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Biomedical subjects

R E Hermann

Publications and source records attributed to R E Hermann.

At least 19 recordsLinked to original sources
PubMed1991

Role of radiation after operative palliation in cancer of the proximal bile ducts.

Cancer of the proximal bile ducts continues to pose a formidable problem to even the most experienced biliary surgeon. From 1977 through 1985, 51 patients with histologically confirmed proximal bile duct cancers underwent surgical treatment. The lesion was confined to the hilar region in 30 patients; there was extensive hepatic infiltration or distant metastatic disease in 21 patients. One patient underwent resection. Biopsy only was performed in six patients. In the remaining 44 patients, transtumoral dilation and intubation were performed. These 44 patients were further analyzed with regard to how survival was affected by the presence of metastatic disease and by the adjunctive use of radiation therapy. Mean survival in those patients with metastatic disease (n = 16) was 6.1 months, and survival was not improved by the use of postoperative radiation. In the absence of metastatic or advanced local disease, however, the addition of external beam radiation did significantly extend the mean survival from 4.5 to 12.2 months and the median survival from 2.2 to 12.2 months. The operative mortality for the series was 14% and postoperative complications occurred in 18 patients. These findings suggest that the addition of external beam radiation improves survival in patients undergoing palliative treatment of hilar tumors. Further confirmation of the value of radiation awaits prospective investigation.

Adenocarcinoma↗
PubMed1991

Indications for gastric bypass in palliative operations for pancreatic carcinoma.

This review was undertaken to determine whether there are specific factors which predict the development of gastric outlet obstruction (GOO) in patients with pancreatic carcinoma. One hundred forty-two patients with biopsy proven pancreatic carcinoma had palliative operations of whom 74 had gastric bypass (GB). Of the 68 who did not, four died after biliary bypass. The 64 patients who remained at risk for GOO are the subject of this report. Seven of those patients developed GOO in the postoperative period and were compared with the 57 who did not. No significant difference was found between the two groups when they were compared on the basis of 20 historic, laboratory, and operative finding criteria. These data indicate that accurate prediction of subsequent GOO is not possible based on available objective data. Because GB creation does not increase operative blood loss, operative time, postoperative stay, or postoperative morbidity, and because prediction of need is difficult, prophylactic GB should be applied very liberally.

Adenocarcinoma↗
PubMed1990

Palliative operations for pancreatic carcinoma.

Controversies in palliation of pancreatic carcinoma include the best biliary bypass, the best gastric by-pass, and how routinely gastric bypass should be used. We reviewed the records of 142 patients who underwent palliative operations for pancreatic carcinoma at the Cleveland Clinic over a 5-year period. Direct choledochal-enteric anastomosis proved superior to cholecystojejunostomy because of the high incidence of postoperative biliary sepsis and obstruction with the latter. The lowest incidence of these complications was achieved with choledochoduodenostomy. Loop gastrojejunostomy and Roux-Y gastrojejunostomy resulted in similar complication rates and postoperative stays, but, because loop reconstruction was simpler, it was deemed superior. Blood loss, operative time, and hospital stay were similar in patients with loop gastrojejunostomy and patients with no gastric bypass. This finding, coupled with a 10% incidence of subsequent gastric outlet obstruction in those without gastric bypass, indicates that gastric bypass should be liberally applied in the palliation of pancreatic carcinoma.

Adenocarcinoma↗
PubMed1979

Nucleation time: a key factor in the pathogenesis of cholesterol gallstone disease.

In earlier studies, we concluded that biliary cholesterol supersaturation may be a necessary but not sufficient cause for gallstone formation. In the present studies, we calculated cholesterol saturation indices (CSI) for 120 bile specimens of cholesterol gallstone patients and controls, using the solubility boundaries of Carey and Small (J Clin Invest 61:998-1026, 1978) for artificial biles. The mean CSI + SD was 1.42 +/- 0.68 for controls and 1.80 +/- 1.02 for cholesterol gallstone patients. Of the control bile samples, 68% were supersaturated. Since the two groups could not be sharply distinguished by saturation index, we studied another property of bile samples: nucleation time for cholesterol crystal formation. The mean nucleation time for 16 control bile samples was 15 days, and a strong correlation (r = 0.84) was found between CSI and nucleation time. Twelve bile samples of cholesterol gallstone patients had a mean nucleation time of 3 days and no correlation between CSI and nucleation time. A discriminant analysis of the data, which took into account both the CSI and the nucleation time for each sample, allowed a sharp distinction between bile samples of cholesterol gallstone patients and controls. This distinction could not have been drawn from studies with artificial biles, since these differ only in their CSI.

Bile↗
PubMed1978

Modified radical mastectomy.

The recent history of operations for breast cancer indicates a growing trend toward conservatism. The modified radical mastectomy achieves the goal of removing all evidence of cancer in the breast involved and removes the regional lymph nodes for accurate staging of the disease. In addition, it provides a cosmetic result superior to that of the standard radical mastectomy. Breast reconstruction may be undertaken at a later time with excellent result. The 5 and 10 year survival rates of comparable groups of patients after modified radical mastectomy and standard radical mastectomy appear to be almost identical.

Biopsy↗
PubMed1977

Surgery for duodenal ulcer. A study relating indications to the results of surgery.

The present study correlates the indications for operation in 215 patients with duodenal ulcer disease with the results of operative management. The majority of patients had conservative surgery utilizing truncal vagotomy and pyloroplasty or gastrojejunostomy. None of the 194 patients operated on electively died and four patients died after emergency operations, for an overall operative mortality in the entire series of 1.8 per cent. The incidence of recurrent ulcer symptoms in all patients was 10 per cent. We could demonstrate only a modest correlation between indications for operation and long-term results of conservative surgical management; the indication for surgery, whether that of chronic (intractability, stenosis) or more acute (hemorrhage, perforation) ulcer disease is only moderately reliable as a predictor of long-term results. In this series of patients, those with obstructing duodenal ulcers (pyloric stenosis) had the best long-term results after conservative surgical management.

Adolescent↗
PubMed1977

Ligation procedures in the management of portal hypertension.

In the 10 year period from 1964 through 1973, 25 patients bleeding from esophageal varices underwent ligation procedures coupled with splenectomy rather than a shunt. These procedures included the transesophageal and transgastric approaches and extragastric ligations. For patients with normal liver function, the risk of this urgent or emergency surgery is comparatively low (two of 12 patients died). The chance of recurrent hemorrhage is high (nine of nine surviving patients), as is the need for subsequent surgery (eight of nine patients). Nevertheless, despite these drawbacks, nine of these 12 patients (75 percent) are alive, and seven have survived 5 or more years. In patients with cirrhosis, the initial operative mortality rate (three of 12 patients) and the subsequent mortality rate (five additional patients) reflect the greater risk because of liver disease. Only five of 13 patients (38 percent) survive, three of whom are alive 5 or more years. In patients with cirrhosis, the initial operative mortality rate (three of 12 patients) and the subsequent mortality rate (five additional patients) reflect the greater risk because of liver disease. Only five of 13 patients (38 percent) survive, three of whom are alive 5 or more years after their initial surgery. These results indicate that there are situations when ligation procedures are valuable, especially in the noncirrhotic patient.

Adult↗
PubMed1976

Obstructing duodenal ulcer.

The incidence, pathogenesis, symptoms, roentgenographic, and endoscopic findings of patients with gastric outlet obstruction from a chronic duodenal ulcer have been reviewed. In the experience of many surgeons, including myself, vagotomy and an adequate drainage procedure (Finney pyloroplasty, gastrojejunostomy, or gastroduodenostomy) provide excellent decompression of the obstructed stomach. as well as excellent control of the ulcer disease in most patients. Postvagotomy gastric atony has not been a problem.

Duodenal Obstruction↗
PubMed1976

Intraluminal duodenal diverticulum associated with trisomy 21.

An intraluminal duodenal diverticulum is an uncommon congenital abnormality that may produce intermittent ostruction. The true pathogenesis of this lesion is still disputed, but it probably results from ballooning of a congenital web or diaphragm with prolonged peristalsis. An intraluminal "wind sock"-like structure filed with barium and surrounded by a radiolucent halo is the classic and diagnostic radiologic appearance. An association with trisomy 21 is made.

Adolescent↗
PubMed1976

Preoperative localization of occult lesions of the breast.

An outpatient procedure that accurately localizes occult lesions of the breast has been used in 26 patients. A small biopsy is performed using local anesthesia, the excised specimen is xerographed and, if necessary, bread-loafed to identify the involved specimen. This has corroborated the xeromammographic diagnosis of cancer in six patients in whom the lesions were clinically not detectable.

Biopsy↗