Kenneth Eng, M.D.

Effect of prophylactic nonsteroidal antiinflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery
Almeida, David R P; Johnson, Davin; Hollands, Hussein; Smallman, Donald; Baxter, Stephanie; Eng, Kenneth T; Kratky, Vladimir; ten Hove, Martin W; Sharma, Sanjay; El-Defrawy, Sherif
2008 Jan;34(1):64-69, Journal of cateract & refractive surgery
PURPOSE: To evaluate the efficacy of prophylactic administration of the topical nonsteroidal antiinflammatory drug (NSAID) ketorolac tromethamine 0.5% on acute (within 4 weeks of surgery) cystoid macular edema (CME) and total macular volume (TMV) in patients having phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada. METHODS: This open-label nonmasked randomized (random number assignment) study comprised 106 eyes of 98 patients. Exclusion criteria included hypersensitivity to the NSAID drug class, aspirin/NSAID-induced asthma, and pregnancy in the third trimester. Ketorolac tromethamine 0.5% was administered starting 2 days before surgery and for 29 days after surgery for a total of 31 days. The outcome measure was macular swelling, which was quantified by the optical coherence tomography. RESULTS: At 1 month, there was a statistically significant difference in TMV between the control group (0.4420 mm3) and the ketorolac group (0.2392 mm3), with the ketorolac group having 45.8% less macular swelling (P = .009). Multiple linear regression with backward selection indicated a 44.3% (P = .013) and 46.1% (P = .030) reduction in macular swelling in the ketorolac group at 1 week and 1 month, respectively. CONCLUSION: Used prophylactically after cataract surgery, ketorolac 0.5% was efficacious in decreasing postoperative macular edema
— id: 95565, year: 2008, vol: 34, page: 64, stat: Journal Article,

Retinal toxicity of intravitreal ganciclovir in rabbit eyes following vitrectomy and insertion of silicone oil
Eng, Kenneth T; Lam, Wai-Ching; Parker, John A; Yucel, Yeni H
2004 Aug;39(5):499-505, Canadian journal of ophthalmology
BACKGROUND: Although intravitreal ganciclovir dosages up to 500 microg have been demonstrated to be safe in some studies, other studies have shown toxic retinal effects in rabbit eyes without silicone oil at lower dosages. In current clinical practice, the same dosage of intravitreal antiviral agent is given regardless of whether there has been retinal detachment repair with silicone oil. We performed a study to investigate, in rabbit eyes following vitrectomy and silicone oil insertion, the retinal toxicity of serial intravitreal injections of ganciclovir, using dosages previously found not to produce significant toxic effects in nonvitrectomized eyes. METHODS: Twenty-eight eyes of 14 New Zealand pigmented rabbits underwent pars plana vitrectomy and silicone oil insertion. One eye of each animal received an intravitreal ganciclovir injection twice weekly for 2 weeks.The other eye received 0.1 mL of normal saline as a control. Three dosages of ganciclovir (50, 100 or 200 microg/0.1 mL) were used in three groups of three to six animals. Scotopic electroretinography and histologic examination were performed 2 weeks postoperatively. RESULTS: No differences in scotopic b-wave threshold (p = 0.23, 0.78 and 0.50 for ganciclovir dosages of 50, 100 and 200 microg/0.1 mL respectively, Mann-Whitney U test) or in light microscopy findings were noted between the treatment and control eyes at any dosage of ganciclovir. Surgical complications were observed in eight eyes; the data for these eyes were not used for analysis. INTERPRETATION: Ganciclovir dosages of up to 200 microg/0.1 mL appear to be safe for serial intravitreal injection in rabbit eyes following vitrectomy and silicone oil insertion
— id: 95566, year: 2004, vol: 39, page: 499, stat: Journal Article,

Retinopathy in sickle cell trait: does it exist?
Nia, Jon; Lam, Wai-Ching; Kleinman, David M; Kirby, Malanie; Liu, Eugene S; Eng, Kenneth T
2003 Feb;38(1):46-51, Canadian journal of ophthalmology
BACKGROUND: Patients with sickle cell trait and concomitant systemic disease are known to be at risk for proliferative retinopathy. However, there are reports of retinopathy in patients with sickle cell trait without systemic disease. There are no population-based studies addressing the risk of sickle cell retinopathy in this group. We performed a study to clarify the relation between sickle cell trait and retinopathy in healthy subjects. METHODS: We reviewed the medical records of 100 children with sickle cell disease who attended the Sickle Cell Clinic at the Hospital for Sick Children, Toronto. We then contacted 200 parents with sickle cell trait, of whom 32 agreed to participate in the study. All participants were proven to have hemoglobin AS status with prior hemoglobin electrophoresis. An ophthalmologic history was obtained, and a complete ophthalmologic examination was performed. We defined sickle cell retinopathy as any salmon patch hemorrhages, iridescent spots, black sunbursts, retinal neovascularization or retinal detachment. The evaluation also included attempts to identify the more subtle signs of sickle cell retinopathy, such as optic nerve head vascular changes, vascular tortuosity, macular changes (e.g., microaneurysms and vascular loops) and peripheral arteriovenous anastamoses. Blood samples were obtained for complete blood count, reticulocyte count and smear. RESULTS: We found no cases of sickle cell retinopathy among the 32 subjects. Ten of 30 subjects had a high reticulocyte count (greater than 120 x 10(9)/L); however, there were no associated eye findings in this subgroup. INTERPRETATION: Our results indicate that there is no increased risk of retinopathy in healthy people with sickle cell trait
— id: 95567, year: 2003, vol: 38, page: 46, stat: Journal Article,

Decreasing length of stay after pancreatoduodenectomy
Brooks AD; Marcus SG; Gradek C; Newman E; Shamamian P; Gouge TH; Pachter HL; Eng K
2000 Jul;135(7):823-830, Archives of Surgery (Chicago)
HYPOTHESIS: Decreased length of stay (LOS) after pancreatoduodenectomy is due to multiple factors, including a lower complication rate and more efficient perioperative care for all patients, with and without complications. DESIGN: A retrospective review, validation cohort. SETTING: A single university hospital referral center. PATIENTS: A consecutive sample of patients undergoing pancreatoduodenectomy from January 9, 1986, to December 21, 1992 (group 1 [n = 104]) and from February 16, 1993, to November 9, 1998 (group 2 [n = 111]). INTERVENTION: Mann-Whitney test and linear [correction of logistic] regression analysis applied to clinical variables and LOS. MAIN OUTCOME MEASURES: Difference in median LOS between early and late groups and identification of factors predictive of decreased LOS. RESULTS: Total LOS decreased between the 2 groups (26 days [range, 13-117 days] vs 15 days [range, 5-61 days]; P<.001), with a decrease in preoperative (4 days [range, 0-28 days] vs 2 days [range, 0-36 days]; P<.001) and postoperative (19 days [range, 11-95 days] vs 12 days [range, 4-58 days]; P<.001) LOS (data given for group 1 vs group 2). Major complications decreased from 49% in group 1 to 25% in group 2 (P<.001). Postoperative LOS decreased for patients with (25 days [range, 15-95 days] vs 20 days [range, 8-58 days]; P = .05) and without (15 days [range, 11-47 days] vs 11 days [range, 4-55 days]; P<.001) major complications (data given for group 1 vs group 2). Multivariate analysis identified age (P = .01), pancreatic fistula (P<.001), delayed gastric emptying (P<.001), biliary complications (P<.001), operative time (P<.005), extra-abdominal infection (P<.005), use of a percutaneous stent (P = .04), and year of operation (P<.001) as independent predictors of total LOS. CONCLUSION: A reduction in complications in combination with factors leading to a streamlining of perioperative care has contributed to the decreased LOS after pancreatoduodenectomy
— id: 9076, year: 2000, vol: 135, page: 823, stat: Journal Article,

Expression of Von Willebrand factor, an endothelial cell marker, is up-regulated by angiogenesis factors: a potential method for objective assessment of tumor angiogenesis
Zanetta L; Marcus SG; Vasile J; Dobryansky M; Cohen H; Eng K; Shamamian P; Mignatti P
2000 Jan 15;85(2):281-288, International journal of cancer
von Willebrand factor (vWF), a glycoprotein produced uniquely by endothelial cells and megakaryocytes, is routinely used to identify vessels in tissue sections. Vessel density in tumor specimens, as determined by immuno-histochemical staining for vWF or other endothelial cell markers, is a negative prognostic factor for many solid tumors. vWF is heterogeneously distributed throughout the vasculature, transcriptional control in response to the tissue microenvironment being responsible for local variations in endothelial cell levels of vWF. Here, we report that fibroblast growth factor-2 and vascular endothelial growth factor, potent angiogenesis inducers expressed in a variety of tumors, up-regulate expression of vWF mRNA and protein in cultured endothelial cells with a synergistic effect. Our data support the measurement of vWF mRNA in tumors to detect activated endothelium or angiogenesis. For this purpose, we developed a semi-quantitative RT-PCR for vWF mRNA. Preliminary results obtained with specimens from colon carcinoma and the corresponding normal colonic mucosa showed higher vWF mRNA levels in most tumors than in their normal counterparts. The differences in vWF mRNA levels were much larger than the differences in vessel counts between a tumor and the corresponding normal mucosa, indicating that high vWF mRNA levels in tumors may indeed be an early sign of activation of the endothelium. The rapidity, objectivity, sensitivity and specificity of this technique make it suitable for routine clinical application to identify aggressive, highly angiogenic tumors.
— id: 9014, year: 2000, vol: 85, page: 281, stat: Journal Article,

Predicting comorbidity in patients with pancreatic fistulae following pancreaticoduodenectomy
Karpoff, HM; Sivamurthy, N; Oh, C; Gouge, TH; Pachter, HL; Eng, K; Shamamian, P; Marcus, SG
1998 APR 15 ;114(4):A1398-A1398, Gastroenterology
— id: 53477, year: 1998, vol: 114, page: A1398, stat: Journal Article,

Endoscopic biliary drainage before pancreaticoduodenectomy for periampullary malignancies
Marcus SG; Dobryansky M; Shamamian P; Cohen H; Gouge TH; Pachter HL; Eng K
1998 Mar;26(2):125-129, Journal of clinical gastroenterology
Despite decreased operative mortality, pancreaticoduodenectomy (PD) remains a formidable operation with substantial morbidity. We have evaluated the influence of preoperative endoscopic biliary drainage (EBD) on morbidity after PD for malignant biliary obstruction by retrospectively reviewing the medical records of 182 patients undergoing PD between April 1985 and August 1996. Of 52 study patients with malignant obstructive jaundice, 22 underwent preoperative EBD, and 30 were not drained. Eighty-three patients were excluded for bilirubin levels less than 5 mg/dl, 43 had other biliary drainage, and 4 had jaundice with benign pathology. Preoperative, intraoperative, and postoperative factors were compared. The two groups were well matched for clinical presentation and operative characteristics except for lower preoperative values of liver chemistries in patients undergoing EBD. Length of postoperative hospitalization for patients undergoing EBD was 13.5 days, compared with 19 days for patients who were not drained (p = 0.02). Patients who were not drained tended to have more overall complications (p = 0.054). Multivariate analysis revealed time to regular diet (p < 0.0001) and no preoperative drainage (p = 0.04) to be independent factors significantly increasing the length of hospitalization. Endoscopic biliary drainage before PD significantly reduced the length of postoperative hospitalization and was associated with less postoperative morbidity. Further studies, including cost analysis, are warranted
— id: 7673, year: 1998, vol: 26, page: 125, stat: Journal Article,

Matrix metalloproteinase (MMP) 2 and 9 activity in experimental acute pancreatitis
Patel, S; Schwartz, J; Chaung, N; Marcus, SG; Pachter, HL; Deutsch, E; Galloway, AC; Eng, K; Mignatti, P; Shamamian, P
1998 APR 15 ;114(4):A1416-A1416, Gastroenterology
— id: 53478, year: 1998, vol: 114, page: A1416, stat: Journal Article,

Soluble factor(s) released from neutrophils activates endothelial cell matrix metalloproteinase-2
Schwartz JD; Monea S; Marcus SG; Patel S; Eng K; Galloway AC; Mignatti P; Shamamian P
1998 Apr;76(1):79-85, Journal of surgical research
OBJECTIVE: Polymorphonuclear leukocyte (PMN) infiltration and microvascular injury are hallmarks of the tissue remodeling associated with multiple organ failure. These processes require the concerted action of various proteolytic enzymes, including serine and matrix metalloproteinases (MMPs). Matrix metalloproteinase-2 (MMP-2) plays an important role in the turnover of various ECM components, including type IV collagen, fibronectin, and gelatins. Like all MMPs, MMP-2 is secreted as an inactive zymogen (proMMP-2) and activated extracellularly by limited proteolytic cleavage. The physiologic mechanism(s) of proMMP-2 activation remains unclear. This study was designed to characterize the effect of PMNs on the activation of proMMP-2 produced by endothelial cells. METHODS: PMNs and human umbilical vein endothelial cells (HUVECs) were grown either separately or together for 2-16 h. To evaluate the role of cell-cell contact, cocultures were also established in which the two cell types were separated by a semipermeable polycarbonate membrane. Alternatively, PMN-conditioned medium was added to HUVEC cultures with or without various proteinase inhibitors (aprotinin, 1,10-phenanthroline, Batimastat, E-64, eglin c peptide, or pepstatin A). After incubation, the culture supernatants were analyzed by gelatin zymography to characterize the gelatinases. RESULTS: HUVECs produce MMP-2 in its inactive (72 kDa) form. PMNs produce high levels of MMP-9 (gelatinase B, 92 kDa) but no MMP-2. Coculture of PMNs with or addition of PMN-conditioned medium to HUVECs results in the production of active (62 kDa) MMP-2. ProMMP-2 activation by PMN-conditioned medium is not blocked by inhibitors of plasmin, cysteine-, acid-, or metalloproteinases. CONCLUSION: PMNs release a soluble factor that activates endothelial cell MMP-2 through a novel mechanism independent of cell-cell contact and not attributable to the activities of plasmin, cysteine-, acid-, or metalloproteinases. These findings may provide insight into the tissue remodeling that accompanies PMN-mediated microvascular injury
— id: 9018, year: 1998, vol: 76, page: 79, stat: Journal Article,

Carboxypeptidase A activity in pancreatic cancer and acute pancreatitis
Shamamian, P; Marcus, S; Deutsch, E; Maldonado, T; Liu, A; Stewart, J; Eng, K; Gilvarg, C
1998 APR 15 ;114(4):A1425-A1425, Gastroenterology
— id: 53479, year: 1998, vol: 114, page: A1425, stat: Journal Article,

Lexipafant inhibits platelet activating factor enhanced neutrophil functions
Schwartz JD; Shamamian P; Grossi EA; Schwartz DS; Marcus SG; Steiner F; Jacobs CE; Tayyarah M; Eng K; Colvin SB; Galloway AC
1997 May;69(2):240-248, Journal of surgical research
Platelet activating factor (PAF) enhances polymorphonuclear leukocyte (PMN) superoxide (.O2-) production, CD11b expression, and elastase release, all essential components in the pathophysiology of multiple-organ failure. This study was designed to determine the effects of Lexipafant, a PAF receptor antagonist, on PAF-mediated PMN functions. PMNs from 10 healthy volunteers were isolated and pretreated with various concentrations of Lexipafant (0-100 microM). PMNs were then incubated for 5 min with 200 nM PAF for .O2- detection or 2000 nM PAF for elastase measurement and activated with 1 microM N-formylmethionylleucylphenylalanine. The mean rate of .O2- production was determined by a cytochrome c reduction assay (nmole .O2-/min/1.33 x 10(5) PMN +/- SEM). Elastase release was measured by the cleavage of the synthetic elastase substrate Meo-Suc-Ala-Ala-Pro-Val-pNA (mean elastolytic activity +/- SEM). In parallel experiments, PMNs were incubated with 200 nM PAF for 30 min following pre-treatment with Lexipafant and CD11b expression was determined by flow cytometry (mean fluorescence intensity +/- SEM). Statistical analysis was performed using repeated-measures ANOVA (P < 0.05). Lexipafant inhibited PAF-enhanced PMN .O2- generation, CD11b expression and elastase release in a dose dependent fashion. The IC50 of Lexipafant for .O2- production, CD11b expression, and elastase release was 0.046, 0.285, and 0.05 microM, respectively. Lexipafant attenuated the PAF-mediated upregulation of PMN .O2- production, CD11b expression, and elastase release in a dose dependent fashion. These data support the hypothesis that Lexipafant may reduce the severity of the inflammatory response to injury produced by PAF-enhanced activation of PMNs
— id: 9020, year: 1997, vol: 69, page: 240, stat: Journal Article,

Abdominosacral resection for midrectal cancer
Eng K; Localio SA
1992 Jun;39(3):207-211, Hepatogastroenterology
Abdominosacral resection is the most reliable radical sphincter-saving operation for midrectal cancers which are too low for anterior resection. The posterior incision provides maximum exposure for wide resection of the tumor, a measured distal margin, and an accurate anastomosis. The procedure can be carried out consistently to the pelvic floor without disrupting the anal sphincters and their innervation. Sphincter function is consistently preserved. Mortality rate is no higher than for other radical rectal resections. Morbidity can be limited by the selective use of protective colostomy. The use of mechanical retractors and the end-to-end stapler facilitates the operation and should encourage its wider application. The transsacral approach allows mobilization of the rectum to the levators in every case, and resection is limited only by the distance of the tumor from the sphincter, and not by poor exposure due to obesity or a narrow pelvis. In the treatment of 926 consecutive patients with rectal cancer, sphincter-saving resection was possible in 79%. In our experience, abdominosacral resection extends the range of sphincter-saving resection beyond that which is possible by the abdominal approach alone, with no compromise in safety and no increased risk of local recurrence or death from cancer
— id: 13582, year: 1992, vol: 39, page: 207, stat: Journal Article,

Adrenal medullary transplants as a treatment for Parkinson's disease
Lieberman, A; Ransohoff, J; Berczeller, P; Brous, P; Eng, K; Goldstein, M; Kaufman, B; Koslow, M; Lieberman, I
1990 ;53:567-570, Advances in neurology
— id: 67625, year: 1990, vol: 53, page: 567, stat: Journal Article,

Adrenal medullary transplants as a treatment for advanced Parkinson's disease
Lieberman, A; Ransohoff, J; Berczeller, P; Brous, P; Eng, K; Goldstein, M; Kaufman, B; Koslow, M; Chin, L
1989 ;126:189-196, Acta neurologica Scandinavica. Supplementum
Open autologous adrenal medullary to caudate nucleus transplantation was performed in 12 patients with advanced Parkinson's disease (PD). Ten of these patients had diurnal response fluctuations including 'wearing off' and 'on/off' phenomena. All of the patients were no longer satisfactorily responding to levodopa/carbidopa and dopamine agonists. The mean age of the patients was 55.1 years (range 37-65 yrs); mean duration of PD was 11.7 years (range 4-40 yrs); mean stage 'on' was 3.3 (range 2-4); mean stage 'off' was 4.8 (range 4-5). Mean duration of follow up from surgery was 10.4 months (range 2-17 months). Three patients improved dramatically with major changes in their lifestyle. The course of improvement in these 3 patients was different in each, implying that different mechanisms were responsible for the improvement. One of the patients died unexpectedly. In this patient, there were no surviving adrenal cells. Three patients improved moderately. Patients reported that they were 'on' longer and had to take medication less often and were less dependent on individual doses of levodopa/carbidopa. The improvement has been sustained in two patients. However, in one of these patients there had to be frequent changes in scheduling to maintain the improvement. Two patients after technically successful implants did not improve. One of these patients subsequently died. In this patient there were a few surviving adrenal medullary cells. Four patients suffered major complications. One patient had a cerebral infarction and two had cerebral hemorrhages. One of these patients has shown a good recovery. One patient with autonomic insufficiency had a cardiac arrest with cerebral anoxia one week after surgery. This patient has shown a partial recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 67629, year: 1989, vol: 126, page: 189, stat: Journal Article,

Factors involved in antibiotic selection in elective colon and rectal surgery
Coppa GF; Eng K
1988 Nov;104(5):853-858, Surgery
During a 24-month period, 350 patients were prospectively studied in an effort to determine the perioperative factors in the development of infections after colon and rectal resections. All patients received standard mechanical bowel preparation; perioperative parenteral cefoxitin (group A) or preoperative oral neomycin and erythromycin, in addition to perioperative cefoxitin (Group B), were also given. Both groups were comparable with respect to age, sex, associated diseases, and primary diagnosis. Wound infections developed in nine of 169 (5%) group B patients and in 15 of 141 (11%) group A patients. Stratification by type of operative procedure revealed that the rectal resections involved the highest rate of infection in group A (22%) and in group B (11%). In patients requiring intraperitoneal colon resection, the rates of wound sepsis were similar (3% in both groups). Analysis of length of operation revealed that in operations lasting 215 minutes or more the infection rate was 12%; in those lasting less than 215 minutes the rate was 4%. Patients with rectal resection and operative times of 215 minutes or more had a wound infection rate of 19% compared to 2% (p less than 0.05) in those with shorter nonrectal operations. Group B patients with the longer rectal operations had lower infection rates (11%) than group A patients (27%), while there was no difference among those who had shorter operations. Intra-abdominal abscesses (p less than 0.01) and anastomotic dehiscence (p less than 0.05) were also significantly reduced in group B patients. Postoperative wound infection is associated with length of operation and location of colon resection and can be significantly lowered by a combination of oral and parenteral antibiotics
— id: 10916, year: 1988, vol: 104, page: 853, stat: Journal Article,

Anorectal, presacral, and sacral tumors : anatomy, physiology, pathogenesis, and management
Localio, S. Arthur; Eng, Kenneth; Coppa, Gene Francis
Philadelphia : Saunders, 1987,
— id: 419, year: 1987, vol: , page: , stat: ,

Symptomatic endosalpingosis in a postmenopausal woman
Onybeke W; Brescia R; Eng K; Quagliarello J
1987 Apr;156(4):924-926, American journal of obstetrics & gynecology
The presence of ectopic fallopian tube epithelium (endosalpingosis) in postmenopausal women is rare and usually asymptomatic. A case is presented of symptomatic endosalpingosis in a postmenopausal woman who had none of the previously described predisposing factors
— id: 63237, year: 1987, vol: 156, page: 924, stat: Journal Article,

Abdominosacral resection of the rectum
Eng, K; Localio, S A
1986 ;75(2):100-105, Annales chirurgiae & gynaecologiae
Abdominosacral resection is the most reliable radical sphincter saving operation for midrectal cancers which are too low for anterior resection. The posterior incision provides maximum exposure for wide resection of the tumor, a measured distal margin, and an accurate anastomosis. The procedure can be carried out consistently to the pelvic floor without disrupting the anal sphincters and their innervation. Sphincter function is consistently preserved. The risk of abdominosacral resection is comparable to that incurred for anterior resection or abdominoperineal resection. Mortality rate is 2%. Morbidity can be limited by the selective use of a protective colostomy. The use of abdominosacral resection has extended sphincter saving resection to include 77% of 646 consecutive patients with rectal cancer. Abdominosacral resection provides the maximum clearance around the tumor and long term follow up has revealed no greater risk of local recurrence or death from cancer
— id: 114639, year: 1986, vol: 75, page: 100, stat: Journal Article,

Hepatic resection for metastatic colon and rectal cancer. An evaluation of preoperative and postoperative factors
Coppa, G F; Eng, K; Ranson, J H; Gouge, T H; Localio, S A
1985 Aug;202(2):203-208, Annals of surgery
Hepatic resection for metastatic colorectal cancer has been reported in over 700 patients. However, approximately 5000 patients each year are candidates for surgical excision. Since 1972, 25 patients have undergone hepatic resection for colorectal metastases at New York University. Potentially curable synchronous lesions were detected by preoperative liver chemistries and operative palpation. Patients were screened for metachronous lesions by serial liver chemistries and carcinoembryonic antigen (CEA) determinations; when clinical findings or laboratory findings were either positive or equivocal, then scanning techniques were used. Most patients had solitary lesions (20). Thirteen of 25 lesions were synchronous; 12 were metachronous. Anatomic lobectomy was performed in 13 patients (6 extended resections); and wedge resection was performed in 12. The operative mortality rate was four per cent; the 2-year survival rate, 65%; the 5-year survival rate, 25%. Hypertonic dextrose solutions were administered during and after operation. Post-operative albumin requirements ranged from 200 to 300 grams/day. Coagulation factors II, V, VII, and fibrinogen decreased after surgery to 30 to 50% of their preoperative levels. Subsequent elevation of these factors correlated with increased bile production and improvement in liver chemistries 10 to 14 days after operation. At present, hepatic resection for colorectal metastases provides the only potential method of salvage, offering a 20 to 25% long-term survival rate
— id: 92872, year: 1985, vol: 202, page: 203, stat: Journal Article,

Surgical management of diffuse cavernous hemangioma of the colon, rectum and anus
Coppa, G F; Eng, K; Localio, S A
1984 Jul;159(1):17-22, Surgery, gynecology & obstetrics
Operative approaches which attempt to spare the rectal sphincter mechanism in patients with diffuse cavernous hemangioma of the sigmoid colon, rectum and anal canal have associated high morbidity and have failed to provide continence in at least 2 per cent of the patients. Sphincter-saving operations should be reserved for the rarer lesions which spares the lower part of the rectum and anal canal. Abdominoperineal resection by the combined synchronous approach with temporary vascular control of the hypogastric vessels provides a safe effective method of managing patients with diffuse cavernous hemangioma of the sigmoid colon, rectum and anus
— id: 114640, year: 1984, vol: 159, page: 17, stat: Journal Article,

Parenteral and oral antibiotics in elective colon and rectal surgery. A prospective, randomized trial
Coppa, G F; Eng, K; Gouge, T H; Ranson, J H; Localio, S A
1983 Jan;145(1):62-65, American journal of surgery
Our evaluation consisted of a prospective, randomized clinical trial in a homogenous group of 241 patients undergoing elective colon and rectal resections. A significant decrease in wound infection was found in the patients who received intravenous cefoxitin in conjunction with standard bowel preparation. The infection rate correlated with the type of resection; rectal resections had the highest rate in each study group, but parenteral prophylaxis produced a significantly lower wound infection rate. E. coli and Staph. aureus were the most common bacterial isolates in both groups. B. fragilis was recovered in only two Group A patients, which most likely reflects the exceedingly low recovery rate of anaerobic bacteria in our laboratory. Urinary cultures were positive in a large number of patients and reflect the standard use of Foley catheterization in all patients who undergo resection of the colon or rectum. These data indicate that perioperative prophylactic administration of cefoxitin reduces the wound sepsis rate when combined with oral antibiotics and mechanical bowel preparation in patients undergoing resection of the colon or rectum
— id: 92880, year: 1983, vol: 145, page: 62, stat: Journal Article,

Management of diverticulitis of the ascending colon. 10 years' experience
Gouge, T H; Coppa, G F; Eng, K; Ranson, J H; Localio, S A
1983 Mar;145(3):387-391, American journal of surgery
Diverticulitis of the ascending colon is an uncommon disease which mimics appendicitis. The correct diagnosis is rarely made, but can be suggested by the patterns of signs and symptoms and confirmed by barium contrast study. Diverticulitis of the ascending colon should be treated by the same plan as diverticulitis of the left colon. If the diagnosis is established, nonoperative management is indicated initially. Operation is indicated when the diagnosis is in doubt, when perforation has occurred, or when the patient does not respond to nonoperative treatment. At operation, ascending colon diverticulitis can be recognized as an inflammatory mass involving the wall and mesentery of the colon. The inflammatory mass is best treated by resection with primary anastomosis of the ileum to the ascending or transverse colon in an area removed from the site of infection
— id: 92879, year: 1983, vol: 145, page: 387, stat: Journal Article,

Abdominosacral resection for midrectal cancer. A fifteen-year experience
Localio, S A; Eng, K; Coppa, G F
1983 Sep;198(3):320-324, Annals of surgery
From 1966 to 1981, 646 patients underwent resection for primary adenocarcinoma of the rectum by one surgeon (S.A.L.) in one hospital. The operation, selected by preoperative sigmoidoscopic measurement, was anterior resection (ASR) in 320 patients, abdominosacral resection (ASR) in 175 patients, and abdominoperineal resection (APR) in 151 patients. The operative mortality rate was 2% following each of the operations. Anastomotic complications occurred in less than 2% after AR and in 9.7% after ASR. All patients were completely continent of stool and flatus after AR and ASR. Follow-up is complete in 419 of 427 patients treated from 1966 to 1976. Five-year survival for curative resection (no distant metastases) was 66.2% after AR (129/195), 62.9% after ASR (56/89), and 43.4% after APR (33/76). For patients with no tumor in lymph nodes, survival rates were 73.9% in AR, 75% for ASR, and 59.5% for APR. With involvement of regional lymph nodes, survival fell to 45.2% in AR, 37.9% for ASR, and 17.7% for APR. Pelvic recurrence was detected in 13.3% after AR, 14.6% after ASR, and 13.2% after APR. The authors believe that for midrectal cancer, ASR is the most reliable sphincter-saving procedure. It affords maximum exposure for wide resection of the tumor and safe anastomosis without disrupting the anal sphincters and their innervation. Sphincter preservation can be consistently preserved with no apparent increase in the risk of local recurrence or death from cancer
— id: 114641, year: 1983, vol: 198, page: 320, stat: Journal Article,

Behcet's syndrome: an unusual cause of colonic ulceration and perforation
Eng K; Ruoff M; Bystryn JC
1981 Jan;75(1):57-59, American journal of gastroenterology
Behcet's syndrome is a multisystem disease which may produce not only the original triad of relapsing iridocyclitis and recurrent oral and genital ulceration but also skin, central nervous system, joint and gastrointestinal disease. A fatal outcome is uncommon but may occur when the central nervous system or the gastrointestinal tract is involved. We present a patient with colonic ulceration progressing rapidly to free perforation and generalized peritonitis successfully treated by emergency resection
— id: 16281, year: 1981, vol: 75, page: 57, stat: Journal Article,

SIMPLIFIED COMPLEMENTARY TRANSVERSE COLOSTOMY FOR LOW COLORECTAL ANASTOMOSIS
ENG, K; LOCALIO, A
1981 ;153(5):734-735, Surgery, gynecology & obstetrics
— id: 40305, year: 1981, vol: 153, page: 734, stat: Journal Article,

Giant Meckel's diverticulum. A cause of intestinal obstruction
Miller DL; Becker MH; Eng K
1981 Jul;140(1):93-94, Radiology
Giant Meckel's diverticula are more likely to cause obstruction than bleeding. In neonates, this is commonly due to volvulus; in adults, it is usually due to adhesions and a mass effect. A lateral view of the abdomen following barium studies can be helpful. This entity should be included in the differential diagnosis of intestinal obstruction, especially incomplete, intermittent, and chronic forms
— id: 66539, year: 1981, vol: 140, page: 93, stat: Journal Article,

Aortic graft infection; secondary to diverticular abscess
Krieger KH; Riles TS; Eng K; Edwards P
1980 Sep;80(10):1608-1610, New York state journal of medicine
— id: 25698, year: 1980, vol: 80, page: 1608, stat: Journal Article,

Abdominosacral approach for retrorectal tumors
Localio, S A; Eng, K; Ranson, J H
1980 May;191(5):555-560, Annals of surgery
The relative rarity and anatomical position of retrorectal tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and management of 20 such tumors (chordoma 8, neurilemmoma 3, teratoma 3, hemangiopericytoma 1, chondrosarcoma 1, osteosarcoma 1, dermoid 1, lipoma 1, and undifferentiated sarcoma 1) have therefore been reviewed. Low back or sacral pain was present in 18 patients and, although all tumors were palpable on rectal examination, pain had been present for a median of 12 months before diagnosis. Mean tumor size was 9.4 cm (range: 2.5-17 cm). Sacral bone destruction was demonstrated radiographically in all chordomas and three sarcomas, but in none of the benign tumors. Three patients had undergone previous partial removal of their tumors. Surgical resection was carried out using a combined abdominal and transsacral approach in 13, a transsacral approach in the right lateral position in four and transabdominally in three. There was one operative death following secondary operation for chbrdoma. Four of 12 patients with malignant tumors are alive and well at seven months to eight years. One died of a myocardial infarct without recurrence at 11 years. For small benign tumors, the right lateral position permits maximal flexibility for resection either by the transsacral, transabdominal or a combined approach. For bulky or malignant tumors, a combined abdominal transsacral approach in the right lateral position permits vascular control and provides good exposure for protection of vital structures and wide resection
— id: 92889, year: 1980, vol: 191, page: 555, stat: Journal Article,

RADIATION ENTERITIS AND RADIATION SCOLIOSIS - INTESTINAL- OBSTRUCTION FOLLOWING SPINAL-FUSION
Shah, M; Eng, K; Engler, GL
1980 ;80(10):1611-1613, New York state journal of medicine
— id: 27898, year: 1980, vol: 80, page: 1611, stat: Journal Article,

Sphincter-saving operations for cancer of the rectum
Localio SA; Eng K
1979 May 3;300(18):1028-1030, New England journal of medicine
— id: 63216, year: 1979, vol: 300, page: 1028, stat: Journal Article,

CANCER OF THE RECTUM
Localio, SA; Eng, K
1979 ;301(22):1237-1237, New England journal of medicine
— id: 30067, year: 1979, vol: 301, page: 1237, stat: Journal Article,

Abdominosacral resection for carcinoma of the midrectum: ten years experience
Localio, S A; Eng, K; Gouge, T H; Ranson, J H
1978 Oct;188(4):475-480, Annals of surgery
Abdominosacral resection allows curative resection of midrectal cancer with excellent preservation of sphincter function. In the last ten years 427 patients underwent resection for rectal carcinoma at University Hospital by one surgeon. (SAL) The operation, selected by preoperative sigmoidoscopic measurement, was anterior resection (AR) in 239, abdominosacral resection (ASR) in 100, and abdominoperineal resection (APR) in 88. Operative mortality was 1.7% for AR, 2% for ASR and 2.3% for APR. All patients were completely continent of stool and flatus after AR and ASR. Follow-up is complete in 194 of 195 patients treated five to ten years ago. Five year survival for curative resection (no distant metastases) was 67.3% after AR (66/98), 58.3% after ASR (21/36), and 50% after APR (15/30). For patients without tumor in lymph nodes, survival rates were 78.3% for AR, 64.3% for ASR and 63.2% for APR. With involvement of regional nodes, survival fell to 41.4% for AR, 37.5% for ASR and 27.3% for APR. For lesions at 5-8.5 cm, five year survival was 61.1% for ASR and 58.3% for APR. No statistical difference in survival time was noted when patients were matched for age, sex, level of lesion and extent of spread. Pelvic recurrences were detected in 16.7% after ASR, 15.3% after AR and 33.3% after APR. All of the pelvic recurrences after ASR and the majority of those after AR and APR occurred in patients with tumor invasion of perirectal fat. These data strongly support the applicability of ASR as an important advance in the treatment of midrectal cancer. Although technically demanding, ASR has permitted preservation of anal continence without sacrifice of long-term cure in approximately 50% of patients who would otherwise have required APR
— id: 92893, year: 1978, vol: 188, page: 475, stat: Journal Article,

Resection of the perforated segment. A significant advance in treatment of diverticulitis with free perforation or abscess
Eng, K; Ranson, J H; Localio, S A
1977 Jan;133(1):67-72, American journal of surgery
As a result of improved medical management of chronic diverticular disease, perforation has become the most common indication for surgical intervention. During the past five years sixty-three patients underwent operation for colonic diverticular disease, of which forty-six were for perforation (generalized peritonitis in 8, abscess in 30, and fistula in 8). The eight patients with generalized peritonitis underwent emergency exploration for spreading peritoneal signs and were managed by resection of the perforated segment, end colostomy, and mucous fistula or Hartmann's pouch. Treatment of thirty-eight patients with abscess or fistula has also stressed primary resection of the perforated segment of colon. Resection and end colostomy without anastomosis was performed in three. Primary anastomosis with proximal diverting colostomy was performed in four. Primary anastomosis alone was done in thirty-one patients. There were no deaths. These results support primary resection of the involved colon with immediate or delayed anastomosis in the operative management of perforated diverticular disease
— id: 92897, year: 1977, vol: 133, page: 67, stat: Journal Article,

Pulmonary capillary permeability - a transfusion lesion
Berman, I R; Iliescu, H; Ranson, J H; Eng, K
1976 Jun;16(6):471-480, Journal of trauma
Massive transfusion of bank blood has been implicated as a major etiologic factor in the evolution of pulmonary insufficiency after injury. In spite of the demonstration of significant debris, including aggregates, in stored blood, a precise and reproducible pulmonary effect of transfusion has not previously been demonstrated. Since clinical pulmonary insufficiency is frequently accompanied by increased lung water, these experiments were designed to measure pulmonary capillary permeability and its response to transfusion of blood and blood components in rats. These experiments demonstrate that: 1) the rat lung is a target organ with regard to blood transfusion; 2) the lung lesion with transfusion is attributable, at least in part, to a selective and acute increase in pulmonary capillary permeability; 3) pulmonary capillary permeability is highly responsive to viable platelets; 4) prolonged storage of blood in polyvinyl chloride containers may enhance its ability to induce pulmonary capillary permeability; 5) increased capillary permeability with transfusion is largely eliminated when platelets and buffy coat are eliminated
— id: 92898, year: 1976, vol: 16, page: 471, stat: Journal Article,

Malignant tumors of the rectum
Localio, S A; Eng, K
1975 Sep;:1-48, Current problems in surgery
— id: 114646, year: 1975, vol: , page: 1, stat: Journal Article,

Objective early identification of severe acute pancreatitis
Ranson JH; Rifkind KM; Roses DF; Fink SD; Eng K; Localio SA
1974 Jun;61(6):443-451, American journal of gastroenterology
— id: 19517, year: 1974, vol: 61, page: 443, stat: Journal Article,

Prognostic signs and the role of operative management in acute pancreatitis
Ranson JH; Rifkind KM; Roses DF; Fink SD; Eng K; Spencer FC
1974 Jul;139(1):69-81, Surgery, gynecology & obstetrics
— id: 19516, year: 1974, vol: 139, page: 69, stat: Journal Article,

Auxiliary transplantation of liver, duodenum, and pancreas
Ranson, J H; Eng, K; Becker, F F; Rapaport, F T; Localio, S A
1974 ;25(0):389-391, Surgical forum
— id: 92901, year: 1974, vol: 25, page: 389, stat: Journal Article,

RADIOLOGY CORNER - MESENTERIC CYST
Rifkind, K; Eng, K; Ruoff, M
1974 ;62(6):540-544, American journal of gastroenterology
— id: 28615, year: 1974, vol: 62, page: 540, stat: Journal Article,

Clostridial myonecrosis of the abdominal wall. Resection and prosthetic replacement
Eng K; Casson P; Berman IR; Slattery LR
1973 Mar;125(3):367-371, American journal of surgery
— id: 25241, year: 1973, vol: 125, page: 367, stat: Journal Article,

Right iliac artery-duodenal fistula in infancy: massive hemorrhage due to "whisk-broom" bristle perforation
Grosfeld, J L; Eng, K
1972 Dec;176(6):761-764, Annals of surgery
— id: 134381, year: 1972, vol: 176, page: 761, stat: Journal Article,