Scott J Boley

Vascular lesions of the right colon are being diagnosed increasingly as a cause of lower intestinal bleeding, but their nature and occurrence, primarily in the elderly, remains unexplained. Colons from patients with clinical and angiographic diagnoses of cecal vascular lesions were studied by injection and clearing, and by histological sections. In all injected specimens one or more mucosal vascular ectasias were identified. The mucosal lesions appeared to be secondary to dilated ...

Increasing recognition of bleeding vascular ectasias of the right colon prompted the present reevaluation of the importance classically attributed to diverticulosis as a cause of lower intestinal hemorrhage in the elderly.The records of all patients more than age sixty-five years admitted to Montefiore Hospital and Medical Center with lower intestinal bleeding from 1971 to 1976 were reviewed. Of 183 such patients, ninety-nine had major and eighty-four had minor bleeding. Of the ...

1.1. The effects of acute bowel distention on intestinal circulation were studied in dogs.2.2. Intraluminal pressures at or above 30 mm. Hg produced a consistent immediate fall in intestinal blood flow. Higher pressures produced correspondingly greater diminutions in flow until an irreducible 20 to 35 per cent of flow remained.3.3. As blood flow fell, there was an associated decrease in the arteriovenous oxygen difference indicating diminished oxygen extraction by the intestine.4.4. ...

Vascular ectasias (angiodysplasias, arteriovenous malformations) of the cecum and ascending colon are a frequent cause of lower intestinal bleeding in the elderly that has been overlooked by clinicians and pathologists. Their nature and etiology have been poorly understood until recently. This article reviews the previous literature and presents a complete and detailed description of these lesions based on the examination of 87 areas showing vascular ectasia from 26 colons. Their ...

The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls. Fifteen girls (4%) had ...

The potential advantages of carbon dioxide over room air to insufflate the bowel during colonoscopy include its nonexplosive nature and rapid absorption. To evaluate whether this rapid absorption would minimize any reduction in colonic blood flow resulting from the distention, we measured inferior mesenteric artery flow before, during, and after insufflation of the canine colon with room air and carbon dioxide under conditions of transient and constant elevations of intraluminal ...

We reviewed the records of 51 patients over 65 years of age admitted for an initial episode of sigmoid volvulus, and adequate information about their subsequent course was obtained in 92 percent. Nonoperative reduction of the initial volvulus was attempted in 43 patients and was successful in 39 (91 percent). Eleven patients required emergency operations, with a mortality rate of 36 percent. Six patients had elective resections with no deaths. Thirty-three patients, 32 after nonoperative ...

The effect of metronidazole was studied in 21 consecutive patients with chronic unremitting perineal Crohn's disease. Drainage, erythema, and induration diminished dramatically in all patients, and complete healing was obtained in 10 of 18 patients maintained on therapy. Five others have shown advanced healing; in 2 patients the inflammation is improved, but healing is minimal. Side effects of metallic taste, dark urine, and mild gastrointestinal upset occurred in many patients. However, ...

The present study of metronidazole in perineal Crohn's disease includes 26 patients, and is composed of 17 of 21 patients who were previously reported and 9 additional consecutive patients. The course of these patients was evaluated to determine if the drug could be reduced or stopped, whether or not it continued to be effective for prolonged periods, and what long-term side effects were encountered. Dosage reduction was associated with exacerbation of disease activity in all patients, ...

Mesenteric venous occlusion produces a spectrum of clinical presentations, the most common of which is the acute onset of abdominal pain with progressive signs and symptoms of bowel infarction. This acute form of mesenteric venous thrombosis, compared with other forms of acute mesenteric infarction, occurs in younger patients, typically has a more indolent and nonspecific course, involves shorter segments of bowel, and has a lower mortality rate. In contradistinction to our recommended ...

Tonometry, a new technique to indirectly assess intestinal blood flow, was used to determine the hemodynamic changes produced by a simulated meal in animals with a fixed, decreased splanchnic blood flow. In experiments on 14 dogs, celiac artery and superior mesenteric artery blood flow was maintained at 50 percent of normal flow by occluders and flow probes, and tonometers were placed in the stomach and small bowel to measure intramural pH, a metabolic marker of intestinal perfusion. ...

Between 1982 and 1987 seven neonates ranging in age from 24 hours to 1 week were treated for idiopathic intestinal perforations at the Montefiore Medical Center, Albert Einstein College of Medicine. Four of the infants were born prematurely; three were full term. Five were being treated in an intensive care nursery when the perforation was diagnosed. All infants whose perforations were due to necrotizing enterocolitis, appendicitis, Hirschsprung's disease, meconium ileus, intestinal ...