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Biomedical subjects

John A Martin

Publications and source records attributed to John A Martin.

12 recordsLinked to original sources
PubMed2005

Gastrointestinal complications of bariatric surgery.

The current epidemic of obesity and its myriad comorbidities represents one of the true major public health crises in the United States today. Data reflecting durable weight loss achieved through surgical treatment of obesity demonstrate impressive results heretofore unattainable with less aggressive modalities. However, these outcomes are accompanied by expected side effects and complications, which require specific knowledge to diagnose accurately and a specialized skill-set to manage precisely. With the ever-increasing demand for bariatric surgery, the number of ensuing complications will also rise, requiring the expertise of a gastroenterologist for both diagnosis and treatment. Thus, the gastroenterologist must develop a keen understanding of bariatric surgical anatomy and physiology, as well as the expected postoperative side effects and potential complications experienced by the post-bariatric patient.

Digestive System Surgical Procedures↗
PubMed2005

Colonoscopic diagnosis of mucocele of the appendix.

BACKGROUND: Appendiceal mucoceles are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus. There have been no reported series of colonoscopically diagnosed mucoceles with clinicopathologic correlation. METHODS: A retrospective review of colonoscopies performed at our institution over the past 14 years was undertaken with patient demographics, clinical data, surgical outcomes, and histopathology obtained from hospital records. OBSERVATIONS: Seven patients (6 women) with mucocele of the appendix were identified at colonoscopy. Three had complained of right lower quadrant pain. All 7 patients underwent surgical resection. Histopathology demonstrated mucinous cystadenoma in all. No cases revealed carcinoma, and there have been no deaths related to the mucocele. CONCLUSIONS: Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Surgery is recommended in all cases given the risk of malignancy or perforation with resultant pseudomyxoma peritonei.

Adult↗
PubMed2005

The Oral Health Information Suite (OHIS): its use in the management of periodontal disease.

Health care costs continue to increase at a rapid rate. Dental costs alone have risen from $31.5 billion in 1990 to $70.3 billion in 2002, outpacing inflation by 160 percent. Payers for health care services have no means to evaluate the value of these large expenditures. Quantified information is not available regarding a patient's condition prior to and after treatment nor on the probability of future disease. The absence of this information prevents dentists from responding effectively to challenges by payers and patients, and specifically prevents dentists from effectively influencing the quality of periodontal care. We have developed a user-friendly Internet-based technology that quantifies risk for periodontitis and periodontal disease severity and extent and generates recommended treatments and interventions. A caries risk assessment tool has also been developed, and an oral cancer assessment tool is being developed. This technology, designated the Oral Health Information Suite (OHIS), provides quantitative information to the clinician and patient as an aid to diagnosis and to facilitate individual, needs-based treatment planning. OHIS enables successful application of the wellness model of oral health care, which may be expected to result in more uniform and accurate clinical decision making, improved oral health, reduction in the need for complex periodontal therapy, reduction in oral health care costs, and improved clinician productivity and income. It also will permit patients to become more involved in their oral health care, payers to quantify and predict their health care expenditures, dentists to experience an increase in trust and respect, and periodontists to be more properly consulted regarding periodontal care.

Adult↗
PubMed2004

Transforming growth factor-beta1, interleukin-10 and interferon-gamma cytokine polymorphisms in patients with hereditary, familial and sporadic chronic pancreatitis.

BACKGROUND: The genetic influence is undefined in about 40% of patients with hereditary and familial pancreatitis and in the majority of patients with sporadic chronic pancreatitis. The pathophysiological mechanisms underlying the progression from acute to chronic pancreatitis have not been clarified. Cytokines participate in the immunological progression of pancreatic inflammation and may play an important role in the development of pancreatic fibrosis. AIMS: We determined whether functional polymorphisms in the transforming growth factor-beta1 gene at positions -509, +869 (codon 10) and +915 (codon 25), in the interleukin-10 gene at position -1082, and in the intron 1 of the interferon-gamma gene at position +874 are associated with hereditary, familial or sporadic pancreatitis. METHODS: We investigated 78 patients with hereditary and familial pancreatitis and 62 patients with sporadic pancreatitis that were tested negative for cationic trypsinogen gene mutations, and 73 controls. Mutational analysis was performed by direct DNA sequencing or by amplification refractory mutational system polymerase chain reaction. We used the age at onset as marker of disease severity. RESULTS: The genotype frequencies were similar between patients and controls for all investigated cytokine polymorphisms (p > 0.05). We did not find an association between the different genotypes and the age at onset of the disease, and we did not detect different genotype distributions in patients with morphological alterations on pancreatic imaging after a disease duration of up to 5 years. CONCLUSION: These genetic variants do not play a dominant role in hereditary, familial or sporadic chronic pancreatitis.

Adolescent↗
PubMed2004

Analysis of tumor necrosis factor-alpha, transforming growth factor-beta 1, interleukin-10, and interferon-gamma polymorphisms in patients with alcoholic chronic pancreatitis.

The pathophysiologic mechanisms underlying alcoholic chronic pancreatitis are poorly understood. Cytokines participate in the immunologic progression of acute and chronic pancreatitis and may play an important role in the development of pancreatic fibrosis. Functional polymorphisms in cytokine genes have been identified that alter cytokine production. The aims of the current investigation were to determine whether functional polymorphisms in the tumor necrosis factor-alpha (TNF-alpha) gene at positions -308 and -238; in the transforming growth factor-beta 1 (TGF-beta(1)) gene at positions -509, +869 (codon 10), and +915 (codon 25); in the interleukin-10 (IL-10) gene at position -1082; and in the intron 1 of the interferon-gamma (IFN-gamma) gene at position +874 are associated with alcoholic chronic pancreatitis. We investigated 42 patients with alcoholic chronic pancreatitis. We studied 94 control subjects for the TNF-alpha polymorphisms and 73 control subjects for the remaining polymorphisms. Mutation analysis was performed by direct DNA sequencing or by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The genotype frequencies were similar between patients and control subjects for all investigated cytokine polymorphisms (P>.05). We did not find an association between the different genotypes and the clinical course of the disease. Therefore, we assume that these genetic variants do not play a dominant role in alcoholic chronic pancreatitis.

Alcoholism↗
PubMed2004

Use of risk assessment in attaining and maintaining oral health.

The cost of health care is increasing rapidly. A transition from the "repair" to a "wellness" model of oral health care that minimizes the occurrence of disease and the need for complex treatment may reduce costs and improve oral health. Quantification of risk is essential for successful use of the wellness model. Subjective risk assessment by expert clinicians is too variable to be useful in clinical decision making. However, user-friendly Internet-based technology has been developed that provides a consistently accurate and valid quantified risk assessment for periodontitis, as well as a quantified measure of disease severity and extent. The numeric information helps clinicians and patients make diagnoses and generate individual, needs-based treatment plans. This technology enables successful application of the wellness model of care in day-to-day dental practice. Use of the wellness model may result in more uniform and accurate periodontal clinical decision making, improved oral health, less need for complex periodontal therapy, lower oral health care costs, and improved clinician productivity and income.

Adult↗
PubMed2003

Ampullary adenoma: clinical manifestations, diagnosis, and treatment.

Ampullary adenomas occur sporadically and in the setting of familial polyposis syndromes. In either case, and whether symptomatic at presentation or found asymptomatically in the setting of endoscopic screening programs, they are premalignant lesions with risk for malignant degeneration to carcinoma following the adenoma-to-carcinoma sequence that is well recognized in colonic adenocarcinoma. Accordingly, many experts advocate excision, although others cite the low rate of histologic progression suggested by some recent studies as justification for close endoscopic surveillance rather than excision before demonstration of dysplastic change. This recommendation, however, is complicated by considerable data underscoring the limited accuracy of endoscopic forceps biopsy in detecting occult foci of carcinoma within ampullary adenoma. Thus, the optimal management of these lesions continues to generate considerable controversy. Indications for excision of an ampullary adenoma include treatment of immediate symptoms as well as prevention of malignant degeneration. Although pancreaticoduodenectomy has long been considered the standard procedure for ampullary carcinoma, much controversy exists regarding the procedure of choice for ampullary adenoma. Radical surgery (pancreaticoduodenectomy) possesses the advantage of low recurrence rate but at the expense of higher morbidity (25%-65%) and mortality (0%-10%). Local surgical excision (surgical ampullectomy) possesses the advantages of lower morbidity (0%-25%), essentially nil mortality, and possibly decreased length of hospital stay, but decidedly higher recurrence rates (generally 5%-30%) and the need for postoperative endoscopic surveillance. Snare ampullectomy is a newer endoscopic excisional technique for which limited data are available; advantages compared with radical surgery mirror those of local surgical excision, with apparent lower mortality (0%-1%) and lower morbidity (12%). Presumed advantages compared with local surgical excision include lack of necessity for general anesthesia and laparotomy with comparable morbidity. Disadvantages seem to include limited availability of experienced operators, procedural complexity sometimes requiring adjunctive modalities such as fulguration, the need for multiple procedures (mean, 2.0 procedures) to effect complete excision, and recurrence rates approaching 30%, with a requirement for continued endoscopic surveillance. Ultimately, choice is driven by availability of local expertise, patient tolerance of or expected compliance with long-term endoscopic surveillance programs, presence or absence of coexisting familial polyposis syndromes, medical comorbidities, and overall life expectancy.

Adenoma↗