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Biomedical subjects

R R Klingman

Publications and source records attributed to R R Klingman.

9 recordsLinked to original sources
PubMed1992

Physiologic assessment and surgical management of diffuse esophageal spasm.

The physiologic abnormalities and management of patients with diffuse esophageal spasm are controversial. We evaluated the symptomatic and functional results of surgical therapy in 19 patients with diffuse esophageal spasm who were incapacitated with dysphagia and chest pain and unresponsive to conservative management. A long esophageal myotomy with an antireflux procedure was performed in 15 patients, and four patients with multiple previous esophageal procedures had an esophagectomy. Eleven patients had increased esophageal exposure to gastric juice on preoperative 24-hour esophageal pH monitoring. The severity of dysphagia, chest pain, regurgitation, and heartburn was scored on a scale of 0 to 3 before and a mean of 24 months (range 8 months to 13 years) after the operation. After myotomy, each of these symptoms and the overall symptom score improved significantly (p < 0.01). The improvement in the symptom scores in the patients who had esophagectomy were comparable with the improvement after myotomy. On self-assessment, 90% of the patients would have the operation again if again faced with the decision. Standard and ambulatory 24-hour manometry showed a significant reduction in the amplitude of the esophageal body contractions, a decrease in the frequency of simultaneous contractions, and the elimination of multi-peaked waves after the myotomy. Despite the addition of an antireflux procedure, lower esophageal sphincter pressure, overall length, and abdominal length were reduced markedly after the myotomy. This was associated with persistent or emerging heartburn or regurgitation in four patients. These data indicate that a long esophageal myotomy is a valid treatment alternative in appropriately selected patients with diffuse esophageal spasm. Esophagectomy and colon interposition is the procedure of choice in patients with multiple previously failed myotomies.

Esophageal Spasm, Diffuse↗
PubMed1991

Cystic and bullous lung disease.

One of the most difficult problems facing clinicians is the evaluation and management of patients with dyspnea whose chest roentgenogram shows single or multiple large cystic spaces. This is made more difficult when underlying lung disease is present. The dilemma focuses on whether the obliteration or removal of the cystic areas will benefit or cause further deterioration of the patient's condition. The pathophysiology of the problem is not completely understood, but accumulated clinical experience has shown that surgical therapy can be beneficial but requires proper patient selection.

Humans↗
PubMed1991

Traumatic hemipelvectomy.

Traumatic hemipelvectomy is an uncommon and devastating injury with few patients alive when they reach the hospital. There are only 19 reported survivors of this injury. This group includes 17 males and 2 females. All had severe, associated injuries. The mechanism of injury involved motorcycle, automobile, pedestrian/motor vehicle, or heavy machinery accidents. All surviving patients are young (10-34 years of age). Most suffered from a variety of postoperative complications. Two interesting patients with traumatic hemipelvectomy are reported. One involves a new mechanism of injury, the propellor of a motorboat. The management of these 2 patients is explained, the experience of others with similar injuries is reviewed, and the benefit of reconstruction with the gluteus myocutaneous flap is discussed.

Adult↗
PubMed1991

Extension of renal cell carcinoma into the vena cava with concomitant coronary artery disease: surgical considerations.

Surgical removal of renal cell carcinoma with extension into the inferior vena cava can be a difficult operation. Cardiopulmonary bypass and circulatory arrest have been used to assist in resection of tumors that extend into the vena cava above the level of the hepatic veins. Coronary artery disease is a common problem and may present together with renal cell tumors. A patient with left main coronary artery disease and a renal cell carcinoma extending into the vena cava provides a management challenge. We present such a case and discuss the surgical options.

Aged↗
PubMed1991

Ambulatory 24-hour esophageal manometry in the evaluation of esophageal motor disorders and noncardiac chest pain.

Standard manometry is currently considered the gold standard for the classification of esophageal motor disorders. We compared the new technique of ambulatory 24-hour esophageal motility monitoring to standard manometry in 108 patients thought to have a primary esophageal motor disorder, assessed the esophageal motor pattern associated with spontaneous noncardiac chest pain, and studied the effect of long esophageal myotomy on circadian esophageal motor function. Standard manometry was found to frequently overestimate and underestimate the severity of esophageal motor abnormalities as compared to 24-hour monitoring. Ambulatory manometry showed a direct correlation of abnormal esophageal motor activity with episodes of noncardiac chest pain in 13 of 26 patients who experienced the symptom during the monitoring period. The abnormal motor activity immediately preceding the pain episodes in these patients was characterized by an increased frequency of simultaneous, double and triple-peaked, high amplitude, and long duration contractions (p less than 0.01). Long esophageal myotomy markedly reduced or eliminated the ability of the esophagus to produce these abnormal contractions (p less than 0.01). These data suggest that ambulatory esophageal motility monitoring allows more precise classification of esophageal motor disorders than standard manometry and identifies abnormal esophageal motor activity associated with noncardiac chest pain that can be abated by long esophageal myotomy.

Adult↗
PubMed1990

Surgical approach to non-small cell lung cancer stage I and II.

No patient with a potentially curable lung cancer should be denied the opportunity for a curative resection. Solitary pulmonary nodules should be approached as though they were malignant until proven otherwise, either by definitive histologic or extremely convincing circumstantial clinical evidence. Consequently, thoracotomy should be performed, assuming that the patient is physiologically able, if cancer cannot be definitely excluded. The evaluation of patients with synchronous lung nodules is complex owing to the possible causes of the two nodules but should be pursued because of its important effect on therapeutic outcome. The major factor influencing survival is the extent of the tumor at the time of resection. When metastatic lymph nodes are found at the time of surgery, regardless of the location, the survival rate is significantly lower. Lobectomy for patients with stage I disease is usually sufficient treatment, but when the tumor is large (exceeding 4 cm) or centrally located or when hilar lymph nodes are involved, a pneumonectomy must be considered in order to eradicate local disease. Those patients with N1 disease can obtain improved survival when resection is combined with adjuvant radiation and chemotherapy.

Biopsy↗