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Biomedical subjects

D Fleischer

Publications and source records attributed to D Fleischer.

At least 55 records · Page 3Linked to original sources
PubMed1985

Endoscopic Nd:YAG laser therapy as palliation for esophagogastric cancer. Parameters affecting initial outcome.

Endoscopic neodymium:yttrium aluminum garnet laser therapy has been shown to be a technically feasible treatment option for relieving blockage in patients with malignant obstruction of the esophagus or gastric cardia. In an attempt to identify factors that would predict clinical benefit or risk, or both, 60 patients were evaluated retrospectively. Thirty-five patients (mean age 65.3 yr, range 47-89 yr) with biopsy-proven squamous cell carcinoma and 25 patients (mean age 61.1 yr, range 47-82 yr) with adenocarcinoma of the gastric cardia were evaluated. Most patients had had previous radiotherapy or surgery, and all had incurable disease. The following parameters were assessed: (a) tumor histology, (b) endoscopic appearance, (c) location, (d) clinical setting. There was no difference in response to treatment between squamous cell carcinoma and adenocarcinoma. Technically it was easier to treat mucosal tumors than to treat submucosal tumors. Also, the outcome was better in mucosal tumors. Results were least good and the technical difficulty greatest for tumors of the cervical esophagus. Tumors at the gastroesophageal junction were problematic if there was horizontal angulation. The best response occurred for tumors in a straight segment of mid-esophagus and distal esophagus, particularly if they were less than or equal to 5 cm in length. It is possible to identify parameters that affect the initial outcome.

Adenocarcinoma↗
PubMed1985

Endoscopic Nd:YAG laser therapy for active esophageal variceal bleeding. A randomized controlled study.

A randomized controlled double-blind study was undertaken to assess the efficacy and safety of endoscopic neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy for active esophageal variceal bleeding. Ten patients were randomized to the laser treatment group and 10 to a control group that received sham endoscopy and standard medical therapy. Initial hemostasis was achieved in seven laser-treated patients but in 0 of 10 controls receiving sham treatment (p less than 0.002). However, four of the seven who were initially controlled with laser therapy had rebleeding 12 to 48 hours later; thus, three of 10 laser patients had lasting hemostasis. The mean blood transfusion requirements were similar in both groups (laser = 7.3 units; control = 7.8 units). Six of the 10 laser-treated patients were discharged from the hospital and four died. There were seven hospital deaths in the control group and three patients were discharged (p = 0.22). In two patients in the treatment group, laser therapy increased bleeding. There were no perforations.

Double-Blind Method↗
PubMed1985

Incidence of bacteremia with elective upper gastrointestinal endoscopic laser therapy.

The incidence of bacteremia associated with endoscopy varies widely for different endoscopic procedures. This study prospectively evaluates the incidence of bacteremia in patients undergoing elective endoscopic laser therapy for two diseases of the upper gastrointestinal tract. In five patients (eight treatment sessions) with arteriovenous malformations, no bacteremia developed. In 15 patients (26 treatment sessions) with esophagogastric carcinoma, bacteremia developed at some time during the procedure in six (40%). However, bacteremia appeared to be associated with the endoscopic insertion through the tumor rather than the laser treatment per se. These findings lead us to conclude that for patients undergoing endoscopy and laser therapy for esophagogastric malignancy, but not for those being treated for arteriovenous malformations, antibiotic prophylaxis to prevent endocarditis may be indicated.

Anti-Bacterial Agents↗
PubMed1985

A new method of esophageal dilation using Savary-Gilliard bougies.

A new method of esophageal dilation has been developed for tight, firm esophageal strictures. The Savary dilating system was evaluated in 300 patients by two groups of investigators who concluded that the Savary dilators were easier to use and more efficacious than the Eder-Puestow dilators.

Adolescent↗
PubMed1984

Endoscopic laser therapy for gastrointestinal neoplasms.

Neoplasms of the esophagus, stomach, duodenum, ampulla, colon, and rectum have been treated with endoscopic laser therapy. For the most part, the therapy has been palliative, although curative treatment has sometimes been achieved. Considerations involved in management of cancers of the GI tract by the laser are discussed and future options envisioned.

Duodenal Neoplasms↗
PubMed1984

Endoscopic Nd:YAG laser therapy as palliative treatment for advanced adenocarcinoma of the gastric cardia.

Fifteen patients with advanced adenocarcinoma of the gastric cardia were treated with endoscopic neodymium:yttrium aluminum garnet laser therapy. Four patients developed recurrence after previous surgery. In 7 patients, a decision was made at exploration that a palliative operation was not feasible. In the remaining 4 patients, surgery was not considered because of widespread disease or the patient's condition. Fourteen of fifteen were classified as stage IV (tumor, node, metastasis). Tumors ranged in length from 3 to 10 cm (mean 6.3). Luminal opening was 4 mm or less in 12 patients. The mean number of treatments required to alleviate symptoms and remove obstruction was 2.8 (range 1-5) and the mean number of days required was 5.7 (range 1-12). An average of 6129 W/s were given per treatment and the mean total energy was 17,570 W/s. Luminal diameter at the narrowest segment increased from 3.3 mm before treatment to 12.1 mm after treatment. Clinical benefit in terms of increased food intake was demonstrated in all patients. No major complications directly attributable to laser therapy were seen. The overall results are encouraging and hold promise for a patient population in whom the therapeutic options are generally very limited.

Adenocarcinoma↗
PubMed1984

Endoscopic laser therapy for gastrointestinal disease.

As recently as 1981, less than 12 medical centers in the United States were using lasers for the treatment of gastrointestinal (GI) disease. Now they are being used in more than 200 American medical centers and the number is increasing. There are several causes for this increase: (1) the applications for the treatment of GI disease have expanded; (2) they are relatively easy to use; (3) they can be cost-effective if the same laser can be used by more than one subspecialty; and (4) lasers may provide therapeutic options where limited ones previously existed. In the past six months, the Food and Drug Administration ruled that lasers were no longer classified as investigational devices for certain GI applications (eg, upper GI bleeding or obstructing esophageal neoplasms). Most importantly, in most instances, they have been safe and effective. With the technology related to lasers and endoscopes advancing to rapidly, an even greater use of lasers for the field of GI disease, in specific, and medicine, in general, can be anticipated.

Biliary Tract Diseases↗
PubMed1983

Pill-induced esophageal injury. Case reports and review of the medical literature.

We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis. A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication. While most of these esophageal injuries are self-limited and produce no morbidity beyond transient retrosternal pain, odynophagia, and dysphagia, major complications have occurred, such as mediastinal penetration, hemorrhage, and death. Patients should be counseled to take pills in an upright posture with liberal amounts of fluid well before retiring for the night.

Adult↗
PubMed1983

Endoscopic Nd:YAG laser therapy for carcinoma of the esophagus: a new form of palliative treatment.

A new palliative treatment technique for esophageal carcinoma using endoscopic neodymium:yttrium aluminum garnet (Nd:YAG) laser therapy is described in 14 patients for whom no curative therapy is possible. Tumors ranged in length from 5 to 11 cm (mean 8.2 cm) and in 11 patients luminal occlusion before treatment was greater than 90%. The mean number of treatments required to alleviate symptoms and remove obstruction was 5.3 (range 2-13) and the mean number of days required was 11.6 (range 5-28). An average of 4615 W-s were given per treatment and the mean total energy per patient was 24,394 W-s. In all 14 patients, clinical, endoscopic, and radiographic improvement was noted. Two major complications occurred which may possibly have been caused by laser therapy. The overall results are encouraging and hold promise for a patient population in whom the therapeutic options are generally very limited.

Aged↗
PubMed1983

Etiology and prevalence of severe persistent upper gastrointestinal bleeding.

A prospective study was undertaken to establish the etiology and prevalence of episodes of upper gastrointestinal bleeding which are severe and persistent. During a 12-mo study period, 175 patients had one or more episodes of upper gastrointestinal bleeding. Thirty-six (20.6%) of the 175 patients had bleeding that was classified as severe and persistent. Upper gastrointestinal bleeding that occurred more than 24 h after admission was more apt to persist than bleeding that was a presenting complaint (32.4% vs. 12.8%, p less than 0.001). Bleeding due to esophageal varices was the single most common cause. Although the majority of upper gastrointestinal bleeding episodes are self-limited, about one-fifth are not. Studies to evaluate the many new therapeutic modalities for upper gastrointestinal bleeding should attempt to exclude patients whose bleeding will abate spontaneously.

Adult↗
PubMed1982

Endoscopic Nd: YAG laser therapy for carcinoma of the esophagus: a new palliative approach.

Since esophageal carcinoma is usually disseminated by the time diagnosis is made, treatment is often palliative. Symptomatic patients for whom no cure was possible were treated endoscopically with the Nd:YAG laser. Five patients aged 49 to 64 years, with tumors ranging in length from 5 to 11 cm, were treated. Significant clinical, endoscopic and radiographic improvements were noted in all patients. No major side effects were encountered. Endoscopic Nd:YAG laser therapy for carcinoma of the esophagus may provide a promising new approach for palliative treatment.

Carcinoma, Squamous Cell↗
PubMed1982

The current status of gastrointestinal laser activity in the United States.

The therapeutic applications of fiberoptic endoscopy in the field of gastroenterology are expanding. In the therapy of gastrointestinal bleeding, the initial results of laser photocoagulation have been encouraging. As of May 1, 1981, 388 patients have been treated for gastrointestinal bleeding at 12 centers in the United States. A tabulation of the results in this uncontrolled compilation reveals that initial hemostasis was achieved in 80 to 95% of patients. Applications of the laser in addition to the treatment of actively bleeding lesions include therapy of neoplastic and angiodysplastic lesions. There is a growing interest in the utilization of endoscopic laser therapy.

Animals↗