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Biomedical subjects

W E Longo

Publications and source records attributed to W E Longo.

At least 55 records · Page 3Linked to original sources
PubMed1997

Congenital intestinal malrotation causing gestational intestinal obstruction. A case report.

BACKGROUND: Intestinal obstruction in pregnancy is rare. The mortality rate is higher during pregnancy than in the general population and applies to fetal as well as maternal survival. Major causes of intestinal obstruction in the pregnant women include adhesions, volvulus and intussusception. CASE: A 27-year-old woman, gravida 2, para 1, estimated gestational age approximately 26 weeks, with a high-level, complete small bowel obstruction. The patient failed a trial of conservative management and required laparotomy, at which time a congenital malrotation was found. She was treated successfully with a modified Ladd's procedure. There was no maternal or fetal morbidity. CONCLUSION: This case represents an extremely rare cause of bowel obstruction in pregnancy; a paucity of such cases have been reported.

Adult↗
PubMed1996

Ischemic colitis complicating abdominal aortic aneurysm surgery in the U.S. veteran.

Ischemic colitis (IC) is an infrequent but serious complication of abdominal aortic surgery. Prior reports have generally described small, selected populations. The aim of this paper is to evaluate characteristics of clinically diagnosed IC in a large non-referral-based population. Using national Veterans Affairs (VA) computer data sets, we identified all patients with the diagnostic codes for both prosthetic replacement of aorta for abdominal aortic aneurysm and subsequent vascular insufficiency of the intestine in the entire VA population from 1987 to 1991. Clinical information on these patients was then requested from the VA Medical Centers where they received care. Patients demographics, clinical data regarding both the aortic surgery and IC, and survival data were extracted from patient charts and computer records. Of 4957 patients who underwent surgery of the abdominal aorta for infrarenal abdominal aortic aneurysm, 58 (1.2%) also had the code for subsequent IC. In 49/58 (74%), sufficient chart-derived and computer-derived data were available for analysis. The mean age was 69 (range 57-95); all were males. Bloody diarrhea was the most frequent symptom and colonoscopy the most common means of diagnosis. Mean time to diagnosis of IC was 5.5 days after aortic surgery (range 1-21 days). Aneurysmal rupture or perioperative hypotension were present in 35/49 patients. Bowel resection with fecal diversion was required in 32/49 (65%). The overall mortality was 54% but it was 89% if bowel resection for bowel infarction was required. Only 2/12 (16%) of those who required fecal diversion and survived underwent eventual stoma closure. Among 7 patients who received second-look laparotomy for IC, additional bowel resection was required in 6. No patient had aortic graft infection diagnosed during the index hospitalization. The overall mean hospitalization duration after the diagnosis of IC was 38 days (range 1-164). IC following aortic aneurysm surgery in this national patient population is infrequently diagnosed. Emergency aneurysm operation and perioperative hypotension are common in patients who develop IC. The majority of patients diagnosed receive surgical intervention. Most patients who undergo fecal diversion retain their stomas.

Aged↗
PubMed1996

The effect of trinitrobenzene sulfonic acid (TNB) on colonocyte arachidonic acid metabolism.

In previous studies we found that luminal perfusion of the isolated left colon of the rabbit with the hapten, trinitrobenzene, resulted in the production of an acute inflammatory process associated with alterations in eicosanoid metabolism. As the colitis was attenuated by cyclooxygenase inhibitors it is possible that the inflammation was mediated by arachidonic acid metabolites. In the present study it was intended to evaluate the effect of trinitrobenzene on eicosanoid metabolism in transformed human colonic cells by exposing Caco-2++ cells to various doses of trinitrobenzene. Cell injury was evaluated by measuring lactate dehydrogenase levels and cyclooxygenase and lipoxygenase activity was evaluated by measuring prostanoid and leukotriene production. In separate experiments resting and trinitrobenzene stimulated cells were treated with indomethacin and dexamethasone. Trinitrobenzene produced increased prostaglandin E2 and 6-keto prostaglandin F1alpha++ and increased lactate dehydrogenase levels. Leukotriene B4 was significantly increased compared to control values at the highest TNB concentration administered. Indomethacin inhibited the lactate dehydrogenase and prostanoid changes, suggesting that the inflammatory changes produced were mediated by the prostanoids. Dexamethasone administered for 1 hr prior to trinitrobenzene decreased the 6-keto prostaglandin F1alpha but did not alter trinitrobenzene produced changes in lactate dehydrogenase concentrations. Exposure of Caco-2 cells to dexamethasone for 24 hr decreased the trinitrobenzene produced lactate dehydrogenase and eicosanoid changes. The results suggest that trinitrobenzene produces an acute injury to Caco-2 cells that may be mediated by the cyclooxygenase enzymes.

Arachidonic Acid↗
PubMed1996

Ischemic colitis.

Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops "spontaneously," in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis.

Colitis, Ischemic↗
PubMed1996

Internal pudendal flap anoplasty for severe anal stenosis. Report of a case.

PURPOSE: A technique for introducing anoderm into the anal canal is described. METHODS: An internal pudendal flap was used. RESULTS: This technique was totally successful in alleviating anal stenosis and maintaining fecal continence. CONCLUSION: Internal pudendal flap should be in the armamentarium of the colon and rectal surgeon for treating severe anal stenosis.

Aged↗
PubMed1996

Colorectal cancer in patients with previous spinal cord injury.

BACKGROUND: The optimum management of large-bowel cancer in patients with previous spinal cord injury (SCI) is uncertain. PURPOSE: The aim is to determine the outcome of patients with SCI who are undergoing colectomy or proctectomy for cancer. METHODS: A population-based study of patients receiving care at hospitals in the Department of Veterans Affairs system from 1987 to 1991 was performed. Patients with ICD-9 codes for SCI and colon and rectal cancer were identified. Patients with previous SCI who underwent colectomy or proctectomy for their cancer comprised the study population. Data were compiled from national computerized Veterans Affairs datasets, supplemented by individual operative reports and discharge summaries. RESULTS: Forty-four patients were evaluable. Mean age was 65 (range, 40-80) years, and mean time since SCI was 24 (range, 1-50) years. Mean follow-up was 4.6 years after resection. Distribution of tumors was 39 percent rightsided, 43 percent left-sided, and 18 percent rectal. All 32 patients with colonic tumors underwent resection; 26 of 32 patients (81 percent) had an anastomosis. Seven of eight (88 percent) rectal lesions were treated by abdominoperineal resection. Twenty-six of 44 patients (59 percent) presented with Stage III or IV disease. Twelve of 44 (27 percent) died, 8 of 12 from cancer. Overall 30-day mortality rate was 4.5 percent (2/44). In-hospital morbidity rate (pulmonary, cutaneous, and urinary tract only) was 34 percent. Among those who received postoperative chemotherapy, 80 percent completed treatment. CONCLUSIONS: Patients with previous SCI tolerate resection well. Tumor distribution and stage are similar to those of neurally intact patients. Morbidity is commonly related to pre-existing complications of SCI. Adjuvant therapy is well tolerated.

Adult↗
PubMed1996

Colonoscopic perforations. Etiology, diagnosis, and management.

Since its introduction into clinical medicine, flexible fiberoptic colonoscopy has had a great impact on diagnosis and management of diseases of the colon and rectum. There are three mechanisms responsible for colonoscopic perforation: specifically, mechanical perforation directly from the colonoscope or a biopsy forceps, barotrauma from overzealous air insufflation, and, finally, perforations that occur during therapeutic procedures. Perforation of the colon, which requires surgical intervention more frequently than bleeding, occurs in less than 1 percent of patients undergoing diagnostic colonoscopy and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal, dilation of strictures, or laser ablative procedures. Management of colonic perforation secondary to colonoscopy remains a controversial issue in that it can be effectively managed by operative and nonoperative measures. If a perforation does occur, signs and symptoms that the patient will experience will be related to both the size and site of the perforation, adequacy of the bowel preparation, amount of peritoneal soilage, underlying colonic pathology (where a thin walled colon from colitis or ischemia, for example, may result in a larger perforation than a healthy colon), and, finally, overall clinical condition of the patient. Radiology often establishes diagnosis. Plain films of the abdomen and an upright chest x-ray may reveal extravasated air confined to the bowel wall, free intraperitoneal air, retroperitoneal air, subcutaneous emphysema, or even a pneumothorax. A localized perforation may demonstrate lack of pneumoperitoneum. Some surgeons recommend surgery for all colonoscopic perforations; however, there does appear to be a role for conservative management in a select group of patients such as those with silent asymptomatic perforations and those with localized peritonitis without signs of sepsis that continue to improve clinically with conservative management. Finally, conservative management works well in those patients with postpolypectomy coagulation syndrome. Surgery is most definitely indicated in the presence of a large perforation demonstrated either colonoscopically or radiographically and in the setting of generalized peritonitis or ongoing sepsis. The presence of concomitant pathology at time of colonoscopic perforation such as a large sessile polyp likely to be a carcinoma, unremitting colitis, or perforation proximal to a nearly obstructing distal colonic lesion may force immediate surgery. Finally, in the patient who deteriorates with conservative management, one should proceed to surgery.

Algorithms↗
PubMed1996

Collagenous colitis: pathogenesis and management.

INTRODUCTION: Collagenous colitis is a rare disease of unknown etiology that primarily affects middle-aged women. It presents with chronic watery diarrhea and thickening of the subepithelial collagen layer of the colonic mucosa in the absence of endoscopic abnormalities. PURPOSE: This study was undertaken to review the current literature on clinical course, pathology, diagnosis, and current management of collagenous colitis. RESULTS: Collagenous colitis is an inflammatory disease of the colon, clinically characterized by a waxing and waning course of watery diarrhea, an inflammatory infiltration of the colonic mucosa, and a thickening of the subepithelial collagen layer. Its pathogenesis remains unclear, but there is evidence for an inflammatory process triggered possibly by an uncommon luminal agent. Diagnosis is established by colonic biopsies; in the setting of normal colonic mucosa, the disorder is primarily managed medically with virtually no role for surgery. CONCLUSIONS: Pathogenesis of collagenous colitis remains unclear. Current data favor an inflammatory etiology, possibly involving an initiating luminal insult. Guidelines for diagnosis are being established, and medical treatment options are variably effective in the majority of cases. Very unusual refractory cases may benefit from surgical management.

Biopsy↗
PubMed1996

Diverticular hemorrhage in the elderly--is it well tolerated?

PURPOSE: Elderly patients frequently develop lower gastro-intestinal bleeding secondary to diverticulosis. This select group of patients potentially tolerates blood loss poorly, often have coexisting cardiovascular morbidity, and may not tolerate surgical intervention. Thus, optimal management of elderly patients with diverticular hemorrhage remains difficult. METHODS: All patients who were admitted with the diagnosis of diverticulosis at the St. Louis University affiliated hospitals during the past 60 months were identified. Those with diverticular bleeding were extracted. Patients were reviewed as to age, sex, diagnosis of diverticular bleeding, number of bleeding episodes, lowest hemoglobin before transfusion, amount of blood received, treatment, operations, the presence of recurrent bleeding, morbidity, and mortality. RESULTS: One hundred fifteen consecutive patients, age 70 years admitted with lower gastrointestinal hemorrhage secondary to diverticulosis who required transfusion, were identified. Mean age was 79 years; 26 of 115 (23 percent) were more than 80 years of age; 78 of 115 (54 percent) were males; 39 of 115 (34 percent) had more than one previous admission for diverticular hemorrhage. The mean serum hemoglobin was 8.9 g/dl. All patients underwent colonoscopy; 34 of 115 (29 percent) underwent 99Tc scanning, of which 18 of 34 (54 percent) underwent arteriogram. Seven of 18 (39 percent) demonstrated extravasation secondary to bleeding diverticulosis. The mean transfusion requirement was 2.8 (range, 1-17) units; 21 of 115 (18 percent) required intestinal resection; 2 of 21 (9 percent) experienced a 30-day mortality. Among those, 94 of 115 were treated without surgery, and 3 of 94 (4 percent) died. Mortality was independent of initial hemoglobin (P = 0.21), previous diverticular hemorrhage (P = 0.44), amount of blood transfused (P = 0.36), and type of treatment (0.09). CONCLUSIONS: Most diverticular bleeding in the elderly is well tolerated using nonoperative management. Success and safety of treatment does not seem to depend on a history of previous diverticular bleeding, initial hemoglobin, or amount of blood transfused. The majority of patients are treated nonoperatively. Surgical intervention seems to be well tolerated.

Aged↗
PubMed1996

Role of cytokines and platelet-activating factor in inflammatory bowel disease. Implications for therapy.

BACKGROUND: Platelet-activating factor (PAF) and cytokines, such as interleukins, tumor necrosis factor, and others, are thought to play a role in the inflammatory process involving gastrointestinal disorders such as Crohn's disease, ulcerative colitis, ischemic colitis, or antibiotic-associated colitis. PURPOSE: This study was undertaken to review the latest literature on the role of PAF and cytokines in the genesis of inflammatory bowel disease and implications for therapy and management. RESULTS: PAF is an endogenous phospholipid involved in hypersensitivity and inflammatory reactions such as platelet and neutrophil aggregation, vasodilation, increased vascular permeability, and leukocyte adhesion, which have been associated with inflammatory processes. Cytokines are peptides that regulate and coordinate inflammatory and immunologic responses. Increased production of cytokines has been reported during Crohn's disease and ulcerative colitis and is correlated with disease activity. CONCLUSIONS: Because PAF and cytokines may have an important role in the pathogenesis of inflammatory bowel disease, their inhibition by specific antagonists, mediators, or other agents such as steroids may have a potential therapeutic benefit in treatment and management of these inflammatory diseases in the near future.

Animals↗
PubMed1996

Management of selected rectal injuries by primary repair.

BACKGROUND: Diversion of the fecal stream with or without primary repair has been the mainstay of therapy for rectal injuries. Because primary repair has replaced colostomy as the treatment of choice for most colon injuries, we reviewed our experience with primary repair of rectal injuries in order to determine if primary repair without diversion is a feasible option in selected patients. MATERIALS AND METHODS: All traumatic rectal injuries over the past 48 months were reviewed for mechanism of injury, diagnosis, treatment, and outcome. RESULTS: Thirty consecutive patients with extraperitoneal rectal injuries were identified. Six of the 30 patients underwent primary repair without diversion. Five were repaired transanally, and 1 was repaired at celiotomy. There was no morbidity related to the rectal repair in patients who underwent primary repair without diversion, and there were no deaths. CONCLUSIONS: Based on a small number of patients, these data suggest that primary repair of rectal injuries in selected patients may be feasible. Further prospective investigation is needed to determine which patients may be successfully treated in this fashion.

Adolescent↗
PubMed1996

How practice patterns in colon cancer patient follow-up are affected by surgeon age.

BACKGROUND: Strategies for the follow-up of colon cancer patients after potentially curative treatment are known to vary widely. The optimal regimen remains unknown. We investigated whether the date of completion of formal surgical training affects choice of surveillance strategy. METHODS: The 1070 members of the Society of Surgical Oncology (SSO) and the 1663 members of the American Society of Colon and Rectal Surgeons (ASCRS) were surveyed using a detailed questionnaire to measure how these surgical experts deal with colon cancer follow-up. Subjects were asked how they use nine specific follow-up modalities during years 1-5 following primary treatment for patients with colon cancer (TNM Stages I-III). Repeated-measures analysis of variance was used to compare practice patterns by TNM stage and year post-surgery, as well as by the year in which the surgeon's formal surgery training was completed. RESULTS: Evaluable responses were received from 349 SSO members (33%) and 646 ASCRS members (39%). Few significant differences in follow-up practices were noted by training period, but follow-up for most of the nine modalities was highly correlated with TNM stage and year post-surgery, as expected. CONCLUSIONS: This analysis indicates that the post-treatment surveillance practice patterns of surgeons caring for patients with colon cancer do not vary substantially with practitioner age. The data provide credible evidence that postgraduate education is effective in homogenizing practitioner behaviour.

Age Factors↗
PubMed1996

Geographic variation in patient surveillance after colon cancer surgery.

PURPOSE: Considerable variation among surgeons exists in the current practice of patient surveillance after colon cancer treatment. We evaluated whether geographic factors are responsible for this observed variation. METHODS: Profiles of hypothetical patients and a detailed questionnaire based on the profiles were mailed to 2,733 members of two national surgical societies. The influence of the geographic location of the respondents on practice patterns were assessed in two ways. Repeated-measures analysis of variance was used to compare the practice patterns among 19 large metropolitan statistical areas (MSAs) and chi 2 analysis was used to determine whether these patterns differed by MSA population size. RESULTS: Seven of nine commonly used surveillance modalities were ordered significantly more frequently with increasing tumor-node-metastasis (TNM) stage and significantly less frequently with year postsurgery among the 995 respondents with assessable responses, but MSA population size and geographic location of physicians generally had no effect on documented practice variability. The remaining two modalities (bone scan and computed tomography [CT]) were used so infrequently as to preclude meaningful analysis. CONCLUSION: Surveillance after potentially curative colon cancer surgery for otherwise healthy patients is not significantly affected by the geographic location of the surgeon who performs the surveillance testing and only modestly affected by the population size of the MSA in which he/she practices. These data should help in the design of prospective trials of this topic.

Analysis of Variance↗
PubMed1996

Outcomes after detection of metastatic carcinoma of the colon and rectum in a national hospital system.

BACKGROUND: Selected institutions have reported good results with resection for metastatic carcinoma of the colon and rectum, but the number of patients and the expenses required to identify the resectable metastases are unknown. STUDY DESIGN: A retrospective survival analysis was performed using computerized files of the United States Department of Veterans Affairs hospitals from 1988 to 1992, complete through December 1994. Survival was calculated from diagnosis or resection until death. Patients without a death record were assumed to be alive. RESULTS: In all, 22,715 patients underwent colectomy for carcinoma, and 12,150 presented with metastatic carcinoma of the colon and rectum, of which 6,607 had hepatic and 2,659 had pulmonary metastases. Only 2,040 patients with hepatic (and 514 with pulmonary metastases had no prior or other metastatic sites. Of the patients with hepatic metastases, 887 had a computed tomography (CT) scan or liver biopsy, or both, for diagnosis; 133 hepatic and 76 pulmonary resections were done. The projected five-year survival rate after hepatic resection was 26 percent, mean survival was 31 months, and the 30-day mortality rate was 4 percent. After pulmonary resection, results were similar: 36 percent, 38 months, and 3 percent, respectively. The 887 patients with hepatic metastases documented by CT scan or biopsy results has a mean survival of 11 months, and less than 2 percent were alive or unavailable for follow-up examination at analysis. Estimated surveillance costs alone averaged $1.3 million per life saved by resection, or $203,000 per year of added life. CONCLUSIONS: Resection of isolated colorectal metastases produced 70 five-year survivors (hepatic, n=42, pulmonary, n=28) and accounted for 446 additional years of patient life over that expected without resection.

Carcinoma↗
PubMed1996

Complications of endoscopic polypectomy.

Colonoscopic polypectomy has revolutionized the treatment of benign colonic neoplasia. It is performed widely by gastroenterologists and surgeons and is a safe procedure. The two major complications of colonoscopic polypectomy include hemorrhage which has a reported incidence of 0.2% to 3% and perforation which has a reported incidence of 0.5% to 3%. Factors that increase the risk of these complications and management strategies are discussed in this review.

Colonoscopy↗
PubMed1995

How tumor stage affects surgeons' surveillance strategies after colon cancer surgery.

BACKGROUND: The factors that influence decision making among surgeons are not well understood. This study sought to evaluate how the tumor stage of patients subjected to potentially curative surgery for colon cancer affects the follow-up strategies used by practicing surgeons. METHODS: Hypothetical patient profiles and a detailed questionnaire based on these profiles were mailed to 2733 members of two major surgical societies. The effect of TNM Stage on the surveillance strategies chosen by the respondents was analyzed. RESULTS: Seven of the nine most commonly used surveillance modalities all were performed significantly more frequently with increasing TNM Stage. This effect persisted through 5 years of follow-up. The other two modalities (computed tomography and bone scan) were performed too infrequently for meaningful analysis. CONCLUSIONS: Surgeons performing surveillance after potentially curative surgery for otherwise healthy patients with colon cancer modify their strategies according to the patient's TNM Stage. These data should help in the design of prospective trials related to this topic.

Colonic Neoplasms↗