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Biomedical subjects

J S Goff

Publications and source records attributed to J S Goff.

At least 55 records · Page 3Linked to original sources
PubMed1987

Esophageal perforation after fiberoptic variceal sclerotherapy.

Our experience and review of the literature suggests that perforation follows fiberoptic sclerotherapy at an incidence of 1-6% per patient. Perforation is delayed for 2-14 days after the procedure and is due to chemical necrosis of the esophageal wall. The risk of perforation is higher in Child's class C patients. The use of large volumes or high concentrations of sclerosant may increase the risk of perforation. To reduce this risk, we suggest a cautious approach to Child's class C patients, with no more than two sclerosis sessions during the first 2 weeks of treatment using less than or equal to 10 ml of 1.5% sodium tetradecyl sulfate per session.

Adult↗
PubMed1986

Surgical treatment of nutcracker esophagus.

The "nutcracker esophagus" has become a commonly diagnosed esophageal motility disorder due to the advent of the more accurate low-compliance perfusion system. The disorder is characterized by high-amplitude peristaltic contractions often of prolonged duration and manifested by dysphagia and chest pain. Typically, symptomatic control is achieved with medical management. We report a case of "nutcracker esophagus" that was refractory to conventional modes of treatment but responded with symptomatic and manometric resolution after an extended esophagomyotomy.

Deglutition Disorders↗
PubMed1986

Bipolar electrocoagulation versus Nd-YAG laser photocoagulation for upper gastrointestinal bleeding lesions.

Nd-YAG laser photocoagulation and bipolar electrocoagulation may be useful for controlling upper gastrointestinal bleeding or preventing rebleeding from ulcers with visible vessels. To determine if one of these methods is superior to the other, data from a small randomized trial and from a nonrandomized experience were evaluated. Altogether, 33 patients underwent 37 coagulation sessions; 19 of the patients were randomized (8 laser and 11 bipolar). In the randomized group, 47.4% had no rebleeding after therapy (laser = 37.5% and bipolar = 54.5%, P greater than 0.1). In the nonrandomized group 56.8% had no further bleeding. Eleven (33%) of the patients required surgery. No patients died of bleeding or complications related to the study. From these data and those in the literature, it is concluded that the Nd-YAG laser and the bipolar coagulator are equally effective for the treatment of solitary upper gastrointestinal bleeding lesions. Since the bipolar unit is cheaper and more easily transported than the laser unit, it may be the method of choice for cauterizing upper gastrointestinal sources until a more effective method is developed.

Adult↗
PubMed1986

Detection of esophageal ulcerations with technetium-99m albumin sucralfate.

Technetium-99m albumin-sucralfate ([99mTc]Su) can be used to demonstrate peptic ulcer disease in man and animals. We evaluated the usefulness of [99mTc]Su for detecting various grades of esophagitis. [99mTc]Su adhered to the distal esophagus for up to 3 hr in five of six patients with esophageal ulcers but adhered to only two of nine with lesser degrees of esophagitis. No adherence was seen in five patients without esophagitis. Thus, [99mTc]Su may not be useful for detecting any but the most severe grade of esophagitis. Based on these results, we speculate that the previously documented beneficial effects of sucralfate on mild to moderate esophagitis may be due to other mechanisms besides adherence to the ulcerated mucosa.

Aluminum↗
PubMed1985

Nonoperative management of acute idiopathic colonic pseudo-obstruction (Ogilvie's syndrome).

In a four-year experience (35 episodes in 27 patients) with the use of medical and colonoscopic therapy for acute idiopathic colonic pseudo-obstruction, we have found that initial conservative measures followed by flexible colonoscopy in nonresponders are effective and safe. Contrary to previous reports, an initial nonoperative approach including colonscopy is frequently successful and the outcome with this approach is not adversely affected even in the few patients who eventually require surgical decompression.

Acute Disease↗
PubMed1983

Endoscopic sclerotherapy for bleeding esophageal varices: effects and complications.

Endoscopic esophageal vein sclerosis recently has been revived as a treatment for bleeding varices because long-term results with portacaval shunts have been poorer than suggested by initial short-term studies. Esophageal vein thrombosis secondary to endothelial damage has been considered the result of the activity of the sclerosing agents, but until 1981 there had been little pathologic documentation. Autopsy findings in ten patients who died after variceal sclerosis suggest that variceal obliteration is achieved by mural necrosis followed by fibrosis, and that thrombosis is only a transient phenomenon. Complications of sclerotherapy that were found included ulceration, hemorrhage, perforation, and stricture.

Adult↗
PubMed1982

A randomized trial comparing cimetidine to nasogastric suction in acute pancreatitis.

Clinical and experimental evidence has suggested that the use of cimetidine might be harmful to patients with acute pancreatitis. We conducted a randomized study comparing cimetidine to nasogastric (NG) suction in 95 patients with 103 episodes of mild to moderately severe, acute or relapsing pancreatitis (86.4% alcohol related). The groups were comparable on entry to the study, and daily evaluation of several clinical and laboratory criteria revealed no consistent differences between the two groups. When these same criteria were evaluated for time of return to normal, if abnormal on entry to the study, no differences were found. The cimetidine group had a significantly shorter stay in the hospital than did the NG group (6.8 +/- 2.7 vs 8.5 +/- 4.8 days). Neither the incidence of relapse or complication nor the duration and extent of hyperamylasemia were significantly different between patients treated with cimetidine or NG suction. We conclude that cimetidine is safe to use in patients with mild to moderately severe alcohol-related pancreatitis, but it offers minimal advantage over NG suction.

Acute Disease↗
PubMed1982

Two-stage triolein breath test differentiates pancreatic insufficiency from other causes of malabsorption.

In 24 patients with malabsorption, [14C]triolein breath tests were conducted before and together with the administration of pancreatic enzymes (Pancrease, Johnson and Johnson, Skillman, N.J.). Eleven patients with pancreatic insufficiency had a significant rise in peak percent dose per hour 14CO2 excretion after Pancrease, whereas 13 patients with other causes of malabsorption had no increase in 14CO2 excretion (2.61 +/- 0.96 vs. 0.15 +/- 0.45, p less than 0.001). The two-stage [14C]triolein breath test appears to be an accurate and simple noninvasive test of fat malabsorption that differentiates steatorrhea secondary to pancreatic insufficiency from other causes of steatorrhea.

Breath Tests↗
PubMed1982

Jejunal rupture caused by a Sengstaken-Blakemore tube.

In a patient with cirrhosis and bleeding esophageal varices who had previously undergone a partial gastric resection, the gastric balloon of a Sengstaken-Blakemore tube was inadvertently placed into the efferent jejunal limb of the gastrojejunostomy. Inflation of the balloon to the standard volume of 150 ml resulted in rupture of the jejunum. Precautions in the use of the Sengstaken-Blakemore tube that might prevent this complication are described.

Esophageal and Gastric Varices↗
PubMed1982

Esophageal ulceration and bleeding after flexible fiberoptic esophageal vein sclerosis.

Three patients with portal hypertension and variceal hemorrhage were treated with flexible fiberoptic esophageal vein sclerosis by injection of sodium morrhuate. Each of these patients bled after sclerotherapy, and deep esophageal ulcers were found at the previous injection sites. Postsclerotherapy pathologic features are presented in 2 patients. It is suggested that the sclerotherapy caused esophageal ulceration and bleeding. Careful evaluation of the sclerosing technique and its histopathologic consequences is needed.

Adult↗
PubMed1981

Pancreatic exocrine function testing.

It is important to understand which pancreatic function tests are available and how to interpret them when evaluating patients with malabsorption. Available direct tests are the secretin stimulation test, the Lundh test meal, and measurement of serum or fecal enzymes. Indirect tests assess pancreatic exocrine function by measuring the effect of pancreatic secretion on various nutrients. These include triglycerides labeled with carbon 14, cobalamin labeled with cobalt 57 and cobalt 58, and para-aminobenzoic acid bound to a dipeptide. Of all these tests the secretin stimulation test is the most accurate and reliable if done by experienced personnel. However, the indirect tests are simpler to do and appear to be comparable to the secretin test at detecting pancreatic exocrine insufficiency. These indirect tests are becoming clinically available and clinicians should familiarize themselves with the strengths and weaknesses of each.

4-Aminobenzoic Acid↗