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J J Bauer

Publications and source records attributed to J J Bauer.

At least 73 records · Page 4Linked to original sources
PubMed1995

Checklist self-evaluation in a standardized patient exercise.

BACKGROUND: Standardized patient (SP) exercises are expensive and time consuming. We hypothesized that self-evaluation would further the goals of teaching and evaluation for a group of medical students. METHODS: Students were given self-evaluation checklists (essentially identical to those filled out by the SPs) and completed them prior to reviewing the SP checklists. Agreement between student and SP checklists (whether each item was checked or not) and the extent of agreement on the interactional skills rating scales were assessed. RESULTS: Overall agreement was 93%, with 98% agreement on interactional items, 92% on physical examination items, and 89% on history items. Disagreements tended to be clustered on a few items in each scale. Scores on the interactional skills rating scales also showed strong agreement. CONCLUSION: The use of checklists and rating scales in this context is well established. At virtually no cost, a self-evaluation tool adds a valuable dimension to the exercise.

Clinical Clerkship↗
PubMed1995

Myxoid liposarcoma of the scrotal wall.

Liposarcomas of the scrotum are rare with 5 cases reported previously. We report a case of myxoid liposarcoma of the scrotal wall, and discuss pathological classification and treatment of genitourinary liposarcomas.

Adult↗
PubMed1995

p53 nuclear protein expression is an independent prognostic marker in clinically localized prostate cancer patients undergoing radical prostatectomy.

Immunohistochemical (IHC) staining for p53 protein nuclear expression was evaluated in archival paraffin-embedded radical prostatectomy specimens from 139 patients with clinically localized prostate cancer followed up from 1 to 8 (mean, 4) years. Elevated nuclear p53 protein expression was detected in 85 (61%) of 139 patients, being heterogeneous and focal in the majority of specimens. Only four specimens displayed homogeneous nuclear accumulation of p53 protein. Disease progression, most commonly prostate-specific antigen elevation, was noted in 46 (33%) patients, with 39 (85%) having positive p53 protein IHC stains. Conversely, 93 (67%) of 139 have not recurred, with 46 (49%) having positive p53. Of all 54 p53-negative patients, 47 (87%) have had no disease recurrence. An increased p53 protein IHC stain was associated with a higher pathological stage (T1 and T2, 51% versus >/=T3, 69%) and Gleason score 2-4, 17%; 5-7, 72%; and 8-10, 87.5%). Despite these associations, p53 IHC staining was an independent predictor of disease-free survival in a multivariate analysis of p53, age, race, stage, and grade. This study revealed that a majority of clinically localized prostate cancers heterogeneously express elevated nuclear levels of p53 protein in at least a subset of malignant cells, and that this expression is an independent predictor of disease progression in prostate cancer patients after radical prostatectomy.

Aged↗
PubMed1994

Adoptive cellular therapy of human breast and colorectal tumor targets using ex vivo activated memory T lymphocytes with potentiation by cis-diamminedichloroplatinum(II).

Autolymphocyte therapy (ALT) is adoptive cellular therapy of cancer using ex vivo activation of autologous peripheral blood lymphocytes (PBL). Memory T cells are the principal effector population in ALT, with in vivo activity in patients with metastatic renal cell carcinoma (RCC) and melanoma, and ex vivo cytotoxicity against autologous tumor targets. However, the noncytolytic lymphocyte portion of ex vivo-activated memory T cells (ALT cells) may also contribute as antitumor effectors. Pretreatment of murine and human tumor cells ex vivo with chemotherapeutic agents can enhance their susceptibility to antitumor lymphocytes ex vivo and in vivo. To determine whether cis-diamminedichloroplatinum(II) (DDP) could enhance ex vivo antitumor effects of ALT cells by immunomodulation, human breast and colorectal carcinoma target cells were derived from both primary and metastatic surgical specimens and incubated in complete medium (CM) with DDP or in CM alone (control group). Viability of each group was confirmed by trypan blue-dye exclusion test. ALT cells were prepared from autologous PBL at surgery. Primary and metastatic tumor cells from each group were used as targets for ALT cells and levels of interferon-gamma (IFN-gamma) release were measured as a determination of antitumor effect and recognition. Primary tumor target cells incubated in DDP showed enhanced antitumor effects and recognition by autologous ALT cells, as measured by the IFN-gamma assay compared to non-DDP-treated controls. Metastatic autologous tumor target cells demonstrated less IFN-gamma release than did the primary targets, although this was enhanced by pre-treating metastatic tumor targets with DDP. ALT cells demonstrated minimal IFN-gamma release when incubated with allogeneic tumor targets. These data suggest that autotumor recognition of metastatic tumor targets is comparable to that of primary lesions following ex vivo pretreatment of metastatic cells with nonlethal doses of certain chemotherapeutic agents. DDP may somehow alter the physical properties of target cells, rendering them susceptible to immune-mediated attack and the combination of ALT and DDP may lead to increased therapeutic efficacy in patients with metastatic breast and colon cancer.

Breast Neoplasms↗
PubMed1992

Low Hartmann's procedure for severe anorectal Crohn's disease.

Perineal wounds often fail to heal following proctectomy for Crohn's disease. Twenty-five patients with severe anorectal Crohn's disease and perineal fistulas, necessitating excisional surgery, underwent a low Hartmann's procedure in lieu of a standard proctectomy. Fifteen of the 25 (60 percent) patients had a completely healed perineum and required no further surgical therapy. Although perineal disease persisted in the other 10 patients, their perinea were much improved compared with the initial presentation. Following a low Hartmann's procedure, the rectal stump becomes atrophic and anoperineal disease regresses, thereby permitting subsequent perineal proctectomy in less inflamed tissues. Since only a 3-cm to 5-cm cuff of rectum was retained from the initial surgery, a perineal intersphincteric approach could be employed and no abdominal dissection was necessary. Of the 10 patients who subsequently underwent perineal proctectomies, three patients still have an unhealed perineum. Twenty-two of the 25 (88 percent) patients have a completely healed perineum (mean follow-up period, 69.1 months). No attempt was made to establish intestinal continuity in any of the 25 patients. We conclude that the problem of the unhealed perineal wound can be averted with this approach, thereby reducing the long-term morbidity to the patient.

Adult↗
PubMed1991

Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach.

The surgical management of rectovaginal fistulas complicating Crohn's disease has been associated with unacceptably high failure rates. We sought to modify the available surgical techniques to provide a solution to this challenging problem. Between December 1983 and January 1990, 14 patients with Crohn's disease underwent repair of a rectovaginal fistula. A modified transvaginal approach was employed by the authors. A diverting loop ileostomy was performed on all patients, either as the initial step in the staged management of intractable perianal disease or concurrent with the repair of the rectovaginal fistula. The fistula was completely eradicated in 13 of the 14 women and did not recur during the mean follow-up period of 55.0 months (range, 3-77 months). Intestinal continuity was reestablished in these 13 patients within 6 months after the initial fistula repair. One patient with a very low-lying fistula constituted our only failure. We have found the transvaginal method preferable to the transanal approach because of the relative ease in raising the vaginal flap as compared with a flap of fibrotic and inflamed anorectal mucosa. On the basis of this study, we conclude that a modified transvaginal approach is an effective method for repair of rectovaginal fistulas secondary to Crohn's disease.

Adult↗
PubMed1991

Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease.

The management of rectovaginal fistulae complicating Crohn's disease is difficult and often unsatisfactory. Between December 1983 and November 1988, 13 patients with Crohn's disease underwent repair of rectovaginal fistulae via a transvaginal approach. All patients had a diverting intestinal stoma either as part of the initial step in the staged management of intractable perianal disease or concurrent with the repair of the rectovaginal fistula. Each of the patients had low or mid septal fistulae; high fistulae generally are treated transabdominally and are not the focus of this discussion. Fistulae were eradicated in 12 of the 13 women and did not recur during the follow-up period, which averaged 50 months (range, 9 to 68 months). The only treatment failure was a patient who had a markedly diseased colon from the cecum to the rectum and a very low-lying fistula. It is concluded that a modified transvaginal approach is an effective method for repair of rectovaginal fistulae secondary to Crohn's disease.

Adult↗
PubMed1987

Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE).

Most abdominal wall incisional hernias can be repaired by primary closure. However, where the defect is large or there is tension on the closure, the use of a prosthetic material is indicated. Expanded polytetrafluoroethylene (PTFE) patches were used to repair incisional hernias in 28 patients between November 1983 and December 1986. Twelve of these patients (43%) had a prior failure of a primary repair. Reherniation occurred in three patients (10.7%). Wound infections developed in two patients (7.1%), both of whom had existing intestinal stomas, one with an intercurrent pelvic abscess. The prosthetic patch was removed in the patient with the abscess, but the infection was resolved in the other without sequelae. Septic complications did not occur after any operations performed in uncontaminated fields. None of the patients exhibited any undue discomfort, wound pain, erythema, or induration. Complications related to adhesions, erosion of the patch material into the viscera, bowel obstruction, or fistula formation did not occur. Based on this clinical experience, the authors believe that the PTFE patch appears to represent an advance in synthetic abdominal wall substitutes.

Adult↗
PubMed1987

Small intestinal obstruction secondary to obturation by a Garren gastric bubble.

A case of small intestinal obstruction by obturation of a Garren gastric bubble, not retrieved after gastroscopy, is presented. The literature is reviewed regarding both the use of and the complications inherent in such balloon devices. Some specific suggestions are made to provide for effective retrieval and radiological localization and monitoring of displaced balloons.

Gastroscopy↗
PubMed1986

Proctectomy for inflammatory bowel disease.

Between July 1973 and October 1984, we performed proctectomy either as part of a primary proctocolectomy or as a secondary staged procedure in 388 patients with ulcerative colitis and in 39 patients with Crohn's disease. The proctectomies were performed using a two-team synchronous approach. An intersphincteric or perimuscular technique was employed. All perineal wounds were closed and drained by suction drainage and the pelvic peritoneum was closed in all cases. Two patients died in the early postoperative period, one from a pulmonary embolus and one from sepsis. Three patients had to be reexplored for postoperative hemorrhage, in all cases from a branch of the superior hemorrhoidal artery. Postoperative perineal hematoma developed in two patients and perineal abscess developed in four patients which necessitated opening of the perineal skin wound. Nonhealing of the perineal wound occurred in 3 of 388 patients with ulcerative colitis and in 5 of 39 patients with Crohn's disease. No perineal dehiscence or hernias were seen. Postoperatively, one man was permanently impotent and two had prolonged but temporary impotence. Three patients had retrograde ejaculation at last follow-up.

Abscess↗
PubMed1985

Use of the long tube in the management of patients with small-intestinal obstruction due to adhesions.

A retrospective analysis was performed of all patients admitted to our hospital over a six-year period with a diagnosis of small-intestinal obstruction due to adhesions, to assess the efficacy of treatment with long-tube decompression. Of 127 episodes of obstruction, two thirds responded to nonoperative treatment. Factors that were associated with a greater likelihood of success with long-tube decompression included incomplete obstruction, recurrent obstruction, and passage of the tube beyond the pylorus. Clinical findings were relatively reliable as diagnostic indicators of strangulation. The overall mortality was 1.5%, with no deaths due to a delay in operative intervention. A trial of long-tube decompression is recommended in patients presenting with a diagnosis of small-intestinal obstruction due to adhesions in the absence of clinical evidence of strangulation.

Adolescent↗
PubMed1985

Is routine postoperative nasogastric decompression really necessary?

Controversy exists regarding the need for nasogastric tube decompression and the incidence of complications resulting from its use following major intra-abdominal surgery. To determine the value of such tubes, 100 patients were managed after surgery with a nasogastric tube in situ until the passage of flatus per rectum (Group I). In a second group of 100 patients, no nasogastric tube was placed after surgery unless vomiting, gross distention, or overt obstruction occurred (Group II). In Group I, the nasogastric tube remained in place an average of 6 days and five patients required replacement of the tube after its initial removal. In Group II, nasogastric intubation was required at some point after surgery in six patients. No aspiration pneumonia, nasal septum necrosis, anastomotic leak, or wound dehiscence was seen in either group. There were three wound infections in Group I and two in Group II. The most obvious difference was the increased comfort and mobility of the group of patients treated without routine nasogastric decompression (Group II). Routine use of the nasogastric tube adjunct to patient care following gastrointestinal tract surgery may be safely eliminated.

Cholecystectomy↗
PubMed1985

Rectourethroperineal fistula in Crohn's disease.

We report the ninth case of a rectourethral fistula in Crohn's disease. The patient had undergone numerous surgical procedures for complications of severe ileocolitis before developing a rectourethroperineal fistula. His symptoms were confined to urine leaking from the perineal opening; the most common symptom of rectourethral fistula in Crohn's disease. He underwent surgical repair by an abdominoperineal approach and has been free of recurrence for a period of 2 years. The literature suggests that the incidence of rectourethral fistulae in patients with Crohn's disease is approximately 0.3% and that this complication comprises 6.2-11.1% of all genitourinary fistulae in Crohn's disease.

Adult↗
PubMed1983

Sexual dysfunction following proctocolectomy for benign disease of the colon and rectum.

Standard surgical therapy for the treatment of chronic ulcerative colitis is total extirpation of the colon and rectum. Since ulcerative colitis is primarily a disease of young adults affecting many people at the inception or height of their sexually active years, postoperative sexual dysfunction is an extremely disconcerting complication. Between July 1973 and May 1981, 291 proctectomies for benign disease of the colon and rectum were performed by the authors. This included 135 men and 156 women. Resection of the rectum was performed using an intrasphincteric technique with dissection kept extremely close to the wall of the rectosigmoid, rectum, and anus. Proctectomy was performed in this manner to prevent significant disruption of the nerves carrying stimuli to the genital organs. Of the 135 males undergoing a proctectomy, four (3%) had a permanent deficit in sexual function. Two men, aged 32 and 30, could sustain an erection but had retrograde ejaculation. Two patients, age 19 and 44, have remained impotent for 1 1/2 and two years, respectively. One hundred fifty-two of the 156 females are sexually active and only two (1.3%) have complained of any physical sexual dysfunction. Each had temporary dyspareunia lasting between nine months and one year after operation.

Adult↗
PubMed1983

Volvulus of the gallbladder.

Torsion of volvulus of the gallbladder is a rare condition. Approximately 300 cases have been reported since the first description by Wendel in 1898 (Ann Surg 1898; 27: 199). This entity appears most often in the elderly, with either acute, or recurrent, subacute symptoms. Such symptoms may mimic a number of other more common intraabdominal emergencies. Although the etiology is unknown, certain predisposing factors have been identified. Of these, the only one that is constant is the presence of the gallbladder on a mobile mesentery ("floating" gallbladder). Torsion occurs when this gallbladder twists around the cystic duct and artery, with subsequent occlusion of bile and blood flow. Diagnosed early and treated with cholecystectomy, this disease has a low mortality rate, between 3 and 5%. We have treated a case of acute torsion of the gall bladder at the Mount Sinai Hospital and have reviewed the existing literature.

Aged↗
PubMed1982

Ruptured hepatic abscess: a rare cause of spontaneous pneumoperitoneum.

A 68-yr-old woman who developed an acute abdomen with clinical and radiological evidence of pneumoperitoneum is is described. At surgery, multiple left lobe hepatic abscesses were identified. Perforation of one abscess was apparent. Bacteriological studies revealed Streptococcus faecalis and gas-producing Klebsiella pneumoniae from the abscess cavities. Spontaneous pneumoperitoneum secondary to a ruptured hepatic abscess has to our knowledge never been reported.

Aged↗
PubMed1981

Experience with the flexible fiberoptic choledochoscope.

Despite significant effort on the part of surgeons, the incidence of retained calculi after common duct exploration still remains unacceptably high. It seems likely that the best way to reduce the incidence of retained calculi would be a more complete exploration of the common duct at the time of the initial operation. We report our experience with a flexible fiber optic endoscope used intraoperatively in 52 patients and postoperatively in one case to visualize the intrahepatic and extrahepatic bile ducts. In addition to visualization of stones, the choledochoscope has a channel through which various instruments can be passed to facilitate stone removal. Flexible choledochoscopy has been performed 53 times in 52 patients between July 1978 and November 1980. In one patient, the choledochoscope was used to explore the bile ducts via the T-tube tract after operation. In 52 patients, the scope was used intraoperatively: a) two patients demonstrated bile duct tumors, b) in 14, stones were not found on exploration. Of these, one had stenosis at the papilla of Vater and one had external compression of the duct by a pancreatic pseudocyst. All of these findings were confirmed by choledochoscopy, c) in 26 patients choledochoscopy confirmed complete surgical removal of all stones, d) in six patients, multiple stones were removed using routine common duct exploration but additional stones were seen with the choledochoscope, e) in three patients no stones were retrieved on routine duct exploration but were seen using the choledochoscope. In groups (d) and (e) the scope facilitated removal of the remaining stones. In eight cases stones were either grasped or crushed using the accessories of the choledochoscope. In one patient calculi were missed both by routine surgical exploration and choledochoscopy. No septic complications were seen in any of these patients.

Endoscopes↗