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Biomedical subjects

G A Decker

Publications and source records attributed to G A Decker.

At least 19 recordsLinked to original sources
PubMed2001

Crohn's disease of the esophagus: clinical features and outcomes.

OBJECTIVES: Crohn's disease of the esophagus is rare. We sought to determine the clinical features and outcome of patients with esophageal Crohn's disease seen at our institution. METHODS: Patients with esophageal Crohn's disease evaluated at Mayo Clinic Rochester between 1976 and 1998 were identified. RESULTS: Twenty patients (0.2%) with esophageal involvement were identified. Median age at diagnosis was 31 years (range, 7-77 years). Eleven patients (55%) were female. Extraesophageal Crohn's disease preceded or was found at the same time as the diagnosis of esophageal Crohn's in all cases. Sixteen patients (80%) had symptoms referable to the esophagus. Endoscopic findings included ulcers in 17 (85%), erythema or erosions in 8 (40%), and strictures in 4 patients (20%). One patient had a fistula. The most common histological findings were active chronic inflammation (75%) and ulcer (30%). No granulomata were identified. Approximately one-half of our patients improved with first-line therapy. Eleven patients (55%) received immune modifier therapy. Six showed significant improvement on azathioprine, 6-mercaptopurine, or cyclosporine. Esophageal dilatation was required in six patients, and three patients required surgery. CONCLUSION: Esophageal Crohn's disease may be underdiagnosed. Patients with Crohn's disease complaining of esophageal symptoms should undergo upper endoscopy with biopsies, and the diagnosis of esophageal Crohn's disease should be entertained if aphthous or deep ulcers or strictures are present. Immune modifier therapy should be considered for steroid-dependent and steroid-resistant cases.

Adolescent↗
PubMed1995

Aberrant common hepatic artery aneurysm. A case report.

A 45-year-old white woman was found on selective superior mesenteric artery angiography to have an aneurysm arising in an aberrant hepatic artery. The aberrant hepatic artery originated from the superior mesenteric artery, and was the only artery supplying the liver. The aneurysm was excised and continuity of the aberrant artery was restored by insertion of a short segment of autogenous long saphenous vein.

Aneurysm↗
PubMed1994

Failure of terfenadine as an antipruritic agent in atopic dogs: results of a double-blinded, placebo-controlled study.

Terfenadine (5 mg/kg body weight, q12h) and placebo (0.5 grain/dog q12h) were both administered orally as individual agents to 18 dogs with atopy in a double-blinded study. No dog improved. Hyperactivity, polyphagia, lethargy, anorexia, increased pruritus, or ocular discharge were seen in three dogs treated with terfenadine. Under the conditions of the study, terfenadine was not a useful antipruritic agent for the atopic dog.

Administration, Oral↗
PubMed1992

Comparison of the clinical efficacy of two commercial fatty acid supplements (EfaVet and DVM Derm Caps), evening primrose oil, and cold water marine fish oil in the management of allergic pruritus in dogs: a double-blinded study.

Twenty dogs with atopy or idiopathic pruritus were treated in a double-blinded clinical trial with computer-randomized and computer-generated sequences of 4 fatty acid-containing products: evening primrose oil, cold water marine fish oil, DVM Derm Caps, and EfaVet. Each dog received each product for a 2-week period. Five of 20 dogs (25%) had a good-to-excellent reduction in their level of pruritus with at least 1 of the products: evening primrose oil (2 dogs), DVM Derm Caps (1), EfaVet (1), DVM Derm Caps and cold water marine fish oil (1). Only 1 dog experienced a side effect (loose stools). Clinical response to fatty acid supplements appeared to be quite individualized, and independent of age, breed, sex, weight, duration of disease, specific diagnosis, or number of positive intradermal test reactions.

Animals↗
PubMed1991

Postoperative external alimentary tract fistulas.

Most series dealing with external gastrointestinal fistulas cover experience of many years and include a heterogeneous sample of fistulas. We present our experience with 117 cases of postoperative external alimentary tract fistulas treated since 1980. Only fistulas caused by anastomotic leaks and operative injury to bowel are included. The overall mortality rate was 37%. The fistulas are classified into four types: type I-abdominal, esophagus, gastroduodenal (mortality rate, 17%); type II-small bowel (mortality rate, 33%); type III-large bowel (mortality rate, 20%), and type IV-all sites associated with a large abdominal wall defect (mortality rate, 60%). The main cause of death was intra-abdominal infection. Seventy-six percent of the patients required further operations. We conclude that despite the availability of all modern diagnostic and management facilities, postoperative external gastrointestinal fistulas treated during the 1980s continue to represent a surgical "disaster." Only prevention and improved methods in the management of the associated intra-abdominal infections could improve the results.

Abdominal Muscles↗
PubMed1990

Gastrointestinal fistulas associated with large abdominal wall defects: experience with 43 patients.

Experience with 43 patients with gastrointestinal fistulas associated with a large abdominal wall defect is presented. The overall mortality rate was 60 per cent; 37 per cent in patients who underwent the primary procedure in the home unit and 74 per cent in those from elsewhere. An average of five operations per patient was performed. The abdominal wall defect developed spontaneously as a consequence of postoperative peritonitis in 24 patients (mortality rate, 71 per cent) and was created intentionally as a part of the 'open management' in 19 cases (mortality rate, 47 per cent). Errors in management were identified in 63 per cent of the patients and this adversely influenced the outcome. Patients with this condition should be referred early to tertiary care facilities where diversion of the intestinal leak away from the defect, prompt control of the associated intra-abdominal infection and adequate handling of the defect itself can be performed.

Abdominal Muscles↗
PubMed1989

Five hundred operations for peptic ulcer disease at J.G. Strijdom Hospital, 1980-1987.

The introduction in the late 1970s of potent and effective anti-ulcer drugs revolutionised the medical treatment of peptic ulcer disease and modified the indications for surgical management. Since, as far as we were aware, there had been no previous detailed evaluation of the pattern of surgery for peptic ulcers in this country during the modern era of ulcer therapy, we decided to look at our experience since 1980.

Female↗
PubMed1989

Surgical audit--workload, utilisation of manpower and beds, pattern of admission and operations in a community teaching hospital.

The first surgical audit from a South African teaching hospital is presented. During a 1-year period (1987) 1,725 patients were treated in a 60-bed unit (29 patients/bed/yr). Eighty per cent of admissions were emergencies; 1036 operative procedures were performed (45% emergency operations). Aspects of workload, utilisation of beds, pattern of admission and operations are discussed. The audit indicated that a surgical unit in an urban teaching hospital for white patients serves mainly as an acute surgical facility.

Hospital Departments↗
PubMed1988

Aggressive treatment of severe diffuse peritonitis: a prospective study.

In a prospective study of 22 patients with diffuse peritonitis managed by the method of electively staged multiple laparotomies, the abdomen was left open in 9 patients. The patients were selected on the basis of the severity of their intra-abdominal infection: only massive faecal peritonitis, postoperative peritonitis and pancreatic abscesses were included. These amounted to only 9 per cent of all patients with intra-abdominal infection treated over a 2-year period. Up to seven re-operations were required per patient. In view of a high mortality rate of 32 per cent, the superiority of this aggressive management strategy over conventional methods is not fully established.

Adult↗
PubMed1987

Colitis cystica profunda simulating rectal carcinoma. A case report.

A case of colitis cystica profunda, the patient presenting with haematochezia and a rectal mass, is reported. The clinical and pathological features of this condition are discussed, and the difficulty in distinguishing this lesion from the much commoner rectal neoplasms is emphasised.

Adult↗