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Biomedical subjects

D J Schoetz

Publications and source records attributed to D J Schoetz.

At least 91 records · Page 5Linked to original sources
PubMed1985

Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia.

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.

Adolescent↗
PubMed1985

Surgical management of complicated diverticulitis. The Lahey Clinic experience, 1967 to 1982.

One hundred forty patients who had complicated diverticular disease were identified in a retrospective review at the Lahey Clinic between 1967 and 1982. Of these patients, 86 underwent resection with primary anastomosis with a 1 percent mortality rate and an 18 percent morbidity rate; 13 had resection with anastomosis and creation of a proximal colostomy with no death and a 22 percent morbidity rate; 19 had the Hartmann operation or colostomy with mucous fistula with a 16 percent mortality rate and a 23 percent morbidity rate; and 22 underwent a traditional three-stage operation with 14 percent mortality and 24 percent morbidity rates. The average duration of hospitalization was 21 days for patients who underwent the one-stage procedure, 31 and 39 days for those who had a two-stage operation, and 52 days for patients who underwent the three-stage procedure. Primary resection for complicated disease is associated with acceptable morbidity and mortality rates under appropriate circumstances.

Anti-Bacterial Agents↗
PubMed1985

Alternatives to conventional ileostomy in chronic ulcerative colitis.

As long as surgeons have performed total proctocolectomy with permanent ileostomy, efforts have been made to avoid the necessity for a permanent stoma. Preservation of sphincter function can now be achieved by more liberal application of the operation of abdominal colectomy and ileorectal anastomosis in carefully selected patients, and knowledge of the progression from dysplasia to cancer can be applied in a prospective fashion to those persons potentially at risk who have retained rectal mucosa. Individuals who are incapable of dealing with conventional permanent ileostomy and who lack the potential use of their own sphincters can be offered the alternative of a continent ileostomy. The advantages of both of these procedures can be combined by greater application of the operation of total abdominal colectomy, mucosal proctectomy, and ileoanal reservoir with ileoanal anastomosis. Although enthusiasm exists for all of these procedures, their results should be compared with the results of what must still be considered the "gold standard" operation, that is, proctocolectomy and conventional ileostomy. Nevertheless, the alternative procedures represent a considerable advance in the overall care of patients with chronic ulcerative colitis.

Abdomen↗
PubMed1985

Operative therapy for anal incontinence.

Operative therapy for fecal incontinence requires exact understanding of the anatomic and physiologic principles involved and of the potential pathophysiologic mechanisms. Many injuries of the external sphincter can be treated by direct sphincter repair. Extensive obstetric injuries with loss of the perineal body require not only reconstitution of the perineal musculature but also plastic surgical reconstruction of the perineal skin. Patients with descending perineum syndrome and resultant idiopathic fecal incontinence or rectal prolapse with associated incontinence should be treated with postanal plication of the puborectalis sling. Patients who have complex neurologic disorders or who have undergone previous unsuccessful attempts at repair of the puborectalis itself should be considered for placement of a Silastic sling. Diverting colostomy is rarely necessary; it should be performed only after thorough investigation and failure of all reasonable alternative operative procedures.

Anal Canal↗
PubMed1985

Skin grafts for circumferential coverage of perianal wounds.

A technique for circumferential skin grafting of the perianal skin after excision of Bowen's disease is described. The technique has proved satisfactory. The protocol for perioperative management of the bowel and the regimen of strict bed rest must be followed carefully.

Adult↗
PubMed1985

Radiology of the ileoanal reservoir.

The radiology of the ileoanal reservoir based on a study of 50 consecutive patients is presented. Small-bowel obstruction (12%) and leakage at the ileoanal anastomosis (8%) were detected most commonly. Partial outlet obstruction from reservoirs fashioned from three segments of terminal ileum was noted radiographically as a common problem unique to this form of ileoanal reservoir. Superior mesenteric artery syndrome (6%), pelvic abscess (4%), pouch-vesicular fistula (2%), and several other problems were less frequent.

Adolescent↗
PubMed1984

Surgical management of Crohn's disease involving the duodenum.

The experience with 25 patients who required operation for Crohn's disease involving the duodenum is reviewed. Two distinct patterns of duodenal involvement are apparent. Intrinsic duodenal Crohn's disease has a characteristic clinical presentation that is distinct from the symptoms seen in patients with involvement of other portions of the gastrointestinal tract. Among 70 patients with duodenal Crohn's disease seen over a 30 year period, 22 required surgical intervention at the Lahey Clinic. Although hemorrhage and intractable pain were associated problems in several of these patients, unrelenting duodenal obstruction remained the primary indication for operation. Of patients who underwent operative bypass, 78 percent had a good result with a median follow-up period of 12.3 years. The presence of associated gastric Crohn's disease did not influence long-term results. A third of the patients required reoperation for duodenal disease. Marginal ulceration and recurrent gastroduodenal obstruction have been the primary reasons for reoperation. Although the addition of vagotomy to operative bypass has not helped to protect against subsequent marginal ulceration, the absence of appreciable morbidity associated with vagotomy in our series and the high incidence of marginal ulcers reported with gastroenterostomy in other clinical settings lead us to recommend gastroenterostomy with vagotomy as the procedure of choice for duodenal Crohn's disease. Proceeding with vagotomy in persons who have had previous ileocecal or extensive small bowel resection should not be undertaken without careful consideration. Similar caution should also be used in patients who are already troubled with poorly controlled diarrhea. The duodenum may also be involved by duodenoenteric fistulas which represent a complication of Crohn's disease involving other portions of the gastrointestinal tract. Most frequently this occurs in patients with Crohn's colitis who have no evidence of intrinsic duodenal disease. Management of the internal fistula requires resection of the involved colon and closure of the duodenal defect. Three patients with duodenocolic fistula have been so treated.

Adolescent↗
PubMed1983

Histamine receptors in primate gallbladder.

The effect of intravenous histamine on intragallbladder pressure (GBp) and subsequent modification of the histamine response by H1- and H2-antagonists was investigated in an awake baboon model. Responses to specific H1- and H2-agonists were also examined in order to further elucidate gallbladder histamine responses. Gallbladder volume (GBv) was arbitrarily set at 60-70% of observed resting GBv, and drugs were then infused intravenously with continuous monitoring of GBp. Histamine administration resulted in a logarithmic dose--response curve with a maximal increase in GBp equal to 31.7 mm Hg at a dose of 0.0625 mg of histamine. Infusion of the H1-antagonist diphenhydramine hydrochloride (Benadryl) resulted in a decreased GBp response to histamine when compared to preblocker response at all doses studied. On the other hand, histamine response following administration of the H2-antagonist metiamide was significantly greater than the preblocker histamine response. Infusion of the H1-agonist 2-pyridylethlamine resulted in a dose-dependent increase in GBp similar to the histamine curve, while infusion of the H2-agonist dimaprit resulted in consistent decreases in GBp. These results extend previous observations in subprimate preparations and demonstrate the presence of both stimulatory H1-receptors and inhibitory H2-receptors in an in situ primate model.

Animals↗
PubMed1981

Primary sclerosing cholangitis.

In spite of an improved understanding of the etiology of primary sclerosing cholangitis, which supports the use of immunosuppressive therapy with steroids and azathioprine, these pharmacologic manipulations have not altered the ultimate outcome of the disease. Drainage remains the most accepted mode of therapy when possible. Recent advances in diagnosis with ERCP and treatment with transhepatic biliary drainage may change the time-honored surgical approach to this disease as these techniques become more widely available. Until then, however, proper surgical management depends upon a high index of suspicion at the time of laparotomy so that irrevocable damage to the biliary tree will not be done prior to the establishment of the correct diagnosis. Simple drainage of the biliary tree will provide symptomatic relief in some patients; unfortunately, most patients will succumb to progressive biliary cirrhosis or sepsis in spite of all treatment.

Adult↗
PubMed1981

Mechanical properties of primate gallbladder: description by a dynamic method.

Biomechanical theory was applied to devise a dynamic method for describing gallbladder tone in an in situ baboon model. Under pentobarbital sodium (Nembutal) anesthesia, cyclical infusion of bile into and withdrawal of bile from the gallbladder with continuous pressure monitoring allow instantaneous measurement of the pressure-volume ratio and thus of mean gallbladder compliance. This paper describes the method and details the manner of data analysis. Pharmacologic and hormonal agents with known gallbladder effects are used in order to demonstrate the sensitivity of the method. Pilocarpine, histamine, and cholecystokinin cause contraction of the primate gallbladder smooth muscle; this contraction is reflected in decreased compliance by continuous monitoring. Atropine administration results in increased ability to accommodate volume infusions; this effect has not been demonstrated by static monitoring in previous experiments. This new method allows continuous monitoring of compliance and offers both simplicity and sensitivity when compared with previous methods.

Animals↗
PubMed1979

The role of the gallbladder in the pathogenesis of cholesterol gallstones.

During the past century, a variety of explanations have been proposed to explain the pathogenesis of cholesterol gallstones. Early attempts to account for the phenomenon of cholelithiasis focused on events in the gallbladder and stressed mucosal inflammatory changes, gallbladder stasis, stratification of bile, and absorption of bile salts from a damaged mucosa. The advent of the concept of "lithogenic bile" redirected attention to the liver and led to the proposal that an enzyme-mediated genetic and/or metabolic defect is the initiator of cholesterol cholelithiasis. While recognizing that the pathogenesis of gallstones is probably multifactorial, alterations in gallbladder and biliary ductal motor function constitute a plausible, but as yet unexplored, mechanism for alterations in enterohepatic circulation dynamics and subsequent cholesterol cholelithiasis. Gallbladder motor function is a complex phenomenon influenced by dynamic compliance, autonomic pharmacology, hormonal responses, and sphincter dynamics. Attempts to describe these aspects of biliary physiology may characterize the next phase in our understanding of the pathogenesis of cholesterol cholelithiasis.

Bile Acids and Salts↗
PubMedDate not supplied

Postcolectomy syndromes.

Resection of the colon and rectum may produce both transient and permanent alterations in colonic function. Furthermore, the nature of some operative techniques may result in autonomic denervation of the rectum and associated pelvic viscera. An understanding of the mechanism of injury and the subsequent functional abnormalities is necessary to provide adequate therapy.

Anastomosis, Surgical↗