Survey of graduates of a physician assistant internship concerning practice characteristics and adequacy of training.
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Employment↗
Biomedical subjects
R J Doerr
Publications and source records attributed to R J Doerr.
Colonoscopic impaction in left colon strictures resulting in right colon pneumatic perforation.
Colonic perforation during flexible colonoscopy is a rare but recognized complication. We reviewed 4,593 colonoscopies performed from 1984 to 1989. The perforation rate for diagnostic colonoscopy was 0.17% (6/3,538) and for therapeutic colonoscopy it was 2% (21/1,055). Four perforations of the right colon occurred at a site proximal to the level of the impacted colonoscope. The lesions being evaluated were obstructive in nature: two diverticular strictures (sigmoid colon), one ischemic stricture (descending colon), and one annular carcinoma (descending colon). The four perforations occurred in the right colon and manifested as distension with pneumoperitoneum or retroperitoneal emphysema. Operative management included total abdominal colectomy in two patients (ileoproctostomy in one and ileostomy in one) and right colectomy in two. Outcome was favorable in all cases.
Aged↗
Immunoscintigraphy in colorectal cancer: surgeon's perspective.
External immunoscintigraphy (IS) is a new imaging tool to diagnose, stage and follow-up solid malignancies. Monoclonal antibodies are raised to tumor-associated antigens, radiolabeled and when injected in the patient localize to the tumor. Detection is with nuclear medicine gamma camera. In colorectal cancer, immunoscintigraphy can be beneficial to the surgeon. With primary colorectal carcinoma, IS detects synchronous primaries, identifies lymph node metastasis, determines extent of disease and detects occult metastasis. Postoperatively, in high-risk patients (Dukes B2, B3 and C lesions) IS assists in the follow-up for recurrence. Particular advantage with IS is seen in pelvic, mesenteric and retroperitoneal recurrences. Rising serum CEA and negative conventional cross-sectional imaging can often be clarified as to site of disease with IS. IS contributes significantly to surgical decision making with alterations in management based on radiolabeled monoclonal antibody scans in 25-32% of primary and recurrent colorectal cancer cases.
Adenocarcinoma↗