Biomedical subjects

P D Gerstenberger

Publications and source records attributed to P D Gerstenberger.

7 recordsLinked to original sources

PubMed1995

Malpractice in gastrointestinal endoscopy.

Malpractice actions arising from gastrointestinal endoscopic care most frequently allege improper performance of the procedure and errors in diagnosis. Virtually all claims alleging an iatrogenic injury involve perforation, which in principle should be defensible if proper informed consent is documented. Allegations of errors in diagnosis primarily pertain to missed colon cancer. The relative malpractice claim risk of sigmoidoscopy, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy are similar. This article summarizes the basic elements of a malpractice suit, the recent history of medical malpractice, and the relationships between iatrogenic patient injury and malpractice suits. The allegations in malpractice claims against endoscopists are examined.

Endoscopy, Digestive System↗

PubMed1994

Successful management of severe gastroesophageal reflux disease with laparoscopic Nissen fundoplication.

BACKGROUND: Nissen fundoplication has been shown to be superior to medical treatment in the management of severe or complicated gastroesophageal reflux disease (GERD). Rapid advances in minimally invasive surgical technique and recognition of the advantages of reduced incision-related morbidity have fostered application of laparoscopic techniques to antireflux surgery. A prospective evaluation of 70 patients undergoing laparoscopic Nissen fundoplication for severe GERD was undertaken. PATIENTS AND METHODS: Rigid selection criteria for laparoscopic Nissen fundoplication included severe or refractory disease with documentation of abnormal esophageal acid exposure by 24-hour pH probe monitoring, documentation of a mechanically defective lower esophageal sphincter by esophageal manometry, and absence of severe esophageal and/or gastric motility disorders. RESULTS: Sixty-eight of 70 patients were completed laparoscopically with an intraoperative morbidity rate of 9%. Major postoperative complications occurred in 3 patients (4%) and included deep venous thrombosis (n = 1), delayed gastric leak (n = 1), and trocar site hernia (n = 1). The average hospital stay was 3.0 days, and the average time to return to normal activity was 7.0 days. All patients experienced relief of symptoms of reflux with mean follow-up of 7.7 months. Transient, mild dysphagia was experienced by 37% of patients, and persistent, severe dysphagia by 7%. The mean increase in lower esophageal sphincter pressure was 16.2 mm Hg. The total and intra-abdominal sphincter lengths increased an average of 1.5 and 1.4 cm, respectively. CONCLUSIONS: These preliminary data suggest that laparoscopic Nissen fundoplication can be performed by experienced laparoscopic surgeons with excellent symptomatic and physiologic results and a morbidity rate comparable to conventional open antireflux procedures. Rigid patient selection criteria will help identify the patients most likely to benefit from reconstruction of a mechanically defective lower esophageal sphincter. Adherence to established operative principles for Nissen fundoplication will reduce the incidence of significant postfundoplication symptoms.

Adult↗

PubMed1986

Barrett's ulcer of the esophagus. Previously unrecognized cause of acquired esophagorespiratory fistula.

Acquired fistulas between the esophagus and tracheobronchial tree are usually associated with malignancy of the esophagus, lung, or trachea. Less commonly, fistulas result from trauma or inflammation involving these structures. Untreated fistulas of any cause lead to fatal complications of aspiration. Although the prognosis in cases of malignant fistula is poor, the recognition and surgical management of nonmalignant fistulas may result in cure. An acquired esophagobronchial fistula resulting from a Barrett's ulcer of the esophagus, a previously unreported cause, is described, and the differential diagnosis and treatment of nonmalignant esophagorespiratory fistulas are discussed.

Aged↗

PubMed1985

Endoscopic neodymium-YAG laser palliation of nonresectable esophageal malignancy.

Seven men and five women with nonresectable esophageal carcinoma were treated endoscopically with the neodymium-YAG (yttrium-aluminum-garnet) infrared laser. Before laser fulguration, tumors were dilated directly with metal olive dilators. Before treatment, mean tumor length was 5 cm with luminal occlusion averaging more than 80%. After a mean of 3.3 treatment sessions spanning 18.5 days, all patients had substantial immediate palliation. Continued symptomatic relief was noted during follow-up (mean, 83 days; range, 8 to 206 days).

Adenocarcinoma↗

PubMed1981

Glossopharyngeal neuralgia with syncope secondary to tumor. Treatment and pathophysiology.

A patient with metastatic laryngeal carcinoma had glossopharyngeal neuralgia and syncope due to hypotension and bradycardia. Treatment of bradyarrhythmias failed to prevent hypotension. The administration of carbamazepine failed to prevent pain or syncope in this patient despite previous reports of success. Symptoms did resolve with intracranial section of the glossopharyngeal nerve and the upper two rootlets of the vagus. Plasma catecholamines were studied during a hypotensive episode. The values obtained demonstrated a suppressed sympathetic adrenergic neural response but an intact adrenomedullary response, suggesting that suppression of adrenergic vasoconstriction contributed to episodes of hypotension. The administration of intravenous atropine produced a transient increase in blood pressure suggesting that, in the presence of suppressed adrenergic vasoconstriction, cholinergic vasodilation may have contributed to the hypotension in this patient.

Carbamazepine↗

PubMed1979

ColE1 hybrid plasmids for Escherichia coli genes of glycolysis and the hexose monophosphate shunt.

The Clarke-Carbon clone bank carrying ColE1-Escherichia coli DNA has been screened by conjugation for complementation of glycolysis and hexose monophosphate shunt mutations. Plasmids were identified for phosphofructokinase (pfkA), triose phosphate isomerase (tpi), phosphoglucose isomerase (pgi), glucose-6-phosphate dehydrogenase (zwf), gluconate-6-phosphate dehydrogenase (gnd), enolase (eno), phosphoglycerate kinase (pgk), and fructose-1,6-P2 aldolase (fda). Enzyme levels for the plasmid-carried gene ranged, for the various plasmids, from 4- to 25-fold the normal level.

Conjugation, Genetic↗

PubMedDate not supplied

Malpractice claims in gastrointestinal endoscopy: analysis of an insurance industry data base.

We investigated 610 endoscopy-associated and 486 gastroenterology-associated malpractice claim files of the Physicians Insurers Association of America data-sharing project. We determined the relative malpractice claim risk for each of the major types of endoscopic procedures by comparing claim frequencies with Medicare performance frequencies. Relative malpractice risks were 1.0 for sigmoidoscopy, 1.2 for esophagogastroduodenoscopy, 1.6 for endoscopic retrograde cholangiopancreatography, and 1.7 for colonoscopy. "Improper performance" was alleged in 54% of claims and "diagnosis error" in 24% of claims. Of 121 claim files alleging a diagnostic error, 74 (61%) pertained to missed malignancies, of which 69% were colorectal. Of 147 claims alleging iatrogenic injury, 140 (95%) involved perforation or similar direct injury to the gastrointestinal tract. Problems with consent were alleged in 44% of 158 endoscopy-related claim files alleging additional associated issues.

Databases, Factual↗