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Biomedical subjects

D Fleischer

Publications and source records attributed to D Fleischer.

At least 37 records · Page 2Linked to original sources
PubMed1990

Endoscopic lithotripsy of biliary stones.

Historically, gallstone therapy has been surgery. Gastrointestinal endoscopists and radiologists are now becoming increasingly active in the definitive management of both cholelithiasis and choledocholithiasis. Today, for uncomplicated cholelithiasis and for many cases of choledocholithiasis in patients without increased surgical risk, biliary surgery remains the recommended treatment by internists and surgeons alike. However, with an increased battery of available therapeutic modalities, management decisions and strategies are becoming more complex and the treatment of biliary stone disease in the future will be different than it was in the past.

Cholelithiasis↗
PubMed1989

Endoscopic laser therapy for esophageal cancer: present status with emphasis on past and future.

Although the major initial application for endoscopic laser therapy was for the management of gastrointestinal hemorrhage, it is now more common to use the laser endoscopically for the treatment of gastrointestinal neoplasms. A major body of literature surrounds the use of endoscopic laser therapy for esophageal cancer. The initial patient evaluation to determine if laser therapy is indicated includes a contrast radiograph, a screening endoscopy, and an imaging study. After these tests have been performed, it can be determined whether endoscopic laser therapy (ELT) is the best of the many endoscopic options. There is some difference of opinion as to the specifics of the treatment technique, and these are described. There is general agreement from reviewing the clinical data that it is possible to open the obstructed lumen in a large majority of cases and that functional success (the ability to achieve technically good results as well as clinical improvement without complications) is also possible in the majority of patients. Despite the information suggesting the benefits of ELT for esophageal cancer, there are both conceptual and technical limitations to the current approach to therapy. These limitations as well as potential future applications are discussed.

Esophageal Neoplasms↗
PubMed1989

Development of a laser balloon for the treatment of gastrointestinal obstruction.

This work describes the initial results using a laser balloon in a canine model in an attempt to deliver the energy in a circumferential pattern. A balloon catheter, 2 cm long and 3 mm in diameter, was developed. Using a standard cw 100 watt Nd:YAG laser, a 600 micron fiber was tapered to 200 microns and passed through the proximal end of the balloon. Laparotomies were performed on mongrel dogs 14-18 kg in weight. After a gastrotomy, the gastric mucosa was exposed and rugal folds were pulled over the balloon to create a cylinder. Using power settings between 10 and 60 watts, and pulse durations between 10 and 40 seconds, radial energy was delivered and the tissue was examined for both gross and histologic effects. Circumferential zones of coagulation and necrosis were demonstrated.

Animals↗
PubMed1989

[Carpal tunnel syndrome. Late results following surgical treatment].

Of 64 patients, who had undergone operation because of a carpal tunnel syndrome in the years 1982 to 1984, 39 patients could be reinvestigated. The measurement of the distal motor latency was useful as well in the diagnosis as in the course of the CTS. After operation the distal motor latency was normal in about 70.7% of the cases. A subjective improvement showed 69.9% of the patients. Patients with preoperative normal motor latency reached similar postoperative results. The diagnosis cannot made only on the basis of electrophysiologic pathological values, but has to take into account the clinical picture and neurological findings. Phalen's and Tinel's signs are useful helps in the diagnosis of CTS. The results after decompression of the median nerve depend on the length of history.

Adult↗
PubMed1987

Depression and body image following mastectomy and lumpectomy.

A twenty year debate about the appropriate surgery for breast cancer has resulted in two clinical trials comparing radical vs more conservative operations. Despite the favorable results of these trials, the majority of breast cancer patients in North America still undergo mastectomy. We investigated the psychological and social adjustment following total and partial mastectomy in a group of patients randomly assigned to one or the other operation (National Surgical Adjuvant Breast Protocol--B-06). Total mastectomy patients showed higher levels of depression and less satisfaction with body image. Partial mastectomy patients did not display any measurable increase in fear of recurrence. Patients undergoing radiation therapy showed surprising increase in depressive symptoms. Radiation therapy could well be more frightening to breast surgery patients than had been anticipated. These patients may benefit from some anticipatory counselling.

Body Image↗
PubMed1987

Palliative bipolar electrocoagulation therapy of obstructing esophageal cancer.

In a multicenter pilot study, a prototype bipolar electrocoagulation tumor probe was employed for palliation of obstructing circumferential esophageal cancer in 20 patients. Mean number of initial treatment sessions was 1.7. Dysphagia and tumor channel size improved significantly after treatment. Mean treatment interval before repeat treatment was 7.6 weeks. Major complications included delayed hemorrhage (two patients) and esophageal-pulmonary fistula (two patients). This new device may provide a less expensive alternative to laser or surgery for palliation of malignant esophageal obstruction.

Adenocarcinoma↗
PubMed1987

Esophageal malignancy: imaging results and complications of combined endoscopic-radiologic palliation.

Fifty-one patients with advanced cancer of the esophagus underwent 191 endoscopic palliative procedures, including bouginage, laser therapy, bipolar electrocoagulation, and stent placement. In three patients free perforations developed; these were treated immediately and no sequelae developed. Perforations confined within the tumor mass were diagnosed with CT in two patients and did not require treatment. Methods of endoscopic palliation are discussed with reference to the radiologic studies and techniques. The radiologist must evaluate tumor topography and esophageal wall thickness with computed tomography and esophagography to aid in the choice of palliative therapy. Knowledge of each technique and its risks by the radiologist is essential for useful consultation with the endoscopist before, during, and after the procedure.

Adenocarcinoma↗
PubMed1986

Laser photocoagulation for upper gastrointestinal bleeding: the American experience.

Laser use in the United States for the treatment of gastrointestinal disease in general, and for upper GI bleeding in particular has grown exponentially. In 1979, only 3 American medical centers were using lasers for the therapy of UGI bleeding. Today, lasers are employed in more than 200 centers. Recently, the Food and Drug Administration, which regulates its use, has ruled that it is safe and effective, and therefore is no longer considered to be an investigational device. Most commonly it is used to treat discrete lesions such as ulcers, but it has been employed for other lesions, including varices. A recent American randomized controlled trial assessing its efficacy in acute esophageal variceal bleeding, found it to be effective for initial hemostasis; however, rebleeding was common. A key question is whether or not the laser is superior to other less costly and more portable modalities for treating acute UGI bleeding. One U.S. investigator recently presented data which suggested to him that the heater probe was better than the laser. There is insufficient comparative data available to answer the critical question about the relative superiority of one endoscopic treatment modality as compared to another. Foreseeable technologic advances may make laser therapy easier and more effective.

Argon↗