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J A Dominitz

Publications and source records attributed to J A Dominitz.

At least 19 recordsLinked to original sources
PubMed2001

Argon plasma coagulation for rectal bleeding after prostate brachytherapy.

PURPOSE: To better define the efficacy and safety of argon plasma coagulation (APC), specifically for brachytherapy-related proctitis, we reviewed the clinical course of 7 patients treated for persistent rectal bleeding. Approximately 2-10% of prostate cancer patients treated with 125I or 103Pd brachytherapy will develop radiation proctitis. The optimum treatment for patients with persistent bleeding is unclear from the paucity of available data. Prior reports lack specific dosimetric information, and patients with widely divergent forms of radiation were grouped together in the analyses. METHODS AND MATERIALS: Seven patients were treated with APC at the Veterans Affairs Puget Sound Health Care System and the University of Washington from 1997 to 1999 for persistent rectal bleeding due to prostate brachytherapy-related proctitis. Four patients received supplemental external beam radiation, delivered by a four-field technique. A single gastroenterologist at the Veterans Affairs Puget Sound Health Care System treated 6 of the 7 patients. If the degree of proctitis was limited, all sites of active bleeding were coagulated in symptomatic patients. An argon plasma coagulator electrosurgical system was used to administer treatments every 4-8 weeks as needed. The argon gas flow was set at 1.6 L/min, with an electrical power setting of 40-45 W. RESULTS: The rectal V100 (the total rectal volume, including the lumen, receiving the prescription dose or greater) for the 7 patients ranged from 0.13 to 4.61 cc. Rectal bleeding was first noticed 3-18 months after implantation. APC (range 1-3 sessions) was performed 9-22 months after implantation. Five patients had complete resolution of their bleeding, usually within days of completing APC. Two patients had only partial relief from bleeding, but declined additional APC therapy. No patient developed clinically evident progressive rectal wall abnormalities after APC, (post-APC follow-up range 4-13 months). CONCLUSIONS: Most patients benefited from APC, and no cases of clinically evident progressive tissue destruction were noted. Although APC appears to be efficacious and safe in the setting of the rectal doses described here, caution is in order when contemplating APC for brachytherapy patients.

Argon↗
PubMed2001

The use of trimodality therapy for the treatment of operable esophageal carcinoma in the veteran population: patient survival and outcome analysis.

BACKGROUND: In an effort to improve the cure rates associated with surgical therapy, neoadjuvant chemoradiotherapy is being used with increasing frequency before resection (trimodality therapy). A variety of clinical trials have reviewed this approach, but only one study to the authors' knowledge has shown a survival benefit for trimodality therapy. The extent to which trimodality therapy has gained acceptance in general practice is not clear. The objective of the current study was to determine the extent to which both surgery and trimodality therapy are used for the management of esophageal carcinoma within a large, national health care system and to determine the outcome of patients treated with these treatment approaches. METHODS: The current study was a retrospective cohort study. The study population was comprised of all veterans who underwent either surgery alone or trimodality therapy for operable esophageal carcinoma between the fiscal years of 1993 and 1997. Data were obtained from the Veterans Administration Patient Treatment File, Outpatient Clinic File, and the Beneficiary Identification Record Locator System. The main outcome measures were perioperative mortality and patient survival. RESULTS: During the study period, 695 patients underwent either surgery alone or trimodality therapy for esophageal carcinoma. Five hundred thirty-four (77%) patients were treated with surgery only. One hundred sixty-one (23%) patients underwent surgery after induction chemoradiotherapy (trimodality therapy). Patients selected for trimodality therapy were younger (mean age, 60.8 years vs. 65.6 years), had fewer comorbidities, and were more likely to have a midesophageal tumor. The median survival for all patients was 15.2 months. The type of treatment had no apparent effect on survival. Favorable prognostic factors included younger age, a distal esophageal tumor, and the absence of metastases. The overall perioperative mortality was 13.7 %. The use of trimodality therapy did not increase perioperative mortality. CONCLUSIONS: Trimodality therapy is commonly used within the VA system. The nonrandomized nature of this study does not allow comparison of trimodality therapy to surgery alone, but the overall survival was limited for all patients. The predictors of survival are related to the biology of the disease, and they include patient age, tumor location, and stage at diagnosis.

Aged↗
PubMed2001

Enteroscopy.

Explore the source record for details and available documents.

Endoscopy, Gastrointestinal↗
PubMed2001

Assessment of vital status in Department of Veterans Affairs national databases. comparison with state death certificates.

PURPOSE: To determine the extent to which Department of Veterans Affairs (VA) database vital status information agrees with Washington state death certificates. METHODS: Using each data source, vital status was determined for 19,481 Washington state resident veterans hospitalized in Washington VA hospitals from 1994 to 1997, and for 33,602 Washington state resident veterans who were seen as outpatients during 1997. RESULTS: The agreement between VA and Washington state records was excellent for hospitalized veterans (kappa = 0.91, p < 0.0001). Three thousand one hundred-eight individuals (86.2% of all deaths) appeared in both files. Of those deaths missing in the VA files, 71% had no service-connected disability, VA pension, or other compensation. Among outpatients, agreement between the death files was very good (kappa = 0.82, p < 0.001). Three hundred seventy-two individuals (69.8% of all deaths) appeared in both files. Of those deaths missing in the VA files, 63% had no service-connected disability or VA pension or other compensation. CONCLUSIONS: The VA death files are a valid source of vital status information for veterans hospitalized in recent years. For veterans having exclusively outpatient visits, however, the VA files miss a substantial proportion of deaths. For these patients, alternative means of vital status ascertainment are warranted.

Aged↗
PubMed2000

Acute presentation of transverse colon injury following percutaneous endoscopic gastrostomy tube placement: case report and review of current management.

We describe a case of a patient who had a percutaneous endoscopic gastrostomy (PEG) tube placed for enteral access. The patient's medical history was remarkable for chronic malnutrition, coronary artery disease, coronary bypass surgery, and severe esophageal dysmotility. We discuss the patient&'s course through treatment and we review the management options for patients that sustain colonic injury related to PEG placement. We conclude that colonic injury can be difficult to diagnose in the acute setting and that diagnosis may be facilitated by abdominal computerized tomographic (CT) scanning.

Acute Disease↗
PubMed2000

A randomized controlled trial of a clinic-based support staff intervention to increase the rate of fecal occult blood test ordering.

BACKGROUND: Colorectal cancer is the second most common fatal malignancy in the United States. Early detection using fecal occult blood tests has been shown to reduce mortality, but these tests are underutilized among those eligible for this screening. Attempts to increase use of fecal occult blood tests in eligible populations have focused on the provider, patient, or system. But none have examined whether a support-staff intervention is effective in achieving this aim. We therefore conducted a randomized controlled trial to test the impact of authorizing support staff to order fecal occult blood tests in a general internal medicine clinic organized into four teams. METHODS: A total of 1,109 patients were included in the study, 545 of whom were in the two teams randomized to treatment. Univariate and multivariate regression analyses were used to evaluate the impact of the intervention. RESULTS: The intervention resulted in significantly more fecal occult blood test ordering in the treatment group than in the control group for all patients (52% vs 15%, P < 0.001). Treatment fecal occult blood test cards were returned as frequently as the control cards for all patients (44% vs 48%, P = 0.571). CONCLUSION: Delegation of selected screening tasks to support staff can enhance patient access to preventive care.

Colorectal Neoplasms↗