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Biomedical subjects

W I Wolff

Publications and source records attributed to W I Wolff.

At least 19 recordsLinked to original sources
PubMed1991

An appraisal of small and diminutive colonic polyps.

A retrospective review of all colonoscopic polypectomies performed in a busy surgical endoscopy unit over a 6-month period was undertaken. All patients were included who presented with colonic polyps measuring less than 1 cm in diameter for which sufficient specimens were available for histopathologic examination. In all, 262 were polyps removed from 206 patients; of these, 158 (60%) were neoplastic. There was a statistically significant predilection for polyps in the right colon to be neoplastic. Worrisome histologic patterns (severe dysplasia, carcinoma in situ, or invasive carcinoma) were seen in 18 specimens (6.5%). In two patients, polypoid carcinoma could be identified; in one case it involved a lesion measuring 0.2 cm in diameter. Since these lesions exhibit no distinctive gross features, only their endoscopic removal and histologic study can ensure proper diagnosis and treatment.

Adult↗
PubMed1989

Colonoscopy: history and development.

Retrograde colonoscopy of the entire colon, and endoscopic excision of polyps from anywhere in the colon, began in June and September of 1969, respectively. Momentous advances have occurred over the past two decades, and the two procedures are now widely accepted and practiced. Development and perfection of the methodology were, at first, fraught with many difficulties, both procedural and technical, which had to be overcome. Significant opposition was engendered in the early years by some who claimed that the methods were both unnecessary and unduly dangerous. Time has proven otherwise. Progress came about as the result of a steady stream of publications from a number of centers documenting the successful and safe application of the methodology. A recounting is presented of the many contributions that predated development of the colonoscope and colonoscopy, and how the latter came about. For those coming into the art more recently, this review of beginnings is offered to allow a balanced evaluation of their craft.

Colonic Polyps↗
PubMed1982

A rationale for the endoscopic management of colonic polyps.

The incidence of invasive cancer in colonic polyps is related to the size of the lesion and the histologic type of the adenoma. It is greatest for villous adenomas and least for tubular adenomas. The malignant potential increases with the size of the polyp, and in lesions 3 cm and larger malignant disease is present in at least 12 per cent. In general, polyps with invasive malignant disease require colon resection, but for pedunculated adenomas, colonoscopic polypectomy is adequate treatment. Even when invasive cancer is close to the line of endoscopic resection but does not invade the stalk or does not display lymphatic or vascular invasion, a case may be made for conservative, endoscopic treatment alone because the occurrence of local or distal metastasis is very unusual.

Adenoma↗
PubMed1979

Morphology, anatomic distribution and cancer potential of colonic polyps.

The concept of a polyp-cancer sequence is assuming increasing credibility as a factor in the development of colorectal cancer. Colonoscopy permits most colonic polyps to be endoscopically removed and studied pathologically. Of various polyp types encountered in the colon only neoplastic polyps are regarded as having malignant potential. Neoplastic polyps include tubular adenomas (formerly, adenomatous polyps), villous adenomas and villotubular adenomas (formerly, mixed or tuboglandular polyps). Cancerous changes must penetrate the muscularis mucosae for a polyp to be regarded as clinically malignant. The present report analyzes a series of 5,786 adenomas from over 7,000 polyp endoscopically removed. The largest number of each type of adenoma presented in the sigmoid colon, followed by the descending colon in terms of frequency. In all zones tubular adenomas were most common, villous least. Abnormal cellular change, from dysplasia to carcinoma in situ to invasive cancer was most frequently found in the sigmoid colon and, in all colon sectors, increased as the villous componency of the polyp increased. However, all categories of neoplastic polyps showed malignant changes. Polyp size, long recognized as a factor, was shown to be importantly related to malignant change, but invasive cancer was found even in polyps less than 1 cm in diameter. In addition, the incidence of malignancy rose parallel to the frequency of synchronous and metachronous polyps. A vigorous program for detection and endoscopic removal of colorectal polyps is recommended as a means of reducing the incidence of colorectal cancer.

Adenoma↗
PubMed1979

Idiopathic calcific pancreatitis, CRST syndrome and progressive systemic sclerosis.

A 43-year old man with CRST syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly and telangiectasia) and progressive systemic sclerosis presented with a four-year history of relapsing abdominal pain, the result of chronic pancreatitis, not associated with alcoholism, biliary disease, or any of the known causes of pancreatitis. He had a good response to retrograde pancreatic duct drainage but exhibited management problems and complications that may be peculiar to the systemic sclerosis patient with pancreatitis. A cause and effect relationship between progressive systemic sclerosis and pancreatic disease is not proven but we believe there is evidence to suggest such a relationship.

Adult↗
PubMed1978

Human spinal fluid methadone levels.

Cerebral spinal fluid (CSF) levels of methadone were measured in nine methadone maintenance patients requiring lumbar punctures for medical or surgical treatment. Concurrent serum methadone levels were also determined. The CSF concentration of methadone in all cases was a fraction of the corresponding serum level--ranging from 2 to 73%. The CSF concentrations of methadone ranged from 0.010 to 0.097 ng%. Peak methadone levels in CSF appeared approximately 3 - 8 hours after methadone administration.

Humans↗
PubMed1978

Vascular trauma observed at an urban hospital center.

The records of 50 patients with 67 major civilian type vascular injuries treated in a large urban center from 1967 to 1975 were reviewed in terms of nature of the injury, form of surgical management and early and late results. Civilian injuries differ in many aspects from those of their military counterparts and often require different treatment. In both, however, treatment protocols should be periodically re-evaluated for a number of reasons, chiefly among which are changing patterns of delivery of the injured patient to the medical center and advances in technical skills. Notable in the presently reported series were the low mortality and the absence of a need for amputation, with a limb salvage rate of 100 per cent. Despite modern advances in technical proficiency in vascular reconstruction, there is still a place for careful vascular ligation in the definitive surgical management of major vascular trauma.

Abdominal Injuries↗
PubMed1977

Primary adenocarcinoma of the duodenum.

Primary adenocarcinoma of the duodenum is rare. An extensive experience with fiberoptic esophagogastro-duodenoscopy in our institution has indicated that duodenal neoplasms may be more frequent than suspected and are readily diagnosed by this modality. With this mind, clinical, pathological, diagnostic and therapeutic aspects of the 71 patients with primary carcinoma of the duodenum reported in the literature in the last 10-year period, 1965-1974, were reviewed. It would appear that fiberoptic endoscopy of the upper gastro-intestinal tract should become the major diagnostic tool for this disease. It enables biopsies, brushings and washings to be taken. A preoperative histological diagnosis ensures that both patient and surgeon can be prepared for major abdominal surgery. It is imperatire that during the endoscopic examination, the entire duodenum be examined. Pancreatico-duodenectomy appears to offer the best chance of long term survival in patients whose lesion is resectable. The role and value of adjuvant chemo- and radiotherapy is still to be determined.

Adenocarcinoma↗
PubMed1977

The value of laparoscopy in general surgical problems.

Laparoscopy offers a simple, rapid and safe way to evaluate and diagnose definitively intra-abdominal disease. An analysis of 65 consecutive patients supports this contention and demonstrates the real advantages and safety of this readily available modaility. A 90 per cent success rate, defined as accomplishing the diagnosis, was achieved in this study. There were no complications and no deaths. Local anesthesia was almost exclusively used and is strongly recommended. Laparoscopy represents an underused diagnostic modality which, when properly performed, can effect significant medical and fiscal economies in patient care.

Abdomen↗
PubMed1977

Angiodysplasia of the colon: diagnosis and treatment.

Gastrointestinal hemorrhage of obscure origin remains a difficult clinical problem, but newer methods of study, particularly endoscopy and angiography, have made inroads into this morass of diagnostic dilemmas. Vascular malformations represent entities that are relatively infrequent of occurrence and also difficult of detection. These characteristics render them particularly refractory to recognition. Once diagnosed, however, they are quite readily treated surgically, without resort to "blind" resections or multiple bowel entries. This report deals with three instances of obscure but important persistent blood loss into the gastrointestinal tract. In each instance, identification by customary diagnostic methods was unsuccessful, but was finally made through endoscopy and promptly cured through surgery. The bleeding in all 3 cases proved pathologically to have been caused by vascular malformations, which we have subsumed under the term "angiodysplasia."

Aged↗