Biomedical subjects

S L Raltz

Publications and source records attributed to S L Raltz.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Transpapillary stenting for pancreaticocutaneous fistulas.

Because transpapillary stents have been successfully placed to treat the ductal disruptions associated with pseudocysts, pancreatic ascites and pleural effusions, and pancreaticoenteric fistulas, we reviewed our experience with endoscopically placed prostheses in patients who had persistent pancreaticocutaneous fistulas but an otherwise intact duct. Nine patients who underwent endoscopic transpapillary stent placement for ongoing pancreaticocutaneous fistulas at our institution were retrospectively reviewed. Fistulas were present for a mean (+/-SEM) of 35 +/- 11 days and averaged 225 +/- 55 ml of output daily. Etiology of the fistulas included percutaneous pseudocyst drainage in four patients, pancreatic necrosis in two, complications of pancreatic surgery in two, and perforation of the duct of Santorini at the time of minor sphincterotomy in one. All patients had an otherwise intact duct at the time of endoscopic retrograde cholangiopancreatography. Six patients had transpapillary stents placed that did not bridge the area of leakage and three had prostheses placed across the ductal disruption. Eight of nine fistulas were successfully closed by means of this technique including five within 48 hours. There was one instance of stent migration and one patient developed prosthesis occlusion and an infected pseudocyst, which was treated with stent exchange. Stents were retrieved 10 to 14 days after fistula closure and no patient has had a recurrence at a median follow-up of 3 years. Transpapillary stents appear to effect closure of pancreaticocutaneous fistulas that fail to respond to conventional therapy.

Adult↗

PubMedDate not supplied

Prospective trial using Virtual Vision as distraction technique in patients undergoing gastric laboratory procedures.

To determine whether distraction techniques using Virtual Vision, an audiovisual system integrated into a modified pair of glasses, improves tolerance to routine gastric laboratory procedures, a prospective study of 50 patients was done. Patients were allowed to view/hear a travelogue tape during testing. Patients and registered nurses, who performed the procedure, were asked their interpretation of Virtual Vision as a device that improved patient tolerance, impaired the patient's ability to follow directions, or impaired the nurse's ability to perform the procedure. Patients graded the procedure from 1 (unbearable) to 5 (reasonably comfortable) and were asked whether they would use the device for a repeat procedure. For those who had undergone previous procedures, patients were queried regarding their preference for routine testing or Virtual Vision. Improved tolerance to procedures was noted in 82% of the patients as perceived by nurses and patients. Eighteen percent of the nurses and 8% of the patients thought that the auditory insert and glasses impaired the patient's ability to cooperate with the test, whereas 88% and 86%, respectively, thought that Virtual Vision was a valuable distraction technique. Using an ordinal scale for testing tolerance, patients graded their test at a mean of 3.8 (SD 1.25) and 82% expressed a desire to use the system in conjunction with future testing. Twenty-six of 33 patients (79%) who had undergone previous gastric laboratory testing preferred distraction techniques using Virtual Vision to conventional testing. Distraction techniques using a system such as Virtual Vision have the potential to improve patient tolerance to routine gastric laboratory studies.

Adolescent↗

PubMedDate not supplied

Do age, gender, or tumor location affect outcomes when using metallic stents in the palliative treatment of esophageal carcinoma?

UNLABELLED: Metallic esophageal stents are marketed as easier to insert with fewer placement and subsequent stent-related problems. Accordingly, we retrospectively/prospectively reviewed our experience placing metallic esophageal stents in malignant strictures. METHODS: The research design was a one-group pre- and post-test quasi-experimental design including all patients who underwent metallic stent placement at Virginia Mason Medical Center in Seattle between August 1987 and August 1997. Data included descriptive statistics of patient demographics, pre- and post-dysphagia scores, acute and subacute complications, repeated interventions, and patient survival outcomes. Descriptive statistics, paired t-test assessing pre- and post-dysphagia scores, and 2-way ANOVA were used to analyze the statistical relationship between complications and 1) stent location, 2) patient gender, and 3) patient age. FINDINGS: Seventy-five metallic stents were placed in 63 patients. Improvement in pre- and post-dysphagia scores was statistically significant. Factor analysis was not statistically significant for complications and stent location, complications and gender, and complications and age. CONCLUSIONS: Metallic esophageal stents showed statistically significant improvement for patient dysphagia. Complications of stent placement did not correlate with location of stent, age, or gender.

Age Factors↗

PubMedDate not supplied

Reusable biopsy forceps: a cost-effective measure for the endoscopy suite.

Some healthcare practitioners have recommended the use of disposable medical accessories as standard practice. Advantages of using disposable medical equipment include the potential for infection prevention, convenience, and decreased reprocessing and storage costs. Disadvantages of reusable accessories include the initial cost, "down time" required for repair and, most importantly, the potential for spreading infection. In this study, the investigators provide a cost analysis of reusable biopsy forceps for a 12-month period from April 1993 through March 1994. This prospective, descriptive study evaluated purchase price, number of uses, repair history, and cleaning costs for reusable biopsy forceps used in the endoscopy unit of a large multi-specialty clinic. Results of the study revealed that the reusable biopsy forceps became cost-effective after seven uses.

Biopsy↗