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Biomedical subjects

Z Steiger

Publications and source records attributed to Z Steiger.

35 records · Page 2Linked to original sources
PubMed1984

Iatrogenic hiatal and diaphragmatic hernias.

Seven patients with hernias occurring after Belsey hiatal hernia repair are described. These hernias were of two types. Four occurred through the hiatus, had the appearance of a parahiatal hernia, and were attributed to the failure to correct a shortened esophagus. In three patients the hernia occurred through a disrupted counterincision in the diaphragm. In the second group postoperative abdominal distension and possibly technical faults were incriminated. In the first group satisfactory repair was achieved by a Collis-Belsey gastroplasty and an antireflux procedure. In the second group reduction of the hernia and resuture of the diaphragm incision encompassing all layers corrected these life threatening hernias.

Female↗
PubMed1983

Combined modality therapy for esophageal squamous cell carcinoma.

Of 55 patients with esophageal squamous cell carcinoma, 30 with localized disease were treated with a combined modality for curative intent. Treatment consisted of mitomycin C (10 mg/m2 day 1) and continuous infusion 5-FU (1000 mg/m2 day, days 1-4, 29-32) (CT), radiation (XRT) (3000 rad, days 1-21) with nutritional support, and surgery (days 49-64). Surgery consisted of celiotomy, esophagectomy and esophagogastrostomy +/- postoperative ventilatory support. Postoperative CT plus an additional 2000 rad XRT was restricted to patients with histologic positive tumor. Since five resected patients with subclinical metastatic tumor had an inferior survival equal to 25 patients treated essentially for palliation, pretreatment celiotomy seems warranted to identify patients with an inferior prognosis. Of 18 resected patients without disseminated tumor evaluable for this combined modality: six were tumor free, three had intramural and nine transmural tumor; the median survival is 76 weeks and five of six living patients are disease free at 95-190 weeks; and local recurrence occurred in two and in two of seven unresected patients. Since toxicity was minimal except for postoperative pneumonitis (13%) and local recurrence low (13%), two courses of chemotherapy and 5000 rad XRT perhaps obviates the need for resection.

Abdomen↗
PubMed1983

Management of malignant bronchoesophageal fistulas.

Twenty-four patients with a bronchoesophageal fistula due to a malignant lesion were seen during the eight years from 1974 to 1981. Twenty of the patients had carcinoma of the esophagus, and four patients had carcinoma of the lung. All three patients who had a Celestin tube inserted had gastric reflux, and in two, the fistula was not completely occluded. Four patients who had a cervical esophagostomy, feeding jejunostomy and ligation of the gastroesophageal junction died in the immediate postoperative period. The best palliative result was achieved in 17 patients who had a bypass of the fistula with the stomach. Fourteen had a substernal gastric bypass to the cervical portion of the esophagus, and three patients had a gastric bypass to the upper thoracic portion of the esophagus by way of a right thoracotomy. Although the operative deaths occurred in six of 17 patients, the surviving patients resumed oral feeding within ten to 14 days after operation, and the pneumonias cleared. These patients had, by far, the best palliative result. We, therefore, advocate substernal or intrathoracic bypass of the bronchoesophageal fistula as soon as the general condition of the patient permits.

Adult↗
PubMed1982

Axillary thoracotomy.

Between 1978 and 1981, we have used a vertical axillary thoracotomy in 106 patients for 109 operations. The approach provides a fast and easy entrance into the thoracic cavity. Exposure was adequate. The procedure was well tolerated, even by patients with respiratory compromise, and morbidity was minimal. This approach is recommended as an alternative to the formal posterolateral thoracotomy and anterior mediastinotomy in selected patients.

Adult↗
PubMed1981

Complete eradication of squamous cell carcinoma of the esophagus with combined chemotherapy and radiotherapy.

Chemotherapy (with 5-fluorouracil and either mitomycin-C or cis-platinum) combined with radiotherapy was used either for palliation or as preoperative therapy in 67 patients with squamous cell carcinoma of the esophagus. In 25 patients having chemotherapy and 5000-6000 rads, good local palliation was obtained in 11 (49%) without surgery. In the remaining 25 patients, swallowing was restored with a variety of procedures (primarily Celestine tube or gastric bypass). The average survival time was seven months and two patients are still alive at 9 and 12.5 months. Of 42 patients receiving preoperative chemotherapy and radiotherapy, 35 had surgery. Of these, 13 (37%) had complete eradication of their tumors with no histologic evidence of carcinoma in the resected esophagus or associated lymph nodes. In another six (17%), the only evidence of tumor was small microscopic foci of cancer cells in the wall of the esophagus. The 6-, 12-, and 24-month survival rates for patients having surgery after the combined preoperative chemotherapy and radiotherapy were 83 per cent, 52 per cent, and 30 per cent, respectively. These results are far superior to those previously obtained.

Adult↗
PubMed1981

The use of anterior mediastinotomy to assess intrathoracic lesions.

A ten-year experience (1970-1979) with 164 anterior mediastinotomies at a VA hospital to diagnose pulmonary or mediastinal lesions or to assess the resectability of carcinoma of the lung is reported. of 135 attempts to obtain diagnosis, 130 (96%) were successful. Of 19 patients who had a subsequent thoracotomy because the anterior mediastinotomy suggested that a curative resection was possible, 17 (90%) had successful resections. Two (1.7%) patients died-one of a paraneoplastic syndrome and one from progressive respiratory failure. Eleven complications in the 162 survivors included eight minor wound infections, an initially unrecognized pneumothorax, persistent bleeding from a lymph node biopsy site, and an air leak necessitating reoperation in another. Anterior mediastinotomy is a relatively safe procedure, even in patients with advanced carcinoma or lung disease. it has much less risks than a formal thoracotomy and provides much better exposure and diagnostic possibilities than a mediastinoscopy.

Adenocarcinoma↗
PubMed1981

Comparison of the results of esophagectomy with and without a thoracotomy.

Two techniques of esophagectomy for carcinoma of the esophagus were compared in 41 patients. Of these, 39 had chemotherapy or radiotherapy, or both, preoperatively. Overall, the 20 patients who had a blind esophagectomy through an abdominal and a cervical incision without a thoracotomy tolerated the procedure quite well. However, two patients died three and five weeks afterward of arrhythmia and respiratory insufficiency, respectively. None of the 21 patients having an esophagectomy by means of a standard thoracotomy died. The blind esophagectomy took an hour less to perform and required slightly more blood than the standard thoracic esophagectomy. Except for the one patient who died of respiratory insufficiency, it appeared that the patients not having a thoracotomy had less pulmonary complications and required less ventilator assistance. The length of stay was almost identical. The main advantages found were the ease of the operation, no change needed in the position of the patient and the shorter duration of the operation. Theoretic advantages, not yet confirmed, include decreased mortality and morbidity if an anastomotic leak occurs and decreased change of local recurrence of the carcinoma.

Adenocarcinoma↗
PubMed1981

Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy.

Between April, 1977, and March, 1981, 86 unselected patients with proved squamous cell carcinoma of the esophagus were treated with a combination of chemotherapy and radiotherapy followed by operation whenever feasible. The preoperative chemotherapeutic agents used initially were 5-fluorouracil, and mitomycin C. After December, 1979, cis-platinum was used instead of mitomycin C. Radiotherapy (3,000 rads) of the tumor was begun at the same time as the chemotherapy. An esophagectomy was performed on suitable candidates 3 to 4 weeks after the chemotherapy and radiotherapy were completed. The mucosal lesion disappeared in 69 of the 86 patients, and dysphagia was relieved at least temporarily in 57 of 62 patients. Recurrent dysphagia resulting from fibrosis at the tumor site caused a secondary stenosis in 11 patients. Excellent palliation was obtained in five patients with bronchoesophageal fistulas who had an initial substernal gastric bypass followed by chemotherapy and radiotherapy. Of the 48 patients who had an esophagectomy, 15 (31%) had no tumor in the resected specimen. Eleven of these 15 patients are still alive with no evidence of disease. All patients with a lesion less than 5.0 cm in length had complete regression of the tumor. We believe that this combination of chemotherapy, radiotherapy, and surgical therapy provides excellent palliation, increases resectability, and has a potential for cure.

Adult↗
PubMed1978

Improved surgical palliation of advanced carcinoma of the esophagus.

Fifty-four patients with far-advanced carcinoma of the esophagus were operated on between the years 1974 and 1976. No attempts were made to resect the lesion. The stomach was used fifty-three times to bypass the lesion and the right colon was used once. In twenty-eight patients the stomach was placed substernally and the anastomosis was done in the neck. Twenty-five patients had the anastomosis to the esophagus done in the chest. The thirty day operative mortality was 7.4 per cent and the average survival was five months. These figures compared favorably with a group of thirty-five patients with far-advanced carcinoma of the esophagus seen between the years 1971 and 1973 and handled with a variety of modalities. In this group the thirty day mortality was 31.4 per cent (11/35) and the average survival was three and a half months.

Adult↗
PubMed1976

Pulmonary tuberculosis after gastric resection.

Reviewing the charts of tuberculosis patients during a span of seventeen years, we found a large number of gastrectomized patients. In our general hospital population, the incidence of tuberculosis was 3.2%. Among the gastrectomized patients, the percentage of tuberculosis was 6.3%. Of our tuberculosis patients 1.9% had gastrectomy, whereas of our general population 0.67% had gastrectomy. We were unable to arrive at any definite conclusions regarding the causative relationship between gastrectomy and tuberculosis. It is a retrospective study with all the fallacies, but the data does show an extremely significant difference between the incidence of gastrectomy in the general hospital population and the incidence of gastrectomy in histories of patients admitted with tuberculosis. It appears that a patient having gastrectomy runs a considerably greater risk of having tuberculosis in later life than a patient admitted for other reasons. Clinically, we were impressed with the widespread character of the disease in association with the poor nutritional status in the majority of the patients. We, therefore, could not avoid associating the loss of stomach substance with its nutritional function and the development of tuberculosis. As a consequence, we recommend a purified protein derivative test for all pateints undergoing gastric surgery. If the test proves to be positive, it is suggested the patient be given a course of isoniazid for one year. In the face of negative purified protein derivative test, we repeat the test at six month intervals. Should a conversion of the purified protein derivative occur, the patient is started on the course of isoniazid therapy. Our current belief is that more conservative methods of gastric surgery, that is, pyloroplasty, vagotomy, or antrectomy, should be substituted for gastrectomy in the treatment of duodenal ulcer disease to preserve a more normal gastric physiologic structure.

Gastrectomy↗