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Biomedical subjects

F H Ellis

Publications and source records attributed to F H Ellis.

At least 109 records · Page 6Linked to original sources
PubMed1978

Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus.

Prolonged reflux esophagitis leads to replacement of the esophageal squamous epithelium by columnar epithelium in some patients. This columnar epithelium resembles gastric or intestinal mucosa and has been implicated as a precursor of esophageal adenocarcinoma. A review of 14 cases of primary esophageal adenocarcinoma disclosed that 12 (86%) arose in a columnar epithelium-lined (Barrett's) esophagus. Ten of the 12 patients had a hiatal hernia or symptoms of reflux esophagitis or both. In ten patients the columnar epithelium adjacent to and remote from the invasive adenocarcinoma showed a spectrum of abnormalities ranging from mild dysplasia to carcinoma in situ. These data support the concept that esophageal adenocarcinoma is one complication of a columnar epithelium-lined esophagus, and suggest that the invasive carcinoma evolves through a sequence of epithelial dysplasia and carcinoma in situ in most cases. Esophageal biopsy and cytology can detect this dysplasia, and should provide an effective means for monitoring patients with Barrett's esophagus for impending malignancy.

Adenocarcinoma↗
PubMed1978

Surgery for short esophagus with stricture: an experimental and clinical manometric study.

The surgical management of short esophagus with stricture has been simplified in recent years by the introduction of an esophageal lengthening procedure (Collis gastroplasty) combined with antireflux maneuvers, such as the Belsey and Nissen operations. This report compares the experimental and clinical manometric findings after these procedures. After myectomy of the lower esophageal sphincter (LES) in the cat, three experimental groups were developed including Collis gastroplasty, Collis-Belsey and Collis-Nissen. formation of a gastric tube did not provide protection against reflux while the Collis-Nissen procedure was more effective than the Collis-Belsey in raising pressures at the high pressure zone (HPZ) (26.0 +/- 3.5 cm H2O vs 15.0 +/- 2.7) and in preventing reflux (pH 6.3 +/- 0.5 vs 2.9 +/- 0.04). Of 20 patients with short esophagus and stricture, 11 underwent a Collis-Belsey procedure and nine a Collis-Nissen procedure. The latter procedure resulted in an HPZ of greater amplitude and length than the Collis-Belsey (18.7 +/- 2.3 mm Hg vs 11.6 +/- 1.7 and 3.9 +/- 0.4 cm vs 2.4 +/- 0.2). It also proved to be a more effective antireflux procedure, for no patient so treated had a positive pH reflux test after operation whereas after the Collis-Belsey procedure all but one patient had a positive pH reflux test. Short-term clinical results also support the superiority of the Collis-Nissen operation.

Animals↗
PubMed1977

Mitral valve replacement with the modified University of Cape Town (UCT) prosthesis: clinical and hemodynamic results.

Mitral valve replacement with the modified University of Cape Town prosthesis was performed in 42 patients. In 35 the procedure was an isolated one, and the hospital mortality was 6%. The late survival rate was 60%, half of the late deaths being the result of thromboembolism or complications of anticoagulant therapy. The incidence of hemolysis was low, and hemodynamic results demonstrated improvement in cardiac index and lowering of pulmonary artery pressure, pulmonary artery wedge pressure, pulmonary arteriolar resistance, and transvalvular mean gradients. However, the calculated prosthetic valve orifice area was lower than the measured area. Because of complications of thromboembolism, the high incidence of late deaths, and high transvalvular gradients, this prosthetic valve is no longer used in patients requiring mitral valve replacement.

Adult↗
PubMed1977

Pulmonary dirofilariasis: report of a human case.

Dirofilaria immitis (dog heartworm) principally infests canine hosts. However, human pulmonary dirofilariasis is being reported with increasing frequency, and the following case illustrates essential features of the disease. It typically presents as a solitary pulmonary nodule without symptoms and invariably requires pulmonary resection to differentiate it from primary or secondary malignancy.

Dirofilariasis↗
PubMed1977

Experimental fundoplication: comparison of results of different techniques.

After the creation of a hypotensive lower esophageal sphincter (LES) by circular myectomy, several techniques of fundoplication were employed to assess the effect of variations in the degree and length of fundoesophageal encirclement on LES function. In series A, 360 degrees wraps were constructed around varying lengths of esophagus: group I, 1 cm; group II, 2 cm; and group III, 3 cm. In series B, 2 cm long fundoplications of varying circumference were performed: group I, 90 degrees; group II, 180 degrees; and group III, 360 degrees. LES evaluation included measurement of LES amplitude and length, the adaptive response of the LES to increased intragastric pressure, pH reflux testing, and LES response to parenterally administered pentagastrin. In series A, 2 and 3 cm wraps restored resting LES pressures to normal (18.8 +/- 0.5 and 20.7 +/- 0.3 cm H2O) in contrast to the 1 cm wrap (12.9 +/- 0.8 cm H2O), and both provided more effective protection against reflux when compared to the shorter variation (pH, 6.2 +/- 0.1 and 6.6 +/- 0.1 versus 4.2 +/- 0.1). In series B, the 360 degrees wrap proved to be more effective than partially encircling techniques. Fundoplication optimally restores normal LES function when it encircles the esophagus completely over a length equivalent to the normal high-pressure zone (1.8 +/- 0.1 cm in the cat).

Animals↗
PubMed1977

Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations.

Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm. Hg in the diseases areas and indicated the required length of myotomy. The lower esophageal sphincter (LES) was within normal limits in most instances, with a mean amplitude of 20 mm. Hg, and its exclusion from the myotomy eliminated the need for additional antireflux procedures. Postoperative manometry in 10 patients disclosed a 70 percent reduction in deglutitive pressures in the myotomized segments, and the mean LES amplitude of 13 mm. Hg remained within the normal range (10 to 20 mm. Hg). Ten of the 11 patients were clinically improved, and postoperative reflux developed in only one patient. These results support the continued use of extended esophagomyotomy in selected patients with DSE and suggest that exclusion of the LES from the myotomy affords satisfactory antireflux protection without ancillary sphincter-enhancing maneuvers.

Adult↗
PubMed1976

The effect of fundoplication on the lower esophageal sphincter.

Fundoplication restores normal length and amplitude of pressure to the hypotensive lower esophageal sphincter. If the procedure is properly performed, symptomatic reflux is almost uniformly prevented. The operation is less successful in patients with esophageal stricture and in those without normal esophageal peristalsis. The effect of fundoplication on the lower sphincter is by mechanical restoration of sphincter strength and the normal physiologic neural response of the sphincter to increases in intragastric pressure.

Esophagogastric Junction↗
PubMed1975

Reoperation after esophagomyotomy for achalasia of the esophagus.

Eleven patients who required reoperation for persistent or recurrent symptoms after esophagomyotomy are reported on. Failure of the original operation was attributed to inadequate myotomy in three, healed myotomy in four, and reflux esophagitis in four. The myotomy was extended or a new myotomy created in the first two categories of patients. Three of the four patients with reflux esophagitis were treated by antrectomy and Roux-en-Y esophagojejunostomy; one of these also required concomitant exision of the esophagogastric junction because of stricture. The fourth patient with esophagitis ultimately required colonic interposition for relief of symptoms. Ten of the eleven patients were improved after reoperation, but results were less good than those achieved by a properly performed primary esophagomyotomy. This -re-emphasizes the need for attention to the technical details of esophagomyotomy if good results are to be achieved.

Adult↗
PubMed1975

Mitral valve replacement with the Smeloff-Cutter prosthesis. Experience with 154 patients and comparison with results of replacement with a Starr-Edwards prosthesis.

Mitral valve replacement with the Smeloff-Cutter (S-C) prothesis was performed in 154 patients between September, 1965, and January, 1970. In 84, only the mitral valve was replaced; in the remainder, other valves were reconstructed or replaced. The hospital and late mortality rates for isolated replacement were 6 and 25 per cent, respectively. Comparable figures for the Starr-Edwards (S-E) (Models 6000 and 6120) prosthesis during this period were 11 and 23 per cent. Similar rates of thromboembolism were associated with the use of either prosthesis in surviving patients (27 per cent for the S-C valve and 30 per cent for the S-E valve). In spite of the acceptable hospital mortality rate for the S-C valve, it is not now considered suitable for clinical use because of the high late mortality rate and the high risk of thromboembolism that accompany its use.

Adolescent↗
PubMed1975

Intraoperative delineation of ischemic and scarred myocardium by localized detection of potassium-42 in dogs.

The range of emission from 42-K was shown, in a model experiment, to be suited to scanning with a detector positioned on the surface of the heart after intravenous injection of the isotope. This finding was verified by comparing surface counts with the activity of transmural samples of underlying tissue. Two groups of dogs were studied. In Group A, dogs with left ventricular scars produced by the agar injection technique were given 42-K 24 hours before study. In Group B, normal dogs were given 42-K immediately after ligation of a coronary artery branch. In Group A, localized counting clearly delineated scar from surrounding normal myocardium, and the values were 39 per cent of normal. When more 42-K was given, low flow in scar was indicated by markedly reduced uptake. In Group B, counts over the acutely ischemic area were as low as 20 per cent of normal. Thus, the possibility of differentiating scarred from normal myocardium was shown. Moreover, the results suggest that ischemic but still viable areas that may be suitable for revascularization can be assessed by application of the method.

Animals↗