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Biomedical subjects

Z Cohen

Publications and source records attributed to Z Cohen.

At least 217 records · Page 12Linked to original sources
PubMed1986

Single-patient randomised clinical trial. Use in determining optimum treatment for patient with inflammation of Kock continent ileostomy reservoir.

A single-patient randomised clinical trial was used to determine optimum treatment for a patient with inflammation of her continent ileostomy. The trial proved to be feasible and acceptable to both patient and clinician. As a result, both the diagnosis of inflammation and the efficacy of metronidazole in treating it were confirmed. The trial design, in which multiple courses of active and control treatments are given to one patient, may be useful in other clinical situations to determine the most effective therapy in an individual case.

Administration, Oral↗
PubMed1986

Restorative proctocolectomy. Clinical results and manometric findings with long and short rectal cuffs.

Clinical results and manometric findings were compared in 82 patients following restorative proctocolectomy. There were 41 patients with long rectal cuffs measuring 8 to 10 cm. There were 39 J-shaped pouches and 2 S-shaped pouches in this group. Forty-one patients had short rectal cuffs measuring 2 to 3 cm. There were 28 J-shaped pouches and 13 S-shaped pouches in this group. Anal manometry was performed in ten patients with long rectal cuffs and in ten patients with short rectal cuffs matched for age, sex, and stool frequency. Postoperative complications were significantly greater in patients with long rectal cuffs. Functional results and manometric findings were similar. No patient demonstrated a normal rectoanal inhibitory reflex. The data in this study suggest that a short rectal cuff can be used safely for restorative proctocolectomy with satisfactory results. A normal rectoanal inhibitory reflex may be absent after restorative proctocolectomy, and this does not interfere with the attainment of continence.

Adult↗
PubMed1986

The double stapling technique for low anterior resection of rectal carcinoma.

The double stapling technique (TA-55 and EEA staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0-43 percent, P greater than 0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.

Adult↗
PubMed1986

Transplantation of the small intestine.

Experimental use of cyclosporine in animal models following small intestinal transplantation is reviewed. The authors' techniques for monitoring allografts and harvesting the small bowel in humans for transplantation purposes are described.

Cyclosporins↗
PubMed1986

Small intestinal transplantation using cyclosporine. Report of a case.

A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.

Adult↗
PubMed1986

Ileal loss of available carbohydrate in man: comparison of a breath hydrogen method with direct measurement using a human ileostomy model.

The breath hydrogen technique has suggested that a considerable amount of available plus unavailable carbohydrate enters the large intestine after the consumption of starchy foods (white bread 11%, wholemeal bread 8%, and red lentils 18%). Direct measurement of the available carbohydrate in ileal effluent after the consumption of test meals by three individuals with ileostomies gave values similar to those determined by the breath hydrogen technique (white bread 10%, wholemeal bread 8%, and red lentils 22%). These studies confirm that considerable amounts of "available carbohydrate" may be lost to the small intestine and physiologically must be considered as dietary fiber. The implications of this with respect to metabolism and colonic disease remain to be investigated.

Adult↗
PubMed1986

Loop ileostomy for anorectal Crohn's disease.

The treatment of symptomatic Crohn's disease of the anorectum can be challenging. Medical therapy may fail and local surgery may be complicated by delayed healing or incontinence. The authors report the clinical course of 12 patients with this condition treated by fecal diversion with a loop ileostomy. Seven patients had a rectovaginal fistula. At the time of review, one of them had restored intestinal continuity following successful fistula repair, three had minimal or no symptoms, one had an active perianal fistula after closure of the ileostomy and two had undergone a proctocolectomy for recurrent symptoms. Five patients with Crohn's proctitis or anorectal sepsis were treated by loop ileostomy. One was asymptomatic, one had recurrent symptoms and three underwent a proctocolectomy. From their experience the authors conclude that construction of a loop ileostomy will temporarily improve the symptoms of anorectal Crohn's disease. Fecal diversion does not appear to alter the long-term course of the disease, and successful restoration of intestinal continuity is uncommon.

Adult↗
PubMed1985

Small intestinal transplantation. A closer reality.

The purpose of this study was to determine whether small intestinal transplantation could be considered as an alternative in the treatment of patients suffering from the short-bowel syndrome. The site of absorption of oral cyclosporine A was determined as were the changes that follow small intestinal transplantation. The interactions between the lipophilic cyclosporine A molecule and fat emulsion solutions used for total parenteral nutrition were investigated. Finally, a technique for harvesting the entire small bowel in man was developed. The absorption of oral cyclosporine A in normal dogs, and in bowel-resected, autotransplanted, and allotransplanted dogs was determined. Cyclosporine A levels were monitored in all animals. This demonstrated that cyclosporine A is absorbed through the small bowel and carried through the lymphatics; that absorption is decreased to 40 percent of normal after autotransplantation or allotransplantation without rejection. Rejection further hampers cyclosporine A absorption. Administration of olive oil alone enhances absorption of cyclosporine A. We also administered cyclosporine A IV to five dogs, with and without a concomitant infusion of fat emulsion solution (Intralipid). No changes in plasma cyclosporine A levels, in the clearance of cyclosporine A, or in the in vivo distribution of cyclosporine A were noted. Finally, dissections in six cadavers and in four brain-dead organ donors were performed, and a reproducible technique for harvesting the small bowel in man was established. In selected patients with the short-bowel syndrome, small intestinal transplant may be considered as an alternative therapy to home total parenteral nutrition.

Animals↗
PubMed1985

The pelvic pouch and ileoanal anastomosis procedure. Surgical technique and initial results.

The pelvic pouch and ileoanal anastomosis procedure should be considered a reasonable alternative for selected patients with ulcerative colitis and familial polyposis. Patients can expect an improved quality of life without a stoma, particularly those with ulcerative colitis. The long-term effects of the reservoir are not completely known; however, from previous reports and from experience with the Kock's ileostomy reservoir, it seems unlikely that there will be a long-term metabolic problems. It appears that a reservoir is essential in adults to minimize stool frequency to an acceptable level and that there is an inverse correlation between pouch size and stool frequency. We still consider this to be an evolutionary procedure and, as such, it should be confined to specialized centers where larger experiences can be accumulated. For the majority of patients who are being considered for proctocolectomy and ileostomy, we urge that they be made aware of alternative forms of therapy and that retaining the rectum should be considered in these patients due to the possibility of reconstructive surgery at a future date.

Adolescent↗
PubMed1985

Cyclosporine absorption in intestinal transplantation.

The absorption of oral cyclosporine (CsA) was studied in a canine small intestinal transplantation model. Absorption of CsA was almost absent in bowel-resected dogs. Autotransplanted dogs showed a persisting malabsorption of CsA (mean peak of 687 +/- 348 ng/ml vs. 1683 +/- 154 ng/ml in control dogs). Allotransplanted dogs with normal graft histology showed a similar malabsorption (mean increase in CsA level: 833 ng/ml), whereas allotransplanted dogs with rejection of the graft showed a markedly decreased absorption (mean increase: 368 +/- 31 ng/ml). In two autotransplanted dogs pretreated with olive oil alone, CsA absorption increased over four weeks to a mean peak of 2215 +/- 5 ng/ml. We conclude that oral CsA is absorbed through the small intestine. Absorption of CsA is decreased after autotransplantation and allotransplantation, and rejection of the graft impedes it further. Regular administration of olive oil alone enhances absorption of oral CsA in a canine model.

Animals↗
PubMed1985

Pharmacokinetic profiles of cyclosporine in rats. Influence of route of administration and dosage.

This study was performed to determine the influence of different routes of administration and of variable doses of cyclosporine (CsA) on the pharmacokinetics of CsA in the rat. Seven groups of 4 adult female Lewis rats were given CsA once daily for 5 days: group 1: 5 mg/kg of CsA p.o. (by gavage); group 2: 10 mg/kg of CsA p.o.; Group 3: 5 mg/kg of CsA i.m.; group 4: 10 mg/kg of CsA i.m.; Group 5: 5 mg/kg of CsA s.c.; group 6: 10 mg/kg of CsA s.c., group 7: 10 mg/kg CsA i.p. CsA plasma levels were determined by RIA at 0, 2, 4, 6, 8, and 24 hr on days 1 and 4. Ease of administration was greatest in the s.c. groups (3 and 4), in which no anesthesia, no restraining device, and no special skills were required. Peak CsA levels varied greatly from group to group, as did trough levels and CsA bioavailability, as determined by the total area under the plasma CsA concentration-time curve. All groups exhibited great variation of CsA plasma level in the 24-hr period following administration, except group 3, in which the peak-to-trough difference was only 26.8% of peak level, as opposed to values over 60% in all other groups. We conclude that: (1) CsA may be administered to rats through different routes to achieve adequate plasma levels; (2) the route and dosage will greatly influence the pharmacokinetic profile of CsA; and (3) the SC route, in addition to being the easiest, provides reproducible and steady CsA plasma levels, with little variation over a 24-hr period.

Administration, Oral↗
PubMed1985

Experimental and clinical intestinal transplantation.

Before 1972 several attempts were made to perform small intestinal transplantation in man for the treatment of diseases leading to major losses of the small intestine. No patient had survived for more than 76 days despite intensive conventional immunosuppressants. Small intestinal allotransplantation has been investigated, experimentally, since 1959. Lillehei initially reported the results of allotransplantation of various lengths of small intestine in the canine model. Surgical techniques for successful allogeneic small intestinal transplantation as well as the methods for graft preservation, were clarified. Autotransplants of the total small bowel in dogs survived indefinitely. However, in dogs receiving total small intestinal allotransplants the mean survival period was 8-15 days. Both rejection and graft-versus-host disease have been implicated in the short survival of experimental animals. With the advent of cyclosporine and its known action against both rejection and graft-versus-host disease, we studied the results of parenteral cyclosporine on the survival of dogs following total small intestinal allotransplantation. Cyclosporine greatly prolongs survival to a mean of 103 days, following transplantation of the small bowel, compared to only 12 days in dogs not receiving any immunosuppressive agent. Two of the treated dogs lived for longer than 200 days and one dog lived for more than 400 days. Following this, we have developed a method of histological monitoring of the allograft by making two exterior isolated pouches of the allograft, representing the histological events leading to rejection of the in-continuity bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Symposium on outpatient anorectal procedures. Alternatives to surgical hemorrhoidectomy.

Hemorrhoids are an extremely common affliction. The prevalence ranges from 1 in 25 to 1 in 30 individuals. There was a 20% decrease in the number of hemorrhoidectomies performed between 1978 and 1982. Alternatives to formal hemorrhoidectomy are injection sclerotherapy and rubber-band ligation. High-fibre diets and bulk laxatives are effective in relieving the symptoms of hemorrhoids, easing defecation and regulating bowel habit and can be used liberally. Bleeding hemorrhoids can be treated by diet alone, or by injection or rubber-band ligation. Prolapsing hemorrhoids are best treated by rubber-band ligation. The relatively few patients in whom these more conservative measures fail can be considered for hemorrhoidectomy.

Adult↗
PubMed1985

Management of chronic perineal sinuses by wide excision and split-thickness skin grafting.

Nine patients who had chronic perineal sinuses following proctectomy for inflammatory bowel disease underwent wide excision of the sinus and split-thickness skin grafting. All patients had persistent pain and discharge. All but one had undergone multiple surgical procedures previously. Fibrous tissue was excised from the sinus tract and the wound was grafted either immediately (six patients) or at a later date (three patients). Five patients had complete healing of the wound initially while four required further procedures. Eight patients have been followed up for an average of 4.6 years (range from 5 months to 12 years). Complete healing was achieved in seven patients; all are free of pain and can work or are unrestricted in their daily activities. One patient is improved but still requires analgesia and is disabled by the persistent pelvic pain.

Adult↗