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Biomedical subjects

J A Coller

Publications and source records attributed to J A Coller.

At least 91 records · Page 5Linked to original sources
PubMed1985

Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia.

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.

Adolescent↗
PubMed1985

Surgical management of complicated diverticulitis. The Lahey Clinic experience, 1967 to 1982.

One hundred forty patients who had complicated diverticular disease were identified in a retrospective review at the Lahey Clinic between 1967 and 1982. Of these patients, 86 underwent resection with primary anastomosis with a 1 percent mortality rate and an 18 percent morbidity rate; 13 had resection with anastomosis and creation of a proximal colostomy with no death and a 22 percent morbidity rate; 19 had the Hartmann operation or colostomy with mucous fistula with a 16 percent mortality rate and a 23 percent morbidity rate; and 22 underwent a traditional three-stage operation with 14 percent mortality and 24 percent morbidity rates. The average duration of hospitalization was 21 days for patients who underwent the one-stage procedure, 31 and 39 days for those who had a two-stage operation, and 52 days for patients who underwent the three-stage procedure. Primary resection for complicated disease is associated with acceptable morbidity and mortality rates under appropriate circumstances.

Anti-Bacterial Agents↗
PubMed1985

Alternatives to conventional ileostomy in chronic ulcerative colitis.

As long as surgeons have performed total proctocolectomy with permanent ileostomy, efforts have been made to avoid the necessity for a permanent stoma. Preservation of sphincter function can now be achieved by more liberal application of the operation of abdominal colectomy and ileorectal anastomosis in carefully selected patients, and knowledge of the progression from dysplasia to cancer can be applied in a prospective fashion to those persons potentially at risk who have retained rectal mucosa. Individuals who are incapable of dealing with conventional permanent ileostomy and who lack the potential use of their own sphincters can be offered the alternative of a continent ileostomy. The advantages of both of these procedures can be combined by greater application of the operation of total abdominal colectomy, mucosal proctectomy, and ileoanal reservoir with ileoanal anastomosis. Although enthusiasm exists for all of these procedures, their results should be compared with the results of what must still be considered the "gold standard" operation, that is, proctocolectomy and conventional ileostomy. Nevertheless, the alternative procedures represent a considerable advance in the overall care of patients with chronic ulcerative colitis.

Abdomen↗
PubMed1985

Skin grafts for circumferential coverage of perianal wounds.

A technique for circumferential skin grafting of the perianal skin after excision of Bowen's disease is described. The technique has proved satisfactory. The protocol for perioperative management of the bowel and the regimen of strict bed rest must be followed carefully.

Adult↗
PubMed1985

Radiology of the ileoanal reservoir.

The radiology of the ileoanal reservoir based on a study of 50 consecutive patients is presented. Small-bowel obstruction (12%) and leakage at the ileoanal anastomosis (8%) were detected most commonly. Partial outlet obstruction from reservoirs fashioned from three segments of terminal ileum was noted radiographically as a common problem unique to this form of ileoanal reservoir. Superior mesenteric artery syndrome (6%), pelvic abscess (4%), pouch-vesicular fistula (2%), and several other problems were less frequent.

Adolescent↗
PubMed1984

Surgical management of Crohn's disease involving the duodenum.

The experience with 25 patients who required operation for Crohn's disease involving the duodenum is reviewed. Two distinct patterns of duodenal involvement are apparent. Intrinsic duodenal Crohn's disease has a characteristic clinical presentation that is distinct from the symptoms seen in patients with involvement of other portions of the gastrointestinal tract. Among 70 patients with duodenal Crohn's disease seen over a 30 year period, 22 required surgical intervention at the Lahey Clinic. Although hemorrhage and intractable pain were associated problems in several of these patients, unrelenting duodenal obstruction remained the primary indication for operation. Of patients who underwent operative bypass, 78 percent had a good result with a median follow-up period of 12.3 years. The presence of associated gastric Crohn's disease did not influence long-term results. A third of the patients required reoperation for duodenal disease. Marginal ulceration and recurrent gastroduodenal obstruction have been the primary reasons for reoperation. Although the addition of vagotomy to operative bypass has not helped to protect against subsequent marginal ulceration, the absence of appreciable morbidity associated with vagotomy in our series and the high incidence of marginal ulcers reported with gastroenterostomy in other clinical settings lead us to recommend gastroenterostomy with vagotomy as the procedure of choice for duodenal Crohn's disease. Proceeding with vagotomy in persons who have had previous ileocecal or extensive small bowel resection should not be undertaken without careful consideration. Similar caution should also be used in patients who are already troubled with poorly controlled diarrhea. The duodenum may also be involved by duodenoenteric fistulas which represent a complication of Crohn's disease involving other portions of the gastrointestinal tract. Most frequently this occurs in patients with Crohn's colitis who have no evidence of intrinsic duodenal disease. Management of the internal fistula requires resection of the involved colon and closure of the duodenal defect. Three patients with duodenocolic fistula have been so treated.

Adolescent↗
PubMed1983

Spontaneous free perforation of the small intestine.

In western cultures, spontaneous free perforation of the small intestine in adults is rare. The vast majority of published reports are of isolated cases. A review of 19 patients treated at the Lahey Clinic over the past 23 years is presented. All patients presented with an acute onset of peritoneal signs, and free perforation subsequently was documented at operation or at autopsy. Causes of the perforations were malignancy, six; inflammatory small bowel disease, four; combinations of radiotherapy, chemotherapy, or steroids, four; mechanical, three; and iatrogenic, two. Of the 19 patients, 15 had a history of previous abdominal surgery or recent steroid use, chemotherapy, or radiation therapy. Although the underlying disease may be of prime importance in causing perforation, these treatment modalities may be important factors in enhancing predisposition to perforation. Of the 16 patients operated on, ten had intestinal resection with primary anastomosis, and six had primary closure of the perforation. Four major complications included two deaths, and five minor complications occurred. In general, earlier operative intervention decreased mortality. A population of patients who may be at risk for small bowel perforations is identified. A review of the pertinent literature is presented.

Abdomen↗
PubMed1982

Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum.

Records of 230 patients who underwent abdominoperineal resection between 1963 and 1976 were reviewed. The median age of the patients was 62 years. The mortality rate was 1.7 per cent, and the morbidity rate was 61 per cent. One hundred eighty patients were followed for five to 13 years to identify patterns of recurrence. Ten-year survival for Dukes' A, B, and C lesions was 83 per cent, 57 per cent, and 31 per cent, respectively. Seventy-eight patients (43 per cent) had recurrent cancer; 10 per cent had local lesions, and 33 per cent had distant lesions. Dukes' B lesions had a greater latency for local recurrence than Dukes' C lesions. Dukes' A lesions with distant recurrence had a greater latency than Dukes' B or C lesions. Once recurrence was established, the survival rate was not significantly different, regardless of Dukes' stage or local or distant site. Radiation therapy for established local recurrence or chemotherapy for established distant recurrence did not seem to alter survival rates.

Adult↗
PubMed1982

Electrocoagulation of rectal cancer.

Electrocoagulation is an effective treatment modality for localized cancer of the distal rectum. Proper selection remains the key to successful treatment. Of potentially curable patients with cancer of the rectum followed up for a median of five years, 69 per cent had no evidence of cancer at the end of the study period. Gross tumor morphology defined two distinct groups with regard to outcome after electrocoagulation. Ninety-two per cent of patients with polypoid/exophytic tumors as compared to 33 per cent of patients with ulcerative lesions had successful treatment. Based on these results, the authors believe that lesions that are exophytic represent early cancers with a low incidence of nodal spread and, as such, can be treated by electrocoagulation with confidence. As a palliative measure, the the authors found electrocoagulation to yield equivocal results.

Adenocarcinoma↗
PubMed1981

Controlled clinical trial of three suture materials for abdominal wall closure after bowl operations.

One hundred sixty-one consecutive patients who underwent bowel procedures were randomly assigned a nonabsorbable multifilament suture material, a nonabsorbable monofilament suture material or a long-term absorbable suture material for abdominal closure. All patients had midline incisions; closure was by an interrupted single layer technique. Patients were evaluated 1 month, 6 months and 1 year after operation. No statistically significant difference was seen in the incidence of wound infection in these groups. By 1 year, six patients had incisional hernias, none in the long-term absorbable suture group. The absence of suture sinus formation and the failure to demonstrate an increased incidence of wound dehiscence or incisional hernia imply that long-term absorbable suture material may be the most appropriate choice after bowel operations.

Abdominal Muscles↗
PubMed1980

Long-term evaluation of rubber ring ligation in hemorrhoidal disease.

Records of 266 patients who had undergone rubber ring ligation for hemorrhoidal complaints from 1969 through 1976 were reviewed to evaluate the long-term results. The minimum follow-up period was 36 months, with a mean of 60 months. Of the patients, 80 per cent were improved, with 69 per cent totally free of all symptoms. A subsequent hemorrhoidectomy was required in 7.5 per cent. Results were similar when either bleeding or prolapse was the primary indication for treatment. Patients who had a single band applied fared as well as those with two or more ligations.

Adult↗
PubMed1980

Technique of flexible fiberoptic sigmoidoscopy.

Flexible fiberoptic sigmoidoscopy allows a maximum amount of colon to be examined expeditiously and thoroughly, and it is predicted that this new instrumentation will be used with increasing frequency. Three techniques of intubation of the sigmoid with a flexible fiberoptic sigmoidoscope are discussed: elongation, looping, and "accordionization" or the "dithertorquing" technique.

Anal Canal↗
PubMed1979

Management of late complications of Teflon sling repair for rectal prolapse.

Recurrent rectal prolapse or postoperative rectal stricture occurred in four of 88 patients (4.5 per cent) who underwent Teflon sling repair at the Lahey Clinic during the past 15 years. Management of these and six other similar patients referred for treatment suggests that young men appear to be at a higher risk for recurrence. Strictures may be more likely to develop in patients with a long history of prolapse or problems with constipation. Teflon sling repair followed by recurrent prolapse or stricture formation should probably be treated by low anterior resection.

Adult↗
PubMed1979

Colorectal carcinoma: a decade of experience at the Lahey Clinic.

Carcinoma of the colon and rectum is the commonest visceral malignancy in this country today. Uncorrected five-year survival rates (1967-1971) for Dukes' A, B, and C lesions were 81 per cent, 62 per cent, and 33 per cent respectively, and are essentially the same as those observed in the previous five-year period (1962-1966). The actuarially corrected five-year survival rates for Dukes' A, B, and C lesions for the ten-year period (1962-1971) were 95 per cent, 90 per cent, and 55 per cent. Further improvement in these statistics depends on bringing the patient to operation with less advanced disease and possibly on supplementing resection with other modalities of therapy.

Colonic Neoplasms↗
PubMed1978

Perineal wound healing after proctectomy for inflammatory bowel disease.

One hundred fifty-one cases of patients who underwent proctectomy for inflammatory bowel disease at the Lahey Clinic were analyzed with respect to the factors that predispose to delay in perineal wound healing. Significantly poorer healing took place in patients with Crohn's colitis, in men with ulcerative colitis, and in patients with ulcerative colitis who underwent one-stage operations. Factors that were not statistically significant but that appeared to contribute to delay in healing were younger age of patients and presence of anal fistula. A comparison is made with the results of other series, and recommendations for treatment and prevention are presented.

Adolescent↗