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Biomedical subjects

R M Katon

Publications and source records attributed to R M Katon.

At least 37 records · Page 2Linked to original sources
PubMed1991

Variation in management based on type of choledochal cyst.

The management of 23 patients treated for choledochal cysts at the Oregon Health Sciences University between 1969 and 1990 is reviewed. The median age was 27 years, with a range from 1 month to 90 years. Seventy-eight percent of patients presented with abdominal pain, and 35% were jaundiced. Three patients presented with cholangitis, two with cyst rupture, and one with recurrent pancreatitis. Nine patients had had previous biliary surgery. The diagnosis was made in all patients with ultrasound and/or cholangiography. Fifteen patients (65%) had type I cysts, 2 had a type II cyst, 5 (22%) had type III cysts, and 1 had a type IV cyst. Stones were present in four (17%) cysts, and all excised cysts were benign. Seventeen patients with type I and II choledochal cysts had complete cyst excision and choledochoenterostomy. Four of five patients with type III cysts had endoscopic cyst incision and drainage, while the fifth patient had transduodenal cyst excision and sphincteroplasty. The patient with a type IV cyst had extrahepatic cyst excision and choledochojejunostomy. There were no operative deaths. Two postoperative complications occurred: cholangitis and a prolonged ileus. All patients had resolution of their pain and jaundice. Two patients had late cholangitis. Cyst excision and choledochojejunostomy are the treatment of choice for types I and II choledochal cysts. Extrahepatic cyst excision and choledochojejunostomy may be adequate treatment for type IV cysts. Endoscopic incision and drainage is appropriate for selected patients with type III cysts.

Adolescent↗
PubMed1991

Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation.

Biliary leaks are uncommon complications of abdominal surgery. Left untreated, they may result in significant morbidity and mortality. The traditional treatment has been surgical, but several authors have reported successful endoscopic management. We review 77 cases of endoscopically managed postoperative biliary leaks reported in the literature over the past 15 yr. Endoscopic treatment was technically successful in 95% of cases, and resulted in biliary leak healing in 82%. Cystic stump leaks had a better prognosis for healing compared with common bile duct or hepatic duct leaks. We also present two additional cases of postoperative biliary leaks with biloma formation successfully treated with endoscopic stent placement. Our experience lends additional support to endoscopic management as the preferred approach to postoperative biliary leaks.

Adult↗
PubMed1989

Skin tags are not a risk factor for colorectal polyps.

To ascertain whether acrochordons (simple skin tags) are associated with a higher risk for colon polyps, we prospectively studied 218 male and female patients, age 40 or older without history of colon cancer, polyps, ulcerative colitis, familial polyposis, or recent lower intestinal symptoms. Each patient was assessed for the presence of skin tags. A screening flexible sigmoidoscopy was then performed without knowledge of the dermatologic findings. All polypoid lesions were recorded, and patients with polyps greater than or equal to 3 mm in diameter underwent full colonoscopy and polypectomy. Twenty patients (9.2%) had documented adenomatous polyps on colonoscopy. Nineteen other patients had hyperplastic polyps and mamillations. There was no significant difference in the prevalence of polypoid lesions in those with skin tags compared with those without skin tags, either analyzed as group totals or stratified by age, sex, or type of polyp. We conclude that skin tags are not associated with a higher than usual risk for colonic polyps and should not be used as a marker for more intensive screening.

Adult↗
PubMed1989

Gastric linitis plastica with metastases to the colon: a mimic of Crohn's disease.

A 60-year-old woman had progressive lower abdominal pain, nonbloody diarrhea, and weight loss, followed by severe epigastric pain and dysphagia. Radiographic evaluation of the colon showed segmental strictures which were interpreted as Crohn's disease. Medical treatment was not helpful. Neither gross endoscopic appearance nor multiple biopsies of the esophagus, stomach, and colon were diagnostic. Finally, laparotomy with full-thickness biopsies of the stomach and colon revealed linitis plastica. The clinician should be alert to colonic metastases from gastric linitis plastica, for it can produce focal or segmental strictures, mimicking more common colonic diseases such as Crohn's disease. A full-thickness biopsy is often necessary for a firm diagnosis. We review the literature on this occurrence, highlighting the clinical and radiologic spectrum, as well as the organ systems most often affected when gastric linitis plastica metastasizes.

Adenocarcinoma, Scirrhous↗
PubMed1987

Hepatic abscesses as a complication of the sump syndrome: combined surgical and endoscopic therapy. Case report and review of the literature.

The "sump syndrome" is an unusual complication of side-to-side choledochoduodenostomy in which the portion of the common bile duct distal to the anastamosis acts as a sump and may collect bile, stones, food, and other debris. Partial or complete obstruction of the stoma and resultant bacterial proliferation may result and lead to recurrent cholangitis or pancreatitis. A single hepatic abscess as a complication of the sump syndrome has been reported only once. We have recently seen a patient presenting with multiple hepatic abscesses as a complication of the sump syndrome. This is the first report of endoscopic treatment of this syndrome associated with a hepatic abscess. The literature on the endoscopic approach to this problem will be reviewed.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1986

Endoscopic palliative treatment in pancreatic cancer.

Patients with carcinoma of the head of the pancreas will develop obstructive jaundice at some point in their course in 80% to 90% of the cases. Surgical biliary digestive anastomosis carries a high 30-day mortality (20%), and hospitalization may be prolonged for several weeks owing to postoperative morbidity. We attempted endoscopic endoprosthesis placement in 221 patients with pancreatic carcinoma for palliation of obstructive jaundice. The procedure was successful in 200 of 221 (90%) with a procedure-related mortality of only 2% and a 30-day mortality of 10%. The serum bilirubin level normalized in 92% of those who survived, and the mean survival of 6 months is comparable to that achieved with biliodigestive anastomosis. Early cholangitis (8%) and late clogging of the endoprosthesis (21% at a mean of 5 months) are problem areas that need to be improved. We believe these results justify considering endoscopic biliary prosthesis as the treatment of choice in nonresectable jaundiced patients with carcinoma of the head of the pancreas.

Adolescent↗
PubMed1986

Endoscopic treatment of postoperative biliary strictures.

Benign postoperative biliary tract strictures may present with jaundice and/or cholangitis. Surgical reconstruction of these usually proximal biliary strictures carries high morbidity and mortality. In addition, recurrences following surgery are common. We attempted endoscopic therapy in 29 consecutive patients with benign biliary strictures, by the placement of one or two large-bore 10 French endoprostheses. The procedure was successful in 27 out of 29 (93%) patients. All 27 had rapid clearance of jaundice and/or cholangitis. Clinical follow-up of 21 patients for at least 6 months (range 6 months to 4 years) shows that 19 out of 21 have good (3) or excellent (16) results. There was no morbidity or mortality associated with the procedure. Although placement of an endoprosthesis in this group of patients is technically difficult, we believe it should be considered as the initial therapeutic modality in this clinical situation.

Adult↗
PubMed1986

Colonoscopy after Golytely preparation in acute rectal bleeding.

Thirty-five consecutive patients with acute hematochezia, negative gastric aspirates, and negative sigmoidoscopy underwent urgent colonoscopy after Golytely purgation. Mucosal visualization was excellent. Colonic bleeding lesions were identified in 24 of 35 patients, and hemorrhage originating proximal to the ileoceal valve was documented in three of these 35 patients. Therapeutic endoscopic electrocautery, employed in 12 of 35 patients, was effective in 11. The peroral preparation was well tolerated, and there were no complications of the preparation or of colonoscopy. The data suggest that urgent colonoscopy following Golytely purgation is a safe, sensitive, and specific diagnostic procedure that provides an opportunity for early nonoperative treatment of acute colonic hemorrhage.

Adolescent↗
PubMed1985

Cardiopulmonary risk of esophagogastroduodenoscopy. Role of endoscope diameter and systemic sedation.

The impact of endoscope diameter and the presence of systemic sedation on the cardiopulmonary risk of esophagogastroduodenoscopy was investigated. One hundred and forty-six patients undergoing elective esophagogastroduodenoscopy were randomly assigned to one of three groups which differed in either endoscope diameter or use of sedation: group 1 (8.5-mm endoscope with no sedation), group 2 (8.5-mm endoscope with diazepam), and group 3 (11.5-mm endoscope with diazepam). Esophagogastroduodenoscopy was tolerated best by group 2, and this group had the fewest electrocardiographic changes observed on a Holter recording during esophagogastroduodenoscopy. The incidence of electrocardiographic changes during esophagogastroduodenoscopy correlated with patient tolerance (p less than 0.001) and the use of the smaller endoscope (p less than 0.05). The most common arrhythmia was sinus tachycardia (49 patients), but more serious electrocardiographic changes were observed in 21 patients. Serious arrhythmias were more common in patients with a prior history of cardiovascular disease compared with patients with no such history (30% vs. 6%, p less than 0.001). Arterial oxygen desaturation (measured by ear oximetry) during intubation and esophagogastroduodenoscopy was usually modest (2%-5%). However, 16 patients receiving diazepam experienced high levels of desaturation exceeding 7%; this small group of patients also experienced more electrocardiographic changes than other patients. The use of diazepam sedation and an 8.5-mm endoscope may offer the safest and most comfortable combination for most patients undergoing esophagogastroduodenoscopy. Diazepam sedation, however, may represent a potential danger to a small number of patients with marginal baseline arterial saturation.

Diazepam↗
PubMed1985

Short (35-cm) versus long (60-cm) flexible sigmoidoscopy: a comparison of findings and tolerance in asymptomatic patients screened for colorectal neoplasia.

The purpose of this study was to compare the utility of the 35-cm versus the 60-cm flexible sigmoidoscope in screening asymptomatic patients for colorectal neoplasia. Two hundred fifty-eight patients 45 years of age or older were examined in a randomized fashion with both the 35-cm and 60-cm instruments. Fifteen percent (39/258) of patients had a total of 50 polypoid lesions 3 mm or greater in diameter (including one carcinoma). Of all polypoid lesions, 76% were detected with the 35-cm instrument compared to 98% with the 60-cm sigmoidoscope. Eighty-four percent of all polyps occurred within the distal 35 cm of colon. The mean time required to complete the examination was significantly less with the 35-cm sigmoidoscope than with the 60-cm sigmoidoscope (2.5 vs. 5.7 min). Moderate to severe discomfort was experienced by 69% of patients with the 60-cm instrument compared to only 29% with the 35-cm sigmoidoscope. Seventy-two percent of patients preferred examination with the shorter instrument compared with 7% for the longer sigmoidoscope, while 21% of patients expressed no preference. The 35-cm flexible sigmoidoscope fulfills many criteria of an effective screening test for colorectal neoplasia including rapidity of examination, safety, good sensitivity, and excellent patient acceptance.

Aged↗
PubMed1984

Arterial embolization for massive upper gastrointestinal tract bleeding in poor surgical candidates.

Therapeutic vascular occlusion was used in 32 patients to control massive upper gastrointestinal tract bleeding. All patients were poor surgical candidates and received an average of 12 U of red cells before embolization. Control of bleeding (for greater than 24 h) was attained in 23 of 32 patients (72%). Six of these 23 patients (26%) subsequently died within a 6-mo follow-up period, 5 due to underlying diseases, and only 1 due to rebleeding. Nine patients were not controlled initially with embolization, although 6 had marked reduction in bleeding. Eight of these 9 patients died (89%), 6 from hemorrhage or emergent gastric surgery, and 2 from underlying diseases. All patients with Mallory-Weiss tears (5) and with hemobilia (3) were successfully treated with embolization. Serious complications included gastric infarction in 2 patients with prior compromise of gastric arterial supply. Embolization offers an efficacious alternative to emergent surgery for control of massive upper gastrointestinal arterial hemorrhage in the poor risk surgical candidate.

Adolescent↗
PubMed1983

Pouch ileitis: report of a case with severe systemic manifestations.

A 28-year-old man with chronic ulcerative colitis had a proctocolectomy with creation of a continent ileostomy. Six months later, he developed a severe systemic illness characterized by malaise, 24-lb. weight loss, fever, night sweats, arthralgias, bloody diarrhea, and problems with ileostomy function. On endoscopy, the pouch showed erythema, edema, friability, and ulceration; on biopsy, there was severe mucosal disruption with ulceration into the submucosa. Features consistent with chronic ulcerative colitis were also present. Laboratory investigation ruled out other causes of the illness so that a diagnosis of pouch ileitis was made. The patient responded dramatically to a 10-day course of metronidazole and remains well 2 years later. In patients with continent ileostomy after proctocolectomy for chronic ulcerative colitis, inflammation of the pouch may be associated with a severe systemic illness. The pathogenesis is unclear, but may involve the interaction of colonic type bacterial flora with ileal mucosa in immunologically susceptible patients.

Adult↗
PubMed1982

Possible foodborne transmission in a case of pseudomembranous colitis due to Clostridium difficile: influence of gastrointestinal secretions on Clostridium difficile infection.

A 78-yr-old woman with a history of hypochlorhydria was found to have pseudomembranous colitis due to Clostridium difficile. She had not received previous antimicrobial therapy. Her onset of disease followed ingestion of possibly contaminated canned salmon, suggesting possible oral transmission of disease. We assessed the possibility of ingested Clostridium difficile organisms or cytotoxin surviving passage through the upper gastrointestinal tract. Normal gastric juice, hypochlorhydric gastric juice, and duodenal secretions were obtained from volunteers and tested for their ability to kill Clostridium difficile organisms or inactivate toxin. These in vitro studies indicated that the primary upper gastrointestinal barriers for ingested Clostridium difficile and cytotoxin were pH-dependent. We suggest that oral transmission of disease due to Clostridium difficile may occur in hypochlorhydric patients.

Aged↗