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Biomedical subjects

N H Hyman

Publications and source records attributed to N H Hyman.

24 records · Page 2Linked to original sources
PubMed1993

Do general surgery residency programs adequately train surgeons to perform anorectal surgery?

The management of anorectal disease remains a major component in the practice of the general surgeon. To assess the adequacy of general surgery residencies in addressing this educational need, data were obtained from the Residency Review Committee (RRC) for surgery on the anorectal experience of all graduating residents in accredited United States programs for a recent five-year period (1987-1991). The mean number of anorectal procedures in which a resident participated throughout the residency was 30.0. This is then further subdivided by type of procedure. It is concluded that general surgery residency programs tend to provide an inadequate training experience in anorectal surgery.

Anal Canal↗
PubMed1992

Consequences of delayed ileostomy closure after ileal pouch-anal anastomosis.

Temporary diverting loop ileostomy is a generally accepted component of the ileal pouch-anal anastomosis (IPAA) procedure. Ileostomy closure is usually performed within two to three months but may be delayed because of disruption of the ileonanal anastomosis, suspected leak from the ileal reservoir, concomitant medical problems, or patient convenience. Of 362 patients undergoing IPAA at The Cleveland Clinic Foundation for inflammatory bowel disease, 10 have had their ileostomy closures delayed for more than six months. Clinical and manometric parameters are examined in these patients and compared with those who had earlier closure. There appears to be no significant difference in the functional outcome of IPAA in these patients in terms of number of bowel movements and degree of continence. Reservoir compliance and maximum tolerated volumes are similar. We conclude that delaying ileostomy closure for more than six months after IPAA has no deleterious effect on pouch function.

Adult↗
PubMed1991

Consequences of ileal pouch-anal anastomosis for Crohn's colitis.

Patients with Crohn's colitis are generally not considered candidates for the ileal pouch-anal anastomosis (IPAA) procedure. We reviewed 362 consecutive patients undergoing IPAA and analyzed the outcome of this procedure on 25 patients with a preoperative diagnosis of mucosal ulcerative colitis who were subsequently proven to have Crohn's disease. The mean follow-up was 38.1 months. Sixteen patients have a functioning pouch, seven have required pouch excision, one is diverted, and one has died. Only one of nine patients in whom there was a preoperative clinical feature suggestive of Crohn's disease has a functioning pouch, with complications uniformly occurring within months of ileostomy closure. In contrast, 15 of 16 patients without preoperative features of Crohn's disease have maintained their pouch, generally with good results. These data suggest that patients in whom there is clinical and pathologic evidence of Crohn's disease do very poorly without meaningful symptom-free intervals. However, patients without any clinical features of Crohn's disease, despite a histopathologic diagnosis of Crohn's colitis, have had a good outcome with IPAA thus far.

Adult↗
PubMed1991

Crohn's disease of the small bowel.

Crohn's disease is a perplexing panintestinal disease whose etiology is unknown. Symptoms and complications vary greatly from patient to patient. Despite the fact that no cure exists, thoughtful, well-planned therapy and appropriate timely intervention, where needed, can result in maintenance of a high quality of life for affected patients.

Anti-Inflammatory Agents↗
PubMed1985

Blood transfusions and survival after lung cancer resection.

The immunosuppressive effects of blood transfusions in renal transplantation patients are now well documented. The question arises as to whether the possible immunosuppressive effects of blood transfusions in cancer patients cause a more favorable host environment for tumor growth. One hundred fifty-five patients undergoing resection for lung carcinoma were analyzed retrospectively, and it was shown that the use of blood transfusions was associated with a significant decrease in survival time in patients undergoing curative resection of lung carcinoma despite multivariate adjustments for age, sex, cell type, right lung versus left lung location, type of operation, and stage. This association supports, but does not prove, the hypothesis that blood transfusions, possibly through an immunosuppressive mechanism, are responsible for a poorer prognosis in patients who undergo resection for carcinoma of the lung.

Adenocarcinoma↗