Search PubMed⌕ Search

Biomedical subjects

H Sloan

Publications and source records attributed to H Sloan.

At least 37 records · Page 2Linked to original sources
PubMed1980

Intraoperative esophageal manometry: is it valid?

Forty-five patients undergoing a Collis-Nissen antireflux operation had preoperative, several intraoperative, and postoperative distal esophageal high-pressure-zone (HPZ) measurements. In 11 patients (24%), intraoperative manipulation of the esophagus alone, prior to beginning the repair, had a major effect upon the HPZ. The final mean intraoperative HPZ pressure (21.2 mm Hg) differed significantly (p less than 0.01) from that obtained postoperatively at 1 to 3 weeks (15.2 mm Hg), 6 months (11.2 mm Hg), and 12 mm Hg), and 12 months, (12.1 mm Hg). However, there was no significant statistical correlation between the final intraoperative HPZ pressures and those obtained after 6 and 12 months. Irrespective of the final intraoperative HPZ value, no patient undergoing acid reflux testing at 6 to 12 months after operation had any gastroesophageal reflux. It is concluded that esophageal manipulation (mobilization or dilation) results in variable intraoperative Hpz values that are not reliable predictors of HPZ values obtained late postoperatively. The rationale for altering the technique of an operation simply to obtain an "ideal" intraoperative HPZ value must be seriously questioned.

Female↗
PubMed1980

Technique of mitral valve replacement.

A technique for mitral valve replacement is described that provides adequate exposure for excision of the valve and secure suturing of the annulus, even in patients with a small left atrium. The technique has been used in more than 100 patients and has resulted in only a minimal amount of perivalvular leak.

Aortic Valve Stenosis↗
PubMed1980

Long-term results of open mitral valvuloplasty.

The long-term results of open mitral valvuloplasty in 51 patients are assessed. At the time of operation, 4 patients were in New York Heart Association Functional Class II, 41 in Functional Class III, and 5 in Functional Class IV. Group I (14 patients) had had previous closed mitral commissurotomy. Three patients died 2 to 4 years after open valvuloplasty. One patient died following valve replacement 7 years after the open valvuloplasty. Five others required mitral valve replacement 1 to 12 years following open valvuloplasty. Only 4 of the 14 patients are in Functional Class I or II 10 to 15 years following valvuloplasty. Group II (36 patients) had never undergone a previous mitral operation. Four of them died of progressive myocardial failure 4 to 6 years following valvuloplasty. One patient died of carcinoma of the lung 2 years postoperatively. Six patients underwent valve replacement 6 to 11 years following initial operation. Twenty-six have survived for at least 10 years without additional operation. Fourteen are in Functional Class I, and 12 are in Funcitonal Class II. Open mitral valvuloplasty allows for (1) accurate commissurotomy and careful subvalvular dissection, (2) direct vision to diagnose clot in the left atrial appendage or left atrium proper, (3) accurate assessment of residual or induced mitral regurgitation and immediate repair, and (4) reasonable operative mortality and morbidity.

Adolescent↗
PubMed1979

Esophageal atresia. A 41-year experience.

Since the first attempted repair in 1935, a total of 365 infants have undergone treatment for esophageal atresia with or without tracheoesophageal fistula. To evaluate the improvement in our results, we have divided our patients into four, approximately equal, time periods. The overall late survival has indeed improved during each of the four decades from between 36% and 53% to 68% in the last ten years. During this past decade, the group A risk infants (35 patients) had a 3% mortality, the group B (20 patients) had a 5% mortality, but the group C babies (22 patients) had a 41% mortality due to associated anomalies or severe prematurity. Anastomotic leaks and recurrent fistulas were each encountered in approximately 5% of the cases in all decades. Postoperative stricture has been encountered in 20% of the entire series and no esophageal replacements have been required.

Abnormalities, Multiple↗
PubMed1979

Clinical presentation and management of patients with carcinoma of the lung: a 14-year experience.

Carcinoma of the lung has been steadily increasing since World War II, and the family physician can now expect to see a greater incidence of the disease in women and persons under age 50 years. The clinical manifestations of carcinoma of the lung are described, based on a 14-year experience at the University of Michigan. Diagnostic procedures are outlined. The preferred treatment for carcinoma of the lung is pulmonary resection, combined, in appropriate situations, with mediastinal lymph node irradiation. Survival is dependent to some degree on the tumor cell type as well as the extent of metastasis. A new immunotherapeutic adjunct to resection and irradiation is being developed. Five to ten-year survivors of resections for lung cancer and normal persons serve as lymphocyte donors. Transfer factor is extracted from these lymphocytes and injected into selected patients who have recently had resections for lung cancer. It is too soon to evaluate the results of this experiment, but it is hoped that immunotherapy using transfer factor will be of help to patients with carcinoma of the lung.

Carcinoma, Bronchogenic↗
PubMed1978

Monilial esophagitis: an increasingly frequent cause of esophageal stenosis?

Acute monilial esophagitis generally responds well to oral nystatin therapy, and long-term sequelae of this condition have not been well recognized. Nor is it generally appreciated that Candida infections of the esophagus may occur in subacute or chronic form. Four men, 34, 40, 41, and 49 years old, have been treated for esophageal stenoses resulting from different types of chronic monilial esophageal involvement. All were seen with painless dysphagia and strictures of the upper half of the thoracic esophagus. In 2 patients, an associated roentgenographic pattern of "intramural esophageal pseudodiverticulosis" was present. Two patients have been treated successfully with esophageal dilation, 1 required substernal colonic bypass of the stenotic, perforated esophagus, and 1 is being evaluated for esophageal bypass. Esophageal moniliasis must be considered in the differential diagnosis of benign esophageal strictures, particularly those involving the upper half of the thoracic esophagus.

Adult↗
PubMed1978

Effects of cardioplegic solution on human contractile element velocity.

A technique for measuring the maximum contractile element velocity (Vpm) of the myocardium was developed, verified, and employed in patients to allow accurate intraoperative assessment of the adequacy of myocardial protection. Four groups of patients were studied. Ten patients had coronary artery bypass grafts (CABG) with cardioplegia; 13 had CABG with coronary perfusion, ventricular fibrillation at 28 degrees C, and aortic clamping for distal anastamoses; 6 had aortic valve replacement (AVR) with cardioplegia; and 7 had AVR with coronary perfusion to the beating heart. For cardioplegia, a solution of 5% dextrose in 0.2% saline at 4 degrees C with 25 mEq of potassium chloride and 12.5 gm of mannitol was infused initially, followed by 500 ml every 30 minutes. Clinically all patients did well, and there were no deaths. Patients having CABG with intermittent coronary perfusion during ventricular fibrillation had significant (p less than 0.01) depression of Vpm from 38.3 to 30.8 sec-1 while Vpm in patients having CABG with cardioplegia was unchanged. Patients having AVR with continuous coronary perfusion or with cardioplegia (average anoxia time, 70.4 minutes) had no significant change in Vpm. We conclude that this cardioplegic solution provided adequate protection of myocardial function for up to 105 minutes of continuous aortic clamping in humans. The depression in Vpm observed following CABG with intermittent coronary perfusion is consistent with previous suggestions that this combination is detrimental because of maldistribution of coronary blood flow during ventricular fibrillation.

Aortic Valve↗
PubMed1978

Combined Collis-Nissen reconstruction of the esophagogastric junction.

Recent reports have indicated that combined Collis-Belsey reconstruction of the esophagogastric junction fails to control reflux in 30 to 46% of patients undergoing the procedure. The major factor thought to be responsible for this result is the limited Belsey fundoplication possible after construction of the gastroplasty tube. This report describes our technique of combining the Collis gastroplasty with a 360-degree Nissen type fundoplication. The radiographic and manometric characteristics of the distal esophageal high-pressure zone produced by the Collis-Nissen operation are discussed.

Adult↗
PubMed1978

Myocardial revascularization in patients receiving long-term propranolol therapy.

Twenty-seven patients receiving long-term propranolol therapy underwent myocardial revascularization to relieve stable or unstable angina. The patients were randomly divided into two groups, one (Group 1) in which propranolol was discontinued 48 hours prior to operation and one (Group 2) in which patients received a final dose of propranolol 1 to 2 hours prior to operation. Several physiological variables were compared, and there was no statistically significant difference between the groups except for a slower pulse rate in Group 2 patients. Although the patients in Group 1 showed a greater frequency of hypertension before bypass, the incidence of postoperative complications and perioperative myocardial infarction was the same for both groups. The findings of this study indicate that myocardial revascularization is safe even if propranolol is administered up to 1 or 2 hours before operation.

Adult↗
PubMed1978

Treatment of caustic injuries of the esophagus: a ten year experience.

The methods of managing 32 patients sustaining caustic injuries to the esophagus are assessed. Treatment of these patients must be individualized according to the type of caustic ingested, the degree of burn and other clinical signs. While an aggressive approach is favored for second and third-degree burns in the form of early esophago-gastrectomy with subsequent colon interposition, operation is not necessary. In all patients, particularly those with first-degree burns. The use of antibiotics is recommended as soon as the diagnosis of esophageal injury is established. The efficacy of steroids in preventing stricture formation, especially with third-degree burns, is questioned.

Adult↗
PubMed1978

Management of unusual traumatic ruptures of the aorta.

Blunt injuries to the ascending aorta and branches of the aortic arch are unusual but must be considered in any victim of a high speed decelerating injury. Because there are no characteristic clinical or roentgenographic findings, aortography is the only definitive method of establishing the diagnosis. Aortography should therefore, be performed upon any patient who has had a high speed decelerating injury, regardless of the clinical or the roentgenographic findings. An early operation will prevent exsanguination.

Adolescent↗
PubMed1978

Esophagectomy without thoracotomy.

Blunt esophagectomy without thoracotomy has been performed in 26 patients: four with benign disease and 22 with carcinomas involving various levels of the esophagus (10 cervicothoracic, one upper third, five middle third, and six distal third). Continuity of the alimentary tract was restored by anastomosing the pharynx or cervical esophagus either to stomach (19 patients) or to a colonic graft (seven patients). Esophageal resection and reconstruction were performed in a single stage in 25 patients, and the esophageal substitute was positioned in the posterior mediastinum in the original esophageal bed in 24 patients. There were no deaths directly related to the technique of blunt esophagectomy. Average intraoperative blood loss was 1,350 ml. for the entire group, 1,650 ml. for those requiring concomitant laryngectomy and 1,050 ml. for those undergoing esophagectomy without laryngectomy. Complications in these patients included pneumothorax (eight), transient hoarseness (five), pleural effusion (five), anastomotic leak (four), subphrenic abscess (one), and cerebrovascular accident (one). The five deaths were due to pheumonia (two), innominate artery rupture (two), and pulmonary embolus (one). Blunt esophagectomy without thoracotomy is safe and is far better tolerated physiologically than the combined transthoracic and abdominal operations more traditionally used for exophageal resection and reconstruction.

Adenocarcinoma↗
PubMed1977

New trends in esophageal replacement for benign disease.

In the past three years 21 patients have required esophageal replacement for benign disease: 6 patients with caustic stricture, 5 with reflux esophagitis, 5 with neuromotor abnormalities, 2 with strictures following radiation therapy, 1 with iatrogenic perforation, 1 with monilial esophagitis, and 1 with esophageal atresia. Esophageal substitution was achieved using isoperistaltic left colon 17 patients and stomach in 4. The preoperative evaluation, postoperative complications, and results of esophageal replacement in these patients are discussed. Changing trends in the benign conditions requiring esophageal substitution are reviewed.

Adult↗