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Biomedical subjects

M B Orringer

Publications and source records attributed to M B Orringer.

At least 163 records · Page 9Linked to original sources
PubMed1978

Monilial esophagitis: an increasingly frequent cause of esophageal stenosis?

Acute monilial esophagitis generally responds well to oral nystatin therapy, and long-term sequelae of this condition have not been well recognized. Nor is it generally appreciated that Candida infections of the esophagus may occur in subacute or chronic form. Four men, 34, 40, 41, and 49 years old, have been treated for esophageal stenoses resulting from different types of chronic monilial esophageal involvement. All were seen with painless dysphagia and strictures of the upper half of the thoracic esophagus. In 2 patients, an associated roentgenographic pattern of "intramural esophageal pseudodiverticulosis" was present. Two patients have been treated successfully with esophageal dilation, 1 required substernal colonic bypass of the stenotic, perforated esophagus, and 1 is being evaluated for esophageal bypass. Esophageal moniliasis must be considered in the differential diagnosis of benign esophageal strictures, particularly those involving the upper half of the thoracic esophagus.

Adult↗
PubMed1978

Combined Collis-Nissen reconstruction of the esophagogastric junction.

Recent reports have indicated that combined Collis-Belsey reconstruction of the esophagogastric junction fails to control reflux in 30 to 46% of patients undergoing the procedure. The major factor thought to be responsible for this result is the limited Belsey fundoplication possible after construction of the gastroplasty tube. This report describes our technique of combining the Collis gastroplasty with a 360-degree Nissen type fundoplication. The radiographic and manometric characteristics of the distal esophageal high-pressure zone produced by the Collis-Nissen operation are discussed.

Adult↗
PubMed1978

Myocardial revascularization in patients receiving long-term propranolol therapy.

Twenty-seven patients receiving long-term propranolol therapy underwent myocardial revascularization to relieve stable or unstable angina. The patients were randomly divided into two groups, one (Group 1) in which propranolol was discontinued 48 hours prior to operation and one (Group 2) in which patients received a final dose of propranolol 1 to 2 hours prior to operation. Several physiological variables were compared, and there was no statistically significant difference between the groups except for a slower pulse rate in Group 2 patients. Although the patients in Group 1 showed a greater frequency of hypertension before bypass, the incidence of postoperative complications and perioperative myocardial infarction was the same for both groups. The findings of this study indicate that myocardial revascularization is safe even if propranolol is administered up to 1 or 2 hours before operation.

Adult↗
PubMed1978

Treatment of caustic injuries of the esophagus: a ten year experience.

The methods of managing 32 patients sustaining caustic injuries to the esophagus are assessed. Treatment of these patients must be individualized according to the type of caustic ingested, the degree of burn and other clinical signs. While an aggressive approach is favored for second and third-degree burns in the form of early esophago-gastrectomy with subsequent colon interposition, operation is not necessary. In all patients, particularly those with first-degree burns. The use of antibiotics is recommended as soon as the diagnosis of esophageal injury is established. The efficacy of steroids in preventing stricture formation, especially with third-degree burns, is questioned.

Adult↗
PubMed1978

Management of unusual traumatic ruptures of the aorta.

Blunt injuries to the ascending aorta and branches of the aortic arch are unusual but must be considered in any victim of a high speed decelerating injury. Because there are no characteristic clinical or roentgenographic findings, aortography is the only definitive method of establishing the diagnosis. Aortography should therefore, be performed upon any patient who has had a high speed decelerating injury, regardless of the clinical or the roentgenographic findings. An early operation will prevent exsanguination.

Adolescent↗
PubMed1978

Esophagectomy without thoracotomy.

Blunt esophagectomy without thoracotomy has been performed in 26 patients: four with benign disease and 22 with carcinomas involving various levels of the esophagus (10 cervicothoracic, one upper third, five middle third, and six distal third). Continuity of the alimentary tract was restored by anastomosing the pharynx or cervical esophagus either to stomach (19 patients) or to a colonic graft (seven patients). Esophageal resection and reconstruction were performed in a single stage in 25 patients, and the esophageal substitute was positioned in the posterior mediastinum in the original esophageal bed in 24 patients. There were no deaths directly related to the technique of blunt esophagectomy. Average intraoperative blood loss was 1,350 ml. for the entire group, 1,650 ml. for those requiring concomitant laryngectomy and 1,050 ml. for those undergoing esophagectomy without laryngectomy. Complications in these patients included pneumothorax (eight), transient hoarseness (five), pleural effusion (five), anastomotic leak (four), subphrenic abscess (one), and cerebrovascular accident (one). The five deaths were due to pheumonia (two), innominate artery rupture (two), and pulmonary embolus (one). Blunt esophagectomy without thoracotomy is safe and is far better tolerated physiologically than the combined transthoracic and abdominal operations more traditionally used for exophageal resection and reconstruction.

Adenocarcinoma↗
PubMed1977

New trends in esophageal replacement for benign disease.

In the past three years 21 patients have required esophageal replacement for benign disease: 6 patients with caustic stricture, 5 with reflux esophagitis, 5 with neuromotor abnormalities, 2 with strictures following radiation therapy, 1 with iatrogenic perforation, 1 with monilial esophagitis, and 1 with esophageal atresia. Esophageal substitution was achieved using isoperistaltic left colon 17 patients and stomach in 4. The preoperative evaluation, postoperative complications, and results of esophageal replacement in these patients are discussed. Changing trends in the benign conditions requiring esophageal substitution are reviewed.

Adult↗
PubMed1977

Long-term esophageal function following repair of esophageal atresia.

Primary repair of esophageal atresia restores gastrointestinal continuity, but does not ensure normal esophageal function. To date 22 patients, six to 32 (average 15) years after repair of their esophageal atresias, have been evaluated by personal interview and esophageal manometrics and acid reflux testing. Previous barium swallow examinations had demonstrated varying degrees of anastomotic narrowing (12 patients), abnormal esophageal motor function (11 patients), gastroesophageal reflux (two patients), and hiatal hernia (one patient). Ten patients experience intermittent dysphagia for solid foods. Seven have typical symptoms of gastroesophageal reflux. Esophageal function tests including manometry and intraesophageal pH recording, have demonstrated varying abnormalities of esophageal motility in 21 patients and moderate to severe gastroesophageal reflux in 13. Two patients have required reconstruction of the esophagogastric junction for control of severe reflux esophagitis. The unexpected high incidence of gastroesophageal reflux in these patients, coupled with their abnormal esophageal motility which impairs normal acid clearing, renders them more prone to reflux esophagitis. Careful long-term evaluation for gastroesophageal reflux and its complications is indicated following primary repair of esophageal atresia. Evaluation of esophageal function with intraesophageal pressure and pH recordings is a far more sensitive indicator of esophageal physiology than the barium swallow examination.

Adolescent↗
PubMed1977

Polypropylene suture in esophageal and gastrointestinal operations.

A comparison was made of the gross and microscopic wound healing and tissue reactivity between stainless steel wire, polypropylene and silk in anastomoses in the u-prepared colon of the dog. While all anastomoses healed irrespective of the suture material used, wire was associated with the least inflammatory response, silk the most and polypropylene intermediate, its low reactivity approaching that of wire. A clinical trial of Prolene for 71 varied anastomoses between pharynx, esophagus, stomach and colon in 47 patients undergoing esophageal resection and reconstruction or bypass was done. In four of the seven anastomotic disruptions which occurred, causative factors unrelated to the suture material could factorily in the remainder of these patients. Monotive suture which works well in esophageal and gastrointestinal anastomoses.

Animals↗
PubMed1977

Complications and failings of the combined Collis-Belsey operation.

Eighty-three patients with risk factors predisposing to recurrent reflux after standard hiatal hernia repairs have undergone the Collis-Belsey operation. There were two postoperative deaths. Complications related to multiple operations on the lower esophagus included injury to the spleen (three patients); gastrocutaneous fistula (two patients), and localized ischemic necrosis of esophagus two patients). There were two esophageal perforations. In four of 15 patients, the combination of esophagomyotomy and the Collis-Belsey operation produced functional esophageal obstruction. Three patients have experienced late major lower esophageal bleeding from ulceration of mucosa adjacent to the gastroplasty tube; two the these patients have no demonstrable gastroesophageal reflux. In addition to postoperative interviews and barium swallows, 77 patients have been evaluated with esophageal manometry and acid reflux testing. After an average follow-up of 12 montsh, 19 percent have symptomatic reflux, but 30 percent have moderate-to-severe reflux with pH reflux testing. The recent enthusiasm for the combined Collis-Belsey operation should be tempered by continued, cautious, objective assessment of its long-term results.

Adolescent↗
PubMed1976

Gastroesophageal reflux in esophageal scleroderma: diagnosis and implications.

Fifty-three patients with scleroderma were evaluated by history, barium swallow, and esophageal function tests. The most common esophageal symptoms were heartburn and dysphagia. Abnormal motility was seen radiologically in 43 patients, gastroesophageal reflux in only 9. Esophageal function tests demonstrated: (1) abnormal motility in 51 patients and lack of a distal esophageal high-pressure zone in 18; (2) moderate to severe gastroesophageal reflux in 38; and (3) abnormal acid-clearing ability in 50. Eleven patients, including 8 with peptic stricture, underwent the combined Collis-Belsey operation. Symptomatically, reflux was abolished in all and dysphagia in 10. Roentgenograms showed that regression of strictures was complete in 5 and partial in 3. Postoperative esophageal function tests in 9 patients demonstrated a competent distal esophageal valvular mechanism in 7. Gastroesophageal reflux, not impaired motility, is the major cause of esophageal symptoms in scleroderma. Its effecitve operative control is not contraindicated by systemic disease in these patients.

Adult↗
PubMed1976

The treatment of acute traumatic rupture of the aorta: a 10-year experience.

Forty-three patients with aortic rupture secondardy to blunt trauma have been treated at the University of Micigan within the past 10 years with an overall salvage rate of 70%. The diagnosis should be suspected in anyone who has sustained a high speed decelerating injury, if the chest roentgenogram shows media-stinal widening, whether or not there is hypertension of the upper extremities; systolic murmur, or external evidence of chest injury. Aortography should be employed to confirm the diagnosis and to determine the site or sites of rupture. Repair of the lesion should be undertaken as soon as possible and takes priority in most instances over associated injuries. Repair in almost all cases can be accomplished safely and quickly using a bypass shunt without the aid of extracorporeal circulation.

Accidents, Traffic↗