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Biomedical subjects

S J Boley

Publications and source records attributed to S J Boley.

At least 55 records · Page 3Linked to original sources
PubMed1982

Metronidazole therapy for perineal Crohn's disease: a follow-up study.

The present study of metronidazole in perineal Crohn's disease includes 26 patients, and is composed of 17 of 21 patients who were previously reported and 9 additional consecutive patients. The course of these patients was evaluated to determine if the drug could be reduced or stopped, whether or not it continued to be effective for prolonged periods, and what long-term side effects were encountered. Dosage reduction was associated with exacerbation of disease activity in all patients, but in all, the perineal manifestations of disease healed promptly when the full dosage of metronidazole was reinstituted. The drug could be successfully discontinued in only 28% of those in whom cessation was attempted; in those patients whose perineal disease worsened with cessation of therapy, rapid healing was achieved if the drug was reintroduced. Sixteen patients received metronidazole for at least 12 mo including 7 for 18-36 mo. Eight of these 16 patients, including 4 on and 4 off the drug, remain healed; the other 8 patients had advanced healing. The only major side effect observed was paresthesias. These occurred in 50% of the patients and developed in the patients at a mean of 6.5 mo after the onset of treatment. They appeared to be dose related and nonprogressive but tended to persist for prolonged periods even after discontinuance of the drug.

Adult↗
PubMed1982

Clinical characteristics and natural history of colitis in the elderly.

The clinical behavior and course of ischemic, ulcerative, and Crohn's colitis in the elderly are analyzed. Fifty-two patients with ischemic colitis, 11 with ulcerative colitis, and four with Crohn's colitis composed the study group. Patients with ischemic colitis were older and had a higher incidence of arteriosclerotic cardiovascular disease than those with inflammatory bowel disease. A potentially obstructing colonic lesion was present in 12% of those with ischemic colitis. Spontaneous rapid resolution occurred in 42% of those with ischemic colitis, but in no patient with ulcerative or Crohn's colitis. Of the 31 remaining patients with ischemic colitis, 20% had recurrent disease and 80% required operation. Almost 10% of patients with ischemic colitis died postoperatively. Of those patients with ulcerative colitis, two developed toxic dilitation, three required operation, and three died on the first admission. All patients with Crohn's colitis required operation. The prognosis for colitis in elderly patients, regardless of type, is worse than in young patients.

Aged↗
PubMed1981

Occult bleeding from a perforated gastric duplication in an infant.

We report what we believe is the first case of a perforated gastric duplication with occult intraperitoneal hemorrhage and massive abdominal distention in the neonatal period. At operation, a perforated ulcer on the free anterior surface of the duplication was identified and the entire cyst excised by submucosal dissection.

Female↗
PubMed1981

Iatric submucosal hemorrhage. A pitfall of intraoperative endoscopy.

Intraoperative fiberoptic endoscopy has been recommended to identify the site of gastrointestinal hemorrhage in patients whose preoperative endoscopic and/or roentgenologic studies have been unrevealing but who require surgical intervention to control the bleeding. We report an undescribed complication of intraoperative endoscopy in such a patient.

Aged↗
PubMed1981

New concepts in the management of emboli of the superior mesenteric artery.

The experience with 47 patients with intestinal ischemia resulting from superior mesenteric artery emboli who were treated at Montefiore Hospital and Medical Center over a 12 year period was reviewed. The over-all mortality was 66 per cent, but patients with infarction of 50 per cent or more of the small intestine did more poorly; 17 of 19 such patients died. Twenty patients were managed according to an aggressive approach which incorporates earlier and more liberal use of angiography and preoperative and postoperative intra-arterial infusions of papaverine into the superior mesenteric artery. Twenty-five patients were managed according to more traditional methods. Two patients died before treatment could be initiated. As the primary treatment, intra-arterially given papaverine was successful in four patients, two who were not operated upon and two with normal intestines at the time of delayed laparotomy. A survival rate of 55 per cent was obtained in the patients managed according to protocol, whereas only 20 per cent of those treated by traditional methods survived. In ten of the 11 survivors in the protocol treated group enough intestine to provide normal gastrointestinal function was preserved. The best survival was achieved in patients who were managed by the protocol and were diagnosed within 24 hours of the onset of pain. Our data indicates that a management plan incorporating the earlier and more liberal use of angiography and of preoperative and postoperative papaverine infusions into the superior mesenteric artery can lower the mortality associated with this catastrophe to less than 50 per cent.

Aged↗
PubMed1980

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.

Adolescent↗
PubMed1980

Healing of perineal Crohn's disease with metronidazole.

The effect of metronidazole was studied in 21 consecutive patients with chronic unremitting perineal Crohn's disease. Drainage, erythema, and induration diminished dramatically in all patients, and complete healing was obtained in 10 of 18 patients maintained on therapy. Five others have shown advanced healing; in 2 patients the inflammation is improved, but healing is minimal. Side effects of metallic taste, dark urine, and mild gastrointestinal upset occurred in many patients. However, the dosage had to be decreased in only 4 patients and the drug discontinued in 1 patient, all because of peripheral neuropathy that proved to be reversible. In 2 other patients, metronidazole was discontinued because of poor compliance. If further experience corroborates this prompt and striking response in patients with extreme, disabling, and otherwise unmanageable disease, metronidazole will play an important role in the therapy of perineal Crohn's disease.

Adult↗
PubMed1979

Profile of 24-hour plasma glucose and insulin concentrations. Their variation with two methods of total parenteral nutrition administration.

The concentration of glucose and insulin in the plasma during total parenteral nutrition (TPN) was measured every 20 minutes during a 24-hour period in three subjects with granulomatous enterocolitis. During a gravity drip, parallel variations in rate of flow and plasma glucose and insulin concentrations were seen, and both hypoglycemia and hyperglycemia occurred. During a constant (pumped) infusion, plasma glucose and insulin concentrations were stable and normal. Glucose excretion in the urine was negligible and adequate gains in weight occurred, suggesting utilization of the administered nutrients. Hypertonic solutions for TPN should be infused at a constant rate either by careful attention to the flow rate during changes of intravenous bottles and tubing or by using a constant-infusion pump. Infusion of TPN solutions at a constant rate minimizes the risk of hypoglycemia or hyperglycemia.

Adolescent↗
PubMed1979

Vascular ectasias of the right colon in the elderly: a distinct pathologic entity.

Vascular ectasias (angiodysplasias, arteriovenous malformations) of the cecum and ascending colon are a frequent cause of lower intestinal bleeding in the elderly that has been overlooked by clinicians and pathologists. Their nature and etiology have been poorly understood until recently. This article reviews the previous literature and presents a complete and detailed description of these lesions based on the examination of 87 areas showing vascular ectasia from 26 colons. Their morphology spans a spectrum from small focal early lesions to multiple large late lesions. The early lesions are characterized by markedly dilated, large, tortuous submucosal veins with minimal dilatation of their tributaries in the mucosa. The late lesions showed further dilatation of submucosal veins and venules and extensive replacement of the overlying mucosa by racemose collections of dilated and thin walled venules and capillaries, three of which demonstrated rupture into the colonic lumen. The pathology of these lesions is considered to be specific enough to establish vascular ectasias of the colon as a distinct entity.

Age Factors↗