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Biomedical subjects

I Cohn

Publications and source records attributed to I Cohn.

At least 19 recordsLinked to original sources
PubMed1998

Early gastric cancer and Helicobacter pylori: 34 years of experience at Charity Hospital in New Orleans.

Good survival rates have been reported for resected early gastric adenocarcinoma (EGC) in patients found via screening procedures. However, the prevalence of Helicobacter pylori in EGC in unscreened populations is unclear. The major purpose of this investigation was to analyze the clinical experience and incidence of H. pylori in unscreened patients presenting with EGC at Charity Hospital over a 34-year period. From 1963 through 1997, the tumor registry at Charity Hospital compiled data on 2497 patients evaluated for gastric carcinoma. Of these patients, 26 (1%) had lesions that were confined to the mucosa or submucosa, i.e., T1N0M0 (American Joint Commission on Cancer classification). Pathology specimens and medical records were retrieved for confirmation of diagnosis and retrospective analysis for H. pylori. H. pylori was analyzed by Steiner staining and immunohistochemistry using a polyclonal antibody. EGC was detected in 12 men and 14 women with a mean age of 62 years. Upper gastrointestinal X-ray studies were performed on 19 of the 26 patients and failed to conclusively demonstrate a lesion in any case. Endoscopy was performed on 22 patients, and preoperative biopsies were positive in 95 per cent of these. Operative procedures included 2 local excisions and 22 subtotal and 2 total gastrectomies. No extended nodal dissections were performed. Microscopic evaluation revealed lesions limited to the mucosa in 63 per cent of cases and involving the submucosa in 37 per cent of the cases. Of the 14 patients evaluable of H. pylori, 79 per cent were positive for the bacterium. The status of 2 patients is unknown, and only 1 patient died of the original gastric cancer, for a disease-free survival of 96 per cent. The 5-year and 10-year overall survival rates were calculated to be 50 per cent and 21 per cent, respectively, when all causes of death were taken into consideration. Median follow-up of the survivors was 64 months. Resection of early gastric carcinoma in unscreened patients without extended lymphadenectomy yielded excellent results. H. pylori was present in 79 per cent of cases. These data suggest an association between H. pylori and EGC. Whether H. pylori infection is an etiologic factor in gastric cancer remains an area of active research.

Actuarial Analysis↗
PubMed1997

Surgical management of chronic pain from chronic pancreatitis.

Chronic pain from chronic pancreatitis remains a difficult clinical problem. We present the results of surgical attempts to control this pain. For the past 3 years, all patients with chronic pancreatitis and pain requiring high-dose narcotics or hospitalization for pain control were evaluated by the following algorithm. Any anatomic pathology causing ductal dilatation was surgically addressed first (Puestow's procedure, pseudocyst drainage, or sphincteroplasty). If there was no evidence of ductal dilatation, or if pain recurred postoperatively, denervation procedures were performed (splenopancreatic flap, thorascopic sympathectomy, or resection). Pain recurrence was defined as the need for further hospitalization or reoperation. Data were analyzed by comparison of two proportions. Follow-up averaged 26 months. Thirty-seven patients underwent 44 operations solely in an attempt to control pain; 62 per cent were male, and 70 per cent had chronic alcoholic pancreatitis. Our results show that surgical management provides relief in 68 per cent of patients, and no one procedure is clearly superior to others.

Adult↗
PubMed1991

Germfree animals and technics in surgical research.

Germfree animals have been reared to a size, weight, and age permitting the performance of major surgical procedures and the pursuit of a variety of surgical research problems. Germfree dogs have been maintained in the isolator system through three generations, indicating that life, reproduction, and growth are all possible in the absence of microbial contamination. The value of the germfree approach to surgical problems has been utilized in studies of a variety of gastrointestinal problems, shock, cancer, immunology, burns, wound healing, and in direct patient application. Patients have been maintained in isolator environments for prevention of infection, for operative procedures, for treatment of extensive burns, and for management of immune-suppressed individuals. We conclude that germfree animals and germfree technics provide a valuable addition to the armamentarium of the surgeon in both research and clinical applications.

Animals↗
PubMed1991

Management of penetrating colon injuries. A prospective randomized trial.

Fifty-six patients with penetrating colon injuries were entered into a randomized prospective study. Management of the colon injury was not dependent on the number of associated injuries, amount of fecal contamination, shock, or blood requirements. Twenty-eight patients were treated with primary repair or resection and anastomosis and 28 patients were treated by diversion (24 colostomy, 3 ileostomy, 1 jejunostomy). The average Penetrating Abdominal Trauma Index score was 23.9 for the diversion group and 26 for the primary repair group. There were five (17.9%) septic-related complications in the diversion group. This included four intra-abdominal abscesses and one subcutaneous wound infection. There were six (21.4%) septic-related complications in the primary repair group. This included one wound infection, two positive blood cultures, and three intra-abdominal abscesses. There were no episodes of suture line failure in the primary repair/anastomosis group. The authors conclude that, independent of associated risk factors, primary repair or resection and anastomosis should be considered for treatment of all patients in the civilian population with penetrating colon wounds.

Adolescent↗
PubMed1989

Villous tumors of the duodenum.

Five cases of villous tumors of the duodenum are reported, all of which involve the ampulla of Vater. Three of the five lesions contained either infiltrating carcinoma or carcinoma in situ. Although preoperative endoscopic biopsy was performed on all tumors no malignancy was identified. Frozen sections done at the time of operation on the three patients with carcinoma also failed to identify malignancy. One patient underwent pancreaticoduodenectomy and four patients had local excision of the tumor. Three of the patients treated with local excision developed recurrence and two subsequently had pancreaticoduodenectomy. Because of the difficulty in making an accurate diagnosis and the chance of recurrence when local excision is employed, strong consideration should be given to pancreaticoduodenectomy as the initial form of treatment of these lesions.

Adenoma↗
PubMed1989

Pedigrees of southern surgical chairmen.

This review details the birth, medical education, surgical training, and previous academic appointments of the chairmen of departments of surgery in the medical schools in the geographic distribution of the Southern Medical Association.

Faculty, Medical↗
PubMed1988

Surgical management of the acutely obstructed colon. A review of 127 cases.

The surgical results in 127 cases of acute obstruction of the colon are presented. Carcinoma continues to account for the overwhelming number of cases, and there has been no appreciable change in the site of obstruction or age groups affected. In the current study, the overall mortality rate in patients with acute obstruction from all causes was 27 percent, which does not appear to be significantly different than it was 30 years ago. The overall mortality rate in patients with obstruction secondary to carcinoma was 23 percent. Under the specific circumstances of the cases reported herein, and on the basis of a limited experience, total colectomy and left colectomy as initial procedures in acute obstruction secondary to cancer had the same mortality rate as staged resection of the left colon. The only benefit found from either approach was an increase in the disease-free 5 year survival rate with staged resection. The overall survival rate was not enhanced by either approach.

Acute Disease↗
PubMed1988

Acute colonic diverticulitis.

Colonic diverticulosis is truly a disease of the 20th century. A direct correlation is thought to exist between the incidence of diverticular disease and the amount of dietary fiber. Acute colonic diverticulitis occurs in approximately 25 per cent of the patients with diverticula, and 20 per cent of the patients with diverticulitis will ultimately require surgical intervention. Because of the often virulent nature of the disease in younger patients and the prevalence in the geriatric population, an aggressive approach is advocated. Primary resection of the involved segment of colon is advocated in all cases requiring operation. A primary anastomosis can be constructed in stage I and some cases of stage II disease. This results in lower morbidity and mortality rates as well as fewer days of hospitalization and disability. Newer techniques such as diagnostic CT scanning, percutaneous drainage of diverticular abscess, and greater application of surgical stapling devices have done much to improve the ultimate outcome of colonic diverticulitis.

Abdomen, Acute↗
PubMed1987

Gastric carcinoma in the young.

Thirty-eight cases of gastric carcinoma in patients 35-years-old and younger, occurring in the period 1948 to 1983, are reviewed. They comprised 2.2% of 1710 cases in all ages for the same 35 year period at the Charity Hospital. Women were afflicted as commonly as men. Blacks outnumbered whites 2.9:1.0. Obstruction, pain, and weight loss of relatively short duration were prominent symptoms. Tumors tended to be located distally in the stomach, and scirrhous in appearance. Histologically, diffuse type lesions were more common than intestinal or other type tumors. Radiographic evidence of disease was usually present in patients undergoing upper gastrointestinal series. Endoscopy with biopsy was a valuable diagnostic tool. Resectability in this group was not less than that achieved for all ages, however, only one patient has survived for five years. Advanced stage lesions predominated and were associated with poor survival. Earlier stage lesions in this age group appear to bear a more favorable prognosis.

Adult↗
PubMed1986

Early gastric cancer. 21-year experience.

From 1963 through 1983, 327 patients underwent resection for gastric adenocarcinoma at Charity Hospital in New Orleans. Fifteen lesions (4.6%) were early gastric carcinoma (limited to the mucosa or submucosa regardless of nodal metastases). These lesions were in eight men and seven women (14 blacks and 1 white), with a mean age of 65.3 years (range: 52-80 years). Upper gastrointestinal series were obtained in 13 (6 suspicious, 2 inconclusive, and 5 normal). By comparison, endoscopy on 11 patients provided a tissue diagnosis in ten patients (90.9%). Surgical procedures ranged from total gastrectomy to a local excision, and every specimen was free of lymph node metastases. Macroscopically, there were six Type I, four Type IIb, and Type IIc, three Type III, and one with two separate lesions (IIa and IIb); microscopically, ten were intramucosal and five had submucosal invasion. Five-year survival calculated by the actuarial method was 64.2% (observed) and 100% (adjusted). This compares with 18.8% (observed) for all 327 patients. Six of the patients with early gastric cancer are alive (range: 16-219 months). The nine patients who died had no evidence of recurrent disease at the time of death. Surgical resection of early gastric carcinoma in the United States offers an excellent prognosis similar to the Japanese experience. Increased detection of gastric carcinoma in its curable stages may be achieved through early endoscopic investigation of symptomatic patients.

Adenocarcinoma↗
PubMed1984

Drainage of intraabdominal abscesses. A comparison of surgical and computerized tomography guided catheter drainage.

Over an 18 month period, 130 patients were sent to the radiology department for diagnostic CT scans to localize intraabdominal abscesses. Of these patients, 71 (55 percent) were diagnosed as having intraabdominal abscesses. Fifty-one surgical procedures and 17 radiologic drainage procedures were done. The cure rate of patients undergoing an operative procedure was 88 percent, and the major complication rate was 23 percent. The cure rate of patients undergoing CT guided catheter drainage was 47 percent and the complication rate was 6 percent. CT guided catheter drainage may be the initial treatment of choice in institutions that specialize in invasive procedures performed by radiologists. However, in institutions that have not concentrated their efforts on this problem, the results may not be as good, and it may not be wise to assume these data have general applicability. Greater cooperative efforts between departments of radiology and surgery should lead to better results in treatment of intraabdominal abscesses and better understanding of the best methods of treating them.

Abdomen↗