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Biomedical subjects

T M Heimann

Publications and source records attributed to T M Heimann.

At least 37 records · Page 2Linked to original sources
PubMed1987

Familial polyposis coli. Results of mucosal proctectomy with ileoanal anastomosis.

The outcome of mucosal proctectomy with ileoanal anastomosis in patients with polyposis coli has not been well studied. A series of 25 patients with polyposis treated at the Mount Sinai Hospital over a period of ten years is reported. The mean age of the patients was 23 years. Early postoperative complications were present in seven patients and consisted of thrombophlebitis (three), pelvic sepsis (three), and retraction of the anastomosis (one). Intestinal obstruction requiring laparotomy occurred in another five patients. Twenty-three patients were followed for a mean of 47 months after closure of the ileostomy. Ninety-one percent are satisfied with the operative results. The mean number of bowel movements per 24 hours is 6.0. All patients are continent, but eight have occasional episodes of rectal seepage at night. Nearly 50 percent require some antidiarrheal medication. New adenomatous polyps have developed just above the dentate line in four patients. Patients with polyposis coli seem to have fewer serious complications requiring excision of the ileoanal anastomosis than patients with ulcerative colitis. They also should have lifelong surveillance of the entire gastrointestinal tract even after total colectomy with ileoanal anastomosis.

Adolescent↗
PubMed1986

Local recurrence following surgical treatment of rectal cancer. Comparison of anterior and abdominoperineal resection.

Three hundred twenty patients with rectal cancer were studied to determine factors that correlate with development of pelvic recurrence. The mean age was 65 years; anterior resection was performed in 202 (63 percent) and abdominoperineal resection in 118 (37 percent). Fifty-two patients (16 percent) developed pelvic recurrence. The mean duration of follow-up to development of pelvic recurrence was 22 months. Depth of tumor invasion, presence of lymph node metastasis, and colloid features were found to correlate with pelvic recurrence. The recurrence rate in patients having anterior resections was the same as that of patients undergoing abdominoperineal resections. Patients having anterior resection with distal margins of 1 cm or less had an extremely high recurrence rate (36 percent). Pelvic recurrent did not continue to improve when the distal margins were extended over 2 cm. Microscopic lateral tumor extension, which is not removed during operation, appears to be the major determinant of local recurrence in rectal cancer.

Adenocarcinoma↗
PubMed1986

Results of surgical treatment for familial polyposis coli.

Seventy-seven patients with polyposis coli operated on at The Mount Sinai Hospital in the last 40 years were studied. Forty-two patients had a subtotal colectomy. Sixteen were found to have colon cancer at the time of operation, and a second rectal cancer developed in 50 percent of the survivors within 1 to 13 years after subtotal colectomy. Rectal cancer subsequently developed in only 3 of 23 patients without colon cancer. Thirty-five patients had total proctocolectomy or total colectomy with mucosal proctectomy and ileoanal anastomosis. Recurrent adenomatous polyps developed in two patients after mucosal proctectomy. A villous adenoma with carcinoma in situ of the ileum developed in one patient 30 years after total proctocolectomy and ileostomy. Another patient died from a periampullary carcinoma 24 years after subtotal colectomy. It seems that as the life expectancy of patients with polyposis improves, the incidence of small bowel and duodenal cancers may be expected to increase.

Adolescent↗
PubMed1986

Blood transfusion, skin test reactivity, and lymphocytes in inflammatory bowel disease.

Peripheral lymphocytes, T and B cell counts, and skin test reactivity to five recall antigens were determined before operation and 6 to 18 months after operation with or without blood transfusion in 59 patients with inflammatory bowel disease. Significantly reduced preoperative peripheral lymphocyte and T cell counts reached normal levels 6 to 18 months after operation in patients who had not received perioperative blood transfusions. However, lymphocytes and T cells of transfused patients remained decreased, unchanged from preoperative levels, and significantly lower than those of control subjects (p less than 0.005) and levels of patients who had not been transfused (p less than 0.05). Before operation, transfused and untransfused patients were identical in age, Crohn's disease activity index, and peripheral lymphocyte and T and B cell counts. Equal numbers of patients were taking steroids and were anergic to skin tests with five recall antigens. Transfused patients weighed less preoperatively than untransfused patients, and these patients then gained a significant amount of weight. These results suggest that some of the immunologic abnormalities that accompany inflammatory bowel disease may be influenced by blood transfusions.

B-Lymphocytes↗
PubMed1986

Mesenteric and retroperitoneal cysts.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumors. Ten new patients are presented as well as 152 other cases reported in the English literature. These 162 cases were then analyzed for significant trends. Patients under 10 years of age were significantly different from the older group with respect to a shorter duration of symptoms, a higher number of patients requiring an emergency operation, a lower number of recurrences and the location of the cyst. Patients with retroperitoneal cysts were more likely to have incomplete excision of the cyst and therefore had a higher incidence of recurrence. They also required marsupialization more often. Retroperitoneal cysts should be considered a different entity from mesenteric cysts even though they present clinically in a similar fashion. The outcome of surgical treatment is less satisfactory in patients with retroperitoneal cysts.

Abdomen↗
PubMed1986

A comparison of multiple synchronous colorectal cancer in ulcerative colitis, familial polyposis coli, and de novo cancer.

Multiple synchronous colorectal cancer (MSCC) among 1537 patients (69 with familial polyposis coli (FPC), 780 with ulcerative colitis (UC), and 685 with de novo colorectal (DNC) cancers) admitted to The Mount Sinai Hospital between 1945 and 1981 was tabulated. MSCC occurred in five of 24 cancer patients with FPC (21%), in 12 of 65 cancer patients with UC (18%), but in only 17 of 685 DNC patients (2.5%). The proportions of MSCC cases with more than two synchronous tumors were also much greater in the former two groups (UC 6/12 = 50%, FPC 3/5 = 60%) than in DNC (0/17 = 0%). Multiplicity of cancers is thus a distinguishing feature of UC and FPC. MSCC differed from solitary cancers by association with older age and more advanced stage at diagnosis in patients with FPC and by a rightward shift in anatomic distribution in all patients, especially those with FPC and UC.

Adult↗
PubMed1986

Prognostic significance of severe preoperative lymphopenia in patients with Crohn's disease.

Nearly 30% of patients with Crohn's disease requiring operative treatment have severe peripheral lymphopenia. The surgical significance of this finding had not been previously determined. One hundred fifty-eight patients with Crohn's disease admitted for resection of the diseased bowel were studied. Forty-six had preoperative peripheral lymphocyte counts under 1000 cells per mm3. Severely lymphopenic patients had a significantly higher incidence of skip areas and epithelioid granulomas than patients with higher lymphocyte counts. Also, lymphopenic patients were more likely to require separate resections of the diseased bowel and more than one anastomosis. Postoperative follow-up revealed that patients with preoperative lymphopenia had a markedly higher incidence of symptomatic recurrences within 3 years of operation (67 vs. 36%, p less than 0.01). It appears that the preoperative peripheral lymphocyte count may be used as an indicator of disease severity and prognosis in patients with Crohn's disease.

Adult↗
PubMed1985

Ultrasonic fragmentation. A new technique for mucosal proctectomy.

We report a new technique for mucosal proctectomy that does not require manual separation of the mucosa and submucosa from the underlying muscularis. Mucosal proctectomy using ultrasonic fragmentation of the rectal mucosa was performed in four patients. Three had severe ulcerative colitis, and one patient had radiation proctitis with a rectal stricture. In all cases an endorectal pullthrough with anastomosis to the area of the dentate line was performed. Healing after ultrasonic mucosal proctectomy occurred without infection or retraction. Ultrasonic fragmentation offers an alternative to the standard technique of mucosal proctectomy. This new method is useful in those patients in whom separation of the rectal mucosal layer is difficult to perform.

Adult↗
PubMed1985

Colorectal cancer in familial polyposis coli and ulcerative colitis.

The records of all patients with familial polyposis coli and ulcerative colitis operated at The Mount Sinai Hospital were reviewed to determine the proportion of patients with cancer at the time of colon resection. Sixty-nine patients with familial polyposis coli undergoing operation between 1947 and 1983 were identified and 25 (36 percent) were found to have cancer. In the group with ulcerative colitis, 548 patients had surgical treatment between 1957 and 1983 and 65 (12 percent) had colonic cancer. There was a significant decrease in the proportion of patients with familial polyposis coli having cancer at the time of colon resection from 50 percent before 1968 to 20 percent since 1978. This change in cancer incidence was found to correlate with a decrease in the mean age at operation from 40 to 25 years. In the group with ulcerative colitis, the mean age at operation has remained essentially unchanged at 36 years. The proportion of patients with ulcerative colitis having cancer at the time of colon resection has remained constant throughout this study. Progression to carcinoma is still a significant concern in both familial polyposis coli and ulcerative colitis. Although removal of the colon and rectum prevents cancer development, patient selection and timing of the operation remain a difficult problem.

Adolescent↗
PubMed1985

Ultrasonic mucosal proctectomy without endorectal pull-through.

The surgical treatment of patients with familial polyposis coli and ulcerative colitis often requires removal of the rectum. Abdominoperineal resection, however, has a substantial morbidity. Ultrasonic fragmentation allows complete removal of the distal rectal mucosa with preservation of the surrounding muscularis. Ten adult mongrel dogs underwent ultrasonic mucosal proctectomy with resection of the proximal rectum and end colostomy. Two months later, the animals were sacrificed and the remaining rectum was removed and examined. The rectal remnant had shrunk and there was fibrous healing of the muscular wall with obliteration of the lumen. There was no mucosal regeneration. Ultrasonic mucosal proctectomy appears to achieve the same results as abdominoperineal resection of the rectum without the morbidity of the perineal dissection. This procedure may be useful in those patients where removal of the rectum is necessary for benign disease and endorectal pull-through is not indicated.

Animals↗
PubMed1985

Early complications following surgical treatment for Crohn's disease.

One hundred thirty patients with Crohn's disease operated at the Mount Sinai Hospital were studied to determine the incidence of early postoperative complications. Thirty per cent of patients developed postoperative complications, while eight per cent had major complications requiring readmission to the hospital, reoperation, or suture of a bleeding vessel. Patients with a low preoperative serum albumin concentration had a significantly higher incidence of nonseptic and multiple complications. Septic complications were more common in patients having extensive resections and in those with multiple previous operations. There was also a significantly higher complication rate in patients requiring permanent or temporary ileostomy as opposed to those having intestinal anastomosis. The majority of complications in the patients with ileostomy were nonseptic in nature. There were no mortalities in this series.

Abscess↗
PubMed1985

Patterns of treatment of gallstone ileus over a 45-year period.

All patients with gallstone ileus admitted to our institutions between 1938 and 1982 were retrospectively analyzed by grouping the patients into 10-year periods. Forty-five patients were studied, of whom 39 required operation. When hospital statistics for admissions, length of stay, and mortality rates from the Mount Sinai Hospital were compared to the gallstone ileus data, it was found that there has been no significant change in the admission rate for these patients. The mortality rate and length of stay of gallstone ileus patients has also remained constant over the past 25 years despite the general hospital decrease in both of these numbers. There has been no change in the complication rate, duration of symptoms prior to admission, or the preoperative diagnostic rate of gallstone ileus during the duration of this study.

Adult↗
PubMed1985

The role of peripheral lymphocytes in the prediction of recurrence in Crohn's disease.

Sixty-five patients with Crohn's disease admitted for surgical treatment to The Mount Sinai Hospital were studied prospectively to determine whether or not preoperative peripheral lymphocyte counts correlate with early recurrence. Twenty-four patients had symptomatic recurrent disease develop within three years after operation. Patients who had recurrences were found to have significantly lower preoperative lymphocyte counts than patients doing well three years after surgical resection. Sixty-nine per cent of the patients with preoperative lymphocyte counts of less than 1,000 cells per cubic millimeter had recurrent disease develop within three years of the operation. In contrast, only 8 per cent of the patients with preoperative lymphocyte counts of more than 2,100 cells per cubic millimeter had recurrences. It appears that patients with marked preoperative lymphocytopenia are more likely to develop early symptomatic recurrences after surgical treatment than patients with normal lymphocyte counts.

Adult↗
PubMed1985

Villous polyposis of the ileum: report of a case.

Villous adenomas occur only rarely in the small intestine and are often associated with malignant changes. Multiple villous adenomas of the small intestine are usually seen only in patients with familial polyposis coli. This is a report of a patient with multiple villous adenomas of the ileum associated with a carcinoma of the cecum which originated from a villous adenoma near the ileocecal valve. There was no evidence of other colonic polyps and no history of familial polyposis coli. It appears that polyposis of the small intestine is a rare clinical entity which cannot often be diagnosed due to difficulty in visualizing this area.

Adenoma↗