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Biomedical subjects

R D Henderson

Publications and source records attributed to R D Henderson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Reflux control following gastric surgery.

Reflux is a common complication in patients who have undergone gastric surgery. These patients have bile reflux, often associated with gastric disease, and are resistant to conservative management. In this study the authors have reviewed 124 patients who were treated surgically for reflux that occurred after gastric operations. They were assessed preoperatively by history, radiologic investigation, manometry with pH and endoscopy. Seventeen patients were treated by Belsey hernia repair, 42 by partial fundoplication gastroplasty and 65 by total fundoplication gastroplasty. Thirty-seven patients required additional gastric surgery. Continued reflux was the commonest problem postoperatively; it was effectively corrected by total fundoplication gastroplasty. Of eight patients who had persistent bile gastritis, four had had bile drainage as part of their operation for reflux. From this study the authors conclude that total fundoplication gastroplasty is the most effective procedure to control reflux, but it must be carefully tailored to avoid overcompetence and dysphagia. Associated gastric problems should be treated simultaneously.

Adult↗
PubMed1984

Dysphagia complicating hiatal hernia repair.

Dysphagia may be a continuing or added problem after operations for the control of reflux. In a series of 208 patients treated surgically for recurrent hiatal hernia, 34 (16.3%) presented with dominant dysphagia either caused by or aggravated by the operation. They were evaluated by history, radiology, manometry, and endoscopy. The causes of dysphagia were diagnosed in all patients: reflux stricture in nine patients, tight or long Nissen wrap in 15, muscle injury in three, inappropriate myotomy with reflux in three, myotomy with overcompetent repair in two, and early Nissen intussusception in two patients. Surgical correction was by total fundoplication gastroplasty in 32 patients, Nissen repair in one, and colon interposition in one. In four patients the myotomy was closed. Complete follow-up averages 5.4 years. There has been one anatomic recurrence, 28 patients are asymptomatic, and five are much improved but have minor persistent dysphagia. Only by complete investigation can the cause of dysphagia be recognized and treated.

Adolescent↗
PubMed1983

Management of the patient with benign esophageal stricture.

Benign esophageal strictures are a diagnostic and therapeutic challenge. If the investigation is carefully performed, the etiologic factors can almost always be clearly established. At all times, the possibility of malignant disease must be considered. With an appropriate combination of medical management, bougienage, or surgery, almost all patients can be effectively treated.

Colon↗
PubMed1983

Ultrastructure of the esophageal muscle in achalasia and diffuse esophageal spasm.

The pathogenesis of dysphagia in achalasia and diffuse esophageal spasm (DES) is not understood completely, and the primary site of damage in these two entities is not known. This project was undertaken to study the ultrastructural changes present in the muscular wall of the esophagus in eight patients with achalasia and nine patients with DES, compared with seven controls. The ultrastructural alterations in the smooth muscle of all patients were neither pronounced nor consistent. However, nonspecific changes, including filament disarray, mottling of the fiber density in myocytes, thick and long cytoplasmic dense bodies, long dense plaques, and few nexus junctions were seen in both achalasia and DES. In addition, the smooth muscle cells in achalasia exhibited nuclear and cytoplasmic inclusions. Statistical analysis of the number of muscle cells per unit area suggested that the gross thickening of the muscular wall of the esophagus in cases of DES is because of hyperplasia and not hypertrophy of muscle cells. A striking change seen in achalasia esophagi and a few cases of DES, as compared to the controls, was the marked loss of small nerve fibers and the paucity of granules in the remaining fibers. This study points to a neurogenic pathogenesis for dysphagia in achalasia with secondary nonspecific changes in the smooth muscle in these two diseases. No nerve abnormalities were noticed in DES.

Adult↗
PubMed1983

Total fundoplication gastroplasty. Long-term follow-up in 500 patients.

Total fundoplication gastroplasty was designed to combine the low anatomic recurrence rate of gastroplasty with the effectiveness of reflux control obtained by total wrap. The problems requiring evaluation are anatomic recurrence, continued reflux, dysphagia, inability to belch or vomit, and gas bloat, all of which have been described in procedures employing a total wrap. Five hundred consecutive patients were analyzed 6 to 60 months following operation. There were no deaths and a 3.6% incidence of short-term operative morbidity. Follow-up was available clinically in 98.4% (495 patients), radiologically in 89.6% (448), and manometrically in 69.5% (347). Two patients have anatomic recurrence (0.4%) and none has reflux. Excellent results occurred in 93.4% (467), improvement in 5% (25), and poor results in 1.6% (eight). Repeat operation was necessary in 0.4% (two) for recurrence and in 0.8% (four) for severe dysphagia. The other problems were minor dysphagia in 2.2% (11), gastritis in 1.2% (six), late cholelithiasis in 0.4% (two), and continued pain with poor results in 0.4% (two). The length of the gastroplasty tube and the subdiaphragmatic position of the high-pressure zone (HPZ) did not affect the result of the operation. A long tube and unwrapped supradiaphragmatic HPZ was present in 18.8% (94); none had reflux or major dysphagia. Total length of the gastroplasty wrap was 3 to 4 cm in the first 200 and the incidence of major dysphagia was 5% (10). Reducing the length of fundoplication to 1.5 to 2 cm reduced the incidence of dysphagia to 1.7% (five). Other problems of gastritis and difficulty with belching and vomiting occurred in a random fashion. This procedure is effective in reflux control, prevents anatomic recurrence and, if the completed fundoplication is maintained at 1.5 to 2 cm, yields a low incidence of significant dysphagia.

Aphasia↗
PubMed1982

Reflux control following myotomy in diffuse esophageal spasm.

Sixty-five patients with diffuse esophageal spasm (DES) were investigated by history, radiology, manometry, and endoscopy prior to surgical management. At operation they underwent extended myotomy to the apex of the chest, including the high-pressure zone; in addition, all had hiatal hernia repair. Four types of repair were used: the Belsey procedure, partial fundoplication gastroplasty, total fundoplication gastroplasty, and the Nissen procedure. With the Belsey or the partial fundoplication, there was a high incidence of continued reflux. With the total fundoplication procedure, there was no reflux; however, 6 patients had minor dysphagia and 1 had major dysphagia. With myotomy and a standard Nissen fundoplication, 13 patients were asymptomatic and 2 had minor dysphagia; none had major residual symptoms.

Adolescent↗
PubMed1981

Characteristics of esophageal pain.

Esophageal pain was investigated in 200 consecutive patients prior to surgical correction of reflux. the pain has been analyzed to determine its characteristic and its atypical features. Arm distribution of pain and exercise induced pain were the most a typical features and led to diagnostic difficulty. Although acid perfusion studies reproduced some component of the pain in 94% of patients, reproduction of arm pain was possible in only 37.2% of those with this symptom. The importance of cardiologic evaluation in patients with atypical esophageal pain is emphasized.

Diagnosis, Differential↗
PubMed1981

Recurrent hiatal hernia: management by thoracoabdominal total fundoplication gastroplasty.

Recurrent hiatal hernia presents a difficult diagnostic and therapeutic challenge. The authors present a series of 121 patients in whom recurrent hiatal hernia was investigated by history, radiology, endoscopy and manometry and acid perfusion testing before surgical correction by thoracoabdominal total fundoplication gastroplasty. The preoperative findings were compared with those of 238 patients who had undergone primary repair. Roentgenography was found to be less accurate in the diagnosis of anatomic recurrence than of the original hernia. Manometry and endoscopy increased the diagnostic accuracy of recurrent hernia. The thoracoabdominal approach was used to allow direct vision dissection both above and below the diaphragm. Gastroplasty minimized the risk of anatomic recurrence and allowed reflux control even in patients with an irreducible hiatal hernia. Total fundoplication, added to gastroplasty, is the most effective method of preventing reflux. There were no anatomic recurrences and no evidence of reflux in the 121 patients who had secondary repair. Two patients have required further surgery to modify the total fundoplication gastroplasty. With a 96.7% follow-up, 94.2% of the patients are considered to have excellent results.

Abdomen↗
PubMed1980

Nemaline rods in cricopharyngeal dysphagia.

Cricopharyngeal dysphagia, a disorder of uncertain pathogenesis, is most frequently found in patients with associated gastroesophageal reflux. Seven patients who had dominant cricopharyngeal dysphagia were evaluated. Manometry showed characteristic motor incoordination. Biochemical profiles and endoscopy were normal. Electronmicroscopic examination of the cricopharyngeal muscle biopsy specimens obtained during myotomy showed significant ultrastructural abnormalities. These included numerous and aberrant mitochondria, increased glycogen, lipid inclusions, and phagolysozomes. A striking finding was the presence of numerous nemaline rods in five of seven biopsy specimens examined. The pathologic changes in this muscle in cryopharyngeal dysphagia have not been reported previously. Structural changes are thought to be a secondary response to reflux injury. Nemaline rods form part of the structural abnormality of muscle in patients who have cricopharyngeal dysphasia with no evidence of underlying generalized disease or myopathy.

Aged↗
PubMed1980

The gastroplasty tube and its role in reflux control: an experimental and clinical study.

The gastroplasty tube has been used in the control of reflux since it was originally described by Collis in 1961. Several variations of the procedure have been reported indicating a low frequency of anatomic recurrence but a high frequency of reflux. Two forms of gastroplasty procedure are used: partial fundoplication in which gastric fundus incompletely wraps the gastroplasty and high pressure zone, and total fundoplication in which a circumferential wrap is constructed. The authors conducted a clinical review, using the patient's history, radiology and manometry, of 135 patients with partial fundoplication gastroplasty (PFG) and 250 patients with total fundoplication gastroplasty (TFG). In both groups the anatomic recurrence rate was low; however, with PFG the frequency of reflux was 44.6% and 25.7% of patients had notable symptoms. With TFG no patient had reflux. The response of the gastroplasty tube to meal-induced gastrin release and to neurogenic stimulation was tested. Basal tube pressure was low and showed no response to gastrin release and no augmented neurogenic response. It was concluded that the gastroplasty tube did not have intrinsic properties of value in controlling reflux and that reflux control depended upon the method of fundoplication. The role of the gastroplasty tube is in preventing anatomic recurrence.

Eating↗
PubMed1980

Further manifestations of Behçet's syndrome.

Behçet originally described a syndrome of iritis and anal and vaginal ulcerations. Many other manifestations of this disease have since been added, including rarely esophageal and bronchial ulceration. The authors report the case of a 65-year-old woman who had a 40-year history of oral and genital ulcers associated with arthritis, thrombosis of the left subclavian artery, asthma and esophageal ulceration. Her esophageal and respiratory symptoms were dominant. In the esophagus, despite effective control of reflux, she continues to have ulceration and secondary stricture requiring intermittent dilatation. When the stricture is tight, aspiration of food occurs, aggravating her asthma. The radiologic, endoscopic and manometric features of her esophageal disorder are described.

Aged↗
PubMed1979

Nissen hiatal hernia repair: problems of recurrence and continued symptoms.

The standard Nissen operation is the most effective method of reflux control. However, the procedure can result in continuance of symptoms, particularly dysphagia, which presents considerable diagnostic difficulty. Experience gained in the management of 17 patients with continued recurrent symptoms following standard Nissen repair has allowed more specific definition of the nature of these problems. The anatomical defect has been categorized as follows: (1) tight repair (tight fundoplication or tight diaphragmatic repair); (2) anatomical recurrence with and without reflux; and (3) intussusception recurrence. Each patient has been evaluated by history, manometry, pH reflux, acid perfusion, radiology, and endoscopy. At the time of corrective operation, the previous repair was carefully dissected to allow confirmation of the type of defect. Correlation is made between symptoms, investigative findings, and the anatomical problem at operation.

Adult↗
PubMed1978

Gastroesophageal reflux following gastric operation.

The combination of previous gastric operation and gastroesophageal reflux produces major difficulties in obtaining effective symptomatic relief. Seventy patients were studied by history, radiology, endoscopy, and esophageal manometry before surgical reflux control. Twenty-eight had had vagotomy and pyloroplasty; 4, vagotomy and gastroenterostomy; 11, Billroth I gastrectomy; and 27, Billroth II gastrectomy. In all patients reflux control was accomplished by hernia repair, and in 14 patients bile diversion was added for control of bile gastritis. A variety of reflux control operations were used. However, the most effective results were achieved with total fundoplication gastroplasty, and in this group of 22 patients there has been no anatomical recurrence and no reflux. The partial fundoplication gastroplasty (Belsey type) was ineffective in reflux control and should not be used in patients who have had a previous gastric procedure. Reflux control and, when necessary, bile diversion give effective relief to patients with bile gastritis and esophageal reflux following gastric operation.

Evaluation Studies as Topic↗
PubMed1978

The gastroplasty tube as a method of reflux control.

Follow-up of 135 patients who underwent Belsey gastroplasty because of intractable reflux demonstrated that 44% had continued reflux and 25% had symptoms of reflux that were serious, despite a very low rate of anatomic recurrence. Most of the patients with symptomatic reflux had major preexisting esophageal pathologic conditions related to previous surgery, esophageal ulceration, stricture, or scleroderma. In this group Belsey gastroplasty was not an effective method of reflux control. Total fundoplication gastroplasty (TFG) in 100 consecutive patients has so far had the same low rate of anatomic recurrence, most likely related to the gastroplasty tube; however, longer follow-up is necessary to confirm this fact. TFG is effective in controlling reflux; none of the 100 patients so treated had clinical or radiologic evidence of reflux on follow-up examination.

Follow-Up Studies↗