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Biomedical subjects

M S Cappell

Publications and source records attributed to M S Cappell.

At least 73 records · Page 4Linked to original sources
PubMed1992

Complications of nasoenteral tubes. Intragastric tube knotting and intragastric tube breakage.

We report two complications of nasoenteral tubes. A nasogastric tube became knotted during gastric intubation in a patient with a small gastric remnant, created during gastric surgery for morbid obesity. A clogged Dobbhoff tube ruptured while it was being flushed manually with a syringe containing normal saline under great pressure. To retrieve the knotted tube, we grasped the distal knotted part visible in the oropharynx with forceps, pulled it out of the mouth, and cut it. To retrieve the broken tube, we snared the intragastric fragment at endoscopy. These case reports suggest that a small gastric remnant may be a risk factor for nasogastric tube coiling and knot formation and that flushing a clogged tube at high pressure may rupture it. To prevent these complications, a nasogastric tube should be carefully passed just into the stomach in a patient with a small gastric remnant, and a clogged feeding tube should be flushed with only moderate pressure. Failure to clear a blocked tube by flushing with normal saline at moderate pressure should lead to tube removal and not to use of excessive pressure.

Adult↗
PubMed1992

The relationship between the clinical presentation and spread of colon cancer in 315 consecutive patients. A significant trend of earlier cancer detection from 1982 through 1988 at a university hospital.

We systematically analyzed the relationship between 47 clinicoepidemiologic parameters and stage of colon cancer in 315 patients who underwent colon cancer surgery from 1982 through 1988 at the Robert Johnson University Hospital. A history of hemorrhoids was correlated with early cancer, possibly because of earlier self-referral (odds ratio = 18.2; chi 2 = 10.4; degrees of freedom = 1; p less than 0.001). However, anemia was correlated with advanced cancer (odds ratio = 0.21; chi 2 = 13.7; degrees of freedom = 1; p less than 0.0002). Anemia may result from chronic bleeding due to a longstanding cancer. Prior studies have suggested that intensive screening programs may produce earlier colon cancer detection; this study demonstrated for all patients at a medical center a significant trend from 1982 through 1988 of detecting colon cancer at an earlier pathologic stage and with a better differentiated histologic grade (for first half of study period 44.4% had Dukes' stage A or B cancer, second half of study period 58.6% had Dukes' stage A or B cancer; odds ratio = 0.56; chi 2 = 5.8; degree of freedom = 1; p less than 0.02). Possible explanations for this phenomenon are earlier self-referral because of increased patient awareness of cancer warning signs, and earlier physician detection because of greater use of colonoscopy and polypectomy and because of increased screening and surveillance. This earlier detection may herald a future significant decrease in colon cancer mortality at this hospital because prognosis is closely related to cancer stage. Further studies are required to determine if this is part of a national trend.

Adult↗
PubMed1992

Gastrointestinal and hepatic effects of Amanita phalloides ingestion.

Three residents of New Jersey suddenly developed vomiting, abdominal pain, and watery diarrhea 12 h after ingesting five to 13 hand-picked Amanita phalloides-type mushrooms. The group was led by an amateur mycologist who had been eating hand-picked mushrooms without complications for 20 years. The patients developed mild to severe acute hepatic injury, with a peak serum aspartate aminotransferase level ranging from 133 to 826 Karmen U/L, and a peak serum alanine amino-transferase level ranging from 163 to 1176 Karmen U/L. One of the patients developed a transient severe coagulopathy, but no one developed renal failure or hepatic coma, and all rapidly improved. These three cases demonstrate that mycetismus can occur in the heavily urbanized northeastern United States, that consuming hand-picked mushrooms even under the guidance of an experienced amateur may be dangerous, and that Amanita phalloides ingestion produces a biphasic illness with early gastrointestinal symptoms and subsequent hepatic injury.

Abdominal Pain↗
PubMed1992

Gastrointestinal obstruction due to Mycobacterium avium intracellulare associated with the acquired immunodeficiency syndrome.

Three patients with the acquired immunodeficiency syndrome (AIDS) had complete or incomplete gastrointestinal obstruction resulting from infection with Mycobacterium avium intracellulare. The pathophysiologic mechanisms of the obstruction in the three cases were ileal volvulus due to adhesions from matted infected mesenteric lymph nodes, ileal intussusception due to engorged infected ileal mucosa, and small bowel displacement and compression by massively enlarged infected intraabdominal lymph nodes. These reports extend the clinical manifestations of Mycobacterium avium intracellulare infection in patients with AIDS to include partial and complete gastrointestinal obstruction.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Mesenteric thrombosis associated with anticardiolipin antibodies in a patient with systemic lupus erythematosus.

A 45-yr-old female with mild chronic systemic lupus erythematosus for 20 yr, and with a stroke, digital infarction, and transient vocal cord paralysis during those 20 yr, had severe abdominal pain for 2 wk due to omental infarction associated with the presence of anticardiolipin antibodies. This report suggests that patients with otherwise mild systemic lupus erythematosus may develop severe recurrent thromboembolic events associated with anticardiolipin antibodies, that anticardiolipin antibodies may be associated with mesenteric ischemia, and that mesenteric ischemia associated with anticardiolipin antibodies should be considered in the differential of significant, unexplained abdominal pain in patients with systemic lupus erythematosus.

Autoantibodies↗
PubMed1992

Gastric lesions in the excluded gastric segment undetected by endoscopy or radiography in patients status post vertical banded gastroplasty.

A patient had two surgical revisions and another patient had one surgical revision of a vertical banded gastroplasty because of intraoperative findings of gastric ulceration, incomplete penetration, and transmural penetration of the silicone band. Preoperative esophagogastroduodenoscopy in all three cases and an upper gastrointestinal series in two of the cases failed to demonstrate these lesions, because the lesions were located in the surgically excluded gastric segment. These reports demonstrate that a normal upper gastrointestinal series or panendoscopy in a patient after vertical banded gastroplasty does not exclude significant lesions in the endoscopically inaccessible, excluded gastric segment, and that it may be necessary to perform a laparotomy on a severely symptomatic patient even when an endoscopy is normal.

Adult↗
PubMed1992

The high mortality of gastrointestinal bleeding in HIV-seropositive patients: a multivariate analysis of risk factors and warning signs of mortality in 50 consecutive patients.

The patterns of which human immunodeficiency virus (HIV)-seropositive patients underwent endoscopy for gastrointestinal bleeding at a university hospital were analyzed in 50 consecutive patients admitted from July 1984 through December 1989, and criteria were developed as to which patients are most likely to benefit from endoscopy. Analyzed patient data included the medical records, follow-up until July 1990 obtained by telephone questionnaire in 46 patients, and autopsy findings in the 11 patients undergoing autopsy. Thirty-seven percent of the patients did not undergo endoscopic or radiographic examinations indicated to determine the cause of bleeding. The adequacy of the evaluation was not related to race, intravenous drug abuse, homosexuality, hemophilia, the diagnosis of known AIDS, or being a public patient. In 21 of the 28 cases in which the cause of bleeding was determined, the diagnosed lesions had a specific, effective therapy. The mortality from gastrointestinal bleeding was 39.0%, compared with 8.3% in 48 controls without known HIV infection (p less than 0.001 by Fisher's exact test, odds ratio = 7.0, odds ratio confidence interval = 5.0-9.7). Statistically significant independent predictors of mortality included leukocytosis, concurrent major diseases, intravenous drug abuse, transfusion of 5 or more units of packed erythrocytes, and the presence of a bloody nasogastric aspirate or hematemesis (Wilk's lambda statistic = 0.369, p less than 0.0001). In particular, 10 of 11 patients (89%) with two or more concurrent major diseases died, whereas only three of 24 patients (13%) with no concurrent diseases died during the hospitalization. We conclude a large percentage of HIV-seropositive patients did not undergo a diagnostic evaluation for gastrointestinal bleeding at a university hospital, and there was no discernible rational pattern as to which patients underwent endoscopy. Endoscopy is an important and indicated procedure in HIV-seropositive patients with no or one concomitant major illness. HIV-seropositive patients with gastrointestinal bleeding and two or more concomitant major illnesses have an exceedingly poor prognosis, and are less likely to benefit from invasive diagnostic tests and aggressive therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Acute colonic diverticular perforation presenting as left ear pain and facial swelling due to cervical subcutaneous emphysema in a patient administered corticosteroids.

A 56-yr-old white female administered corticosteroids presented with left ear pain and facial swelling due to cervical subcutaneous emphysema from a diverticular perforation of the sigmoid colon. This case demonstrates that localized signs of a bowel perforation may be absent in patients administered corticosteroids, that these patients may present with unusual, remote findings, and that bowel perforation can produce cervical subcutaneous emphysema.

Acute Disease↗
PubMed1992

Changing epidemiology of gastrointestinal angiodysplasia with increasing recognition of clinically milder cases: angiodysplasia tend to produce mild chronic gastrointestinal bleeding in a study of 47 consecutive patients admitted from 1980-1989.

It is important to recognize patients with gastrointestinal bleeding who are at high risk of having angiodysplasia, because these patients should be evaluated by endoscopy rather than barium studies. Sixty-two clinical and epidemiologic parameters were compared between 47 consecutive patients bleeding from angiodysplasia and 47 consecutive controls bleeding from other lesions admitted to two university teaching hospitals from 1980 through 1989. This study demonstrated statistically significant differences between these two groups. The patients with angiodysplasia generally presented with symptoms and clinical findings compatible with hemodynamically well-compensated, chronic bleeding: they were more likely than other gastrointestinal bleeders to experience weakness or fatigue, less likely to experience dizziness or syncope, and less likely to be orthostatic or hypotensive. They had more prior admissions for gastrointestinal bleeding, particularly for gastrointestinal bleeding of undetermined etiology. They were more likely than other gastrointestinal bleeders to be smokers. Patients with angiodysplasia had a milder hospital course: they had fewer transfusions of packed erythrocytes, shorter hospitalizations, and a lower mortality. The in-hospital mortality of patients bleeding from angiodysplasia was 2.1%. Despite the futility of diagnosing angiodysplasia by barium studies, patients ultimately diagnosed as having angiodysplasia were more often initially evaluated by barium studies than the other gastrointestinal bleeders. The currently identified risk factors for bleeding from angiodysplasia should help to select which gastrointestinal bleeders should be evaluated initially by endoscopy.

Adult↗
PubMed1992

Gastrointestinal hemorrhage due to gastrointestinal Mycobacterium avium intracellulare or esophageal candidiasis in patients with the acquired immunodeficiency syndrome.

A 33-yr-old black intravenous drug abuser with the acquired immunodeficiency syndrome (AIDS) had a massive fatal upper gastrointestinal hemorrhage due to profound and diffuse esophageal ulceration from Candida, as demonstrated by postmortem examination. A 2-yr-old white male with congenitally acquired AIDS had a massive fatal esophageal bleed as a result of esophagitis from Candida albicans, as proven by pathologic examination and culture of endoscopic biopsies. A 27-yr-old black human immunodeficiency virus-seropositive female died from massive lower gastrointestinal bleeding due to extensive small and large intestinal ulceration caused by Mycobacterium avium intracellulare, as proven by microscopic examination and mycobacterial culture of intestinal tissue. These reports extend the clinical spectrum of these infections in AIDS patients by demonstrating that these infections can produce gastrointestinal bleeding.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Esophageal dysmotility from a small esophageal granular cell tumor.

Although typically small and submucosal, esophageal granular cell tumors frequently produce dysphagia. Esophageal manometry and a cine-esophagram in a patient with a 7-mm-wide esophageal granular cell tumor and dysphagia showed esophageal aperistalsis and a hypertensive lower esophageal sphincter that relaxed normally with swallowing. This finding suggests that dysmotility may contribute to the dysphagia frequently attributed to this tumor. This tumor is commonly believed to originate from Schwann cells and has a propensity to encompass and disrupt nerves that could produce the abnormal motility. Esophageal manometry is recommended when a small nonobstructing granular cell tumor is found in the evaluation of dysphagia.

Adult↗
PubMed1991

Endometriosis of the terminal ileum simulating the clinical, roentgenographic, and surgical findings in Crohn's disease.

A 38-yr-old nulliparous female presented with endometriosis of the terminal ileum which mimicked the clinical, roentgenographic, and surgical findings of Crohn's disease. The patient presented with diarrhea, right lower quadrant pain, fever, and significant weight loss. At surgery, the terminal ileum was inflamed, indurated, thickened, and angulated. Ileal endometriosis may be expected to simulate Crohn's disease, because intestinal endometriosis frequently produces local bowel inflammation, adhesions, stricture, and angulation. Ileal endometriosis should be carefully considered in the differential diagnosis of Crohn's disease in menstruating females who are nulliparous and have dysmenorrhea, dyspareunia, dyschezia, menometrorrhagia, or other perimenstrual symptoms. It is important not to mistake endometriosis for Crohn's disease because endometriosis has a different therapy.

Adult↗