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Biomedical subjects

S J Boley

Publications and source records attributed to S J Boley.

At least 37 records · Page 2Linked to original sources
PubMed1990

Ischemic diseases of the bowel.

The ischemic bowel diseases are a heterogeneous group of disorders usually seen in elderly individuals. They represent ischemic damage to different portions of the bowel and therefore produce a variety of clinical syndromes and outcomes. Proper diagnosis and management of patients with ischemic bowel disease require vigilance on the part of the physician and a willingness to embark on an aggressive plan of diagnosis and management in the appropriate setting.

Age Factors↗
PubMed1989

Idiopathic intestinal perforations in the newborn: an increasingly common entity.

Between 1982 and 1987 seven neonates ranging in age from 24 hours to 1 week were treated for idiopathic intestinal perforations at the Montefiore Medical Center, Albert Einstein College of Medicine. Four of the infants were born prematurely; three were full term. Five were being treated in an intensive care nursery when the perforation was diagnosed. All infants whose perforations were due to necrotizing enterocolitis, appendicitis, Hirschsprung's disease, meconium ileus, intestinal atresias, or drug therapy are excluded from the series. None of the infants had associated anomalies. The sites of the perforations were as follows: two in the jejunum, two in the ileum, one in the cecum, and two in the transverse colon. Six of the perforations were on the antimesenteric aspect of the bowel; one was on the mesenteric aspect. The sizes of the perforations ranged from pinhole to 1 cm in diameter. All the infants did well. Pathologic examination of the resected specimens failed to reveal an etiology for the perforations. There were no cases of duplication or muscular hypoplasia. We believe the etiology of this condition may be ischemic necrosis, secondary to a localized vascular accident in the wall of the affected viscus, but we do not have a good explanation for the upsurge in cases we are seeing.

Colonic Diseases↗
PubMed1987

Hemodynamic basis of the pain of chronic mesenteric ischemia.

Tonometry, a new technique to indirectly assess intestinal blood flow, was used to determine the hemodynamic changes produced by a simulated meal in animals with a fixed, decreased splanchnic blood flow. In experiments on 14 dogs, celiac artery and superior mesenteric artery blood flow was maintained at 50 percent of normal flow by occluders and flow probes, and tonometers were placed in the stomach and small bowel to measure intramural pH, a metabolic marker of intestinal perfusion. Intramural pH was determined at 100 percent and 50 percent splanchnic blood flow, at 50 percent flow after instillation of cream into the stomach, and again when cream was placed into the small bowel. Intestinal intramural pH decreased significantly when blood flow was decreased to 50 percent, as expected, but decreased significantly again when cream was placed in the stomach. The hemodynamic explanation of the decrease when cream was placed in the stomach is a steal from the intestinal to the gastric circulation stimulated by food in the stomach. Such a steal could explain the temporal nature of the pain experienced by patients with chronic mesenteric ischemia.

Animals↗
PubMed1986

Sigmoid volvulus in elderly patients.

We reviewed the records of 51 patients over 65 years of age admitted for an initial episode of sigmoid volvulus, and adequate information about their subsequent course was obtained in 92 percent. Nonoperative reduction of the initial volvulus was attempted in 43 patients and was successful in 39 (91 percent). Eleven patients required emergency operations, with a mortality rate of 36 percent. Six patients had elective resections with no deaths. Thirty-three patients, 32 after nonoperative reduction of a volvulus and 1 after operative reduction, were discharged without definitive treatment. Twenty-three of the 33 patients (70 percent) managed by expectant observation had one or more episodes of recurrent volvulus. Five of the 23 patients died from the recurrence without operation, and 16 were operated on either emergently (3 patients) or electively (13 patients) after nonoperative reduction. The mortality rate related to recurrent volvulus or its treatment in the 33 patients observed was 21 percent. The mortality rate for 18 elective resections (6 for initial volvulus and 12 for recurrent volvulus) was 5.6 percent. After successful nonoperative reduction of a sigmoid volvulus in elderly patients, maximal survival is achieved by early elective resection. Age alone is not an adequate reason for adopting a nonoperative approach.

Aged↗
PubMed1986

Carbon dioxide and room air insufflation of the colon. Effects on colonic blood flow and intraluminal pressure in the dog.

The potential advantages of carbon dioxide over room air to insufflate the bowel during colonoscopy include its nonexplosive nature and rapid absorption. To evaluate whether this rapid absorption would minimize any reduction in colonic blood flow resulting from the distention, we measured inferior mesenteric artery flow before, during, and after insufflation of the canine colon with room air and carbon dioxide under conditions of transient and constant elevations of intraluminal pressures. Intraluminal pressures remained elevated for briefer periods after carbon dioxide administration, and blood flow was far less compromised. At lower levels of transient (40 mm Hg) and constant (60 to 70 mm Hg) intraluminal pressure elevation, colonic blood flow was actually increased. Because it is nonexplosive and rapidly absorbable and interferes only minimally with colonic blood flow, carbon dioxide is the preferable agent to use during colonoscopy, especially in patients with suspected or proven colon ischemia in whom prolonged distention and diminished blood flow are to be avoided.

Air↗
PubMed1985

Simulation of colonic carcinoma by ischemia.

Nine cases of colonic ischemia are presented in which an initial diagnosis of carcinoma was made from roentgenographic, endoscopic, or intraoperative appearance of the lesion. The clinical features were insufficient to differentiate colonic ischemia from carcinoma. In 7 patients a barium enema was interpreted as, or consistent with, carcinoma. In 3 of these patients colonoscopy also suggested malignancy. In 2 patients, endoscopy suggested a neoplasm but no barium enema was performed. Endoscopic biopsies when performed were negative for malignancy. Three patients were considered to have cancer from the gross appearance of the lesion at laparotomy. Routine use of both barium enema and colonoscopy in patients with suspected colonic neoplasms will usually identify the ischemic nature of lesions incorrectly diagnosed by one technique or the other. In the uncommon patient in whom both studies suggest a neoplasm, but biopsy specimens are negative for tumor, repeat studies 7-10 days later may identify the evolving nature of ischemic lesions and obviate the need for surgery. When no changes are seen, prompt laparotomy is indicated.

Aged↗
PubMed1985

The effect of metronidazole on wound healing in rats.

Metronidazole is gaining increasing acceptance as a perioperative antimicrobial agent. We studied the effect of metronidazole on wound healing in Sprague-Dawley rats, which received seven daily intraperitoneal injections of either metronidazole, 20 mg/kg/day, (simulating a therapeutic course) or equivalent volumes of physiologic saline solution. On the second day of treatment 25 treated rats and 20 control rats had full-thickness circular skin defects created on the back and standardized midline celiotomy incisions. The fascial incisions were closed with staples, and the abdominal skin was closed with silk sutures. On the seventh postoperative day all rats were put to death. The breaking strength of 1 cm wide segments of skin and fascial celiotomy wounds was measured, and the contraction of the open back wounds was computed. There was no significant difference in wound contraction or skin wound breaking strength, but fascial wound breaking strength was lower in treated rats than in control rats (283 versus 548 gm mean; 2 p less than 0.001). To determine whether metronidazole permanently altered or only temporarily delayed fascial wound healing, 39 additional rats treated with metronidazole and 40 control rats underwent celiotomies as described above on the second day of a 7-day course of treatment. Fascial wound breaking strength was measured 2, 3, and 5 weeks after operation. The wound breaking strength in rats treated with metronidazole remained significantly lower than that of control rats at 2 and 3 weeks (860 versus 1005 gm at 2 weeks and 1071 versus 1369 gm at 3 weeks; both 2 p less than 0.05), but at 5 weeks there was no significant difference between treated and control groups (1358 versus 1399 gm). Metronidazole apparently interferes with early fascial wound healing, but the wounds of treated rats ultimately attain the same strength as untreated controls.

Animals↗
PubMed1984

Qualitative and quantitative fluorescein fluorescence in determining intestinal viability.

Clinical evaluation and qualitative (visual) and quantitative (fluorometric) fluorescence for predicting intestinal viability were compared in an animal model of temporary arterial occlusion with early revascularization. Quantitative fluorescence was determined with a perfusion fluorometer after an intravenous bolus of fluorescein. Qualitative fluorescence was determined by examination under a Wood's lamp in a darkened room. The effectiveness of each diagnostic technique in determining nonviability was expressed in terms of sensitivity, specificity, and accuracy. All three methods had 100 percent specificity; only bowel deemed nonviable proved to be so. Quantitative fluorescence also had a 100 percent sensitivity, but clinical evaluation and qualitative fluorescence had only a 33 and 11 percent sensitivity, respectively (some segments of bowel that were ultimately nonviable were not correctly predicted to be so). The inaccuracy of qualitative fluorescence was due to the fact that ischemic intestine with a hyperfluorescent pattern often progressed to necrosis. Fluorometric quantitation identified those hyperfluorescent segments that were viable. This study suggests that visual fluorescence is not reliable in assessing intestinal viability after early revascularization after arterial occlusion, but quantitative fluorometric fluorescence is reliable in almost all instances.

Animals↗
PubMed1984

The role of colonoscopy in the diagnosis and management of lower intestinal bleeding.

Colonoscopy and roentgenographic studies are complementary techniques in the evaluation of disorders involving the large bowel. The exact roles of these methods in the diagnosis and management of lower intestinal bleeding, however, remain to be established. In this paper, we have formulated various roles for colonoscopy in lower intestinal hemorrhage depending upon the rate and activity of the bleeding according to whether the episode is: 1) recent minor bleeding or recurrent minor or occult bleeding; 2) severe bleeding which has stopped; 3) severe and active bleeding. In addition, we discuss colonoscopic therapy of bleeding lesions and intraoperative endoscopy of the small and large bowel.

Adolescent↗
PubMed1984

A new operative approach to total aganglionosis of the colon.

Aganglionosis of the entire colon with or without involvement of the small intestine presents special problems in operative management. A new operation is described herein combining the technique of the endorectal pull-through and primary anastomosis with the creation of a reservoir made up of aganglionic right colon and ganglionic small intestine. Decreased fecal fluid and electrolyte losses, and minimization of residual internal sphincter obstruction are advantages of this operation.

Colon↗
PubMed1982

A role for endoscopy in the placement of ventriculoperitoneal shunts.

Compartmentalization of the lateral ventricle may prevent adequate functioning of ventriculoperitoneal shunts. We recently treated a patient with postinfectious hydrocephalus who required bilateral shunts. In addition, the left ventricle was shown to contain a large noncommunicating cyst. Prior to placement of the shunt, ventriculoscopy was performed and a channel established surgically between the cyst and the remainder of the ventricular system. Application of this new interventional technique may be indicated in complicated cases of compartmentalized hydrocephalus.

Cerebrospinal Fluid Shunts↗