PubMed Health⌕ Search

Biomedical subjects

C A Hiebert

Publications and source records attributed to C A Hiebert.

At least 19 recordsLinked to original sources
PubMed1999

Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon.

BACKGROUND: Injury to the recurrent laryngeal nerve (RLN) is an unwelcome and not infrequent complication of operations on or near the upper thoracic or cervical esophagus. Because anatomic information useful to the surgeon is difficult to come by, the aim of this study was to reinvestigate and display the RLNs and superior laryngeal nerves in humans. METHODS: Postmortem en bloc specimens were studied: 23 by macroscopic dissection and 11 by large field serial histology. The nerves and their branches and supply areas were photographed at each step of dissection from the lateral (the surgeon's approach) and from the posterior aspect. RESULTS: The RLNs were 2- to 3-mm thick compact slack cords, sinuously passing upward within the lateral peritracheal, and less frequent periesophageal, loose connective tissue, the left RLN being closer to the tracheoesophageal groove than the right. Both RLNs gave off 8 to 14 branches, equally distributed to the esophagus and trachea. These were 2.5- to 1-cm long when stretched. The primarily identical pattern became unpredictable underneath the thyroid gland, an area that covered approximately 3 cm of the proximal esophagus. The RLN, still fairly robust (>1 mm) dipped, being firmly attached, into the larynx laterocaudad to the cricopharyngeus muscle. As the RLN and superior laryngeal nerves supply the same laryngeal muscles and mucosa, this twofold innervation may compensate for some sequelae of RLN injury. CONCLUSIONS: Displaying the RLNs, an important step in a variety of neck operations, dissection of the RLNs branches close to the esophagus and intestinocervical anastomosis as low as possible, will certainly reduce RLN injury.

Adult↗
PubMed1997

Sleeve recording of upper esophageal sphincter resting pressures during cricopharyngeal myotomy.

OBJECTIVE: The manometric effects of a 6-cm cricopharyngeal myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. SUMMARY BACKGROUND DATA: Cricopharyngeal myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. METHODS: Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole myotomy. RESULTS: Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). CONCLUSIONS: Extension of the cricopharyngeal myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.

Aged↗
PubMed1987

Survival following nonpenetrating traumatic rupture of cardiac chambers.

We report the cases of 3 patients who survived cardiac chamber rupture resulting from blunt external trauma. All were drivers in motor vehicle collisions. All were seen with signs of pericardial tamponade and were treated by pericardiocentesis followed by emergency thoracotomy performed in the operating room. Ruptures of the right atrium and right and left ventricles were repaired by manual suture techniques without cardiopulmonary bypass. The cases of 37 previously reported patients who survived this injury are reviewed. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.

Accidents, Traffic↗
PubMed1979

The Belsey operation for hiatal hernia: a twenty year experience.

A twenty year experience with the Belsey operation for hiatal hernia repair demonstrated good to excellent results in 80 per cent of patients, a fair outcome in 15 per cent, and unacceptable results in 5 per cent of patients. Good results included the absence of reflux symptoms, pleasant swallowing, the preservation of a normal capacity for belching and vomiting, minimal flatulence, and a comfortable incision. Although most recurrent symptoms appear within five years after operation, symptoms first recur ten or more years after operation in 10 per cent of patients.

Adolescent↗
PubMed1977

Gastroesophageal reflux and ascorbic acid insufficiency.

The incidental discovery of scurvy in a patient with a symptomatic hiatal hernia has led to the identification of 9 other individuals with chemically proved vitamin C deficiency secondary to an expressed aversion to "acid" food in any form. These patients were screened with capillary fragility tests and serum ascorbic acid determinations from approximately 200 hiatal hernia and reflux patients. With resumption of a normal vitamin C intake, scattered deficiency symptoms disappeared and both capillary fragility tests and serum ascorbic acid levels returned toward normal. There were no wound healing problems.

Ascorbic Acid Deficiency↗
PubMed1976

Aortoduodenal fistula. Primary repair with saphenous vein patch graft.

A successful primary repair of a fistula between the proximal aortic suture line and duodenum was performed in a 47-year-old man with the use of a saphenous vein patch graft with omental interposition between the aortic repair and the duodenum. Massive local and parenteral antibiotics were given. The patient remains completely well 3 1/2 years later.

Aortic Aneurysm↗
PubMed1976

Effect of methylprednisolone on myocardial preservation during coronary artery surgery.

It has been proposed that a single preoperative dose of a corticosteroid may protect the myocardium from ischemic injury during open heart surgery. To test this hypothesis, a prospective, randomized, double blind study was carried out in ninety-five patients undergoing coronary bypass surgery using intermittent ischemic arrest with systemic and local hypothermia. Half the patients received 2 gm (approximately 30 mg/kg) of methylprednisolone 2 hours prior to the initiation of cardiopulmonary bypass and the other half received a placebo. Postoperative electrocardiograms and blood levels of serum creatine phosphokinase (CPK), lactic dehydrogenase (LDH), and serum glutamic oxalacetic transaminase (SGOT) were compared in the two groups. No apparent difference was noted in the number of patients with significantly elevated levels of CPK, LDH, or SGOT or in the number with positive isoenzyme patterns of CPK and LDH. Moreover, there was no significant difference in the mean values of CPK, LDH, or SGOT between the two groups. The number of patients with electrocardiographic evidence of myocardial injury (10 per cent) was the same in both groups and no difference was noted in (1) the ease with which patients could be weaned from cardiopulmonary bypass, (2) postoperative arrhythmias, (3) postoperative bleeding, (4) postoperative respiratory insufficiency, and (5) length of hospital stay. It is concluded that a single preoperative dose of 2 gm of methylprednisolone offers no demonstrable protection to the myocardium from the effects of ischemia during coronary artery bypass surgery.

Adult↗
PubMed1976

Surgery for cricopharyngeal dysfunction under local anesthesia.

Six new instances of primary cricopharyngeal achalasia are reported. Since 1961, treatment of these as well as eight other cases of sphincter dysfunction with secondary pharyngoesophageal diverticulum has consisted of posterior division of the muscle and inversion rather than excision of the diverticulum. The validity of this approach is supported by restoration to normal or near normal swallowing based on clinical and cineradiographic evidence. The advantages of performing this surgery under local anesthesia include the opportunity to observe directly the pathophysiology of the swallowing disorder, precise division of the cricopharyngeus muscle, and the ability of this older group of patients to eat, drink, and function normally immediately after operation.

Aged↗
PubMed1975

Thoracicoabdominal trauma: a plan for initial management.

Trauma to multiple organs damages the body but it also disrupts the orderly process of history taking, physical examination, laboratory work, calm deliberation and treatment. The need for a rehearsed resuscitation protocol is important, as is a systematic scheme that emphasizes the skilful use of eight specific cannulas and the treatment of priority problems first.

Abdominal Injuries↗