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Biomedical subjects

T R Schrock

Publications and source records attributed to T R Schrock.

At least 19 recordsLinked to original sources
PubMed1992

The efficacy and limitations of percutaneous endoscopic gastrostomy.

We analyzed 64 percutaneous endoscopic gastrostomy procedures performed by us between 1986 and 1990. Thirty patients had neurologic disease; 16 had head and neck cancers; eight had other malignancies; two had acquired immunodeficiency syndrome; and eight had other problems. Seven patients died within 30 days of complications (n = 4) or the primary illness (n = 3). Mean follow-up was 6 months; an additional patient died of aspiration and eight others died of their underlying illness. There were 19 complications (32%). Four wound complications occurred. Nine patients developed aspiration pneumonia within 3 days of the procedure, four of whom died in the hospital. Of the 24 patients with a history of aspiration, nine experienced aspiration during or after percutaneous endoscopic gastrostomy. Patients with a history of aspiration were more likely to have perioperative aspiration pneumonia, and patients who experienced aspiration were more likely to die.

Adult↗
PubMed1989

Colonoscopic diagnosis and treatment of lower gastrointestinal bleeding.

Methods of diagnosis and treatment of lower gastrointestinal bleeding depend on the rate of bleeding and the amount of blood lost. If bleeding is occult, colonoscopy is the single best way to determine the source, if bleeding is gross but mild, causing melena or small amounts of hematochezia, colonoscopy or a combination of flexible sigmoidoscopy and double-contrast barium enema should be used to evaluate the colon. In most patients with melena, the upper tract must be examined endoscopically. Acute lower gastrointestinal bleeding stops spontaneously in 75 to 90 per cent of patients, permitting preparation of the colon before colonoscopy. If bleeding is continuing, diagnostic options include colonoscopy with no preparation of the colon, relying on the cathartic effect of blood, or a red cell radionuclide scan followed by angiography if the scan is positive. A bleeding lesion seen on angiography is usually treated by infusion of vasopressin. Colonoscopic treatment of a bleeding site uses the BICAP probe, heater probe, or argon laser. Patients who bleed severely and those who do not respond to treatment or rebleed after treatment are candidates for operation. Segmental resection is preferred if the bleeding site is known. If not, total colectomy with ileorectal anastomosis may be necessary. A mortality rate of 10 to 15 per cent in patients with severe bleeding reflects the advanced age of many of these patients and the difficulty of managing gastrointestinal bleeding in the presence of associated medical conditions.

Acute Disease↗
PubMed1988

Conceptual developments through colonoscopy.

Fiberoptic colonoscopy is 25 years old this year. Improvement in instruments led rapidly to wide acceptance of colonoscopy in diagnosis and therapy of colorectal diseases. The diagnosis of benign and malignant neoplasms was revolutionized by colonoscopy. The differential diagnosis of inflammatory bowel disease, assessment of its extent and severity, response to treatment, and potential for development of cancer are all made easier by colonoscopy. Colonoscopy has improved the diagnosis of diverticular disease, rectal bleeding, identification of ischemia, and other problems. Therapeutic colonoscopy has radically changed the management of colonic polyps, and colonoscopic polypectomy is now the standard form of treatment for most of these lesions. Treatment of bleeding lesions, decompression of obstruction, and removal of foreign bodies are other examples of therapeutic colonoscopic procedures.

Colonic Diseases↗
PubMed1979

Complications of continent ileostomy.

Immediate postoperative complications occurred in 15 per cent of 39 patients undergoing continent ileostomy, and late complications developed in 46 per cent of these patients. Age over 40 years, obesity, and Crohn's disease were related to the morbidity rate, but corticosteroid therapy was not a factor. Results of primary operations were superior to those of secondary continent ileostomies. With careful selection of patients and attention to technical detail, success in 90 per cent of initial continent ileostomy operations is a realistic goal.

Adolescent↗
PubMed1978

Total gastrectomy.

Total gastrectomy is indicated principally for Zollinger-Ellison syndrome and for potentially curable gastric cancer. The diagnosis of cancer should be verified by biopsy before the resection is performed, and the margins of resection should usually be examined by frozen section. Of the various reconstructions, Roux-en-Y esophagojejunostomy gave the best long-term results.

Adult↗
PubMed1978

Radiologic evaluation of the continent (Kock) ileostomy.

The continent ileostomy is a solution to the persistent difficulties of leakage, odor, and skin irritation produced by the conventional permanent ileostomy in patients who have had proctocolectomy. Patients with continent ileostomy do not use ileostomy appliances, have complete fecal continence, and need empty the ileal reservoir only 2 to 4 times a day. Radiographic examination is often of great value in assessing patients with continent ileostomy. Radiographic features of the normal continent ileostomy and complications of continent ileostomy are discussed with regard to plain film and contrast examinations.

Humans↗