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Biomedical subjects

P Slezak

Publications and source records attributed to P Slezak.

At least 37 records · Page 2Linked to original sources
PubMed1994

The costs of colonoscopy in patients with ulcerative pan-colitis in Sweden.

The costs of colonoscopy examinations at a hospital in Sweden were calculated in ten consecutive patients with ulcerative pan-colitis. Since colonoscopy in such patients is incomplete if not followed by microscopic study of the state of the colon mucosa, the costs of both the endoscopic and histological examinations were calculated together. The costs of the material used (disposable items, recycled items and durable items) and the wages for personnel involved (endoscopists, pathologists, nurses, laboratory technicians, secretaries and clerks) were calculated for each colonoscopic and histological examination. The mean cost per complete examination was US$223, which is moderate despite the high personnel costs in Sweden. Since the biopsy material obtained in an endoscopic examination is of value not only for conventional histological study but also for DNA analysis, periodic colonoscopy is still to be recommended in patients with long-standing ulcerative pan-colitis until new methods of cancer detection and prevention become available.

Adult↗
PubMed1994

The significance of mucosal staining for the endoscopic diagnosis of chronic esophagitis as assessed in biopsy findings.

A total of 115 patients with clinical signs of esophagitis were examined by endoscopy and mucosal biopsy combined with Lugol solution. Overall, 175 mucosal areas (105 stained and 70 unstained) were subjected to histopathological examination. The correlation between the staining properties of the esophageal mucosa and the histopathological diagnosis resulted in a diagnostic sensitivity of 51.9%, a specificity of 70.2%, a positive predictive value of 60.0% and a negative predictive value of 62.9% for Lugol combined endoscopy. Lugol combined endoscopy did not appear to result in any improvement in the diagnosis or staging of reflux esophagitis in our study.

Adult↗
PubMed1994

Duodenitis--distinguishing features in a retrospective endoscopic and histological study.

Routine films of 596 upper GI endoscopies with the diagnosis of duodenitis were reviewed and a classification was made into granular (G), multi-polypoid (MP), reddened (R) and erosive (E) types. Two hundred and thirty-four histological specimens from 117 of the patients, as well as 100 specimens from 50 controls, were analyzed for villous obliteration, Brunner's gland dilatation and mucus depletion, erosion, mucosal hemorrhage and edema, atypia of the surface epithelium and gastric surface epithelial metaplasia. Inflammatory cell counts for polymorphonuclear and mononuclear cells in the epithelium, in the lamina propria together with a histological score was also made. On the basis of this study and a review of classifications of duodenitis in the literature, it is concluded that some endoscopical features like erosions and redness may represent more acute phases of duodenitis, mucosal elevations representing more hyperplastic changes and that the endoscopic classification into G, MP, R and E types seem relevant to use in clinical practice.

Biopsy↗
PubMed1993

Gastric intestinal metaplasia eleven years after randomized selective proximal vagotomy for peptic ulcer.

The presence of intestinal metaplasia (IM) 11 years after selective proximal vagotomy (SPV), selective proximal vagotomy with pyloroplasty (SPV + PP) and selective vagotomy with pyloroplasty (SV + PP) was investigated in 38 consecutive patients. IM was significantly more frequent in SPV than in SV + PP, SPV + PP or in unoperated controls of matching ages. IM occurred more frequently both at an older age (> or = 60 years) in SPV and in a larger number of gastric areas than in the other group of patients. Reports in the literature indicate that vagotomy may increase the risk of gastric carcinoma and that IM may antedate malignant transformation. It would thus appear that patients previously operated with SPV (without pyloroplasty) having IM, should be the group of patients to be enrolled in endoscopical surveillance programs for detection of possible cancer development.

Adult↗
PubMed1992

Comparison between double-contrast barium enema and colonoscopy to investigate lower gastrointestinal bleeding.

A retrospective study was performed to compare the diagnostic accuracy of high-quality double-contrast barium enema (DCBE) against gold standard colonoscopy in 288 patients with suspected lower gastrointestinal bleeding who went through both examinations. Colonoscopy detected the potential cause of bleeding in 99 patients (100%); in order of frequency: polyps greater than or equal to 1 cm (N = 47; 48%), carcinoma (N = 21; 21%), inflammatory bowel disease (IBD) (N = 15; 15%), solitary ulcers (N = 6; 6%), other types of colitis (N = 5; 5%), angiodysplasia (N = 3; 3%), and stenosis (N = 2; 2%). DCBE diagnosed 88 cases (89%) and missed 11 consisting of IBD (N = 4), angiodysplasia (N = 3), solitary ulcers (N = 3), and polyps (N = 1). The overall sensitivity and specificity of DCBE was 0.89 and 0.97, respectively. The sensitivity for carcinoma, polyps, and IBD was 1.00, 0.98, and 0.73, respectively. We conclude that DCBE is very effective to diagnose carcinoma and polyps greater than or equal to 1 cm, the most frequent causes of bleeding, but less effective to diagnose IBD and other nonfrequent causes. If a high-quality DCBE does not reveal the cause of bleeding, the contribution of a following colonoscopy will be to diagnose causes of bleeding other than carcinoma and polyps less than 1 cm and to offer therapeutic possibilities.

Adolescent↗
PubMed1992

Colectomy-proctomucosectomy with S-pouch: operative procedures, complications, and functional outcome in 69 consecutive patients.

Sixty-nine patients were operated upon in a three-stage procedure. Early complications occurred in 29 percent after colectomy-ileostomy, in 25 percent after proctomucosectomy with ileoanal anastomosis and loop ileostomy, and in 9 percent after closure of loop ileostomy. Only three of these were considered serious. Seventy-one percent of the patients were readmitted into the hospital between the three operations or after the last one. Total hospital stay was 49 days (median); the range was 20 to 345 days. Reconstruction of the reservoir was performed in four patients owing to defecation problems, with satisfying functional results in two patients, while two emptied by catheter. There was no postoperative mortality or pelvic sepsis, and no pouches were excised. Ileostomy was re-established in two patients. At histopathologic re-evaluation of colectomy specimens, the diagnosis was changed from ulcerative colitis to Crohn's disease in three patients and to indeterminate colitis in five. Median follow-up was 4.3 years. Continent anal defecation without ileostomy was achieved in 67 patients (97 percent), with 4.1 bowel movements per day and 0.6 per night. Perfect continence was achieved in 55 percent in the daytime and in 43 percent at night. The low rate of reservoir-threatening complications is attributed to the three-stage procedure and the technical details in the surgical procedures.

Adolescent↗
PubMed1992

Can somatostatin prevent injection pancreatitis after ERCP?

In a double-blind randomized study, 30 patients received somatostatin infusion during ERCP and 30 patients placebo with the aim of evaluating whether somatostatin can reduce the incidence of injection pancreatitis. S-amylase, U-amylase and S-lipase were evaluated before, during and after (up to 48 hours) ERCP. C-peptide was also determined as a marker of the function of the endocrine pancreas. While no statistically significant effect of somatostatin in terms of amylase and lipase was to be found, somatostatin did significantly decrease c-peptide levels in plasma, indicating that the peptide inhibited beta-cell secretion. About 40% of patients in the somatostatin group and about 50% in the placebo group showed signs of injection pancreatitis (elevated levels of enzymes) and in both groups there are patients with clinically apparent pancreatitis.

Aged↗
PubMed1991

Ischemic colitis of the cecum after renal transplantation masquerading as malignant disease.

Fourteen years after kidney transplantation and following protracted rejection of the transplant, a patient developed abdominal pain, fever, and leukocytosis. Ultrasound demonstrated a pericolic abscess, and barium enema a deformity of the ascending colon suggesting malignant growth. Colonoscopy showed ulcerative and necrotic lesions of the cecum, and colonic carcinoma was suspected. At surgery, a granulomatous inflammatory reaction with fibrosis involving the kidney transplant and cecum was found. Histological examination revealed ulcerations secondary to ischemic colitis, but no malignancy. Thus, ischemic colitis should be ruled out in cases with a presumptive diagnosis of colonic malignancy at x-ray or endoscopy.

Adult↗
PubMed1991

Crohn's disease and adenocarcinoma of the intestinal tract. Report of four cases.

Four patients with intestinal adenocarcinoma complicating Crohn's disease are reported. The youngest of the four patients was a 21-year-old female with a 9-year history of Crohn's disease of the terminal ileum as well as of the entire colon. She developed mucus-producing moderately differentiated adenocarcinoma in the cecum. Of the remaining three patients with Crohn's disease, one presented an adenocarcinoma in the ascending colon, one in the rectum and the remaining one in the duodenum. All three colorectal adenocarcinomas originated in areas of high-grade dysplasia and all four in areas with chronic transmural inflammation. The review of the literature indicates that a total of 174 small and large bowel cancers occurring in Crohn's disease have been recorded (including the four reported herein). The vast majority of the reported cases have been found in the North American subcontinent. Only in a few instances were bowel adenocarcinoma and Crohn's disease observed in the European continent. It is therefore remarkable that three of our four cases were seen within a period of 12 months. Interestingly, six patients having colorectal adenocarcinoma in association with Crohn's disease were recently reported from a single hospital in England. The question therefore arises whether our cases and those reported recently from England are unrelated and merely coincidental or whether carcinomas are now also affecting European CD patients. If the latter is the case, the surveillance policy for patients with CD should be reconsidered at this hospital.

Adenocarcinoma↗
PubMed1989

The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure.

Results from the consecutive examination of 675 patients using both flexible sigmoidoscopy and a double-contrast x-ray technique were analyzed with special reference to the detection of polyps in the rectum and sigmoid colon. A total of 193 polyps were found. Histological examination of 93 polyps revealed that half of those less than 5 mm in diameter and 93.3% of those more than 6 mm in diameter were adenomas. The x-ray examination failed to detect 44% of the proven adenomas smaller than 5 mm, 35.3% of those 6-10 mm in size, and 16.7% of those larger than 11 mm in diameter. These rates were significantly higher than those of flexible sigmoidoscopy, which had corresponding miss rates of 8, 11.2, and 0%, respectively. The double-contrast barium enema (DCBE) failed to detect every second polyp in the rectosigmoid. Every second polyp in the same region proved to be adenoma. The DCBE combined with flexible sigmoidoscopy gives the most reliable and precise diagnosis of various disorders of the rectum and sigmoid colon.

Adolescent↗
PubMed1988

Ulcerative colitis in protracted remission. A quantitative scanning electron microscopic study.

Colonoscopic biopsies from 32 patients were studied at the ultrastructural level using a scanning electron microscope (SEM). Sixteen of the 32 patients had a previous diagnosis of total ulcerative colitis (UCR greater than 10 years) in protracted remission. The colonic mucosa was normal at endoscopic and histologic examinations (UCRN). The remaining 16 patients had normal colonic mucosa, but had an adenoma or an adenocarcinoma elsewhere in the colon. Several ultrastructural parameters were investigated, such as the number of crypts per area, the distance between the crypts, the outline of mucosal units, the number of mucous cells, the outline of absorptive cells, and the number of villi per area. Quantitative determinations of SEM structures (including measurements with an interactive digital image analyzer system; MOP 30, Zeiss Contron) were made. The results showed no significant differences between the various parameters (except for the number of crypts per area) between patients with UCRN and controls. The possibility of a total (or quasi-total) restitutio ad integrum of the colonic mucosa in certain patients with UCR is discussed. An international policy regarding the colonoscopic surveillance of patients with UCRN should be elaborated. It is suggested that the time interval between control colonoscopic biopsies in patients with UCRN should be increased substantially.

Adenocarcinoma↗
PubMed1988

Foveolar cell vacuolization in operated stomachs.

Gastric biopsies from 223 patients were scrutinized for the presence of subnuclear vacuolization in the foveolar epithelium. The results demonstrated that foveolar epithelial vacuolization occurred in seven (15.9%) of 44 patients who had a previous Billroth I gastrectomy and in 56 (87.5%) of 64 patients who had a Billroth II remnant stomach. None of the 21 patients who had a vagotomy and pyloroplasty, and only two (2.1%) of the 94 unoperated controls, had vacuolated foveolar cells. The vacuolization is apparently not related to the patients' sex, and it seems to develop some years following gastric resection. Since both human and experimental studies have demonstrated that the duodenogastric reflux is more frequent in Billroth II than in Billroth I operated stomachs, it appears that subnuclear vacuolization in foveolar gastric cells is a histological marker for protracted duodenogastric reflux.

Adult↗
PubMed1984

Early detection of malignancy in ulcerative colitis. A flow-cytometric DNA study.

The cellular DNA content in colorectal biopsies from 51 patients with chronic ulcerative colitis has been studied with flow-cytometric technique. The DNA pattern has been related to the duration of the disease, and to histopathology. Aneuploid cell lines were found in eight patients, two of which had histopathologically verified malignancies. Aneuploid cell lines were found in 2% of biopsies from mucosa classified as normal, in 10% of biopsies with inflammation, hyperplasia or atrophy, in 25% of polyps and in biopsies with dysplasia and in seven of eight biopsies from adenocarcinomas. Four of 27 cases with 11 to 20 years duration of disease, and 4 of 10 with more than 20 years disease, had aneuploid cell lines. Combined with colonoscopy the flow-cytometric technique can routinely be used in the follow-up of patients with ulcerative colitis in screening for malignant cell lines.

Adult↗
PubMed1984

Villous dysplasia. An ominous histologic sign in colitic patients.

Preoperative biopsies and colectomy specimens from 40 patients with long-standing ulcerative colitis (of whom 20 had adenocarcinoma at colectomy) were searched for the presence of villous adenomatous changes with or without cellular dysplasia. Villous adenomatous changes were found in available preoperative punch biopsies in nearly 70 per cent of the patients with carcinoma, but in none of the preoperative punch biopsies from the 20 patients without cancer. Only three of the preoperative biopsies from patients with carcinoma showed severe dysplasia, and also one of the 20 colitic patients without carcinoma. The mucosal tip in villous adenomatous changes was usually covered by columnar epithelium without dysplasia. In preoperative punch biopsies from patients with long-standing ulcerative colitis, the presence of structures compatible with villous adenoma--even those without cellular dysplasia--should be considered an ominous histologic sign and, thus, an indication for panproctocolectomy.

Adenoma↗
PubMed1984

Bioconversion of arachidonic acid in the human gastrointestinal tract.

The data presented demonstrate that the bioconversion of [14C]arachidonic acid in homogenates like these is very easily influenced by protein (enzyme) and substrate concentration as well as exogenous cofactors. This is not unexpected but variations will lead to artifactual differences. Neither quantitative nor qualitative differences could be detected between biopsies taken from healthy as compared to diseased individuals. No products other than PGE2, PGF2 alpha, TxB2, and 6-keto-PGF1 alpha (and metabolites thereof) could be demonstrated although special efforts were undertaken to determine whether there was any detectable lipoxygenase activity. Therefore it seems that future studies on the possible roles of prostaglandins in gastrointestinal physiology should be restricted to those compounds identified, primarily PGE2 and PGF2 alpha. The monotony in the pattern of products formed in homogenates from different tissues also suggests that in order to be able to detect possible differences between various conditions such studies should involve a minimum of tissue manipulation.

Adolescent↗