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Biomedical subjects

H A Shaffer

Publications and source records attributed to H A Shaffer.

At least 19 recordsLinked to original sources
PubMed2005

Terminal ileal stricture in Crohn's disease: treatment using a metallic enteral endoprosthesis.

Enteral strictures are a frequent indication for surgery in Crohn's disease. Postoperative complications are increased in patients with poor preoperative nutritional status, which is common in this patient population. We present a 49-year-old female with longstanding Crohn's disease admitted to our Digestive Health Center with four weeks of increasing abdominal symptoms and radiographic evidence of small-bowel obstruction caused by ileal stricture. Given her poor nutritional status, our team elected to pursue metallic enteral stenting as a bridge to surgical resection. Two Wallstents were placed; luminal patency was subsequently confirmed by a fluoroscopic study. The patient tolerated regular diet and was discharged. When seen in follow-up, she remained asymptomatic and wished to defer surgical intervention indefinitely.

Contrast Media↗
PubMed1997

Effect of octreotide on human sphincter of Oddi motility following liver transplantation.

The effect of octreotide on sphincter of Oddi motility was investigated in six liver transplant patients, employing percutaneous (through the T-tube tract) manometry. Continuous and simultaneous sphincter of Oddi and duodenal motor activities were recorded before and for 60 min after the administration of octreotide (100 micrograms subcutaneously) and after the injection of cholecystokinin (0.02 microgram/kg intravenously). With octreotide, contraction frequency and basal pressure significantly increased (P < 0.05). This effect lasted more than 60 min, long after octreotide-induced duodenal migrating motor complex phase III activity had ceased. Sphincter of Oddi contraction amplitude and duration were unaffected by octreotide. Subsequent cholecystokinin administration transiently reduced sphincter of Oddi basal pressure and contraction frequency. We conclude that octreotide significantly increases sphincter of Oddi basal pressure and contraction frequency. This effect is distinct from octreotide induction of migrating motor complex phase III activity, persists for a prolonged period, and is inhibited by cholecystokinin.

Cholecystokinin↗
PubMed1995

Symptomatic webs of the upper esophagus: treatment with fluoroscopically guided balloon dilation.

PURPOSE: To evaluate treatment of symptomatic esophageal webs with fluoroscopically guided balloon dilation. MATERIALS AND METHODS: Nine consecutively seen patients (women aged 46-87 years) with esophageal webs who reported dysphagia underwent the procedure. Webs were dilated with 20-mm-diameter angioplasty balloons for less than 3 minutes (total procedure time, approximately 30 minutes). Results of treatment (relief of dysphagia) were assessed by evaluating the clinical charts of six of the nine patients and by means of telephone interviews in four. Three patients were lost to follow-up. RESULTS: For effective treatment, one balloon inflation was necessary in seven patients, two in one patient, and three in another patient during the same session. In two patients with two esophageal webs each, the strictures were treated simultaneously. There were no complications, and all patients reported immediate symptomatic relief. Six patients remained asymptomatic during follow-up of 3 months to 6.8 years (mean, 2.6 years). CONCLUSION: Fluoroscopically guided balloon dilation is easy and highly effective in treating symptomatic esophageal webs.

Aged↗
PubMed1995

Influence of breathing pattern on the esophagogastric junction pressure and esophageal transit.

The esophagogastric junction (EGJ) is guarded by two sphincters, a smooth muscle lower esophageal sphincter (LES) and a skeletal muscle crural diaphragm. The LES relaxes in response to a swallow but the crural diaphragm does not. Since contraction of the crural diaphragm is affected by the pattern of breathing, the latter may also influence the EGJ pressure and swallow-induced EGJ relaxation. Our aims were to study the effects of alterations of the breathing pattern on the EGJ pressure, swallow-induced EGJ relaxation, and esophageal transport of liquid bolus. Manometric, electromyographic, and videofluoroscopic studies were performed in 12 healthy subjects. The subjects were trained in two types of breathing patterns, hyperventilation and partial expiration, using the visual biofeedback from their own respiratory waveform. Hyperventilation increased the frequency of inspiratory pressure oscillations at the EGJ without affecting the end-expiratory EGJ pressure. Partial expiration resulted in an increase in the end-expiratory EGJ pressure. Swallow-induced relaxation at the EGJ was markedly reduced during partial expiration. An inspiration during a swallow (control breathing and hyperventilation) caused transient interruption of flow across the EGJ. Partial expiration resulted in cessation of the flow across the EGJ, failure of esophageal peristalsis to traverse the entire length of the esophagus, increased esophageal transit time, and incomplete esophageal clearance of a liquid bolus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Strictures after gastric surgery: treatment with fluoroscopically guided balloon dilatation.

OBJECTIVE: Stricture formation resulting in impedance of gastric emptying is a relatively common complication after gastric surgery that involves anastomosis creation or pyloroplasty. Treatment of the stenosis with fluoroscopically guided balloon dilatation avoids further surgery. Accordingly, we report our experience with 32 dilating procedures in 24 consecutive patients who had the postoperative complication of obstruction at a surgically created gastric outlet. MATERIALS AND METHODS: Out of our series of approximately 650 fluoroscopically guided balloon dilatations, 32 procedures were performed on 24 patients with anastomotic strictures or pyloric narrowing after gastric surgery (vertical banded gastroplasty or gastric bypass surgery [n = 15], partial esophagectomy with esophagogastrostomy and pyloroplasty [n = 6], and partial gastrectomy with gastrojejunostomy [n = 3]). The group included 13 men and 11 women ranging from 32 to 79 years old (mean, 51 years). Diameters of the balloons chosen ranged from 10 to 20 mm, depending on the size of the surgically created anastomosis or pyloroplasty. Indications for balloon dilatation were clinical and radiographic evidence of gastric outlet obstruction. The procedures were done between 13 days and 10 years (mean, 14 months) after gastric surgery. The result of each procedure was assessed by evaluating clinical outcome (relief or recurrence of symptoms) during the follow-up period of 2 days to 36 months (mean, 8 months) after the procedure. RESULTS: In 17 of the 24 patients, the obstructive symptoms were treated successfully with a single dilatation procedure, and symptoms did not recur during follow-up ranging from 1 to 36 months (mean, 11 months). In the other seven patients, the procedure was considered unsuccessful because the patients experienced recurrent obstruction within 2 days to 13 weeks (mean, 3 weeks) after the initial procedure. In one of these, symptoms were relieved by a second procedure. Repeat dilatations in the other six patients were unsuccessful, and all six eventually required surgical revision for definitive treatment. No complicating perforations were noted as a result of dilatation. CONCLUSION: Our experience shows that fluoroscopically guided balloon dilatation is a simple and safe technique for treating obstructive symptoms caused by strictures occurring after gastric surgery. In the majority of patients, symptoms are relieved with a single balloon dilatation, eliminating the need for further surgery. However, patients whose obstructive symptoms recur after the initial balloon dilatation procedure are less likely to benefit from further dilatations and usually require surgery.

Adult↗
PubMed1994

Esophagoenteric anastomotic leaks: treatment with fluoroscopically guided balloon dilatation.

OBJECTIVE: Disruption of anastomosis soon after esophagectomy and esophagoenterostomy is a relatively common complication that leads to chronic enterocutaneous fistulous drainage through the surgical wound in the lower part of the neck or upper part of the chest. It is believed that narrowing of the anastomosis by postsurgical edema and granulation tissue forces the flow of swallowed saliva through the disrupted anastomosis and contributes to the maintenance of the leakage. We evaluated the role of fluoroscopically guided balloon dilatation for treatment of these esophagoenteric anastomotic leaks. MATERIALS AND METHODS: Sixteen consecutive patients with leaking esophagoenteric anastomoses in the neck or the upper part of the chest underwent fluoroscopically guided dilatations of the anastomosis 7-32 days (mean, 13 days) after surgery with 15- or 20-mm angioplasty balloons. Dilatation was done empirically, regardless of whether the anastomosis was visibly narrowed. Discharge of secretions through the surgical drains in the wounds was measured before and after the procedure to determine the response to treatment. RESULTS: In 10 patients whose anastomoses were leaking for an average of 6 days before the balloon dilatation, drainage ceased immediately after the procedure. In four patients with leakage averaging 13 days, response to dilatation was delayed; drainage continued briefly after the procedure but ceased after an average of 5 days. In one patient, drainage increased after dilatation but ceased after 4 days. In another patient, drainage continued for more than 2 weeks after the procedure, after which a second dilatation was performed without apparent success as drainage persisted for another 10 days. In no case was there evidence of further disruption of the anastomosis by the balloon dilatation. CONCLUSION: Fluoroscopically guided balloon dilatation appears to be an effective and safe technique for treatment of leaking esophagoenteric anastomoses. Early intervention seems to increase the effectiveness of the procedure.

Adult↗
PubMed1993

Factors affecting the thickness of the cervical prevertebral soft tissues.

Lateral cervical spine films of 227 patients examined over 2 years were analyzed to determine the thickness of the soft tissues anterior to C2 through C4. These measurements were correlated with patient age, sex, weight, shoulder width, neck width, and calculated radiographic magnification. We found that only patient weight and age had any statistically significant effect on the soft tissue thickness. A stepwise regression model produced a simple equation for predicting the mean value of the soft tissue thickness (specifically at C3) using the patient's age and weight: C3 width = 3.7 mm-0.02 x age (years) + 0.01 x weight (pounds). Using this formula we determined that weight and age account for 28% of the observed variability in the soft tissue measurements at C3. These relationships were similar at C2 and C4. Interestingly, patient sex and radiographic magnification had no detectable effect on the measured widths.

Adolescent↗
PubMed1993

Human sphincter of Oddi motility and cholecystokinin response following liver transplantation.

The reported incidence of sphincter of Oddi dysfunction following orthotopic liver transplantation has ranged from 3% to 7%. If sphincteric dysfunction is unrecognized, therapy may be inappropriate; when recognized, extensive surgery may be required. To prospectively identify patients with sphincteric dysfunction, we performed sphincter of Oddi motility studies through the t-tube tract three months after transplantation. Baseline sphincter motility and response to intravenous cholecystokinin were evaluated. The results of 10 subjects are reported; nine had normal basal sphincter pressure (16 +/- 5.8 mm Hg), and all had normal frequency (3.6 +/- 1/min), amplitude (86 +/- 31 mm Hg), and duration (4.5 +/- 1 sec) of phasic contractions. One subject had an elevated basal pressure (47 mm Hg). All, including the subject with elevated basal pressure, demonstrated a normal response to intravenous cholecystokinin with significant inhibition of phasic contraction frequency and amplitude. We demonstrate that simultaneous studies of the sphincter and duodenum can be obtained via the t-tube tract, providing the opportunity for prospective evaluation of sphincteric function. We conclude that sphincter of Oddi function usually remains normal following liver transplantation with choledochocholedochostomy.

Cholecystokinin↗
PubMed1992

Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy.

Treatment for esophageal perforation has traditionally been surgery, but development of more effective antibiotics and parenteral nutrition has led to a cautious trend toward nonoperative management. The goal of this investigation was to identify relevant presenting features that would guide a physician in making the therapeutic choice between medical and surgical therapy. Twenty-five consecutive patients with esophageal perforation--20 iatrogenic and five spontaneous--were reviewed. Treatment was medical in 12 cases and surgical in 13. The findings indicate that many patients with esophageal perforation can be treated medically. The following guidelines are suggested for selecting nonoperative treatment: (1) clinically stable patients; (2) instrumental perforations detected before major mediastinal contamination has occurred or perforations with such a long delay in diagnosis that the patient has already demonstrated tolerance for the perforation without the need for surgery; and (3) esophageal disruptions well contained within the mediastinum or a pleural loculus.

Adult↗
PubMed1992

Perforation and obstruction of the gastrointestinal tract. Assessment by conventional radiology.

Proliferation of new imaging modalities has changed the way abdominal emergencies are evaluated in medical centers where ready access to equipment and personnel make emergency CT, ultrasonography, interventional radiology, and endoscopy available at all hours of the day or night. In many cases, plain abdominal radiography is being relegated to an ancillary diagnostic role. Conversely, in medical centers with fewer resources, plain radiography remains a primary screening modality for most acute abdominal conditions. Even in centers with unlimited resources, plain films supplemented by gastrointestinal contrast studies as needed remain the modern standard for evaluation of patients who have suspected gastrointestinal perforation and mechanical obstruction. These widely available, easy to perform, and relatively inexpensive procedures are relatively sensitive and specific for evaluation of these problems. It is, therefore, crucial for radiologists to be familiar with the often subtle signs of gastrointestinal perforation and obstruction on plain films. Skills of plain film interpretation should not be permitted to erode in the environment of newer technologies.

Duodenal Ulcer↗
PubMed1991

Rectal strictures: treatment with fluoroscopically guided balloon dilation.

The authors performed 25 fluoroscopically guided balloon dilation procedures in nine patients with rectal strictures. In all cases, the stricture developed after rectal surgery. Four patients underwent ileoanal anastomosis after total colectomy for various conditions; five patients underwent rectosigmoid end-to-end anastomosis after resection of a tumor or as treatment for diverticulitis. Maximal stricture dilatation was attained in 20 instances with a single 15-30-mm balloon. In five procedures, two balloons (20 or 15 mm) were inflated simultaneously ("kissing balloons" technique) to dilate the strictures. In five patients, only one dilation procedure was required for effective treatment of the strictures, with no clinical evidence of strictures after follow-up of 1.5-56 months (mean, 29.5 months). In the other four patients, multiple procedures were performed: nine in one patient, five in one patient, and three in two patients. In these patients, no recurrent symptoms developed during follow-up of 1.25-18 months (mean, 8.1 months) after the last dilation. Complicating leaks, infection, or hemorrhage did not occur after any of the procedures. Fluoroscopically guided balloon dilation is a safe and effective procedure for the treatment of rectal strictures.

Adult↗
PubMed1990

Modulation of feline esophageal contractions by bolus volume and outflow obstruction.

We studied the effect of bolus volume and esophageal obstruction on esophageal peristalsis by using synchronized video-fluoroscopic and manometric techniques in cats. A specially designed pressure cuff was surgically implanted around the distal esophagus to control the degrees of outflow obstruction. Secondary esophageal peristalsis was evoked by injecting bolus volumes of 3, 6, and 9 ml at cuff pressures of 0, 20, 40, and 60 mmHg. Increases in outflow obstruction reduced the velocity of peristalsis. The amplitude of esophageal contraction increased with increasing outflow obstruction at low bolus volumes but decreased with larger bolus volumes and larger outflow obstruction. In the absence of outflow obstruction, each esophageal contraction traversed the entire esophagus distal to its site of origin, but in the presence of outflow obstruction contractions only traversed part of the esophagus. The incidence and site of failure of propagation was directly related to cuff pressure and bolus volume. The relationship between the onset of manometric pressure complex at a given site in the esophagus to the passage of the bolus from that esophageal site was markedly affected by outflow obstruction. We conclude that esophageal peristalsis can be modulated by the bolus volume and outflow obstruction.

Animals↗