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Biomedical subjects

G Van Stiegmann

Publications and source records attributed to G Van Stiegmann.

At least 37 records · Page 2Linked to original sources
PubMed1987

Flexible angioscopy seems faster and more specific than arteriography.

Fiberoptic angioscopy was performed with 2.5- and 3.3-mm angioscopes in 25 arteries and grafts in 19 patients. Radiologically normal and abnormal arteries and anastomotic sites were examined. All vessels and grafts were visualized and images of normal arterial wall, subclinical and obstructing atherosclerotic plaque, and suture lines were defined. Unexpected endovascular findings were noted in five patients (26%) and included large amounts of free-floating clot (one patient), atherosclerotic debris (two patients), and membranelike obstructions (two patients). Angioscopy required three to ten minutes and resulted in no complications. Experience with the flexible angioscope indicates that satisfactory visualization and specific recognition of angiographically unsuspected problems can be obtained. The flexible angioscope is faster and appears more etiologically specific than arteriography.

Angiography↗
PubMed1986

Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas.

53 patients with obstructive jaundice due to incurable carcinoma of the head of the pancreas were randomly allocated to percutaneous transhepatic placement of a permanent biliary endoprosthesis (PTE) or bypass surgery. After exclusions 25 patients in each group were treated. Technical success was achieved in 21 patients (84%) in the PTE group and 19 (76%) in the surgery group. The incidence of postprocedural complications (PTE 7, surgery 8) and 30-day mortality (PTE 2, surgery 5) were similar. Recurrent jaundice occurred more often in the PTE (8/21) than the surgery group (3/19). Duodenal obstruction developed in 3 patients in the PTE group. Although the initial median postprocedural hospital stay was significantly shorter in the PTE than the surgery group, the difference was no longer significant when readmissions for blocked endoprosthesis and gastric outlet obstruction were taken into account. There was no difference in the median survival time in the two groups (PTE 19 weeks, surgery 15 weeks).

Aged↗
PubMed1986

Simplified endoscopic placement of nasoenteral feeding tubes.

A technique for expeditious and safe placement of nasoenteric feeding tubes under direct vision is described. Adult patients undergo feeding tube placement with intravenous sedation and topical anesthesia. Endoscopic tube placement requires an average of 10 min and eliminates many risks associated with blind passage.

Endoscopy↗
PubMed1985

Endoscopic jejunal feeding tube through decompressing gastrostomy.

A simple technique is presented to provide rapid, accurate placement of a jejunal feeding tube through a decompressing gastrostomy using readily available supplies. Transgastrostomy feeding tube placement avoids prolonged nasal intubation and this endoscopic technique allows easy changing of the feeding tube should the need arise.

Enteral Nutrition↗
PubMed1984

Endoscopic laser endarterectomy.

The effects of the Neodymium YAG laser on atheroma have been examined in human cadaver aortoiliac arteries and in normal porcine vessels. YAG laser is effective when used to ablate atheroma in an air environment and can be used successfully through the vascular endoscope. When atheroma were treated in the saline solution environment necessary for vascular endoscopy, the laser was less effective. Laser-treated areas of porcine arteries were not thrombogenic. Severe laser damage was easily recognized by blanching and marked elevation of the initma and consistently resulted in late aneurysm formation. ELE is feasible and further investigation is warranted.

Air↗
PubMed1982

Esophageal endosclerosis in children with portal vein thrombosis.

During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.

Adolescent↗
PubMed1979

Failure of spleen repair.

A 25-year-old man underwent splenorrhaphy for a laceration of the inferior pole following blunt trauma. After 5 weeks of uneventful convalescence re-exploration was necessary for delayed formation of a perisplenic hematoma. We conclude that spleen repair is justified in the adult patient with simple injury to the poles of the organ. Careful selection and followup are essential for patients who undergo splenorrhaphy.

Adult↗
PubMed1979

Surgical lesions of the colon in the hemolytic uremic syndrome.

Hemolytic uremic syndrome (HUS) is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure, usually in children under 10 years of age. Gastrointestinal symptoms, including abdominal pain and bloody diarrhea, frequently precede the onset of renal failure. It has not been generally appreciated that the intestinal disease process may proceed to frank ischemic lesions of the colon requiring surgical intervention. An illustrative patient is presented in whom total infarction of the descending colon occurred. The patient represents the fourth reported case of surgical colonic disease as a consequence of the hemolytic uremic syndrome.

Adolescent↗
PubMed1977

Tension pneumomediastinum.

Tension pneumomediastinum is an infrequently diagnosed but potentially fatal condition. The collection of air under pressure in the mediastinum compromises venous return to the heart and compresses major bronchi, leading to sudden and profound cardiovascular collapse. Although its mechanism was elucidated in the 1940's, when tension pneumomediastinum was most commonly a complication of tuberculosis, the same mechanism explains its formation in neonates with respiratory distress and in patients ventilated with volume respirators. Awareness of this condition will lead to more frequent diagnosis, but, more important, will also lead to prompt mediastinotomy and relief of this rapidly fatal condition.

Diagnosis, Differential↗
PubMed1975

Regionalization of trauma patient care: the Illinois experience.

1. A program of regionalization of critically injured trauma patients has been ongoing in Illinois since July 1, 1973. 2. The Illinois trauma system was initiated with the functional categorization of some 47 local, areawide, and regional and three special regional hospital trauma centers strategically located across the state, and established a frame-work for a statewide comprehensive emergency medical services program. 3. Program concepts, subsystems components, and trauma registry clinical data have been presented to describe the dynamics of this trauma-EMS care system. 4. Trauma patient care, because of its complex requirements, provides an excellent model from which to design a basic emergency health care delivery system, and one that can be expanded to include all types of emergency medical problems. 5. Because of the obvious demanding clinical needs of critically injured trauma patients for comprehensive care and the necessity for consolidation of medical resources for these patients at all community levels, surgeons should take a leadership role in regional and areawide trauma-EMS planning and implementation in their local communities.

Abdominal Injuries↗
PubMedDate not supplied

Approaches to the endoscopic treatment of esophageal varices.

Endoscopic therapy is commonly employed for both initial and subsequent definitive treatment of variceal bleeding. Sclerotherapy performed with a flexible endoscope is currently the most widespread technique. Available data suggests that such treatment does not improve outcome in the acute treatment of variceal bleeding (first 30 days) but appears superior to conventional medical management in the long term. Sclerotherapy does not appear better or worse than pharmacological therapy or surgical therapy when these treatments are compared in the elective setting. Although effective, endoscopic sclerotherapy is recognized to be associated with many major and minor treatment-related complications and a significant incidence of recurrent hemorrhage. In response to these shortcomings newer forms of endoscopic therapy such as polymer injection and endoscopic ligation have been developed. Polymer injection appears well suited for patients with active bleeding and for those with gastric varices but does not have advantages for chronic treatment aimed at variceal eradication. Endoscopic ligation appears at least as effective as conventional sclerotherapy for control of acute bleeding and prevention of rebleeding and is associated with few treatment induced complications. While endoscopic therapy will likely continue as the most commonly employed treatment for patients with hemorrhage from esophageal varices, newer methods with wider margins of safety and efficacy seem destined to supplement or replace conventional endoscopic sclerotherapy.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Endoscopic esophageal varix ligation: preliminary clinical experience.

Endoscopic variceal ligation (EVL) was performed in 14 consecutive patients who had recently bled from esophageal varices. None was actively bleeding at initial treatment. Ligations were accomplished using an endoscopic ligating device and an overtube. There were no procedural complications. 132 varix ligations were performed during 44 separate EVL sessions. Two patients were lost to follow-up and two died; neither death resulted from hemorrhage or treatment complications. Variceal rebleeding occurred in 2 noncompliant patients (14.3%) and was successfully controlled with emergent EVL. Ten patients achieved complete variceal eradication with from 1 to 6 (mean, 3.9) EVL sessions. No major complications (perforation, secondary bleeding, deep ulceration) resulted and there were no treatment failures. Follow-up of 10 surviving patients ranged from 240 to 370 (mean, 280) days. Endoscopic observation suggested that varices were obliterated by a process of mechanical strangulation, ischemia, superficial ulceration, and scar formation. Preliminary data indicate that EVL is a safe and effective treatment for esophageal varices.

Esophageal and Gastric Varices↗