Search PubMed⌕ Search

Biomedical subjects

R M Katon

Publications and source records attributed to R M Katon.

At least 19 recordsLinked to original sources
PubMed1979

Fine-needle cholangiography (FNC) in the nonjaundiced patient.

Fine-needle cholangiography (FNC) in the jaundiced patient is well established, but its role in the diagnostic work-up of nonjaundiced patients has not been emphasized. We present 44 consecutive nonjaundiced patients with a serum bilirubin level of 2.4 mg% of less who underwent FNC. The indications were recurrent RUQ pain (77%), painless cholestasis (16%), and relapsing pancreatitis (7%). In all but two patients, one or more inconclusive techniques [oral cholecystography, ultrasonography, intravenous cholangiography, or endoscopic retrograde cholangiography (ERC)] had been employed prior to FNC. Biliary tract opacification was successful in 35 of 44 (80%). In nine of 35 (26%) choledocholithiasis and/or cholelithiasis was present. In four (11%) a significant extrahepatic biliary stricture was noted. More than five needle insertions were often required for successful entry. No complications occurred. Indications for FNC should be extended to include nonjaundiced patients with RUQ pain or painless cholestasis in whom oral cholecystography, ultrasonography, and intravenous cholangiography have been of no diagnostic help. The relative ease and low cost of FNC make it preferable to ERC in these patients.

Adolescent↗
PubMed1979

Percutaneous transhepatic gallstone removal by needle tract.

A percutaneous transhepatic cholangiogram tract was used to visualize a large stone in the common duct; following the tract's dilation, the stone was crushed and partially removed. Fragments were flushed and also passed spontaneously into the duodenum. The approach described offers a feasible alternative to surgery.

Cholangiography↗
PubMed1979

The pansigmoidoscope: one year's experience in a gastrointestinal diagnostic unit.

Since May 1976, the Olympus pansigmoidoscope has been available for routine use at the University of Oregon Health Sciences center. Two hundred sixty-five examinations were performed over the next year. The average distance examined was 49 cm. Time per examination ranged from 3 to 15 minutes, with an average of 8 minutes. Preparation consisted of one or two tap water enemas, except in known inflammatory bowel disease where no preparation was given. No patient received sedation and there were no complications. Small biopsy (2.8 mm), large biopsy (4.0 mm), "hot biopsy" and polypectomy were performed when indicated. The procedure was most helpful for the following indications: 1) differential diagnosis and follow-up of inflammatory bowel disease, 2) hematochezia, 3) evaluation of abnormal barium enema, 4) left-sided polypectomy, 5) diarrhea with normal barium enema, and 6) guaiac-positive stools. It was of no value in patients with abdominal pain with normal barium enema. Comparing the frequency of examinations this year with last year we found a 50% decrease in use of the rigid (25 cm) sigmoidoscope (538 to 270 exams) and a 98% decrease in use of the MB2 (100 cm) colonoscope (80 to 2 exams).

Adolescent↗
PubMed1979

Intramural hematoma of the small intestine presenting with major upper gastrointestinal hemorrhage. Case report and review of the literature.

We report a case of an anticoagulated patient presenting with a massive upper gastrointestinal hemorrhage, abdominal pain, and a palpable abdominal mass, demonstrated to be an intramural hematoma of the jejunum. Approximately two-thirds of intramural hematomas of the small intestine are preceded by abdominal trauma with the remainder associated with pancreatic disease, alcoholism, unknown causes, or clotting defects. Spontaneous occurrence of intramural hemorrhage is uncommon. Of the varied clinical presentations, gastrointestinal bleeding, previously thought unusual, is seen in 30% of cases, although major hemorrhage is rare. Conversely, reports of intramural hematoma of the small intestine as a case of major gastrointestinal bleeding has not been recognized. A review of the literature follows, and the authors stress that abdominal trauma should raise the possibility of an intramural hematoma of the small bowel.

Abdominal Injuries↗
PubMed1979

Flexible sigmoidoscopy as a screening procedure for neoplasia of the colon.

Two hundred asymptomatic United States veterans older than 40 years of age were evaluated with a flexible sigmoidoscope plus Hemoccult stool tests. Mean distance and time for the former were 56.4 centimeters and 7.4 minutes, respectively. There were no complications. Polyps greater than or equal to 0.5 centimeter in diameter were found in 11.9 per cent of those older than 50 years. No polyps of this size were found in patients younger than 50 year of age. Results of Hemoccult tests were negative in 83.3 per cent of those with polyps. A flexible sigmoidoscope is a safe, rapid and effective means of identifying that portion of the asymptomatic adult population having colonic polyps. For this purpose, it is vastly more sensitive than Hemoccult stool testing. Because of the relationship between colonic polyps and carcinoma, this technique may prove invaluable in the identification of those patients with an increased potential for the development of carcinoma of the colon.

Adult↗
PubMed1978

Endoscopic retrograde cholangiopancreatography in the diagnosis and management of nonalcoholic pancreatitis.

Twenty-eight consecutive patients with idiopathic pancreatitis were studied. Endoscopic retrograde cholangiopancreatography was diagnostic in 21 of 28, while an operation was diagnostic in four of the remaining seven patients. Fifteen of 25 patients had operable disease of the gallbladder, common bile duct, ampulla of Vater or pancreatic duct. Of ten patients who had an operation on the pancreas or biliary tract, or both, for painful attacks of pancreatitis, none had a recurrence in a seven month to three year follow-up study. Two patients had reconstruction of the pancreatic duct for chronic painless steatorrhea, one of whom had marked clinical improvement. Ten of 25 patients had normal biliary tracts with normal or minimally abnormal pancreatic ducts and were treated medically. Visualization of biliary and pancreatic ducts should be attempted by endoscopic retrograde cholangiopancreatography in patients with pancreatitis of unknown cause. Operable lesions were found in 15 of 25 patients, and the postoperative results were excellent.

Acute Disease↗
PubMed1977

Obstructive jaundice after bone marrow transplantation.

Jaundice after bone marrow transplantation is usually a consequence of graft versus host disease. Reported is a patient who presented with obstructive jaundice several months after a successful marrow allograft. Despite a benign bone marrow examination, abdominal ultrasound, upper gastrointestinal series, and endoscopic biopsy were utilized to diagnose recurrent leukemia at the pancreatic head and descending duodenum. The entities of graft versus host disease as related to jaundice, and gastrointestinal leukemia, in the presence of a "remission" bone marrow, are reviewed.

Biopsy↗
PubMed1977

Fiberoptic pansigmoidoscopy. An evaluation and comparison with rigid sigmoidoscopy.

A flexible 60-cm fiberoptic sigmoidoscope was evaluated in 139 patients. In 120 patients flexible sigmoidoscopy was compared with routine rigid sigmoidoscopy with respect to patient tolerance, distance of inspection, procedure time, and diagnostic yield. All patients were prepared with a single cleansing enema, and given no analgesia. Despite the fact that the flexible instrument was inserted nearly 3 times as far into the colon (55 cm versus 20 cm), more patients preferred the flexible examination. Significant pathological lesions were discovered by the flexible examination in 39% of patients, whereas rigid sigmoidoscopy discovered lesions in only 13%. Fluoroscopy performed during flexible sigmoidoscopy in 19 additional patients revealed that the instrument tip had reached the descending colon or beyond in 84% of patients. There were no complications. The flexible fiberoptic pansigmoidoscope offers promise as a practical diagnostic tool for a rapid and complete examination in patients with suspected colorectal diseases.

Adolescent↗
PubMed1976

Intramural barium in ischemic colitis: a new radiographic finding.

Two cases of ischemic colitis are presented, demonstrating a new radiographic finding of intramural dissection of barium. Colonoscopic findings were compatible with that diagnosis. Deep, discrete ulcerations were observed during the healing process. Both patients recovered and prolonged retention of the intramural barium was seen.

Aged↗
PubMed1976

"Blind" evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: the "double duct" and other signs.

A "blind" review of 40 "look-alike" ERCP examinations was conducted to determine if pancreatic carcinoma could be diagnosed by ERCP findings alone, and if there were specific findings which occurred only in carcinoma. All 11 cases of carcinoma involving the pancreas were diagnosed correctly, with no false positives or negatives. Irregular (nodular or rat-tailed) pancreatic duct encasement or obstruction occurred exclusively in carcinoma. When the adjacent common bile duct was similarly involved (Double Duct Sign), the diagnostic certainty increased. The results suggest that ERCP is an accurate and reliable method for diagnosing pancreatic carcinoma.

Cholangiography↗
PubMed1976

Evaluation of sclerosing cholangitis by endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography contributed considerably to diagnosis or subsequent management of two cases of sclerosing cholangitis, In the first patient, sequential studies helped to determine the timing and nature of the surgical intervention that was used. In the second patient, the diagnosis was suggested by ERCP, which led to surgical exploration and biopsy of the common bile duct to confirm the diagnosis. The quality of the films obtained in both patients was excellent. We suggest that ERCP is a relatively noninvasive and accurate means of follow-up in cases of sclerosing cholangitis.

Adult↗
PubMed1976

Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases.

Of 402 United States owners of side-viewing duodenoscopes surveyed, 222 (55%) responded, reporting 10,435 endoscopic retrograde cholangiopancreatograms. Procedure failed occurred in 30%, complications in 3%, and death in 0.2%. Complications included pancreatitis, cholangitis, pancreatic sepsis, instrumental injury to the gastrointestinal tract, and drug reactions. Pancreatitis was associated with injection into the pancreatic duct, sepsis with injection into an obstructed duct or pseudocyst, and injury with abnormal gastroduodenal anatomy. Experienced workers had a 15% incidence of complications, whereas inexperience gave 4 times the failures (62%) and twice the complications (7%). The causes of complications and their prevention are discussed.

Cholangiography↗