Fibrin glue application in the treatment of recurrent anorectal fistulas.

Purpose: This prospective study was done to analyze the efficacy of autologous fibrin glue application in the healing or closure of recurrent anorectal fistulas. Autologous cryoprecipitate was used as fibrin glue in all patients. This group included complex anorectal fistulas, rectovaginal fistulas, and urethrovesicorectal fistulas.

Colonic angiodysplasia.

Colonic angiodysplasia (AD) is an important vascular lesion responsible for approximately 6.0% of cases of lower gastrointestinal hemorrhage. Lesions are usually located in the right colon and, although the pathophysiology is unknown, most are probably acquired as the result of a degenerative process associated with aging.

Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention.

Unlabelled: Over a 3-yr period, we performed colonoscopy on five patients (mean age 71 yr) in whom a specific diverticulum that contained a pigmented protuberance (PiP) was unequivocally identified as the cause for hemorrhage. Four of these individuals had endoscopic bipolar cauterization of the PiP, and two patients had surgery.

Aim: To (1) determine the clinical significance of an intradiverticular PiP, (2) correlate endoscopic features of a PiP with histopathological findings and, (3) assess results of endoscopic treatment for affected patients with lower GI bleeding.

Surgical treatment of traumatic cloaca.

Purpose: This study was designed to evaluate the repair of traumatic cloaca and determine the satisfactory outcome as determined by improvement in the continence mechanism of patients.

Methods: Forty-four patients were entered in this study during a 14-year period. The majority of traumatic cloaca occurred secondary to obstetric injury, most frequently during the first childbirth.

Diverticular bleeding: are nonsteroidal anti-inflammatory drugs risk factors for hemorrhage and can colonoscopy predict outcome for patients?

Objective: This retrospective study was performed to determine if certain endoscopic features of a bleeding diverticulum predict outcome for patients and to assess the role of nonsteroidal anti-inflammatory drugs (NSAID) as a risk factor for hemorrhage.

Methods: Over a 28-month period, colonoscopy was performed on 13 patients (mean, age 74 yr) in whom a specific diverticulum was unequivocally identified as a cause for bleeding. Endoscopic features of the affected diverticulum were recorded and correlated with outcome for patients.

Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people.

Objective: The prevalence of colonic angiodysplasia (AD) among healthy asymptomatic people is unknown, and the natural history of these lesions has not been clearly defined. The purpose of our study was to determine prevalence and to review and assess the natural history of AD.

Methods: Each of the authors had previously published his own prospective study that involved screening colonoscopy for the detection of neoplasia in asymptomatic adult men and women who had never bled.

Narcolepsy: pathogenesis and nursing care.

Narcolepsy is a chronic, incurable disorder affecting at least a quarter of a million Americans. It is characterized by a tetrad of symptoms, which include excessive daytime sleepiness, cataplexy, sleep paralysis and hypnogogic hallucinations. Individuals may experience severe negative psychosocial consequences associated with these symptoms.

Cefotetan-induced anaphylaxis.

Three cases of anaphylactic reactions associated with the use of intravenous cefotetan as surgical prophylaxis for cesarean section (two cases) and transabdominal hysterectomy (one case) are presented. Comprehensive review of these cases revealed no evidence of lot-specific association, drug-drug interaction, or methodologic variance. During the 4-month interval that cefotetan was selectively used for surgical prophylaxis at our hospital, we observed a 1.