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Biomedical subjects

S Galandiuk

Publications and source records attributed to S Galandiuk.

66 records · Page 4Linked to original sources
PubMed1989

Strictureplasty in Crohn's disease.

Fifty patients with fibrotic small bowel strictures secondary to long-standing Crohn's disease underwent a total of 225 strictureplasties during the period from June 1984 to July 1988. Forty-two patients (84%) presented with obstructive symptoms. Patients had a 1- to 30-year history of Crohn's disease (mean, 14 years). Sixty-two per cent of patients were taking steroids at the time of admission, and 70% had had previous small bowel resections. All patients had one or more areas of small bowel affected with a fibrotic stricture and partial obstruction. Short strictures were treated by Heinecke-Mikulicz strictureplasties, and longer strictures by Finney side-to-side strictureplasties. In 30 patients (60%), 6- to 65-cm segments of small bowel were also resected due to acute inflammation with phlegmon or fistulae. Patients were discharged from the hospital 5 to 20 days after operation (mean, 10 days). After operation all patients with obstructive symptoms reported relief of symptoms and weight gain. Steroid doses could be tapered and nutritional parameters, such as total lymphocyte count, and serum albumin improved. Strictureplasty had 0% mortality and 16% morbidity rates. Complications included 3 enterocutaneous fistulae, 2 intra-abdominal abscesses, 2 hemorrhages requiring transfusion, 1 prolonged postoperative ileus that could be treated conservatively in 2 patients, and 1 restricture of a strictureplasty. Patients were followed for 1 to 40 months after operation (mean, 8 months). Resection of small bowel disease, especially that associated with perforation, is usually required in Crohn's disease. However, strictureplasty minimizes the need for bowel resection in patients with short fibrotic strictures resulting in recurrent small bowel obstruction.

Adolescent↗
PubMed1989

Re-emphasis of priorities in surgical antibiotic prophylaxis.

The results of two prospective, randomized trials, comparing single dose piperacillin with multidose cefoxitin prophylaxis in elective surgical procedures of the gastrointestinal tract were combined to examine some basic aspects of clinically, applied antibiotic prophylaxis. As there was no difference in the efficacy of prophylaxis between the groups, data from both centers and both drug groups were combined for analysis. Patients whose ages were greater than 40 years, the presence of cancer and the administration of an antibiotic for longer than 60 minutes preoperatively were associated with a higher rate of infectious complications. Duration of operation was also related to subsequent infection, ranging from 6 per cent in procedures lasting less than two hours to 27 per cent in operations lasting more than four hours. There was a greater failure of prophylaxis in patients undergoing rectal procedures, with a 29 per cent rate of infectious complications compared with 14 per cent in patients undergoing operations upon the colon. This difference was present even when duration of operation was taken into account.

Adult↗
PubMed1988

Fluorescein endoscopy. A technique for noninvasive assessment of intestinal ischemia.

Late diagnosis contributes significantly to the mortality and morbidity of mesenteric ischemia. Although flexible endoscopy permits noninvasive assessment of the colon, ischemic colitis is often difficult to differentiate from nonspecific proctitis/colitis or mucosal changes seen in inflammatory bowel diseases. Intravenously administered fluorescein sodium (FSC) has long been used intraoperatively to assess bowel viability because its uptake is inversely proportional to the degree of intestinal ischemia. The authors wished to determine if FSC could be used to augment conventional endoscopy in an attempt to identify and monitor ischemic areas of the bowel within reach of the endoscope. Segmental mesenteric ligation of canine rectum was performed, and serial transanal biopsies obtained. Endoscopy was performed after intravenous FSC administration, using a rigid proctoscope, with a long-wave ultraviolet light source inserted into the lumen of the scope. Areas of nonspecific-appearing proctitis did not take up FSC and were easily differentiated from well-perfused areas by their failure to fluoresce. Ischemic areas were monitored in this manner over a 28-day period. Complete resolution of ischemic mucosal changes occurred with late stricture formation. In humans, the sigmoid and left colon are the areas most frequently affected by ischemic colitis. Because long-wave ultraviolet light is not transmitted through glass fibers, a different light source was needed for potential clinical application. To this end, a single fiber of an argon laser was inserted through the instrument channel of a colonoscope, resulting in greater fluorescence than seen with the ultraviolet light. FSC endoscopy appears to be a sensitive and accurate method of detecting and monitoring ischemic colitis and has many potential clinical applications.

Adult↗
PubMed1988

Villous tumors of the duodenum.

Records of 32 patients with 34 villous and tubulovillous adenomas of the duodenum, treated at the Cleveland Clinic over the past 21 years, were reviewed. Twenty-two patients (69%) had complete resection of the adenoma; the incidence of malignancy was 47%. Five patients underwent a Whipple procedure; 4 patients had segmental resection of the duodenum; 12 had wide local excision of the adenoma; 1 had both a segmental resection and a local excision for two separate adenomas; and 5 patients had endoscopic excision alone. The remaining five patients underwent exploratory laparotomy alone or with palliative bypass procedures. A 28% recurrence rate was observed, all of these after segmental resection, local excision, or endoscopic excision. The highest recurrence rate was associated with local excision. The 2- and 5-year survival rates for patients with adenomas containing invasive cancer were 22% and 0%, respectively, compared to 87% and 87%, respectively, for benign adenomas (including those with carcinoma in situ). Twenty-two per cent of patients had intestinal polyposis syndromes. Duodenal adenomas were diagnosed a mean of 17 years after colectomy for polyposis, indicating the need for continued surveillance in these patients.

Adenocarcinoma↗
PubMed1987

Villous and tubulovillous adenomas of the colon and rectum. A retrospective review, 1964-1985.

The records of 1,040 patients with 1,440 villous and tubulovillous adenomas of the colon and rectum treated at the Cleveland Clinic over a 21 year period were reviewed. The incidence of invasive adenocarcinoma was higher in patients with multiple adenomas at the time of presentation, in patients with a family history of colorectal cancer, and in those with adenomas greater than 4 cm in diameter. Eighty percent of the adenocarcinomas were Dukes' A or B, 15 percent were Dukes' C, and 5 percent presented with distant metastases. Clinical impression on examination was more accurate than biopsy in assessing the presence of malignancy in these tumors. Recurrence after local treatment of both benign and malignant tumors was high. Recurrence was significantly related to the size of the adenoma (more common when the tumor was more than 4 cm in diameter), location (more common when it was located in the rectum), and the type of treatment. Only 4 percent of the patients had died from colorectal cancer at the time of follow-up. The overall 5 year actuarial survival rate was 85 percent.

Adenocarcinoma↗
PubMed1986

Pneumatosis cystoides intestinalis. A review of the literature.

Pneumatosis cystoides intestinalis is a condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel. Both fulminant and benign forms exist. Fulminant pneumatosis cystoides intestinalis is associated with an acute bacterial process, sepsis, and necrosis of the bowel, while benign pneumatosis cystoides intestinalis can be totally asymptomatic and observed as an incidental finding at laparotomy. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes. A review of the literature is presented with emphasis on the etiology of pneumatosis cystoides intestinalis, which probably can be attributed to bacterial and mechanical factors. Diagnosis and different forms of therapy and their efficacy are also discussed.

Animals↗
PubMed1986

Cancer of the esophagus. The Cleveland Clinic experience.

The therapy and survival rates of patients with esophageal carcinoma at the Cleveland Clinic over the 12-year period 1969-1980 are reviewed. Data on 238 patients were analyzed. Seventy-one per cent of the patients underwent surgery, with esophagogastrectomy being performed in half of these. One or more early postoperative complications occurred in 72.6% of these patients. Most of these complications were pulmonary and related to the patients' chronic obstructive pulmonary disease. The mortality rate for esophagogastrectomy at the Cleveland Clinic has decreased over the past 15 years to 7.1%. The 5-year survival rate after "curative" esophagogastrectomy was 15.4% with a mean survival time of 34.4 months. Invasion of the tumor through or beyond the serosa in this group of patients was associated with an increased relative risk of death of 3.3 compared to those with lesser degrees of invasion. The cell type, degree of differentiation, stage of disease, and presence of tumor at the lines of resection were all prognostically significant for all patients.

Adenocarcinoma↗
PubMed1985

Strictureplasty in diffuse Crohn's jejunoileitis.

Strictureplasty recently has been advocated in the treatment of obstructive strictures of the small bowel in patients with Crohn's disease. In contrast to conventional methods of treatment, such as conservative therapy with total parenteral nutrition (TPN) or surgical resection of the involved bowel, strictureplasty eliminates the obstruction without loss of small bowel. The possibility of creating a short-bowel syndrome is of special concern in patients with diffuse Crohn's jejunoileitis. These patients usually present for surgery with chronic obstruction, anemia, weight loss, and malnutrition with folate and other vitamin deficiencies. The authors report the results of 12 strictureplasties for extensive Crohn's jejunoileitis in three patients presenting with chronic obstruction secondary to multiple small-bowel strictures. Both Heineke-Mikulicz and Finney strictureplasties were performed. In two patients, resection of an acutely inflamed phlegmonous segment was also performed. Symptoms (pain, abdominal distention, and nausea) were markedly improved postoperatively in all patients. Nutritional parameters, including serum albumin and total lymphocyte count, improved postoperatively. Dramatic rises in weight were noted also. All three patients were symptom-free six months postoperatively.

Adult↗
PubMed1985

Pneumatosis cystoides intestinalis in Crohn's disease. Report of two cases.

Two cases of pneumatosis cystoides intestinalis in patients with Crohn's disease are reported. These cases illustrate both benign and fulminant forms of pneumatosis cystoides intestinalis, and highlight the diagnostic and therapeutic dilemma of patients in whom pneumatosis cystoides intestinalis and Crohn's disease coexist. While therapy is seldom indicated in benign forms of pneumatosis cystoides intestinalis, mortality rates with fulminant pneumatosis cystoides intestinalis are high, regardless of the type of therapy.

Adult↗
PubMed1983

Functional anatomic reconstruction of the cardia.

Experiments on bastard dogs have shown that cardia reconstruction using an omega sling is effective. This sling is a pedicled, extramucosally excised, longitudinal muscle flap from the ventral aspect of the greater gastric curvature, which is prestretched at least 100%, wrapped around the cardia twice and sutured to the posterior gastric wall. A physiological pressure gradient is created with the help of intraoperative manometry. Perfusion manometry, radiology, histology and microangiographs demonstrate the competence of the omega sling.

Animals↗
PubMed1980

Continent valve ileostomy.

2 years of experience with the sphincteroplasty in colostomy as well as intensive histological studies have shown that gastrointestinal smooth muscle can be autotransplanted without loosing functional or histological integrity. The following conclusions are based on experimental studies in dogs: (1) the sphincteroplasty technique can be successfully applied in ileostomy, and (2) the sphincteroplasty must, however, be combined with a pre-sphincter valve and an omega loop with Braun's anastomosis. The first clinical results confirm this concept.

Animals↗