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Biomedical subjects

G Lehman

Publications and source records attributed to G Lehman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Comparison of three nonsurgical treatments for bleeding esophageal varices.

Ninety-seven patients with recent or active variceal bleeding were randomly assigned to oral propranolol, endoscopic sclerotherapy plus oral propranolol, or transhepatic sclerotherapy plus oral propranolol. The effects of treatment on the number of units transfused, rebleeding of any magnitude, major rebleeding, and death were assessed in these patients, 82% of whom were alcoholic and 81% Child's Class C. After a minimum follow-up interval of 2 yr (range, 27-65 mo), major rebleeding rates were 65% for propranolol alone, 45% for endoscopic sclerotherapy plus propranolol, and 60% for transhepatic sclerotherapy plus propranolol. The corresponding death rates were 81% for propranolol alone, 55% for endoscopic sclerotherapy plus propranolol, and 66% for transhepatic sclerotherapy plus propranolol (p = 0.03). Thirty-three patients (34%) never received propranolol; 8 due to medical contraindications and 25 because they died or bled enough to meet the definition of treatment failure within 3 or 4 days of randomizations (no significant differences among treatment groups). Patients assigned to propranolol alone bled sooner, bled more units, and had a higher mortality rate than patients treated by endoscopic sclerotherapy plus propranolol. Patients treated with transhepatic sclerotherapy plus propranolol had intermediate results. Propranolol alone is inadequate treatment for esophageal variceal bleeding in patients with advanced liver disease.

Blood Transfusion↗
PubMed1985

Enteroclysis in the diagnosis of chronic unexplained gastrointestinal bleeding.

In a six-year period (1977-83), lesions were identified by enteroclysis in 26 patients with melena or recurrent gastrointestinal bleeding undiagnosed by other modalities. These included nine Meckel's diverticula, three metastatic lesions, three primary carcinomas, one lipoma, four leiomyomas, five surgically created blind pouches, one carcinoid, and one idiopathic dilatation of the ileum. Our experience suggests that, when the standard diagnostic procedures used to investigate chronic gastrointestinal blood loss are unrevealing, enteroclysis should be performed. The method is fast, accurate, is done in one sitting, and can be productive in the diagnostically difficult patient.

Adenocarcinoma↗
PubMed1982

Screening examination of the larynx and pharynx during upper gastrointestinal panendoscopy.

With the flexible fiberoptic esophagogastroduodenoscopes now in use, the larynx and posterior pharynx can be easily viewed during routine upper gastrointestinal endoscopy. Screening laryngeal-pharyngeal examinations were carried out during 1120 upper gastrointestinal endoscopies. Mean additional examination time was 30 sec. Thirty-nine laryngeal lesions were detected, mostly variants of chronic laryngitis. Two patients had leukoplakia, one of whom on subsequent biopsy revealed squamous cell cancer. The brief additional endoscopic time may result in the detection of early curable neoplasms. Thus a screening laryngeal-pharyngeal examination should be part of each upper gastrointestinal endoscopic examination.

Carcinoma, Squamous Cell↗
PubMed1978

Polypoid colonic lesions undetected by endoscopy.

Fifty-four endoscopically missed colonic polypoid lesions reveal the limitations of colonic endoscopy. Colonoscopy failed to identify 31 of the lesions, whereas 24 lesions were initially missed by proctosigmoidoscopy. One polypoid tumor of the rectosigmoid junction was missed by both. Most undetected lesions ranged from 0.5 to 1.5 cm. Endoscopic and radiologic diagnostic techniques are clearly complementary. Their combined diagnostic accuracy exceeds that of either technique alone. If results of the two methods conflict, one or both should be repeated. With a combined approach, completely missed lesions can be kept at a minimum.

Adenocarcinoma↗
PubMedDate not supplied

Endoscopic sphincterotomy complications and their management: an attempt at consensus.

Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines for prevention and management of complications, based on a workshop of selected experts, and a comprehensive review of the literature. We emphasize particularly the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Sphincter of Oddi manometry: interobserver variability.

To determine the frequency and magnitude of interobserver variability, 50 sphincter of Oddi manometry tracings were read by three separate physicians experienced in reading such manometry. Ninety station pull-throughs were read, and attention was focused on the reference duodenal baseline pressure and two methods of reading the basal sphincter pressure. A high degree of correlation was found among the three observers with correlation coefficients of > 0.9 for reading baseline duodenal and basal sphincter pressures. Differences in basal sphincter pressure readings were greatest in patients with very high basal sphincter pressure. The most clinically relevant parameter was thought to be the mean basal sphincter pressure. All three observers agreed on normal (mean basal pressure < or = 40 mm Hg) versus abnormal (mean basal pressure > 40 mm Hg) in 82% to 90% of tracings. When the definition of agreement was broadened to include patients with pressures of 40 +/- 3 mm Hg (37 to 43 mm Hg), the observers agreed 87% to 94% of the time. Overall, these findings are thought to indicate that interobserver variability for reading sphincter of Oddi manometry is minimal when the observers are experienced in reading these tracings.

Humans↗
PubMedDate not supplied

Sphincter of Oddi dysfunction in patients with intact gallbladder: therapeutic response to endoscopic sphincterotomy.

Increasing evidence exists of the occurrence of sphincter of Oddi dysfunction in patients with an intact gallbladder. Optimal therapy for such patients has not been defined. From 1989 to 1991, 35 patients with sphincter of Oddi dysfunction (abnormal basal sphincter pressure > 40 mm Hg) and an intact gallbladder were identified. The patients with abnormal ductography (except for duct dilation), pancreas divisum, or pancreato-biliary malignancy were excluded. All patients had disabling upper abdominal pain, which was quantified on a 0 = none to 10 = severe pain scale. All patients received standard endoscopic biliary sphincterotomy and were followed up for 4 to 26 months with a mean of 13 months. Initially, 27 of 35 patients (77%) showed at least 50% improvement in the pain score, whereas only 15 of the 27 remained improved throughout the follow-up interval. Patients who were unimproved or had relapses were offered cholecystectomy and 11 patients underwent the procedure. These patients were followed up after cholecystectomy for 2 to 24 months, with a mean of 13 months. Eight of 11 were improved. In summary, the combination of endoscopic sphincterotomy and selective cholecystectomy and minimal medical treatment resulted in a good and excellent response rate of 68%. Better techniques are needed to select patients who will respond to these therapies.

Abdominal Pain↗