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C Deveney

Publications and source records attributed to C Deveney.

8 recordsLinked to original sources
PubMed2001

Zenker's diverticulostomy with cricopharyngeal myotomy: the endoscopic approach.

BACKGROUND: The gold standard for the surgical treatment of Zenker's diverticulum is diverticulectomy and cricopharyngeal myotomy by an external approach. Unfortunately, many of the patients who present with this entity are elderly and have significant comorbidities that increase operative risk. Traditional minimally invasive approaches have not met with widespread success. However, by combining the exposure afforded by the otolaryngologist's newer bivalved operating laryngoscopes with the operative techniques made possible by the general surgeon's laparoscopic instrumentation and staplers, it is possible to achieve reliable and safe endoscopic outpatient management of this disease entity, with resumption of a normal diet on the same day. METHODS: We reviewed the physiologic basis, instrumentation, and technical considerations for this endoscopic procedure. We also documented our operative experience with 21 patients treated over an 18-month period. RESULTS: Successful minimally invasive management of Zenker's diverticulum was possible in 18 of 21 patients. In two patients, anatomic limitations of mouth and neck anatomy precluded exposure of the diverticulum; in another patient, the diverticulum was too small. Small operative perforations of the apex of the diverticulum occurred in three cases. Two of these perforations were repaired primarily with minimally invasive techniques; in the other case, treatment consisted of observation alone. In all but this last patient, oral diet was resumed on the day of the operation. Eleven of the patients were discharged from the hospital on the same day; the remaining patients went home the following morning. CONCLUSIONS: With proper patient selection, minimally invasive management of Zenker's diverticulum is a safe and effective surgical technique that allows for outpatient management of the majority of patients who present with this disease.

Cricoid Cartilage↗
PubMed1999

Topical treatments of laparoscopic port sites can decrease the incidence of incision metastasis.

BACKGROUND: Anecdotal reports of port site tumor recurrence have dampened the enthusiasm for laparoscopic colectomy for cancer. We developed a rat model that creates a high incidence of port site metastasis following laparoscopic intervention. Our goal was to assess the feasibility of minimizing implantations using port site irrigation prior to wound closure. METHODS: Colon cancer carcinomatosis was established in 46 female BD9 rats using intraperitoneal injections of 10(6) DHD-K12-TRb rat colon cancer cells. This preparation yielded an 81% incidence of port site metastasis in a control group. Laparoscopic sham surgery was performed using four ports and a CO(2) pneumoperitoneum. Four treatment groups were studied by irrigating each port site as follows: Group I, sterile water; group II, normal saline; group III, heparin; group IV, 5-fluorouracil (5-FU). The animals were killed at 4 weeks, and the port sites were examined for tumors. RESULTS: There were no differences in port site metastasis between controls and groups I, II, and III. The 5-FU group showed a significant decrease (30% vs 81%) in metastasis. CONCLUSIONS: Port site irrigation with 5-FU at the time of laparoscopy reduces the incidence of port site tumor implantation in a rat colon cancer model. This finding may have utility in patients at high risk of such metastasis who undergo laparoscopy for colon cancer.

Administration, Topical↗
PubMed1998

Biopsy-negative malignant esophageal stricture: diagnosis by endoscopic ultrasound.

Endoscopic ultrasound (EUS) of the esophagus has been used primarily in staging biopsy-proven cancers. Its use as a primary diagnostic modality for esophageal malignancy has not been previously described. We report our recent experience in four patients with dysphagia and endoscopic biopsies negative for malignancy, including one patient with clinical and manometric features suggestive of achalasia. In all cases, EUS revealed a large infiltrating tumor invading through the esophageal wall into the surrounding tissues, and in one case into the aorta. Computed tomography suggested the possibility of a tumor in only one of the cases. Two patients underwent esophagectomy and were found to have adenocarcinoma. Two patients underwent repeat biopsy with alternative aggressive biopsy techniques and were found to have squamous cell carcinoma. We conclude that EUS is useful in the diagnosis of esophageal cancer and should be performed in selected patients with esophageal strictures whose biopsies are negative for malignancy; i.e., those with suspicious endoscopic or radiographic appearance, atypical presentation (e.g., profound weight loss, short duration of symptoms, or advanced age), and failure to respond to treatment.

Adenocarcinoma↗
PubMed1990

Effects of verapamil and degradable starch microspheres during hepatic artery infusion of doxorubicin.

Chemotherapeutic tumoricidal activity may be enhanced by altering regional blood flow between host organ and tumor by transient embolization with degradable starch microspheres (DSMs) or by altering cellular drug transport with drugs such as verapamil. This study evaluated the effects of intraarterial verapamil and DSMs on hemodynamics and doxorubicin tissue levels. Rabbits (n = 34) with hepatic VX-2 carcinomas underwent hepatic artery infusion of doxurubicin (3 mg/kg) alone, with two doses of verapamil, and with verapamil plus DSMs. Blood pressure and heart rate were monitored, and heart, liver, and tumor tissue was obtained after 30 or 90 minutes. After verapamil (2 mg/kg) alone, mean heart rate decreased but infusion of verapamil plus DSMs resulted in only a 14% decrease in mean heart rate. Thirty minutes after drug infusions, mean hepatic tissue levels of doxorubicin were increased significantly by 2 mg/kg of verapamil compared with results with 1 mg/kg of verapamil and those in control groups (p less than 0.05). Mean tumor doxorubicin levels were not significantly different with verapamil alone. Verapamil plus DSMs or DSMs alone resulted in significantly lower mean hepatic and myocardial levels and increased mean tumor/liver ratios of doxorubicin after 90 minutes, compared with results in control or verapamil-alone groups. These results suggest that hepatic tumor drug levels are more affected by changes in regional blood flow with DSMs than by cellular drug transport changes caused by calcium channel blockers such as verapamil.

Animals↗
PubMed1985

Intraoperative sonography of perisplenic pseudocysts.

Three patients with pseudocysts of the pancreas affecting the spleen were examined with intraoperative sonography, which demarcated the fluid collections either within the pancreas (two cases), in the splenic hilum (one case), encapsulating the spleen (one case), or along the lateral aspect of the spleen (one case). This method was useful in defining the location of the cysts, distinguishing one from another, determining the relation of the cyst to adjacent organs, and assessing the adequacy of the surgical drainage.

Adult↗
PubMed1976

The effect of acute hyperglycemia on meal-stimulated gastric, biliary, and pancreatic secretion, and serum gastrin.

The effects of hyperglycemia on pancreatic, biliary, and gastric secretory responses to meals have not been hitherto quantified in man. In the present study seven normal volunteers were fed on two occasions a 500-ml liquid test meal containing fat and protein. During one of the meals the subjects were made acutely hyperglycemic with intravenous glucose, whereas in control experiments, each subject received intravenous saline in place of glucose. A jejunal perfusion method was used to measure pancreatic outputs of trypsin and biliary outputs of bile salts for 150 min after the meal; the same method was used to quantify indirectly the amount of acid secreted by the stomach in the 150-min period. Serum gastrins were also measured basally and at intervals after the meal. Hyperglycemia suppressed serum gastrin, gastric acid production, trypsin secretion, and bile salt output in response to the test meal.

Bile Acids and Salts↗
PubMed1974

Ulcer disease, metabolic alkalosis and hyperparathyroidism: A mechanism of interrelationship?

In both normal volunteers and in patients with primary hyperparathyroidism, the induction of a metabolic alkalosis by infusion of sodium bicarbonate results in a decrease in serum calcium ion and in an increase of circulating parathyroid hormone concentrations. Bicarbonate infusion may serve in man as a new provocative test for release of parathyroid hormone. Furthermore, we speculate that the metabolic alkalosis which is found at times in patients with the Zollinger-Ellison syndrome and severe peptic ulcer disease may result in parathyroid gland stimulation.

Adult↗