Search PubMed⌕ Search

Biomedical subjects

K J Herlihy

Publications and source records attributed to K J Herlihy.

14 recordsLinked to original sources
PubMed2001

Prospective trial evaluating early initiation of feeding in patients with newly placed one-step button gastrostomy devices.

The purpose of this study was to prospectively assess the feasibility and safety of early feeding in patients with newly placed one-step button (OSB) gastrostomy devices. Twenty-five patients who underwent percutaneous endoscopic button gastrostomy placement were prospectively enrolled. The patients underwent radiographic assessment (Gastrografin gastrograms) 3 hr after gastrostomy placement. Contrast extravasation was not documented in any patient. Aside from one patient who aspirated the contrast solution after the radiologic study, all others (96%) were successfully fed on the day the gastrostomy buttons were placed. In this prospective study of patients with newly placed OSB gastrostomy devices, early initiation of feeding was feasible and safe. In a fashion similar to their tube-style counterparts, button gastrostomy devices provide adequate apposition between the stomach and abdominal wall immediately after their initial placement.

Adult↗
PubMed1984

Barrett's esophagus: clinical, endoscopic, histologic, manometric, and electrical potential difference characteristics.

The clinical, endoscopic, histologic, manometric, and esophageal potential difference characteristics of 20 patients with columnar epithelia lining the lower esophagus (Barrett's esophagus) are presented. Endoscopically, two distinct types were identified: a circumferential-type and an island-type Barrett's esophagus. Patients with these types exhibited similarities in mean age, duration of symptoms, mean lower esophageal sphincter pressure, and frequency of gross esophagitis. Only patients with the circumferential lesion, however, had esophageal strictures or esophageal ulcers. Manometric testing revealed a range of lower esophageal sphincter pressures from 3 to 33 mmHg and qualitative motor abnormalities (i.e., aperistalsis, repetitive waves, tertiary waves) in 3 patients. Histologically, the frequency of epithelial types was junctional greater than specialized columnar greater than atrophic fundic epithelium. More importantly, dysplasia was identified in 2 patients with the circumferential lesion and in 1 patient with the island lesion. Potential difference measurements demonstrated that a high potential difference (greater than -25 mV) was highly specific (92%), but only moderately sensitive (70%) for detecting Barrett's esophagus. Based on these findings, we conclude (a) that there are at least two endoscopically distinct types of Barrett's esophagus involving the lower esophagus--a circumferential type and an island type, (b) that both types are associated with chronic gastroesophageal reflux, with the island type being accompanied by less severe epithelial injury than the circumferential type, and (c) that the identification of dysplasia in the two types suggests that both are unstable lesions requiring continued surveillance with endoscopy and biopsy.

Adolescent↗
PubMed1982

Barrett's esophagus.

Barrett's esophagus denotes the presence of columnar epithelium in the esophagus instead of the usual stratified squamous epithelium. Barrett's esophagus had been thought to represent a mediastinal extension of the stomach in patients with a congenital short esophagus. Subsequent clinical and experimental data have established the abnormality as an acquired condition resulting from chronic gastroesophageal reflux. Although roentgenographic studies may show a mild-esophageal stricture or an esophageal ulcer, definitive diagnosis requires endoscopy with directed biopsy of erythematous mucosa in the esophagus, or manometrically guided biopsies for showing the presence of columnar epithelium above the lower esophageal sphincter. Although the origin of the cells causing this epithelium is still unclear, three distinct epithelial types have been found: atrophic gastric-fundic, junctional, and specialized columnar. Esophageal strictures and esophageal ulcers are complications associated with Barrett's esophagus, but its major significance is the association with the development of adenocarcinoma of the esophagus. Treatment of Barrett's esophagus is aimed at preventing gastroesophageal reflux with the additional need for close endoscopic surveillance for the development of dysplasia or early adenocarcinoma. Whether the diagnosis of Barrett's esophagus mandates anti-reflux surgery (fundoplication) remains controversial.

Barrett Esophagus↗
PubMed1981

Pseudomembranous (antibiotic-associated) colitis.

We have come to understand the cause of antibiotic-associated pseudomembranous colitis (PMC) only in the last decade. Clostridium difficile produces the intestinal dysfunction and the characteristic finding of exudative plaques on the mucosa by elaborating a toxin in the colon. This report reviews the development of our knowledge of this disease and the rapid adoption of a rational therapy once the cause was specified. C. difficile or its toxin can be cultured or isolated from the stools of 90% of the patients with PMC. This organism is almost never found in healthy people or in any other conditions except inflammatory bowel disease, where its significance is not yet known. The detection of pseudomembranes by sigmoidoscopy establishes the diagnosis. The laboratory technics that confirm the presence of C. difficile and its toxin are being incorporated into many laboratories around the country. Treatment of diagnosed PMC is relatively simple and usually completely effective. The offending antibiotic is stopped, a proper fluid and electrolyte balance maintained, and oral vancomycin begun, 125 to 500 mg four times a day. Cholestyramine can also be used as an adjunct to this regimen. Relapse can occur in patients treated with oral vancomycin, necessitating a repeat course of therapy.

Anti-Bacterial Agents↗