevated renal clearance of amylase relative to creatinine in acute pancreatitis. Glucagon does not appear to be the sole factor responsible for the elevation of renal clearance of amylase relative to creatinine in acute pancreatitis.

Adult

Antral diaphragm--a cause of gastric outlet obstruction in infants and children.

Gastric outlet obstruction in infants and children may be due to a partial, prepyloric antral diaphragm. Twelve new patients are added to the 32 described previously. Onset of symptoms varied from shortly after birth to five years. Nonbilious vomiting was the most common presenting symptom. Radiographic evaluation requires specific technique for demonstration of the web and to differentiate this from pylorospasm and pyloric stenosis. Gastroscopy was employed in three patients. Repair usually consisted of incision of the web and construction of a patulous gastric outlet. All patients remained asymptomatic after operation. The etiology of the webs remains unknown, but they may result from an excessive local endodermal proliferation early in gastric development.

Abnormalities, Multiple

Clindamycin and colitis: a review.

Many studies have shown that clindamycin may cause pseudomembranous colitis, a potentially fatal complication. At present, prevention of this complication depends on (1) prescription of the drug only for specific severe infections, (2) early investigation and discontinuation of clindamycin if diarrhea ensues, and (3) vigorous supportive therapy.

Adolescent