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Biomedical subjects

T R Viggiano

Publications and source records attributed to T R Viggiano.

At least 19 recordsLinked to original sources
PubMed2006

Black esophagus: report of six cases and review of the literature, 1963-2003.

Black esophagus is the uncommon endoscopic finding of extensive black discoloration of the esophageal mucosa, usually from acute esophageal necrosis. Six cases of black esophagus were seen at Mayo Clinic (Rochester, Minnesota, USA) from 1997 through 2003, and 46 cases were reported in the English-language literature from 1963 through 2003. We studied the demographics, clinical features, and outcomes of these 52 cases of black esophagus. Age and sex were known for 50 patients: the mean (SD) age was 65 years (19), and 42 patients (84%) were men. Symptoms were known for 51 patients: the most common symptom was upper gastrointestinal tract bleeding, occurring in 40 patients (78%). All 52 patients had at least one comorbid condition (with most having two or more), including duodenal ulcer in 17 (33%), cancer in 15 (29%), renal insufficiency in 15 (29%), and diabetes mellitus in 14 (28%). The suspected cause of black esophagus was reported for 40 patients: ischemia in 22 (55%); massive gastroesophageal reflux in seven (18%); and esophageal infection (Lactobacillus acidophilus, herpes simplex, Candida albicans) in four (10%). Most patients received supportive therapy, particularly acid suppression therapy. Of the 47 patients for whom outcomes were known, 17 (36%) died. There were no statistically significant differences between survivors and non-survivors. Black esophagus typically occurs in older men with at least one comorbid condition; a substantial number of patients die. Although the underlying mechanism leading to black esophagus is unknown, clinicians caring for patients with black esophagus should focus on optimizing perfusion, minimizing acid reflux, and treating esophageal infection if present.

Acute Disease↗
PubMed2005

Assessing professionalism in early medical education: experience with peer evaluation and self-evaluation in the gross anatomy course.

INTRODUCTION: As today's healthcare model moves toward more streamlined and corporate industrialism, it is our responsibility, as doctors, to ensure the integrity of medicine's foundation in professionalism. The erosion of professional values not only creates a climate of animosity, but reverberates negatively to impact the development of students, who model their behaviour after those they most respect. This hazard has spurred an evaluation of medical school curricula, with a new emphasis on professionalism in the philosophy of medical education. Courses such as Gross Anatomy that, in the past, offered "pure content," are now being used to teach and evaluate professionalism. The goal of this study was to determine if peer evaluation and self-evaluation used in conjunction and implemented early in the medical curriculum, can serve as useful tools to assess and provide feedback regarding professional behaviour in first-year medical students. MATERIALS AND METHODS: From 1999 to 2003, students at Mayo Clinic College of Medicine evaluated themselves and their peers during the Gross and Developmental Anatomy Course. Numerical evaluations and written comments were statistically analysed within established categories of professionalism and correlated with academic performance, gender, and peer rating and self-rating. RESULTS: The majority of written comments pertained to inter-professional respect, responsibility, and excellence. Students who gave higher peer evaluation and self-evaluation scores provided more positive comments, and students performing well in the course provided more positive comments about their peers and themselves than did those struggling academically. Students consistently rated their peers higher than themselves, and male students rated themselves higher than did female students. CONCLUSIONS: Implementing peer evaluation and self-evaluation early in the medical curriculum is a valuable exercise in teaching first-year medical students assessment skills when evaluating their behaviour, as well as the behaviour of their colleagues.

Anatomy↗
PubMed2000

The Mayo Clinic's Clinician-Educator Award: A program to encourage educational innovation and scholarship.

In 1998, the Board of Governors of the Mayo Clinic requested that the Education Committee design and implement a program to grant time and resources to clinical faculty to support the development of educational projects. The essence of the resulting Clinician-Educator Award Program is the concept of using funding to award time and resources for educational projects judged to be meritorious by an impartial, peer-review-based faculty mentoring process. The authors report early experiences with the program, which was enthusiastically accepted by faculty, to provide a model to help other academic health centers, especially those with salary-based faculty, to facilitate educational innovation and scholarship despite the growing constraints on academic clinicians' time and resources.

Academic Medical Centers↗
PubMed1997

A new syndrome of Crohn's disease and pachydermoperiostosis in a family.

Few syndromic associations with Crohn's disease are described. The aim of this study was to characterize a new syndrome of Crohn's disease associated with pachydermoperiostosis in 3 brothers. Three probands, 6 siblings, both parents, 20 of 21 third-generation relatives, and 9 spousal controls were evaluated. Serological evaluation for antineutrophil cytoplasmic antibodies and human leukocyte antigens as well as genetic testing for tumor necrosis factor microsatellites, intercellular adhesion molecule 1 polymorphisms, the interleukin 1 receptor antagonist gene, and the interleukin 1 beta gene were performed. Only the 3 probands were affected and developed pachydermoperiostosis between ages 14 and 17 years. Pachydermoperiostosis preceded Crohn's ileocolitis by 6 and 20 years in two probands, excluding secondary hypertrophic osteoarthropathy. Two probands were antineutrophil cytoplasmic antibody positive vs. 1 of 27 unaffected relatives (P < 0.001, chi 2). Haplotypes for human leukocyte antigen and tumor necrosis factor microsatellites were discordant. The probands' generation was homozygous for the common allele 1 of the interleukin 1 receptor antagonist and interleukin 1 beta genes. Two probands carried a rare polymorphism of the intercellular adhesion molecule 1 gene. A new syndrome of Crohn's disease and pachydermoperiostosis associated with antineutrophil cytoplasmic antibodies is described. Inheritance is most likely autosomal recessive by pedigree. No clear association was found between this syndrome and the gene regions evaluated.

Adolescent↗
PubMed1993

Acute gastrointestinal bleeding from portal hypertensive gastropathy: prevalence and clinical features.

The clinical and endoscopic features of patients diagnosed with acute bleeding due to portal hypertensive gastropathy (PHG) were evaluated. Acute bleeding from PHG was diagnosed in 12 patients (0.8%) of 1496 patient admissions prospectively evaluated by our Gastrointestinal Bleeding Team over a 3-yr period, and accounted for 8% of nonvariceal bleeding diagnosed in patients with liver disease. The median age of PHG patients (8M:4F) was 66 yr (range, 37-72). The most common underlying liver disease was alcoholic cirrhosis (five patients). The majority of patients presented with melena. There was no hemodynamic instability. Six patients had prior sclerotherapy. Esophageal varices, grades 1 (five patients) and 2 (three patients), were present. Severe PHG was encountered in seven patients. There was no correlation between the presence or absence of varices, the grade of esophageal varices, and prior sclerotherapy on the severity of PHG or continued bleeding. The mean hospital stay was 6 days. An average of 4 units of blood was transfused per patient (range, 2-8). Continued bleeding occurred in nine patients (75%), one of whom had mild PHG. Two patients with continued bleeding subsequently were diagnosed with portal hypertensive vasculopathy distal to the stomach. There was one episode of encephalopathy and no related mortality. Acute (overt) bleeding from PHG is uncommon, likely to recur, and can evolve into a pattern of chronic blood loss.

Acute Disease↗
PubMed1993

Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon.

UNLABELLED: Endoscopic laser coagulation effectively controls bleeding from radiation-induced rectal vascular lesions. OBJECTIVE: To assess the outcome of endoscopic treatment of radiation-induced bleeding due to vascular lesions located proximal to the sigmoid colon. METHODS: We identified 15 consecutive patients with such proximal radiation enteropathy treated at our Institution with Nd:YAG laser between 1984 and 1991. Ten patients (66%) had gastric and/or small bowel involvement, and five (33%) had colonic involvement with or without more proximal lesions. Bleeding first appeared at a mean of 21.2 +/- 12.5 months after completion of radiotherapy. Mean duration of gastrointestinal bleeding before laser treatment was 7.6 +/- 4.6 months. RESULTS: After completion of laser therapy, bleeding ceased in nine (60%) patients, decreased in three (20%), and persisted in three (20%). The mean hemoglobin level increased from 8.4 +/- 0.5 g/dl to 10.4 +/- 0.6 g/dl after completion of laser treatments (p < 0.02). The mean number of transfusions per patient per year decreased from 10.5 +/- 2.8 to 0.9 +/- 0.7 (p < 0.01). No treatment-related complications or deaths occurred. CONCLUSIONS: Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon appears to be safe and, in most cases, effective.

Colonic Diseases↗
PubMed1992

Treatment of benign esophageal stricture by Eder-Puestow or balloon dilators: a comparison between randomized and prospective nonrandomized trials.

To determine whether the natural history of strictures is affected by the type of dilator used to treat newly diagnosed peptic strictures, we designed a prospective randomized trial to compare the results after Eder-Puestow or Medi-Tech balloon dilation. We entered 31 patients into the trial. We also prospectively followed up all 92 nonrandomized patients who underwent their first dilation for a benign stricture during the same period as the prospective randomized trial. The nonrandomized patients also underwent dilation with either the Eder-Puestow or the balloon technique at the discretion of the gastroenterologist performing the endoscopy. We found no statistically significant differences in the immediate or long-term results of the two methods among the randomized, nonrandomized, and overall combined groups. All but 1 of the 123 patients had immediate relief of dysphagia. Within each group of patients, the probability of remaining free of dysphagia 1 year after the initial dilation was approximately 20%, and the probability of not requiring a second dilation was approximately 65% with either technique. Major (esophageal rupture) and minor (bleeding or chest pain) complications occurred in 1% and 5% of the patients and 0.4% and 3% of the total dilation procedures, respectively. The esophageal rupture and four of six minor complications occurred after repeated dilations. Five of the six minor complications occurred with use of the Eder-Puestow dilators. We conclude that Eder-Puestow and balloon dilations of benign esophageal strictures are associated with similar outcomes, but repeated dilations and the Eder-Puestow technique may be associated with an increased risk of complications.

Adult↗
PubMed1992

Acute gastrointestinal bleeding. Experience of a specialized management team.

The initial experience of a specialized management team organized to provide expedient care for all acute major gastrointestinal bleeding in protocolized fashion at a large referral center is presented. Of the 417 patients, 56% developed bleeding while hospitalized. Upper gastrointestinal bleeding accounted for 82%. The five most common etiologies included gastric ulcers (83 patients), duodenal ulcers (67 patients), erosions (41 patients), varices (35 patients), and diverticulosis (29 patients). Nonsteroidal anti-inflammatory drugs were implicated in 53% of gastroduodenal ulcers. The incidence of nonbleeding visible vessels was 42% in gastric and 54% in duodenal ulcers. The rates of rebleeding were 24% (20 patients) in gastric ulcers and 28% (19 patients) in duodenal ulcers. Predictive factors for rebleeding included copious bright red blood, active arterial streaming, spurting, or a densely adherent clot. The rebleeding rate for esophagogastric varices was 57%. The mortality rate overall was 6% (27 patients), with rates varying from 3% (five patients) for gastroduodenal ulcers to 40% (14 patients) for esophagogastric varices. The morbidity rate for the entire patient population was 18% (77 patients), dominated by myocardial events (34 patients). The average length of hospitalization for gastroduodenal ulcers was 5 days, for diverticulosis 8 days, and for varices 10 days. The major efforts of a specialized Gastrointestinal Bleeding Team would be best directed at both reducing the morbidity associated with acute bleeding and reducing the overall cost of care.

Adolescent↗
PubMed1992

The clinical and endoscopic spectrum of the watermelon stomach.

The watermelon stomach is an uncommon but treatable cause of chronic gastrointestinal bleeding. We report our experience with the clinical and endoscopic features of 45 consecutive patients treated by endoscopic Nd:YAG laser coagulation. The prototypic patient was a woman (71%) with an average age of 73 years (range of 53-89 years) who presented with occult (89%) transfusion-dependent (62%) gastrointestinal bleeding over a median period of 2 years (range of 1 month to > 20 years). Autoimmune connective tissue disorders were present in 28 patients (62%), especially Raynaud's phenomena (31%) and sclerodactyly (20%). Atrophic gastritis occurred in 19 of 19 (100%) patients, with hypergastrinemia in 25 (76%) of 33 patients tested. Antral endoscopic appearances included raised or flat stripes of ectatic vascular tissue (89%) or diffusely scattered lesions (11%). Proximal gastric involvement was present in 12 patients (27%), typically in the presence of a diaphragmatic hernia. Endoscopic laser therapy after a median of one treatment (range of 1-4) resulted in complete resolution of visible disease in four patients (13%) and resolution of > 90% in 24 patients (80%). Hemoglobin levels normalized in 87% of patients over a median follow-up period of 2 years (range of 1 month to 6 years) with no major complications. Blood transfusions were not necessary after laser therapy in 86% of 28 initially transfusion-dependent patients. The characteristic clinical, laboratory, and endoscopic features allow for a confident diagnosis that can lead to successful endoscopic treatment.

Aged↗
PubMed1992

Portal hypertensive intestinal vasculopathy: a review of the clinical, endoscopic, and histopathologic features.

Over the past decade, awareness of the association between portal hypertension and changes in the intestinal circulation has increased. Most of the observations have been made by endoscopic examination and biopsy of the mucosa. The fundamental pathologic change is a vasculopathy. Portal hypertensive intestinal vasculopathy (PHIV) most often involves the stomach (gastropathy) and can be a common source of bleeding. The significance of small bowel involvement (enteropathy) is unknown. Colon involvement (colopathy) has been associated with bleeding, and mimics inflammatory bowel disease. The reliability of endoscopic appearances and histologic examination in establishing the diagnosis is questionable. Recent observations of other diagnostic modalities and associated physiologic alterations and treatment options are discussed. Further prospective evaluations that use uniform terminology for endoscopic and histologic descriptions are needed to establish criteria for accurate diagnosis and assessment of response to treatment.

Humans↗
PubMed1989

Endoscopic laser therapy for watermelon stomach.

Thirteen patients (9 women, 4 men) with anemia from acute and chronic gastrointestinal bleeding were found to have antral vascular disease consistent with watermelon stomach. The median age was 73 yr, with a range of 54-88 yr. Eight of the patients were transfusion-dependent, requiring a median of 5.5 U within the 12 mo before treatment. All were treated with endoscopic neodymium:yttrium-aluminum-garnet laser coagulation. Endoscopic and hematologic improvement were evident in 12 patients available for follow-up after a median period of 6 mo. There was a median increase of 4 g/dl in hemoglobin concentration; thus, the need for transfusion was eliminated. No major complications were encountered. Laser coagulation for watermelon stomach appears to be safe and efficacious and may be a therapeutic alternative for this disorder.

Aged↗
PubMed1988

Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy.

Ninety-three consecutive patients with transfusion-dependent gastrointestinal bleeding from vascular malformations (VMs) underwent systematic assessment in our gastrointestinal laser suite with extended upper gastrointestinal endoscopy and colonoscopy. Of these patients, 83 had angiodysplasia and 10 had the Osler-Weber-Rendu (OWR) syndrome. The median age in each of these groups was 70 and 63 years, respectively. Cardiovascular disease, especially valvular disease, was common. A poor correlation existed between the results of endoscopically identified VMs and visceral angiography in patients with angiodysplasia. A combination of upper and lower gastrointestinal VMs was found in 11% of patients with angiodysplasia and 60% of those with the OWR syndrome. All identified VMs were completely obliterated by photocoagulation with use of a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Bleeding was successfully controlled in 9 patients with the OWR syndrome and in 72 patients with angiodysplasia (range of follow-up, 1 to 39 months). In 243 laser treatments, 3 perforations and 5 episodes of delayed bleeding occurred. This experience demonstrates that extended upper endoscopy is useful in identifying VMs and that gastrointestinal bleeding from VMs can be safely and successfully controlled with use of endoscopic Nd:YAG laser therapy.

Aged↗
PubMed1987

Endoscopic laser palliation of malignant dysphagia: a prospective study.

We prospectively studied the short-term and long-term efficacy and safety of endoscopic laser treatment in 25 patients with dysphagia from advanced esophageal cancer. Malignant stenoses were recanalized in all patients, and the ability to swallow was improved in about 80%. Results were best in patients with adenocarcinomas and in those who reported a good appetite. A single laser treatment provided adequate palliation in more than half the patients until the time of death. In those patients in whom stenosis recurred, re-treatment was necessary a median of 3.2 months after the initial laser treatment. No laser-related mortality or major morbidity occurred. We conclude that endoscopic laser therapy seems to be a feasible method of palliating malignant dysphagia.

Adenocarcinoma↗