Biomedical subjects

J Efron

Publications and source records attributed to J Efron.

21 records · Page 2Linked to original sources

PubMed2000

Complications following formalin installation in the treatment of radiation induced proctitis.

Formalin installation has been safely and effectively used to treat refractory bleeding caused by radiation proctitis. This study evaluated the results of such treatment in terms of outcome and complications. All four patients who underwent formalin irrigation for transfusion-dependent radiation proctitis over a 15-month period were evaluated retrospectively. The procedure was performed under sedation in the operating room, with patients in the prone jack-knife position. A solution of 4% formalin was introduced in aliquots of 50 ml kept in contact with the mucosa for 30 s and then cleared away using saline irrigation; five to six aliquots were used in each session. In a fifth patient formalin-soaked gauze pads were applied directly to the injured mucosa. At a mean follow-up of 18 months (range 6-26) two patients had repeat episodes of bleeding, one underwent successful repeat irrigation, and the other refused further treatment. One patient suffered from severe anococcygeal pain and worsening of incontinence after the procedure. The pain was treated with lidocaine ointment and sitz baths with partial success. Another patient developed severe formalin-induced colitis 5 days after the procedure, which required intravenous antibiotics and hydration. Formalin installation may be effective in controlling refractory bleeding due to radiation induced proctitis. The procedure, however, is not risk free and may induce major complications such as acute colitis.

Aged↗

PubMed2000

The use of rectal ultrasound for the correct diagnosis and treatment of rectal villous tumors.

BACKGROUND: One of the difficulties associated with surgery for rectal villous tumors (RVT) is the finding of invasive adenocarcinoma after transanal excision (TAE) and the possible need for more radical procedures or adjuvant therapy. Improved preoperative evaluation may eliminate this dilemma. The aim of our study was to evaluate the role of transrectal ultrasound (TRUS) in establishing the correct diagnosis of RVT. METHODS: All patients with biopsy proven RVT, who were referred for TAE, underwent preoperative TRUS in addition to the routine evaluation. If invasion beyond the submucosa was suspected by TRUS, multiple biopsies were taken before any surgical intervention in order to exclude invasive cancer. If no invasion was noted, biopsies were avoided and a TAE was performed. The final pathology results were compared with both the preoperative diagnosis and TRUS results. RESULTS: Thirty-five patients (19 female, 16 male; mean age 67.5 years, range 36 to 88) were studied. The mean distance of the distal extent of the lesion above the anal verge was 5.8 cm (1.5 to 6). In 27 patients, the tumor was limited to the submucosa (uT0, uT1) on TRUS and, therefore, TAE was performed. In 26 of 27 patients (96%), pathology examination confirmed the presence of RVT without evidence of malignancy. One patient was found to have invasion of the muscularis propria and required postoperative radiation therapy. In 8 patients (23%), TRUS showed extension beyond the submucosa; 3 of these patients had uT2 lesions, 4 had uT3 tumors, and 1 had perirectal nodes. These 8 patients underwent repeated biopsies with the finding of invasive adenocarcinoma in 7. Two patients underwent abdominoperineal resection, 3 had a low anterior resection, and 3 had a TAE. Final pathology confirmed the preoperative diagnosis of invasive adenocarcinoma in 7 patients. In the 1 patient with a uT2 lesion and negative biopsies, the final diagnosis was RVT with no evidence of malignancy. CONCLUSIONS: Preoperative TRUS provides an accurate diagnosis of RVT. In conjunction with TRUS-directed biopsies, directed management of these tumors could be achieved.

Adenoma, Villous↗

PubMed1997

Effect of nitroglycerin and cerebrospinal fluid drainage on spinal cord perfusion pressure and paraplegia during aortic cross-clamping.

When sodium nitroprusside (SNP) is used to control proximal blood pressure (Px-BP) during cross-clamping (AXC) of the thoracic aorta, it decreases spinal cord perfusion pressure (SCPP) by reducing distal aortic pressure (Ds-BP) and increasing cerebrospinal fluid pressure (CSFP). The decrease cannot be reversed by CSF drainage (CSFD) because such drainage is limited by a reduction in compliance of the spinal canal. Nitroglycerin can also be used to control Px-BP, but its effect on CSF dynamics has not previously been investigated. In the present study we have compared the effects of NTG alone and in combination with CSFD, with SNP and CSFD. Each group (Gp) of six dogs was treated with SNP + CSFD (Gp 1), NTG alone (Gp 2), and NTG + CSFD (Gp 3). Left carotid and right femoral arteries were catheterized to monitor Px-BP and Ds-BP, respectively. CSFP was monitored and CSF was drained through a spinal needle placed in the cisterna cerebellomedullaris. The thoracic aorta was cross-clamped via a left thoracotomy for 60 min. Data were acquired at baseline, during aortic occlusion, and 24 hr after surgery. There were no significant differences in any measurements among the three groups before AXC; after AXC, Px-BP was maintained between 85 and 95 mm Hg in all groups. Ds-BP was significantly lower in Gp 1 than Gp 2 and 3 (7 +/- 2 mm Hg vs. 13 +/- 3 mm Hg and 17 +/- 2 mm Hg, respectively P < 0.05). CSFP did not differ between Gp 1 and 2 (10 +/- 3 mm Hg vs. 9 +/- 1 mm Hg, P > 0.05). CSFD effectively kept CSFP at zero values in Gp 3 during AXC, but not in Gp 1. SCPP was significantly higher in Gp 3 than in Gp 1 and 2 (17 +/- 2 mm Hg vs -3 +/- 4 mm Hg and 4 +/- 1 mm Hg, respectively, P < 0.05). All animals in Gp 1 and 2 suffered paraplegia, as opposed to none in Gp 3. NTG causes paraplegia by decreasing SCPP. When used in conjunction with CSFD, it controls Px-BP without causing paraplegia. CSFD cannot counteract the negative effects of SNP on SCPP; therefore, SNP contributes to postoperative paraplegia. The effects of NTG on cerebrospinal fluid dynamics are different from those of SNP. We caution surgeons against the use of NTG without CSFD during aortic cross-clamping.

Animals↗