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J S Barkin

Publications and source records attributed to J S Barkin.

At least 55 records · Page 3Linked to original sources
PubMed1997

Nonsurgical management of acute jejunal diverticulitis: a review.

BACKGROUND: Diverticular disease of the colon and its complications are well known and readily considered when patients present with the proper clinical scenario. Conversely, complications of small bowel diverticula are very uncommon entities and are not often thought of as a cause of bleeding, obstruction, or an acute abdomen. OBJECTIVE: To report two patients presenting with an acute abdomen caused by acute jejunal diverticulitis who were treated nonsurgically as opposed to surgically as the literature dictates. METHODS: Two patients presented with sudden onset of acute periumbilical pain that had increased progressively over 1-2 days before admission. An emergent CT scan performed in each patient with localized peritonitis revealed "collections" consistent with abscess cavities. One patient was treated with antibiotics alone and the other with a combination of antibiotics and percutaneous CT-guided aspiration. CT-guided needle aspiration was performed and the injection of contrast clearly revealed communication with a jejunal diverticulum. Both patients did well and were subsequently discharged without incident or surgical intervention. CONCLUSIONS: Acute jejunal diverticulitis must be considered in the differential diagnosis of an acute abdominal process and may be successfully treated nonsurgically despite the recommendations of previous reports.

Acute Disease↗
PubMed1996

Conservative management of esophageal nontransmural tears after pneumatic dilation for achalasia.

OBJECTIVE: We sought to determine the incidence and outcome with conservative management of esophageal nontransmural tears after pneumatic dilation for achalasia. METHODS: Retrospective review of 50 pneumatic balloon dilations in 30 patients with achalasia was performed at one center over an 18-month period. RESULTS: Forty-four of 50 procedures (88%) were performed without complication. Two patients (4%) developed transmural perforations requiring immediate surgical repair; both recovered uneventfully. Four patients (8%) were found to have linear mucosal tears on routine postprocedure esophagrams. One patient was asymptomatic, and three had chest pain. No patient had fever. These four patients were managed conservatively with in-hospital observation for a mean of 4.3 days (range 3-6): nothing by mouth for a mean of 1.3 days (range 1-2) and i.v. antibiotics for a mean of 3 days (range 2-5). All were discharged within 6 days and were asymptomatic and tolerating a regular diet. CONCLUSIONS: Esophageal nontransmural tears are not uncommon after pneumatic dilation for achalasia and can be safely treated with conservative medical management.

Adult↗
PubMed1996

Pancreatic fungal infections: a case report and review of the literature.

Pancreatic necrosis as a consequence of acute pancreatitis usually implies a poor prognosis. Infection is the most common complication affecting mortality and appears to be increasing. While bacterial infections, particularly with coliforms, account for the majority of cases of infected necrosis, fungal infections are being more frequently documented. This may be due to increased recognition through improved laboratory techniques, more aggressive diagnosis by percutaneous aspiration, or the more widespread use of broad-spectrum antibiotics or parenteral nutrition. While the majority of documented fungal pancreatic infections have been with Candida species, recent reports have highlighted the importance of Torulopsis glabrata. This haploid yeast of the family Cryptococcaceae is a fungal commensal organism accounting for 16% of all human yeast isolates. Here we report the first case of T. glabrata infection complicating pancreatic necrosis and review the current knowledge of pancreatic fungal infections complicating acute pancreatitis. Superimposed infection, either bacterial or fungal, needs to be diligently sought in patients with pancreatic necrosis who fail to improve or deteriorate despite supportive care.

Aged↗
PubMed1996

Occult gastrointestinal bleeding. General overview and approach.

Occult gastrointestinal bleeding is most commonly defined as an acute or chronic loss of blood, the source of which has not been identified after gastroscopy, colonoscopy, and upper gastrointestinal series have been performed. As the title suggests, this article provides a general overview of this disorder. Specific topics discussed include etiology, diagnostic procedures, laboratory studies, radiologic procedures, radionuclide studies, angiography, and endoscopy.

Adult↗
PubMed1996

Solitary metastatic tumors to the pancreas: a case report and review of the literature.

Secondary pancreatic tumors should be considered in those patients who present with a solitary pancreatic mass and who have had a previous nonpancreatic malignancy. The most common primary tumor origin of solitary pancreatic metastases is renal cell carcinoma, but many other primary sites have been reported. Radiological studies are useful for determining size and resectability, but a biopsy for tissue confirmation is required to differentiate primary and secondary pancreatic tumors. Survival data from patients who had solitary metastasis to other organ sites suggest that an aggressive surgical approach may improve survival. Characteristics of the primary tumor including tumor grade and histology may also affect prognosis. Prospective studies evaluating survival after surgical therapy have not been undertaken.

Carcinoma, Renal Cell↗
PubMed1995

Standard biopsy forceps versus large-capacity forceps with and without needle.

Endoscopic biopsy forceps vary in size and design. The purpose of this prospective randomized study was to compare the quality and quantity of gastric tissue obtained by needle and non-needle versions of standard biopsy forceps and newly designed large capacity forceps. Fifty consecutive patients who underwent endoscopy with gastric biopsy forceps were enrolled in the study. There was no significant difference in the presence of crush artifact between the two forceps, both with and without the presence of a needle. Both needle and non-needle versions of the large capacity biopsy forceps were found to obtain significantly larger sized specimens (p = 0.02) than needle and non-needle versions of the standard biopsy forceps. Overall, there was no significant difference in the depth of specimen obtained when comparing the large capacity forceps to standard forceps. Needle versions of each forceps were found to obtain significantly deeper biopsies than non-needle versions of each forceps. In conclusion, our study found that large capacity forceps obtained larger specimens than standard biopsy forceps. Further clinical trials with a larger study population need to be undertaken to determine the impact of these findings on the determination of diagnoses.

Analysis of Variance↗
PubMed1994

Role of somatostatin and octreotide in the treatment of pancreatic pseudocyst, fistula and ascites.

Somatostatin and its analogue (SMS 201-995, octreotide) have proven to effectively inhibit various gastrointestinal functions including exocrine and neuroendocrine secretion, motility and splanchnic blood flow. The long half-life and the ability to administer the analogue subcutaneously has liberalized its use in different intestinal and extraintestinal disorders. In particular, the profound inhibitory effects on exocrine pancreatic function have prompted the use of SMS in several pancreatic disorders. Despite the lack of controlled studies, somatostatin has been used in different pancreatic disorders, fistulas, pseudocysts and ascites. The preliminary evidence supports a definite role of this analogue as adjunctive and primary therapeutic agents.

Ascites↗
PubMed1994

Occupational exposure to Helicobacter pylori for the endoscopy professional: a sera epidemiological study.

OBJECTIVES: The purpose of this prospective study was to determine if medical and nursing staff in the United States who are regularly involved in endoscopic procedures are at an increased risk of acquiring Helicobacter pylori infection. METHODS: One hundred and twenty-two gastroendoscopists and endoscopy nurses attending an advanced gastroendoscopy course (17 women, 105 men) completed a questionnaire consisting of past medical and professional history. Serum from each subject was collected and tested using a validated ELISA assay (sensitivity 99%, specificity 96%). H. pylori prevalence in the experimental group was compared to that of 510 blood donors. RESULTS: In all age groups, H. pylori positivity was significantly higher among the study subjects compared with controls. Caucasian subjects, when matched to controls for age, race, and level of education, had significantly higher rates of H. pylori positivity. Foreign-born subjects, when compared to US-born subjects, also had higher rates of H. pylori positivity. There was no statistical difference of H. pylori positivity with respect to gender, years involved in endoscopy, or number of endoscopies performed monthly. CONCLUSION: H. pylori infection is more common in gastroendoscopists and endoscopy nurses than the general population and should be viewed as an occupational hazard.

Adult↗
PubMed1994

Idiopathic fibrosing pancreatitis causing obstructive jaundice in young adults: two case reports and literature review.

Chronic pancreatitis is uncommon in children and adolescents. A rare syndrome of idiopathic fibrosing pancreatitis has been reported in 28 patients, ages 4 months to 17 yr. We report two young adults with this syndrome who presented with obstructive jaundice. Both were seen in adult gastroenterology practice, and one is the oldest reported patient at age 20. We review the clinical features, diagnosis, and treatment of this disorder, which merits attention by adult gastroenterologists.

Adolescent↗