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Biomedical subjects

J L Grobe

Publications and source records attributed to J L Grobe.

11 recordsLinked to original sources
PubMed1985

Evaluation of Angelchik antireflux prosthesis. Long-term results.

Fifteen patients with intractable reflux or its complications were sequentially studied after the placement of the Angelchik antireflux prosthesis. In all, 16 devices were inserted. Parameters were measured before and 3, 12, 24, and 36 months after prosthesis placement and included symptom scoring, esophageal manometry with Tuttle test, endoscopy, suction biopsy, barium swallow, and gastroesophageal scintigraphy. In addition, a subset of patients underwent stimulation/inhibition of the lower esophageal sphincter (LES) with pentagastrin, metoclopramide, edrophonium, and atropine. At a mean time of 16 months postsurgery, 10 of 16 (63%) patients were reflux-free and there was significant improvement in endoscopic, biopsy, and symptom scoring. Post-insertion, there were statistically significant increments in LES pressure with intravenous boluses of pentagastrin, metoclopramide, and edrophonium, and a significant decrease with atropine. Two patients who developed prosthesis herniation into the chest required removal because of ongoing reflux and dysphagia. An additional patient had prosthesis disruption and migration, which also required removal. Four patients with previously failed antireflux procedures had five prostheses placed. All continued to reflux postoperatively. No patient who was initially reflux-free subsequently developed reflux, despite a tendency for LES pressure to decline with time. Although this procedure proved effective for up to 36 months in patients who had had no previous antireflux procedure, the displacement rate (3/16 = 19%), reoperation rate (3/16 = 19%), and the progressive decline in LES pressure over time should make one cautious about its routine use in the surgical treatment of reflux esophagitis.

Endoscopy↗
PubMed1984

Venography during endoscopic injection sclerotherapy of esophageal varices.

Utilizing an equal mixture of 5% sodium morrhuate and 60% renografin, we studied four patients during a total of nine sessions of injection sclerotherapy of esophageal varices to determine radiographically the fate of injected sclerosant. Despite attempted intravariceal injections, 44% resulted in local and presumably paravariceal accumulation of contrast material within the esophageal wall. During 42% of injections, contrast material was rapidly cleared in a cephalad direction and proximal balloon compression of the esophagus did not prevent cephalad flow of sclerosant. In 14% the injected material was rapidly cleared in a caudal direction toward the gastric veins. This technique may be useful in future evaluations of the efficacy of various methods of injection sclerotherapy of esophageal varices.

Contrast Media↗
PubMed1984

Self-bougienage in the treatment of benign esophageal stricture.

Although recommended for patients requiring frequent dilations in whom surgery is not feasible, self-bougienage for benign esophageal stricture has not been examined critically. Thirteen patients performing self-dilations over a mean period of 4.8 years were evaluated. Dysphagia decreased in all patients and reflux symptoms were well-controlled in most patients with an antireflux regimen of elevation of the head of the bed, antacids, and cimetidine. Major complications of bleeding or perforation were not encountered, although three episodes of esophageal food impaction related to missed home dilation sessions did occur. Long-term self-bougienage is both safe and effective therapy for benign esophageal stricture for patients who require frequent dilations.

Aged↗
PubMed1983

An anti-reflux prosthesis in the treatment of gastroesophageal reflux.

The Angelchik anti-reflux prosthesis, a C-shaped, silicone filled device surgically secured around the distal esophagus, received premarket approval by the Food and Drug Administration's Bureau of Medical Devices in 1979. Despite its use in over 9000 patients, there are few physiologic data documenting its effectiveness. We studied ten patients before and 3 months after prosthesis implantation with barium meal, endoscopy, esophageal biopsy, standard acid reflux testing, esophageal manometry, gastroesophageal scintigraphy, and symptom scoring. After surgery all patients were able to discontinue cimetidine and elevation of the head of the bed. Two patients had documentation of mild reflux, one of whom needed to have the prosthesis removed because of its herniation into the mediastinum. Eight patients had no reflux. There was statistically significant improvement in endoscopic, symptomatic, and biopsy grading as well as increased lower esophageal sphincter pressure after surgery. Prosthesis implantation is a promising surgical treatment of intractable esophageal reflux, but we believe additional and long-term studies are needed before its general use.

Adult↗
PubMed1983

"Pseudo-ascites" associated with giant ovarian cysts and elevated cystic fluid amylase.

Two patients with massive ovarian cysts that mimicked ascites on physical examination, ultrasonography, and abdominal plain film are reported. Elevated cyst amylase in both patients, and in one, elevated serum amylase, further confused the diagnosis. Massive ovarian cysts should be considered in the differential diagnosis of presumed ascites in female patients, particularly in the setting of elevated serum or "ascitic" fluid amylase.

Adult↗
PubMed1983

Flexible versus rigid sigmoidoscopy: a comparison using an inexpensive 35-cm flexible proctosigmoidoscope.

Seventy-one patients with symptoms of colorectal disease were evaluated with the rigid 25-cm sigmoidoscope and an inexpensive 35-cm flexible proctosigmoidoscope (American Optical FPS-2) to determine if the latter is a diagnostically reliable alternative for routine sigmoidoscopy. Examination time was comparable, 3.6 min for the rigid and 4.2 min for the flexible sigmoidoscope. Average insertion length was 21 cm for the rigid and 29.5 cm for the flexible instrument. Forty-two patients had more discomfort during the rigid versus nine during the flexible examination. Significant lesions were documented in eight patients with the rigid and 13 with the flexible sigmoidoscope. One rectal carcinoma and seven polyps were detected with both instruments, while an additional nine polyps were documented only with the flexible instrument. The 35-cm flexible proctosigmoidoscope may be a feasible alternative for routine sigmoidoscopy.

Colonic Diseases↗
PubMed1982

Colonoscopic retroflexion in the evaluation of rectal disease.

Although previously described and advocated, rectal retroflexion has not been well studied as a diagnostic maneuver. We report 75 cases in which the maneuver was performed during colonoscopy or fibersigmoidoscopy. The technique was both easily performed by the examiner and well tolerated by patients. Rectal retroflexion increased diagnostic yield in six of 75 patients. It proved a useful adjunct to the standard forward-view of the rectum in the evaluation of internal hemorrhoids and in the detection of small perirectal polyps and rectal inflammatory bowel disease. Excluding patients with severe proctitis or a contracted rectal vault, rectal retroflexion is a valuable technique for the evaluation of suspected rectal disease.

Colonoscopy↗