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Biomedical subjects

W E Longo

Publications and source records attributed to W E Longo.

At least 73 records · Page 4Linked to original sources
PubMed1995

Cost of patient follow-up after potentially curative colorectal cancer treatment.

OBJECTIVE: To estimate the cost of follow-up among colorectal cancer patients treated with curative intent based on the broad spectrum of surveillance strategies suggested in the literature. DESIGN: Economic analysis of the costs associated with 11 separate surveillance strategies. Charge data were obtained from the Part B Medicare Annual Data file and the Hospital Outpatient Bill file. SETTING: Ambulatory care. MAIN OUTCOME MEASURES: Medicare-allowed charges and an actual-charge proxy for 5 years of follow-up after treatment for colorectal cancer patients on a nationwide basis. RESULTS: Medicare-allowed charges varied widely for the 5 years of posttreatment follow-up from a low of $561 to a high of $16,492. When Medicare-allowed charges were converted to a proxy for actual charges using a conversion ratio of 1.62, the range was $910 to $26,717, a 28-fold difference in charges. CONCLUSIONS: Charges vary extensively across follow-up strategies, with no indication that higher-cost strategies increase survival or quality of life.

Colorectal Neoplasms↗
PubMed1995

Crocidolite asbestos fibers in smoke from original Kent cigarettes.

The original version of the Kent Micronite cigarette filter used crocidolite, a form of asbestos, from 1952 until at least mid-1956. Cigarettes from intact, unopened packs of the brand from this period were examined. One filter contained approximately 10 mg of crocidolite. Crocidolite structures were found in the mainstream smoke from the first two puffs of each cigarette smoked. At the observed rates of asbestos release, a person smoking a pack of these cigarettes each day would take in more than 131 million crocidolite structures longer than 5 microns in 1 year. These observations suggest that people who smoked the original version of this cigarette should be warned of their possible substantial exposure to crocidolite during the 1950s.

Asbestos, Crocidolite↗
PubMed1995

Evidence for a colonic PAF receptor.

We sought to determine the effect of exogenously administered platelet-activating factor (PAF) on eicosanoid release from the left colon of the rabbit. Using an isolated buffer-perfused rabbit left colon preparation, 1.0- or 5.0-micrograms doses of PAF were infused into the inferior mesenteric artery. Effluents from the inferior mesenteric vein and colonic lumen were collected and the concentrations of the eicosanoids, prostaglandin E, 6-ketoprostaglandin F1 alpha, thromboxane B2, and leukotriene B4 (LTB4), were measured by ELISA. During PAF infusion there was a significant increase of all prostanoids, but not LTB4 into the venous effluent and colonic luminal perfusate when compared to control experiments. Additional studies were performed by pretreating the colons with the PAF antagonists WEB-2170 or alprazolam prior to PAF infusion. Both venous and luminal effluent prostanoid release was effectively blocked by WEB-2170, but not by alprazolam. Colons pretreated with WEB-2170 prior to PAF had markedly diminished tissue injury when compared to colons treated with PAF alone. Inhibition of PAF-stimulated prostanoid release by WEB-2170 suggests that a PAF-sensitive receptor is present in rabbit colonic tissue which may induce eicosanoid-mediated tissue injury.

Animals↗
PubMed1995

Colonoscopy in the elderly. Low risk, high yield.

An evaluation of the utility, morbidity, and patient tolerance of colonoscopy in elderly (> or = 70 years) patients was undertaken and compared to data for a similar group of younger patients (50-70 years) who underwent colonoscopy during the same 48 months. Data reviewed for both groups included demographics, indications for colonoscopy, effectiveness of bowel preparation, colonoscopy completion, endoscopic findings, and complications. The mean age of the entire 656-patient population was 69 +/- 10 years; 87 (25%) of the 354 elderly patients were greater than 80 years of age and the average age of the 302-member control group was 59.8 +/- 5.8 years. Indications for colonoscopy were the same in both groups and included rectal bleeding, 134 (20%); prior colorectal operation, 115 (18%); a history of adenomatous polyps, 82 (12%); guaiac-positive stools, 49 (8%); abnormal finding on barium enema, 19 (3%); and miscellaneous other gastrointestinal symptoms, 151 (23%). Screening colonoscopy was performed in 106 (16%). Colonoscopy was successfully completed to the cecum or the ileocolic anastomosis in 85% (555/656) of the entire population. Only 78% (275/354) of elderly patients had colonoscopy successfully completed compared to 93% (281/302) of their younger counterparts (P = 0.001). Elderly patients were significantly more likely to have an abnormality than younger patients (74% vs 60%, P < 0.05). Malignant colorectal neoplasia was more common in the elderly (6% vs 2%, P = 0.03); however, benign neoplasia was equally present in both age groups (30% vs 27%, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively.

BACKGROUND: The characteristics of patients who develop clinically significant angiodysplasia of the lower gastrointestinal (GI) tract are unknown, and methods of treatment are evolving. PURPOSE: This study was undertaken to identify patient characteristics, methods of diagnosis, and current management of patients who require operation and outcome. METHODS: Patients with the diagnosis of angiodysplasia of the lower GI tract at St. Louis University affiliated hospitals over the past five years were reviewed. RESULTS: Thirty-two consecutive patients were identified. The mean age was 69.8 (range, 29-86) years; 62.5 percent were males. Patient characteristics included: age greater than 65 years, 22 of 32 patients (69 percent); documented coagulopathy, 9 of 32 patients (28 percent); and cardiac valvular disease, 8 of 32 patients (25 percent). Diagnosis was established by colonoscopy in 27 of 32 patients (84 percent), enteroscopy in 3 of 32 patients (9 percent), and angiography in 2 of 32 patients (6 percent). Seventy-eight percent of the angiodysplasias were located in the right colon. Patients were treated by endoscopic coagulation in 16 of 32 patients (50 percent), surgical resection in 9 of 32 (12.5 percent), or observation in 3 of 32 patients (9 percent). Four of 32 patients (12.5 percent) developed recurrent bleeding. Four of 32 patients (12.5 percent) died of various causes. FOLLOW-UP: Follow-up was possible in 25 of 28 surviving patients, and the follow-up period ranged from 3 to 42 months, during which rebleeding occurred in 5 patients who had been previously treated by endoscopic coagulation and in 1 patient who had been treated by transfusion alone. Two patients died of unrelated causes and one from a recurrent lower GI bleed. CONCLUSION: Angiodysplasia is primarily a disease of elderly patients. These patients are frequently anticoagulated and often have co-existing cardiac valvular disease. Endoscopy usually establishes the diagnosis, and endoscopic coagulation is an effective and safe method of treatment. Most patients can be managed without operation.

Adult↗
PubMed1995

Congenital colonic varices in the adult. Report of a case.

PURPOSE: This study was conducted to report a rare cause of colonic bleeding. METHODS: Case report. CONCLUSION: Surgical resection of congenital colonic varices is associated with a low incidence of morbidity and mortality, and a favorable long-term prognosis can be expected when there is no evidence of hepatocellular disease (portal hypertension).

Adult↗
PubMed1995

Colorectal manifestations of endocrine disease.

PURPOSE: The aim of this review is to alert the colon and rectal surgeon to the colorectal manifestations of endocrine disease. METHODS: This report was obtained by a review of the medical literature. Endocrine disease may initially present as a symptom felt to be referable to colorectal disease. Furthermore symptoms of well-established endocrine disorders may have refractory colorectal symptoms. RESULTS: Constipation is the most common gastrointestinal symptom of diabetics; however, in patients with brittle diabetes, diarrhea may be chronic and intermittent. Unexplained diarrhea, despite an exhaustive work-up for an etiology, should alert the clinician to the possibility of a pancreatic endocrine tumor. Thyroid disorders, depending on activity of the gland, may have refractory constipation, diarrhea, or steatorrhea as the only presenting symptoms. Constipation is a common symptom of hypercalcemia, secondary to hyperparathyroidism. Primary hyperparathyroidism has been associated with increased incidence of malignancies, specifically of colonic origin. In patients with acromegaly a threefold to eightfold increased risk of colon carcinoma or adenomatous polyps is seen. Chronic adrenal insufficiency may present initially as diarrhea and malabsorption. The adrenal gland is a frequent site of metastases from colorectal cancer. Pheochromocytomas may be a cause of occult gastrointestinal bleeding or ischemic colitis. CONCLUSION: Unexplained symptoms referable to the colon and rectum should alert the clinician to the possibility of an underlying endocrine disorder.

Colonic Diseases↗
PubMed1995

Surveillance after curative colon cancer resection: practice patterns of surgical subspecialists.

BACKGROUND: In the literature, suggested strategies for the follow-up of colon cancer patients after potentially curative resections vary widely. The optimal regimen to monitor for recurrences and new primary tumors remains unknown. The nationwide cost impact of wide practice variation is also unknown. METHODS: The 1,070 members of The Society of Surgical Oncology (SSO) were surveyed using a detailed questionnaire to measure the practice patterns of surgical experts nationwide. Respondents were asked how often they use nine separate methodologies in follow-up during years 1-5 postsurgery for TNM stage I, II, and III patients. Costs were estimated for representative less and more intensive strategies. RESULTS: Evaluable responses were received from 349 members (33%). Office visit and carcinoembryonic antigen analysis were performed most frequently. SSO members generally see patients every 3 months in years 1-2, every 6 months in years 3-4, and annually thereafter. There was wide variability in test ordering patterns and moderate variation between SSO and previously surveyed American Society of Colon and Rectal Surgeons members. The charge differential between representative less and more intensive follow-up strategies for each annual U.S. patient cohort is approximately $800 million. CONCLUSIONS: Actual practice patterns vary widely, indicating lack of consensus regarding optimal follow-up. The enormous cost differential associated with such variation is difficult to justify because there is no proven benefit of more intensive follow-up.

Colonic Neoplasms↗
PubMed1995

Improved outcome by identification of high-risk nonocclusive mesenteric ischemia, aggressive reexploration, and delayed anastomosis.

BACKGROUND: The factors associated with outcome of patients with nonocclusive mesenteric ischemia are poorly defined. METHODS: Over a 7-year period, 34 consecutive patients with nonocclusive mesenteric ischemia were identified. RESULTS: The mean age of the study patients was 63 years (range 31 to 94); 21 of 34 (62%) were men. The mean delay in diagnosis was 31 hours (range 7 hours to 6 days). Seven of 34 (21%) underwent preoperative visceral arteriography. Two of these 7 required surgery, and both died as a result of intestinal infarction. The remaining 27 had the diagnosis made at celiotomy. Among the 29 who were explored, 16 of 29 (55%) had intestinal infarction. Twenty-one of 29 (72%) had segmental bowel injury whereas 8 of 29 (28%) had massive injury. Among those with segmental infarction, primary anastomosis was performed in 12 of 21 patients (57%); 5 of the 12 (42%) died. Nine of 21 patients (43%) underwent delayed anastomosis; 2 of the 9 (22%) died. No patient with massive injury underwent primary anastomosis. Second-look laparotomy was performed on 22 of 29 (76%). Eleven of those 22 (50%) had a further bowel resection. Overall, 16 of 29 (55%) who underwent surgery for nonocclusive mesenteric ischemia are alive. CONCLUSIONS: Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups, aggressive reexploration, and delayed intestinal anastomosis.

Acute Disease↗
PubMed1995

Cisapride for constipation in spinal cord injured patients: a preliminary report.

Chronic constipation in patients with spinal cord injury (SCI) has significant impact on quality of life. To measure baseline clinical functioning, colonic transit time and anorectal manometry and the effect of cisapride on these clinical and physiological parameters, we studied 12 SCI patients. Patients initially received baseline clinical scoring, measurement of colonic transit time and anorectal manometry. Patients then received cisapride 20 mg orally three times each day. After one and three months of cisapride therapy, all measurements were repeated. The mean duration cisapride treatment was 5.2 months. Six of 12 (50 percent) reported that symptoms of constipation improved. No patient had worsening of symptoms. Prior to cisapride treatment, 23 percent of patients passed colonic transit markers by day five and 57 percent by day seven; baseline anal manometry revealed variable resting and squeeze pressures. After treatment, 33 percent of patients passed their colonic transit markers by day five and 71 percent by day seven. Six of 12 (50 percent) demonstrated a 10 percent or more increase in resting anal canal pressures. We conclude that about 50 percent of SCI patients have subjective improvement in constipation after cisapride therapy. Cisapride appears to improve both colonic and anorectal function.

Cisapride↗
PubMed1995

Rare anal canal cancers in the U.S. veteran: patterns of disease and results of treatment.

Nationwide treatment results among U.S. veterans with rare anal cancers (AC) have not been previously reported. We sought to evaluate the demographics and treatment outcome of patients with rare AC in Veterans Affairs Medical Centers (VAMCs). Using national VA computer data sets, we identified all patients with the ICD-9 diagnostic code (154.2) for anal cancer from 1987-1991. Patient demographics, histopathology, tumor size, results of treatment, and survival data were sought from local tumor registrars. A total of 405 patients with AC were identified by computer search; 204 (51%) were evaluable. 164 (80%) had squamous cell carcinomas, 25 (13%) had basaloid carcinomas, 8 (4%) had melanomas and 7 (3%) had anal gland adenocarcinomas. Patients were treated either by local excision, abdominoperineal resection (APR), or primary chemoradiation. Mean follow-up was 5.1 years. Among 25 patients with basaloid tumors, 19/25 were treated with chemoradiation; 13/19 (68%) are alive, and 3/5 treated with radical surgery are living. Among the seven patients with adenocarcinoma, those treated with CR fared better than those who underwent APR. Among the 8 patients with melanoma, 3/7 (38%) underwent primary APR, and 5 (62%) were treated by local excision; 7/8 died. Rare anal tumors account for 20 per cent of all anal canal cancers in the VA population. Patients with basaloid tumors respond well to chemoradiation. Patients with anal melanoma continue to have a poor prognosis.

Adenocarcinoma↗
PubMed1995

Laparoscopic restoration of intestinal continuity after Hartmann procedure.

Two cases of laparoscopic restoration of intestinal continuity are presented. The procedures were technically straightforward and both patients did well. These cases add to a small but growing literature documenting the technical feasibility of laparoscopic intestinal surgery. The potential risks and benefits of this minimally invasive technique are discussed.

Colon↗
PubMed1995

Barrett's esophagus: a review.

Complications of Barrett's esophagus include ulceration, stricture, hemorrhage, perforation, and the development of malignancy. Barrett's esophagus and adenocarcinoma may be diagnosed simultaneously and that gastroesophageal reflux symptoms may be absent in many cases. Although endoscopic surveillance is justified, no agreement on the frequency can be made. Survival of patients with adenocarcinoma in Barrett's esophagus depends on the stage at diagnosis.

Adenocarcinoma↗
PubMed1994

Effect of platelet-activating factor and its antagonists on colonic dysmotility and tissue levels of colonic neuropeptides.

We investigated whether platelet-activating factor (PAF) alters colonic tissue levels of substance P and vasoactive intestinal peptide (VIP), two neuropeptides that regulate colonic motility. Left colons were harvested from NZ White Rabbits and underwent vascular perfusion via the inferior mesenteric artery. Strain gauge transducers were sewn onto the serosal surface of the colon to evaluate colonic motility. Colons were perfused with either buffered saline alone or with 5.0 x 10(-5) M PAF. PAF administration increased tissue VIP and substance P levels and decreased the force of colonic contractions. Pretreatment with WEB-2170 or alprazolam decreased concentrations of both tissue neuropeptides, and decreased the force of colonic contractions and minute motility index. These results suggest that both VIP and substance P are stimulated by PAF and may participate in colonic dysmotility during inflammatory states.

Alprazolam↗
PubMed1994

Radical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical management of rectal cancer.

Radical abdominopelvic lymphadenectomy for rectal cancer is based on the tenet that removal of all potentially involved lymphatic tissue will yield a lower rate of locoregional failure and improve survival. At centers with extensive experience with the procedure, the operating time is only modestly prolonged compared with conventional resection. Blood loss and postoperative hospitalization are not significantly increased. Urinary dysfunction and impotence associated with radical abdominopelvic lymphadenectomy (as high as 80 percent and 76 percent, respectively, in recent series) have been major deterrents to its more routine application. Preservation of the hypogastric plexus and even selective preservation of a unilateral S4 nerve root have been shown to reduce the occurrence of genitourinary complications. Improved five-year survival of 68 percent and local recurrence rates of 5 to 20 percent for TNM Stage III cancers have been achieved with radical abdominopelvic lymphadenectomy. These results compare favorably with recent trials of adjuvant chemoradiation after conventional resection in stage-matched patients. The rationale, evolution, and application of radical abdominopelvic lymphadenectomy to the surgical management of rectal cancer are critically examined. The potential benefits of radical abdominopelvic lymphadenectomy, which have been demonstrated in nonrandomized trials, should be evaluated in a prospective and properly randomized study to clearly establish or refute its efficacy.

Abdomen↗
PubMed1994

Mesenteric ischemia. Acute arterial syndromes.

Acute mesenteric ischemia represents one to two percent of all gastrointestinal illnesses. There are three possible causes of acute arterial mesenteric ischemia: embolism, thrombosis, and nonocclusive mesenteric insufficiency. The key to early diagnosis is a high index of suspicion. The classic clinical picture of obvious cardiac disease, sudden onset of severe abdominal pain and gastrointestinal emptying, is not always present. Serum markers and plain films are often nondiagnostic but may suggest acute arterial mesenteric ischemia. Angiography establishes the diagnosis and allows for planning of aortomesenteric bypass, if indicated. Papaverine is immediately instilled to decrease splanchnic vasoconstriction. Embolic and thrombotic disease is treated by laparotomy with re-establishment of visceral perfusion. Only after blood flow is restored is nonviable bowel resected. Clinical methods of assessing intestinal viability include Doppler scanning, intravascular dyes, and tissue oximetry. The decision to perform a second-look laparotomy is made prior to closure of the abdomen. Pharmacologic treatment is the mainstay of nonocclusive ischemia. Surgery is reserved for clinical deterioration. Survival is dependent on the cause and extent of occlusion as well as the rapidity of diagnosis and therapy. Bowel necrosis results in mortality rates between 80 percent and 95 percent.

Abdominal Pain↗
PubMed1994

Patterns and prognosis of Clostridium difficile colitis.

UNLABELLED: The incidence of Clostridium difficile colitis has increased during recent years, presumably because of liberal use of broad-spectrum antibiotic regimens. METHODS: A retrospective review to determine patterns of C. difficile colitis development, morbidity, and treatment results was undertaken. During an 18-month period, 90 patients were diagnosed with C. difficile colitis by fecal toxin assays. Patient demographics, symptoms, previously administered antibiotic regimens, diagnostic evaluations, treatment modalities, morbidity, and mortality were identified, entered into a computer data base, and analyzed. RESULTS: The mean age was 58 years; males outnumbered females 1.2:1. Among 90 patients, 41 (46 percent) developed C. difficile colitis after surgical procedures. Eighty (89 percent) patients received antibiotic therapy before developing C. difficile colitis: 35 (44 percent) for documented infections and 45 (56 percent) as empiric or prophylactic therapy. Cephalosporins, penicillins, quinolones, vancomycin, and aminoglycosides were the most frequently administered antibiotic classes prior to C. difficile colitis diagnosis. Ten (11 percent) patients developed C. difficile colitis without previous antibiotic therapy. Eighty-two (91 percent) patients presented with diarrhea, while eight (9 percent) had fever only. Primary C. difficile colitis treatment for both groups included vancomycin (66 percent), metronidazole (24 percent), or both drugs (10 percent). Ten (11 percent) patients received no treatment. No patient developed toxic colitis or megacolon. Colonoscopy was performed in four (4 percent) patients; pseudomembranes were identified in one (25 percent) patient. There was one C. difficile colitis recurrence after treatment, but no C. difficile colitis-associated morbidity. Mortality (14 patients, 16 percent) was not related to C. difficile colitis, but to underlying illness. No difference in patient age, sex, previous antibiotic administration, serum albumin, total days hospitalized, duration of C. difficile colitis antibiotic therapy, C. difficile colitis treatment regimens, or mortality was identified between nonsurgical and surgical patients. The white blood cell count was significantly lower in the nonsurgical group however. Clostridium difficile colitis developed most commonly after antibiotic administration with symptoms of diarrhea, but did occur without previous antibiotic administration or diarrhea. CONCLUSION: Despite the clinical setting, C. difficile colitis had no associated morbidity and treatment was highly effective. Mortality was related to underlying medical illness, not C. difficile colitis.

Algorithms↗