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Biomedical subjects

G W Falk

Publications and source records attributed to G W Falk.

51 records · Page 3Linked to original sources
PubMed1993

Surgical management of high-grade dysplasia in Barrett's esophagus.

The role of surgery in patients with Barrett's esophagus and high-grade dysplasia is controversial. The aims of this study were to determine the prevalence of unsuspected early cancer and to evaluate surgical outcome in a cohort of patients with high-grade dysplasia. Records of all 16 patients who underwent esophagectomy for high-grade dysplasia from 1986 to 1991 were reviewed. All had preoperative endoscopy with no gross evidence of carcinoma, and none had a preoperative diagnosis of intramucosal or invasive carcinoma. Intramucosal carcinoma was found in six (38%) resection specimens. There were no cases of invasive carcinoma or lymph node metastases. One patient (6%) died 3 months postoperatively. The remaining patients are alive without evidence of recurrent cancer (range of follow-up, 2-68 months). Early postoperative complications occurred in seven patients (44%). Late complications occurred in 11 patients (73%). Anastomotic strictures accounted for seven of the 11 (64%) late complications. Complications were successfully managed conservatively in all but two patients. One required laryngectomy for chronic aspiration and another required a gastrojejunostomy for gastric outlet obstruction. Intramucosal carcinoma that had been unsuspected is frequently found in patients with Barrett's esophagus and high-grade dysplasia. Mortality associated with esophagectomy is low, and perioperative complications can usually be managed conservatively. Esophageal resection is indicated in appropriately selected patients with Barrett's esophagus and high-grade dysplasia.

Adenocarcinoma↗
PubMed1993

Interaction between patient and test administrator may influence the results of edrophonium provocative testing in patients with noncardiac chest pain.

Edrophonium is a widely used provocative agent in the evaluation of noncardiac chest pain, with reported positivity rates of 30-55%. The influence of a subjective response and psychological factors on test results have not been examined previously. A retrospective analysis was performed to compare positivity rates for three physicians in the same laboratory. This was followed by a prospective study of 62 patients with noncardiac chest pain randomized to two groups. Group 1 patients were told that intravenous medication was given to observe changes in the tracing. Group 2 patients were told that the injection was to elicit their usual pain. During the 2-yr retrospective review, 260 patients were tested. The positivity rate varied from 31.1% with physician A to 20.2% with physician B and 7.5% for physician C (p = 0.001 for A vs. C, and p = 0.04 for B vs. C). In the prospective study, chest pain was elicited in nine of 62 patients (14.5%). Two of the 29 patients in group 1 (6.9%) and seven of 33 patients in group 2 (21.2%) contributed to this result. Contraction amplitude and duration increased similarly in all groups. These data suggest that edrophonium testing may be influenced by coaching, that manometric changes are similar in positive and negative tests, and that the prevalence of positive tests is lower than previously reported.

Adult↗
PubMed1993

Assessment of upper gastrointestinal motility in the cancer-associated dyspepsia syndrome.

Cancer patients experience many gastrointestinal symptoms which may lead to weight loss. Assessment of gastrointestinal motility may contribute to our understanding of these symptoms and suggest rational therapeutic approaches to the anorexia-cachexia syndrome. We have evaluated a simple, inexpensive, well-tolerated test of upper gastrointestinal motility in patients with advanced cancer. One-centimetre portions of radiopaque nasogastric tubing were ingested with food. Six hours later, a flat-plate abdominal x-ray was obtained to determine the marker placement. Patients were evaluated for gastrointestinal symptoms. Those with more symptoms, particularly early satiety, had a greater incidence of reduced upper gastrointestinal motility.

Adult↗
PubMed1991

Acute colonic pseudo-obstruction associated with interleukin-2 therapy.

In this case report, we present a patient with metastatic gastric carcinoma who developed massive colonic dilatation during treatment with recombinant interleukin-2. The spectrum of gastrointestinal symptomatology associated with interleukin-2 therapy is broad. However, colonic pseudo-obstruction, to our knowledge, has never before been reported. We review therapy for colonic pseudo-obstruction and a proposed mechanism of interleukin-2 toxicity. We report this case to heighten awareness of the potential for the development of this complication in patients undergoing interleukin-2 immunotherapy.

Acute Disease↗
PubMed1989

Primary biliary cirrhosis in a patient with multiple sclerosis.

A 47-yr-old patient with primary biliary cirrhosis and multiple sclerosis is reported. Although primary biliary cirrhosis has been associated with numerous other autoimmune disorders, it has not, to the authors' knowledge, previously been reported in association with multiple sclerosis.

Autoimmune Diseases↗
PubMedDate not supplied

Endosonography in the evaluation of patients with Barrett's esophagus and high-grade dysplasia.

Endosonography, which provides high-resolution images of the esophageal wall, could potentially detect carcinoma not visible endoscopically in patients with Barrett's esophagus and high-grade dysplasia. We studied the ability of endosonography to detect early esophageal carcinoma in 9 patients with Barrett's esophagus and high-grade dysplasia who were candidates for esophagectomy. Pre-operative endoscopy and biopsy revealed high-grade dysplasia without evidence of carcinoma in all patients. Pre-operative endosonographic evaluations were compared to the pathologic diagnoses of resected specimens. Post-operatively, 3 of the 9 patients were found to have intra-mucosal carcinoma. Endosonography identified a tumor in only 1 of these 3 patients and over-staged it as invasive carcinoma (T2, N1). In 2 of the 6 patients without intra-mucosal carcinoma, endosonography predicted invasive carcinoma (T2, N0). Endoscopy revealed mucosal nodularity in each of the 3 over-staged patients. We conclude that recommendation of the routine use of endosonography to determine the need for surgery in patients with Barrett's esophagus and high-grade dysplasia would be premature, because the current generation of echo-endoscopes does not reliably differentiate between benign and malignant wall thickening.

Adenocarcinoma↗
PubMedDate not supplied

Omeprazole: a new drug for the treatment of acid-peptic diseases.

Omeprazole is the first of a new class of gastric antisecretory drugs, proton pump inhibitors. It inhibits the H+,K(+)-adenosinetriphosphatase enzyme of the gastric parietal cell, resulting in potent, long-lasting suppression of basal and stimulated acid secretion. The drug is currently approved for treatment of gastroesophageal reflux disease and Zollinger-Ellison syndrome. In clinical trials, treatment with omeprazole results in rapid healing of duodenal ulcers; it is also effective in treating gastric ulcer disease. It is uniformly well tolerated without significant adverse effects, although animal studies linked profound long-term suppression of gastric acid secretion with the development of gastric carcinoids. Potential future uses include the prophylaxis of ulceration secondary to stress or use of nonsteroidal anti-inflammatory drugs, and the prophylaxis of recurrent peptic ulcer disease.

Animals↗
PubMedDate not supplied

Current status of Helicobacter pylori in peptic ulcer disease.

All patients with documented, past or present gastric or duodenal ulcers and who are infected with Helicobacter pylori should undergo antimicrobial therapy to eradicate it. Data do not yet support giving antimicrobial therapy to treat nonulcer dyspepsia or to prevent gastric neoplasia. H pylori infection is the main cause of chronic superficial gastritis and is associated with both gastric and duodenal ulcers. However, it has no proven relationship with nonulcer dyspepsia. H pylori infection is currently diagnosed by either endoscopic biopsy or serologic titers for a specific immunoglobulin (IgG) antibody. No noninvasive technique is available to document eradication of infection, although urea breath tests will soon simplify both the diagnosis of infection and documentation of eradication. Eradicating H pylori infection decreases the rate of ulcer recurrence. Treatment currently involves a 2-week, three-drug regimen of bismuth subsalicylate, tetracycline, and metronidazole, or a two-drug regimen of omeprazole and amoxicillin; other, simpler regimens are under investigation.

Anti-Bacterial Agents↗
PubMedDate not supplied

Treatment of Helicobacter pylori in nonulcer dyspepsia: should we or shouldn't we?

Two recent trials of treatment to eradicate Helicobacter pylori in infected patients with nonulcer dyspepsia seemingly came to opposite conclusions: one found such treatment to be beneficial but the other did not. My interpretation: If a patient has unexplained dyspepsia and no abnormal findings on endoscopy, blood chemistry, or the blood count, it is reasonable to test for H pylori and to give antibiotics if he or she tests positive. However, in no more than approximately one fourth of such patients will the problem respond to therapy. Furthermore, one should never give anti-H pylori treatment without first obtaining proof of infection.

Anti-Ulcer Agents↗