Search PubMed⌕ Search

Biomedical subjects

Bruce Schirmer

Publications and source records attributed to Bruce Schirmer.

8 recordsLinked to original sources
PubMed2006

Peroneal neuropathy following successful bariatric surgery. Case report and review of the literature.

Peroneal neuropathy has been observed in starvation, anorexia, and other situations of extreme weight loss. The authors report a case in which sequential bilateral peroneal neuropathies developed after successful bariatric surgery resulting in a weight loss of 114 lbs over 12 months. The diagnosis was confirmed using nerve conduction studies and electromyography. Clinical improvement occurred with decompressive surgery at the level of the knee.

Decompression, Surgical↗
PubMed2005

The night float system: ensuring educational benefit.

BACKGROUND: The ACGME mandated a change in resident work hours effective July 2003. We postulated that taking a block of night call would provide an opportunity for residents to improve clinical decision-making without detracting from operative experience. METHODS: The educational benefit of the Night Float model was evaluated weekly by anonymous questionnaires that assessed resident conference attendance, operative experience, attending teaching interactions, and consultations for the previous seven days. RESULTS: Preliminary results demonstrated that a higher percentage of Night Float residents reported less exposure to each educational opportunity than their colleagues. These data prompted several remedial interventions that resulted in significant improvement. Compliance with the 80-hour workweek was equal for both groups. CONCLUSIONS: The Night Float model has the advantage of fulfilling ACGME requirements, but it also has the potential to limit educational experience. Continued monitoring and faculty intervention are critical if we are to succeed in our goal to provide our residents with the best possible training.

Attitude of Health Personnel↗
PubMed2002

Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation.

PURPOSE: To evaluate the efficacy of fluoroscopically guided balloon dilation (FGBD) in patients with symptoms of gastric outlet obstruction following surgery for morbid obesity. MATERIALS AND METHODS: Forty-one FGBDs were performed in 28 patients with symptoms of gastric outlet obstruction following gastric restrictive surgery for morbid obesity. The efficacy of FGBD was determined using five end points: (a) no recurring symptoms for an interval of at least 3 months, or recurring symptoms treated either (b) surgically, (c) with endoscopically guided balloon dilation (EGBD), (d) with FGBD, or (e) medically. RESULTS: Following initial FGBD, 11 of 28 patients (39%) remained asymptomatic during at least 3 months of follow-up. Recurrent dysphagia occurred in 17 patients (60%), who were treated either surgically (n = 3), with EGBD (n = 4), with FGBD (n = 9), or medically (n = 1). Of the nine patients who underwent a second FGBD, two became asymptomatic. The seven patients who remained symptomatic were treated with surgery (n = 3), EGBD (n = 1), or FGBD (n = 3). Of the three patients treated with a third FGBD, one became asymptomatic. Overall, FGBD was effective in 14 (50%) of 28 patients. CONCLUSION: Among patients with symptoms of obstruction following gastric surgery for morbid obesity, 50% experienced relief of symptoms following FGBD.

Adult↗
PubMed2002

Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass.

BACKGROUND: Flexible upper endoscopy (FUE) is an important diagnostic and therapeutic tool in the management of upper gastrointestinal diseases. We examined the role of FUE in the management of patients undergoing Roux-en-Y gastric bypass (RYGBP). METHODS: All patients undergoing RYGBP at a single institution from 1986 to 2001 were studied. Preoperative FUE was performed by the surgeon to assess the anatomy of the esophagus, stomach, and duodenum. Since 1997, gastric biopsies were obtained, testing for the presence of H. pylori. Colonized patients were treated preoperatively. Postoperatively, FUE was performed by the surgeon as indicated clinically, for management of symptoms suggesting anastomotic stenosis, upper gastrointestinal bleeding, inflammation, or ulcers. Endoscopic balloon dilatation was performed as indicated. RESULTS: 560 patients underwent RYGBP during the study period. Of these, 536 underwent preoperative FUE. Endoscopic findings changed or altered the operative procedure in 26 patients (4.9%). Preoperative testing for H. pylori was performed on 206 patients, of whom 62 (30.1%) were positive. Patients tested for H. pylori had a lower incidence of postoperative marginal ulcers (n = 5, 2.4%) than did patients who did not undergo such screening (n = 354, 6.8%, P < 0.05). Postoperatively, 54 patients underwent 80 endoscopic balloon dilatations for stenosis of the gastrojejunostomy. In addition, 18 patients underwent 28 FUEs that proved negative for such stenosis. In addition, 64 patients underwent 88 additional diagnostic or therapeutic FUEs in the postoperative period, including investigation of symptoms of pain, bleeding, persistent vomiting, or weight regain. CONCLUSION: Upper endoscopy is a tool which may be used by the surgeon in the preoperative and postoperative management of patients undergoing RYGBP to modify therapy, improve outcomes, and diagnose and treat postoperative complications.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Psychosocial evaluation of bariatric surgery candidates: a survey of present practices.

OBJECTIVE: Successful outcome for bariatric surgery is largely dependent on patients' ability to adhere to postoperative behavior changes. A thorough psychological evaluation is often required before patients' approval for surgery. In addition to a standard psychiatric interview, assessment of behavioral components specific to this surgery seems indicated. No uniform guidelines exist on how to conduct such an evaluation. This survey was designed to collect information on the level of involvement of mental health professionals with bariatric surgery programs and their approach to evaluating bariatric surgery candidates. METHODS: Surveys about psychological evaluation practices were mailed to 188 bariatric surgery programs. Eighty-one surveys were returned. RESULTS: Eighty-eight percent of programs require patients to undergo a psychological evaluation and almost half require formal standardized psychological assessment. Current illicit drug use, active symptoms of schizophrenia, severe mental retardation, and lack of knowledge about the surgery were the most commonly cited contraindications, preventing patients from gaining approval for surgery. DISCUSSION: The majority of programs use psychological evaluations; however, the exclusion criteria for surgery vary greatly. Establishing uniform guidelines for the screening of bariatric surgery candidates is necessary. Suggestions on how to begin this process are provided. More research about behavioral and cognitive predictors of postsurgical success is needed.

Attitude to Health↗
PubMedDate not supplied

Laparoscopic Toupet versus Nissen fundoplication for the treatment of gastroesophageal reflux disease.

The Nissen fundoplication is the most popular laparoscopic operation performed for the surgical treatment of gastroesophageal reflux disease (GERD). However, for patients in whom esophageal peristalsis is documented to be weak preoperatively, use of a partial wrap, or Toupet procedure, has often been used as an alternative to lessen the potential for postoperative dysphagia. Recent reports have criticized the Toupet procedure as having a higher long-term failure rate than the Nissen approach, especially for patients with severe forms of GERD. We reviewed our experience performing laparoscopic antireflux surgery over a 7-year period and compared the results of patients undergoing laparoscopic Nissen versus Toupet procedures. All procedures were performed at our institution by a single surgeon. Data recorded included preoperative demographic data, preoperative disease parameters, perioperative data, postoperative course, and symptom scores. Follow-up was based on a combination of medical records and phone interviews. There were 142 patients with complete records allowing review for this study. Of these, 118 underwent 122 Nissen fundoplications and 26 underwent 27 Toupet fundoplications. Selection of the procedure was based on preoperative manometric studies. There were seven reoperations. Seven of the patients (28%) who underwent Toupet procedures had severe GERD, a percentage comparable to the Nissen group (31.6%). Preoperative parameters were comparable for both groups, although the Toupet patients had lower average preoperative LES pressures (9.79 mmHg) than did the Nissen patients (16.1 mmHg, P < 0.05). The operative duration, operative blood loss, morbidity, length of hospitalization, need for reoperation, and efficacy in terms of relieving symptoms (average follow-up = 27.5 months) were comparable for both groups. Based on this experience, the Toupet procedure seems safe and effective in treating the symptoms of GERD, including patients with severe forms of the disease. We recommend its selective use in patients with preoperative esophageal hypomotility who are undergoing laparoscopic antireflux surgery.

Adolescent↗