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Biomedical subjects

Robert S. Fisher

Publications and source records attributed to Robert S. Fisher.

6 recordsLinked to original sources
PubMed2004

Treatment of Epiphrenic and Mid-esophageal Diverticula.

Thoracic esophageal diverticula are uncommon. They account for less than 30% of esophageal diverticula. The majority of patients are asymptomatic or have minimal symptoms. About one third of patients present with severe symptoms. Occasionally, pulmonary symptoms can be the sole manifestation of the disease and can be life threatening. Dysphagia, food regurgitation, chest pain, weight loss, and reflux symptoms are the most commonly encountered gastrointestinal symptoms. Malignancy is a rare complication of esophageal diverticula; therefore, patients should be educated regarding this complication. Appropriate diagnostic tests should be arranged promptly if alarming symptoms develop. Esophageal motor disorders are found in the majority of patients and need to be taken into account when planning therapy. Medical and endoscopic therapies have limited roles in treatment. Surgery is the standard of care for patients with pulmonary or incapacitating symptoms related to an epiphrenic diverticulum, and myotomy is the cornerstone of surgery. To ensure complete relief of the obstruction, the myotomy should extend distally at least 1.5 to 2 cm into the stomach and proximally at least to the neck of diverticulum. Adding a nonobstructing entireflux procedure is recommended to prevent the development of gastroesophageal reflux disease. Occasionally, a specific treatment such as a diverticulectomy or diverticulopexy needs to be directed to the diverticulum. Preliminary treatment results from minimally invasive surgery, especially laparoscopy, have been promising. In the future with increased experience, minimally invasive surgery may become the standard of care.

Journal Article↗
PubMed2002

Functional (Nonulcer) Dyspepsia.

Functional (nonulcer) dyspepsia refers to upper abdominal pain or discomfort with or without symptoms of early satiety, nausea, or vomiting with no definable organic cause. The current Rome II criteria help to diagnose functional dyspepsia and avoid misdiagnosis of gastroesophageal reflux disease and irritable bowel syndrome as functional dyspepsia. Assessment of gastric emptying with scintigraphy or breath testing may be useful in identifying delayed gastric emptying in patients with dyspeptic symptoms and may be helpful in patient management. Electrogastrography is a noninvasive test that evaluates for gastric dysrhythmias. Satiety testing is being evaluated as an indirect test for impaired fundic relaxation and visceral hypersensitivity. The symptom response to Helicobacter pylori therapy in patients with functional dyspepsia and a negative endoscopy examination but a positive H. pylori test is marginal. Lifestyle modifications often are suggested for initial treatment of functional dyspepsia. Dietary changes such as frequent small meals, low-fat diet, and avoidance of certain aggravating foods may improve symptoms. Additional measures include cessation of smoking, avoiding excess alcohol intake, and minimizing coffee intake. Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an "on-demand" therapy for intermittent symptoms. They are safe and relatively inexpensive. Different subgroups of functional dyspepsia are based on the predominant symptom and may help in choosing an appropriate drug to initiate therapy. If the predominant symptom is epigastric pain (ulcer-like functional dyspepsia), histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice. If fullness, bloating, early satiety or nausea is the predominant complaint (dysmotility-like functional dyspepsia), a prokinetic agent may help. Metoclopramide is the only available effective prokinetic agent at present. If metoclopramide is used, short-term treatment and discussion of possible side effects with the patient are advised. If there is no response to these initial treatments, switching therapy from proton pump inhibitor to prokinetic or vice versa can be tried. If these treatment options fail, patient re-evaluation for other disorders (including other functional bowel disorders) is advised. A low-dose tricyclic antidepressant at bedtime may be helpful for treatment of visceral hypersensitivity.

Journal Article↗
PubMed2002

Psychological factors in the genesis and management of nonepileptic seizures: clinical observations.

Nonepileptic seizures (NES) are frequently thought to have a "psychogenic" basis. Two 6-month group psychotherapy programs were provided for patients diagnosed as having NES [eight patients were treated during the first program, seven during the second (N=15)] to explore the potential role of psychological factors in the genesis of NES and to determine if psychotherapeutic interventions reduced the frequency of NES. Of the 15 patients, 9 (60%) completed at least 58% of the treatment sessions. Of those 9 patients, 6 (66%) reported a decline in "seizure frequency." One reported an increase (11%). Self-reported frequency highly correlated with paranoid ideation. Dissociative phenomena were common as was a history of sexual abuse. Each patient reported being in an adult situation that they found unacceptable or intolerable. None perceived a solution to their situation. Reports by health care providers that their seizures were not "real" (i.e., true epilepsy) restimulated feelings associated with their not being believed when they reported being sexually abused as children. The psychological genesis of NES in this sample of patients appears rooted in the recurrent experience of being in abusive or exploited relationships for which they perceived no solution.

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PubMed2000

Epilepsy from the Patient's Perspective: Review of Results of a Community-Based Survey.

A total of 1023 individuals with epilepsy responded to a community-based questionnaire survey. Relative to U.S. population norms, respondents had lower household incomes and lesser levels of educational and vocational attainment. Although 89% of respondents reported that their seizures were, in their estimation, at least somewhat controlled, 57% reported having suffered at least one seizure in the preceding year. Of the many concerns that accompanied life with epilepsy, fear (of a seizure, of embarrassment, even of death) was the issue most frequently reported. Eighty-eight percent of respondents reported having health insurance, and this insurance covered epilepsy treatment in 93% of cases. The majority of respondents said that they were satisfied with the medical care they were receiving but wished for more information about epilepsy. Despite advances in epilepsy therapy, freedom from seizures and optimal quality of life eludes many.

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