Transcutaneous ileopyelostomy fiberoptic fulguration (TIFF). New treatment of renal pelvic tumors in solitary kidney.
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Biomedical subjects
Publications and source records attributed to J B Raskin.
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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.
Two hundred forty patients with benign gastric ulcer were treated in a controlled clinical trial to assess the effect on healing of cimetidine, antacids, and hospitalization. Inpatients and and outpatients were randomly assigned to one of three treatments: cimetidine plus antacid, cimetidine plus dummy antacid, or placebo tablet plus antacid. In 206 patients who met criteria for analysis, ulcer healing as shown by endoscopy occurred by 12 days in 11 to 26 percent and by 42 days in 58 to 76 percent. There were no significant differences in healing between hospitalized and nonhospitalized patients or between treatment subgroups. Symptomatic response was equivalent in all groups. The median antacid consumption was 328 mEq of in vitro buffering capacity per day. Patients taking antacids experienced significant diarrhea compared with those taking no antacid. This investigation suggests that the effect of cimetidine is equivalent to that of large amounts of antacid, but because a true placebo group was not studied it is not possible to conclude from this study alone whether either agent influenced healing. In contrast to widespread belief, initiation of treatment in the hospital did not enhance healing, but because patients were not randomly assigned to inpatient and outpatient status no final conclusion about the effect of hospitalization on healing can be drawn.
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A 51-year-old man with clinical and laboratory findings consistent with the diagnosis of pancreatic ascites is reported. Response to usual medical measures was inadequate. Single-dose irradiation to the pancreatic area (550 rads) resulted in marked improvement in his ascites. Operative pancreatogram months later revealed no evidence of ductal leakage. Low-dose pancreatic irradiation may be a unseful therapeutic adjunct in the older, high-risk patient with pancreatic ascites in whom surgery is not considered feasible.
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Juvenile polyposis coli associated with neurofibromatosis in a 24-year-old white man is reported. Juvenile polyposis coli is now recognized as a distinct clinical entity. Differentiating it from the other hereditable gastrointestinal polyposis syndromes is important because of the lack of reported malignancies. Radical surgery is unnecessary unless warranted by the clinical features of bleeding or diarrhea. The known gastrointestinal and extra gastrointestinal associations with juvenile polyposis coli are reviewed along with the gastrointestinal manifestations of neurofibromatosis. This is the first reported association of neurofibromatosis with this unusual syndrome.
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Endoscopic findings can be extremely valuable in directing or altering specific treatment. Endoscopy also has therapeutic applications, such as removal of polyps (gastric or colonic), coagulation of bleeding sites in cases of upper gastrointestinal bleeding, and the removal of foreign objects from the gastrointestinal tract. Laparoscopy is an easily performed procedure with minimal risk. On of its greatest values is in investigating diseases of the liver. Coloscopy has many uses, including evaluation of equivocal x-ray findings and histologic confirmation of cancer. Endoscopic retrograde cholangiopancreatography (ERCP) is a new, highly sophisticated procedure that offers a major advantage in investigating pancreatic disease and evaluating jaundice.
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