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Biomedical subjects

J M Streitz

Publications and source records attributed to J M Streitz.

18 recordsLinked to original sources
PubMed1992

Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis.

The pathogenesis and treatment of epiphrenic diverticula remain controversial subjects. Most surgeons recommend esophagomyotomy in association with diverticulectomy in every patient. We believe that selective use of myotomy, based on manometry, should be used. From 1960 to 1990, 16 patients underwent surgical treatment for epiphrenic diverticulum at the Lahey Clinic Medical Center, Burlington, Mass. Six patients, three of whom underwent diverticulectomy alone and three who underwent an associated long myotomy, had the lower esophageal sphincter left intact; long-term results were good in all patients. The remaining 10 patients underwent myotomy of the lower esophageal sphincter. Reflux esophagitis developed in two of these patients who had a normal lower esophageal sphincter. Clinical results support the selective use of esophagomyotomy applied to areas of demonstrated dysmotility. A normal lower esophageal sphincter should be left intact to prevent reflux complications.

Academic Medical Centers↗
PubMed1992

Current concepts concerning the nature and treatment of Barrett's esophagus and its complications.

Current concepts regarding the nature and the treatment of Barrett's esophagus and its complications are reviewed. The columnar-lined lower esophagus is being increasingly recognized as an acquired condition caused by gastroesophageal reflux. Many patients are asymptomatic. Barrett's esophagus occurs in about 10% to 15% of patients with reflux esophagitis. The diagnosis depends on endoscopy and biopsy. Complications are common and include ulceration, stricture, dysplasia, and adenocarcinoma. Esophagitis, ulceration, and stricture can usually be treated medically. Surgical approaches are discussed for patients whose condition is refractory to medical therapy. The premalignant nature of Barrett's epithelium is well recognized, and strategies for surveillance and resection are discussed. Survival after resection of adenocarcinoma in Barrett's esophagus is not appreciably different from that of other carcinomas. Surveillance with endoscopy offers the best chance for early detection and cure.

Barrett Esophagus↗
PubMed1992

Subfascial implantation of implantable cardioverter defibrillator generator.

The automatic cardioverter defibrillator generator is a relatively large unit, which has most often been implanted in a subcutaneous pocket. In a consecutive series of 120 primary implantations, we employed a subrectus fascia pocket that has resulted in a cosmetically superior result with a 0.8% incidence of system infection. The technique of subfascial implantation is described.

Electric Countershock↗
PubMed1992

Traumatic dislocation of testes and bladder rupture.

Traumatic dislocation of the testes with bladder rupture occurred in 2 multiply injured patients with pelvic fracture. One had a history of retractile testes and the other of previous testicular dislocation. Surgical correction was performed after closed reduction failed. These injuries must be recognized and treated promptly to maximize the likelihood of testicular salvage. If early intervention is not possible, duplex ultrasonography and pulsed Doppler analysis are the optional valuative studies.

Adult↗
PubMed1991

Airway injury after tracheotomy and endotracheal intubation.

Iatrogenic airway injury after tracheotomy and endotracheal intubation continues to be a serious clinical problem. Endotracheal tubes cause pressure injury to the glottis and may result in severe commissural scarring that is difficult to treat. Tracheotomy tubes may result in severe stomal stenosis in the trachea or subglottic region, which is more amenable to surgical treatment. Both methods of airway intubation may result in pressure necrosis from the tube cuff that can be prevented by careful monitoring of inflation pressures. The technique of laryngotracheal resection and reconstruction has been well developed and may be applied successfully to most patients with subglottic and tracheal stenosis. The surgical treatment of glottic stenosis remains a challenge.

Glottis↗
PubMed1991

Adenocarcinoma in Barrett's esophagus. A clinicopathologic study of 65 cases.

The natural history of Barrett's esophagus, particularly the prevalence and incidence of malignant changes in it, remains controversial. Furthermore the prognosis of surgically treated patients with carcinoma in Barrett's esophagus has not been elucidated fully. To examine these and other issues, the records of 65 patients with carcinoma in Barrett's esophagus presenting at the Lahey Clinic Medical Center from January 1973 to January 1989 were reviewed. During this period, 241 patients with documented Barrett's esophagus were seen, for a prevalence of carcinoma of 27%. Adenocarcinoma in Barrett's esophagus accounted for 30% of the surgically treated carcinomas of the thoracic esophagus during this period. All but four of these patients were men. Symptoms of chronic reflux were present in less than one half of the patients and dysphagia was often the presenting symptom. In eight patients the carcinoma was discovered on routine surveillance endoscopy, and in four patients progression of disease from benign columnar epithelium to dysplasia to carcinoma was documented. Tumors developed in six patients who had undergone previous antireflux surgery, and in four other patients a second carcinoma developed in residual Barrett's epithelium after a previous resection. Of the 65 patients, 61 (94%) were considered to have operable disease, all of whom underwent resection. Two patients (3.3%) died within 30 days of operation. The resected specimens were staged as follows: stage 0, 4; stage I, 10; stage II, 17; stage III, 25; stage IV, 4. Of the resected specimens, 73% showed areas of dysplasia adjacent to the tumor. The overall adjusted actuarial 5-year survival rate was 23.7%. The 3-year survival rate was 100% for patients with stage 0 carcinoma, 85.7% for patients with stage I carcinoma, 53.6% for patients with stage IIA carcinoma, 45% for patients with stage IIB carcinoma, 25.2% for patients with stage III carcinoma, and 0% for patients with stage IV carcinoma. The premalignant nature of Barrett's esophagus requires endoscopic surveillance to detect early carcinoma because symptoms often occur late or are absent. Antireflux surgery does not protect against the development of carcinoma. All of the Barrett's epithelium must be resected because a second carcinoma may develop in residual columnar epithelium. Severe dysplasia should be considered an indication for resection. Although operability and resectability rates are high, long-term survival is not. Early detection is mandatory if long-term survival is to be achieved.

Adenocarcinoma↗
PubMed1991

Complications of percutaneous dart therapy in management of pneumothorax.

Treatment of patients who have pneumothorax is increasingly being undertaken with a small-diameter dart catheter. Although the catheter usually is effective, complications can arise with its use. We describe a patient in whom empyema developed during treatment of spontaneous pneumothorax with the use of such a catheter. Limitations and guidelines for its use are discussed.

Adult↗
PubMed1990

Iatrogenic paraesophageal hiatus hernia.

Between January 1970 and January 1990, 101 patients with paraesophageal hiatus hernias were operated on at the Lahey Clinic Medical Center. Thirteen patients had hernias that were identified as being iatrogenic in origin, a prevalence of 13%. Ten hernias were secondary to antireflux procedures, and esophagomyotomy, esophagogastrectomy, and placement of an Angelchik prosthesis accounted for one case each. Symptoms did not differ substantially from those of patients with primary hernias. Incarceration occurred in 2 patients, but neither sustained strangulation. The pathogenesis was most frequently disruption of a previous hiatal closure. Other etiological factors included disruption of the phreno-esophageal membrane by operative dissection, postoperative gastric dilatation, and failure to recognize esophageal shortening or an existing hiatal defect. Abdominal repair was usually possible, but 3 patients required thoracotomy for reduction. There has been one known recurrence during a median follow-up of 41 months.

Adult↗
PubMed1988

Fatal hypoxemia following mitral valve replacement.

Patency of the foramen ovale is a common condition. In certain clinical settings it permits the development of right-to-left intracardiac shunting. A case is described of sudden, fatal hypoxemia due to shunting through a patent foramen ovale immediately following mitral valve replacement.

Aged↗
PubMed1988

Polyuric urinary tract dilatation with renal damage.

Polyuria of diabetes insipidus and psychogenic polydipsia can produce massive dilatation of the urinary tract in the absence of any mechanical obstruction. Renal failure in these cases is rare. We report the second case of nephrogenic diabetes insipidus with nonobstructive hydronephrotic renal damage. Temporary suprapubic drainage restored renal function to normal and decreased the upper tract dilatation. Renal function has been preserved for more than 10 years. Surgical intervention beyond temporary vesical drainage is unnecessary.

Child↗
PubMed1981

A 1,500-year-old bladder stone.

A calcium oxalate calculus was found in the anatomically normal bladder of a 1,500-year-old native American male mummy from the Northeastern Arizona Basketmaker cultural group. Results of analysis by chemical, optical, spectrographic and x-ray diffraction methods are listed and compared to several other reported prehistoric uroliths.

Adult↗
PubMed1980

Serum alpha-fetoprotein and human chorionic gonadotropin in patients with seminoma.

We analyzed the case histories of 31 patients who initially had a diagnosis of seminoma and elevated serum levels of alpha-fetoprotein or human chorionic gonadotropin. We concluded that an elevated alpha-fetoprotein level is firm evidence of the presence of non-seminomatous germ cell tumor and that the patient should be treated accordingly. However, if the level of human chorionic gonadotropin alone is elevated the diagnosis may be either non-seminomatous tumor or seminoma. Patients with seminoma and an elevated level of human chorionic gonadotropin do respond well to radiation therapy if they have low stage disease but if metastatic seminoma is present an elevated human chorionic gonadotropin level appears to be a poor prognostic sign if conventional treatment is given. A plan of treatment is proposed for these patients.

Adult↗