Biomedical subjects

E A Mittendorf

Publications and source records attributed to E A Mittendorf.

4 recordsLinked to original sources

PubMed2001

Utility of intraoperative endoscopy: implications for surgical education.

BACKGROUND: The use of intraoperative endoscopy by surgeons can identify pathology and help determine the appropriate procedure to perform. However, residency training in endoscopy is often variable and unstructured. The purpose of this study was to determine the indications for and impact of intraoperative endoscopy performed at the time of general surgical procedures. METHODS: The records of all patients who underwent intraoperative endoscopy from January 1998 to December 1999 were reviewed. The indications for endoscopy, endoscopic findings, the impact of these findings on the operation performed, complications, and whether the patient was spared from undergoing a second procedure on a separate date were noted. RESULTS: A total of 107 intraoperative endoscopic procedures were performed in 103 patients. Excluding breast, endocrine, central line, and peritoneal dialysis catheter cases, endoscopy was utilized in 5.1% of all general surgery procedures performed during this time period. In 91 patients (88%), the endoscopic procedure was planned preoperatively; in 13 (12%), intraoperative findings dictated its use. The most common indications for endoscopy were identification of lesions and determination of extent of resection (n = 27); evaluation of rectal bleeding (n = 21); colonic evaluation in patients with perianal infections (n = 13); evaluation of extent of injury in trauma cases (n = 8); evaluation of pain (n = 6); evaluation of intestinal tract hemorrhage (n = 6); performance of procedures such as placement of a biliary stent, placement of a nasojejunal tube, or polypectomy (n = 5); and surveillance of chronic disease (n = 5). In 37 patients (36%), the endoscopic findings affected the operation performed. Sixty-nine patients (67%) were spared an endoscopic procedure at a second date, which would have required additional sedation or anesthesia. There were no complications related to endoscopy. CONCLUSION: Intraoperative endoscopy is a valuable tool that can be performed safely for multiple indications and is frequently of value in determining the operation to be performed. Surgical residents should be trained in the indications for endoscopic evaluation as well as the competent performance of such procedures.

Adult↗

PubMed2001

Thyroidectomy for selected patients with thyrotoxicosis.

OBJECTIVE: To examine the indications for operation and the frequency, efficacy, and outcome of surgical therapy for thyrotoxicosis. METHODS: The medical records of all patients who underwent thyroidectomy between 1990 and 1998 were reviewed. Operative indications, laboratory evaluations, extent of thyroidectomy, pathologic findings, and morbidity and mortality were determined for patients with thyrotoxicosis. RESULTS: Of the 347 patients who underwent thyroidectomy, 54 (16%) had thyrotoxicosis, secondary to Graves' disease (32 patients), toxic multinodular goiter (18 patients), thyroiditis (2 patients), or amiodarone (2 patients). The indications for operation were compressive symptoms or substernal extension or both (35 patients), patient preference (12 patients), thyrotoxicosis (4 patients), or a dominant nodule (3 patients). Most patients received pharmacological preparation, followed by total (32 patients), near-total (13 patients), subtotal (8 patients), or unilateral (1 patient) thyroidectomy. The initial 8 patients with Graves' disease underwent subtotal thyroidectomy, and after a mean 28-month follow-up, 1 was euthyroid; 2, hyperthyroid; and 5, hypothyroid. Associated carcinoma was present in 4 (7%) of the 54 patients. Symptomatic hypocalcemia occurred in 10 patients (19%), with a mean free thyroxine level of 60.49 +/- 16.09 pmol/L vs 40.41 +/- 19.56 pmol/L (4.70 +/- 1.25 ng/dL vs 3.14 +/- 1.52 ng/dL) in 25 patients (46%) with asymptomatic hypocalcemia (P<.05). Vocal cord paresis and a hematoma requiring operative evacuation occurred in 1 patient each. There was 1 mortality in a patient with amiodarone-induced thyrotoxicosis. CONCLUSIONS: Massive thyroid enlargement with compressive symptoms, a dominant nodule, and patient preference are indications for surgical treatment of thyrotoxicosis. Near-total or total thyroidectomy is safe and more effective than subtotal thyroidectomy in preventing recurrence and should be considered in most patients referred for surgical treatment of thyrotoxicosis. Transient postoperative hypocalcemia is common and is related to the severity of thyrotoxicosis.

Adult↗

PubMed1999

Endoscopic placement of nasojejunal feeding tubes in ICU patients.

BACKGROUND: Enteral nutrition is an important component in the management of critically ill patients, but it may be limited by gastric ileus and unreliable positioning of standard feeding tubes. The purpose of this study was to determine the risk, utility, and outcome of endoscopically placed nasojejunal feeding tubes (NJT) in intensive care unit (ICU) patients. METHODS: We reviewed the records of all ICU patients who underwent endoscopic NJT placement from May 1995 to May 1997. A through-the-scope method was used with placement of either an 8-Fr or 10-Fr 240-cm tube. Comparison was made between tubes secured to a nasopharyngeal bridle and tubes secured without bridling. RESULTS: A total of 66 NJT were placed in 56 patients. Previous gastric feeds had been attempted in 39 patients (70%) an average of 8.4 days prior to placing the NJT. Fifty tubes (76%) were placed in the ICU and 16 (34%) in the OR at the time of additional procedures. Procedure time ranged from 7 to 28 mins (mean, 15.2), and bridling was used in 24 of 66 placements (36%). Full caloric goal rates were achieved via 56 of 66 tubes (85%) at an average of 26.1 h after placement (range, 1-144). Goal rates were not achieved in 10 cases due to inadequate tube positioning in six, ileus in three, and early dislodgement in one. A procedure complication, consisting of aspiration, occurred in one case (1.5%). Length of tube use averaged 18.5 days (range, 1-74). Accidental tube dislodgement or migration occurred in 16 of 42 (38%) nonbridled tubes vs one of 24 (4%) bridled tubes (p <.05). CONCLUSIONS: Endoscopic placement of nasojejunal feeding tubes in critically ill patients is a safe, quick, and reliable option for enteral nutrition. Full caloric goal rates can be achieved rapidly in a high percentage of patients, even in cases where previous gastric feeds have not been tolerated. Use of a nasopharyngeal bridling system for tube security significantly decreases the risk of migration or accidental tube dislodgement.

Adult↗

PubMed1999

Follow-up evaluation and clinical course of patients with benign nodular thyroid disease.

Reliance on fine-needle aspiration biopsy (FNAB) in determining which patients with a thyroid nodule can be observed depends on a low false-negative rate. The purpose of this study was to determine the false-negative rate of FNAB, the utility of routine repeat FNAB, and the clinical course of patients with benign nodular thyroid disease. The records of all patients with nodular thyroid disease evaluated between June 1990 and May 1998 were reviewed. Patients with a benign FNAB were identified, and nodule size, substernal extension, the results of repeat FNAB, clinical course, histologic diagnosis, and length of follow-up were determined. Of the 341 patients referred with nodular thyroid disease, 121 had a benign FNAB. In 80 patients with a mean nodule size of 3.5 +/- 1.6 cm, clinical follow-up was recommended. The mean duration of follow-up was 20.5 months for 74 patients, and 6 patients were lost to follow-up. Nodule resolution was observed in 7 patients. Repeat FNAB was performed in 45 patients and was benign in 39 (87%), nondiagnostic in 2 (4%), cellular in 3 (7%), and malignant in 1 (2%). Thyroidectomy was performed in the patients with the cellular and malignant aspirates, and the pathology was adenomatous hyperplasia (2), follicular adenoma (1), and papillary carcinoma (1). Thyroidectomy was performed for increasing nodule size and/or compressive symptoms in 41 patients with a mean nodule size of 5.7 +/- 1.9 cm, 19 of whom had substernal extension (P < 0.05). Pathology included benign disease in 39, papillary cancer in 1, and lymphoma arising in Hashimoto's thyroiditis in 1 patient. Given that repeat FNAB was of value in only 1 patient and the false-negative rate for FNAB was only 2.5 per cent, the routine use of repeat FNAB in patients with benign nodular thyroid disease may not be justified. Development of compressive symptoms and diagnosis of unsuspected malignancy in patients with nodule enlargement, including lymphoma in patients with Hashimoto's thyroiditis, underscores the importance of long-term follow-up.

Adenoma↗