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Biomedical subjects

R F Heitmiller

Publications and source records attributed to R F Heitmiller.

At least 55 records · Page 3Linked to original sources
PubMed1996

Esophagectomy for benign disease: trends in surgical results and management.

BACKGROUND: Esophagectomy for benign disease is uncommon. METHODS: From July 1987 to April 1995, 45 consecutive patients (30 men, 15 women; mean age, 50 years) were evaluated in whom the senior author (R.F.H.) performed an esophagectomy, esophageal reconstruction, or both. The study period was divided into two time intervals, July 1987 to January 1992 (time 1) and February 1992 to April 1995 (time 2). RESULTS: Indications for operation included obstruction (23 patients, 51%), benign neoplasia (17.38%), and perforation (5 patients, 11%). A nonthoracotomy approach was used in 19 (42%) patients: 15 transhiatal and 4 substernal. Thoracotomies were performed in 26 (58%) patients through a left thoracoabdominal or multiincisional techniques. Morbidity occurred in 15 (33%) patients, and there was one operative death (2%). CONCLUSIONS: Despite an operative morbidity of 33%, esophagectomy for benign disease may be performed with acceptably low mortality. We observed the following trends: (1) an increase in patients with benign neoplasia and a decline in patients with obstruction, (2) an increased use of transhiatal esophagectomy, (3) a decreased use of colon, an increased use of stomach for esophageal replacement; and (4) a decreased length of hospital stay.

Adolescent↗
PubMed1996

Tracheal release maneuvers.

Tracheal release procedures are specialized surgical techniques designed to permit low tension end-to-end primary reconstruction after tracheal sleeve resection. Therefore, an understanding of the principles and techniques of these tracheal release maneuvers is essential in order to perform tracheal surgery safely. The release procedures include dissection of the pretracheal plane, cervical flexion, and laryngeal and hilar release. Dissection of the pretracheal plane and cervical flexion are the most commonly employed techniques.

Anastomosis, Surgical↗
PubMed1994

Subacute ischemia of the colon esophageal interposition.

The most devastating complication of colon interposition is acute ischemia with colon necrosis. Delayed complications of the interposed colon, including long segment stricturing develop in an occasional patient. Some investigators have speculated that these late complications result from delayed colon ischemia. We believe that these patients represent a small subgroup who have nonnecrotic vascular insufficiency (subacute ischemia) of the interposed colon, which is present from the time of the operation. We reviewed the postoperative contrast radiographic studies of 3 patients with subacute colon ischemia. The radiographic findings are characteristic, and are identical to those seen in ischemic colitis of the nonmobilized colon. They include loss of haustral folds, an ill-defined bowel wall border, and mucosal changes such as "thumbprinting," and "urticaria." Fibrosis and stricturing represent the end-stage of the ischemic process.

Acute Disease↗
PubMed1994

Lung cancer and the left internal mammary artery graft.

A patient with a left upper lobe non-small cell lung cancer involving a previous left internal mammary artery graft is presented to highlight the potential complications associated with resective lung operations in these patients. If left internal mammary artery involvement by tumor is suspected, coronary and left internal mammary artery catheterization should be added to the standard non-small cell lung cancer staging evaluation before considering surgical resection.

Aged↗
PubMed1994

Simplified, standardized technique for cervical esophagogastric anastomosis.

Using transhiatal esophagectomy, the ease of performing the cervical esophagogastric anastomosis varies greatly depending on neck size, length of mobilized stomach, and adhesions from previous neck operations. We therefore have developed a technique, used in 45 consecutive patients undergoing transhiatal esophagectomy, that has simplified the technical performance of cervical esophagogastric anastomosis.

Anastomosis, Surgical↗
PubMed1994

Thoracoscopy for pleural space disease.

We reviewed the results of 40 consecutive patients who underwent thoracoscopy on the general thoracic surgery service at our institution. Pleural space disease was the indication for thoracoscopy in 34 patients (85%). In 18 patients (46%), a malignant tumor accounted for the pleural space disease. In all patients with malignant disease, the diagnosis was established by a single thoracoscopy. For patients with benign pleural space disease, the timing of the thoracoscopic intervention is important. Despite advances in the extended application of thoracoscopy, the diagnosis and management of pleural space disease continues to be the primary indication for the procedure.

Adenocarcinoma↗
PubMed1993

Endobronchial metastasis.

Endobronchial metastases from nonpulmonary neoplasms are rare. Since 1971, we have treated 23 patients with endobronchial metastases, the findings for which form the basis of this article. Many types of primary tumors are capable of endobronchial metastases, although breast, colon, and renal carcinomas predominate. The mean time from the diagnosis of the primary carcinoma to the diagnosis of endobronchial metastases was 59.9 months. Bronchoscopic results were diagnostic in all cases. Although the mean time for the appearance of endobronchial metastases is almost 5 years, on examination the majority of patients will have symptomatic extrabronchial metastatic disease, the quality of their survival will often be poor, and their survival time will be limited (12.5 months). Surgical resection should be confined to patients with localized disease.

Adolescent↗
PubMed1992

Percutaneous replacement jejunostomy.

After esophagectomy in which a surgical jejunostomy is performed, there is a small group of patients whose jejunostomy tube has been removed who require late postoperative nutritional support. For these patients, a percutaneous replacement jejunostomy technique is described that is simple and safe and that allows for enteral alimentation.

Catheterization↗
PubMed1992

Prognostic significance of massive bronchogenic tumor embolus.

Massive arterial bronchogenic tumor embolus is rare, and most commonly occurs intraoperatively during pulmonary resection. Arterial obstruction from the tumor embolus carries substantial morbidity and mortality. For those patients who survive embolectomy, prognosis is most closely correlated with the TNM staging of the primary lung tumor ignoring the tumor embolus.

Bronchoscopy↗
PubMed1992

Cervical esophago-esophageal anastomosis.

We describe our results with cervical esophagoesophageal anastomosis. This approach has been used with success in 4 patients. It has the advantage of avoiding esophagectomy in patients with benign disease and allows restoration of esophageal continuity in patients having limited options for esophageal replacement.

Adolescent↗
PubMed1992

Results of standard left thoracoabdominal esophagogastrectomy.

The left thoracoabdominal incision is approaching its first century of use. Although less popular than the Ivor Lewis and transhiatal techniques, it continues to be a useful approach for esophageal or gastric tumors near the gastroesophageal junction. For these tumors, the incision provides excellent exposure, and maximizes reconstructive options during esophagogastrectomy. The incision has a proven track record of safety and is well-tolerated.

Esophageal Neoplasms↗
PubMed1991

Transient diminished airway protection after transhiatal esophagectomy.

Fifteen consecutive patients undergoing transhiatal esophagectomy for esophageal carcinoma were studied cineradiographically to evaluate postoperative pharyngeal function. Cinepharyngo-esophagograms were obtained preoperatively and 1 week (range: 6 to 10 days) and 1 month (range: 18 to 52 days) postoperatively. One week after transhiatal esophagectomy, new radiographic swallowing abnormalities were identified in 10 patients (67%). The most common abnormalities observed were laryngeal penetration or aspiration (seven patients, 47%) and incomplete laryngeal elevation (five patients, 33%). Abnormal epiglottic tilt was seen in only two patients (13%). No postoperative pharyngeal retention and no cricopharyngeal obstruction to swallowed contrast was observed. One month after transhiatal esophagectomy, all radiographic swallowing abnormalities had resolved or improved. Laryngeal penetration or aspiration is common after transhiatal esophagectomy and is a consequence of diminished airway protection with incomplete laryngeal elevation rather than a result of esophageal obstruction with "spill-over" aspiration. These changes resolve or improve within the first postoperative month.

Adult↗
PubMed1991

Duodenobronchial fistula.

Duodenobronchial fistulas are an extremely rare subgroup of abdominobronchial fistulas, which include bronchobiliary, gastrobronchial, enterobronchial, colobronchial, and splenobronchial fistulas. Only one case of a duodenobronchial fistula has been previously reported. Duodenobronchial fistulas occur as a complication of a duodenal injury. The characteristic symptoms are a cough that produces copious bilious secretions, shortness of breath, and fever. The diagnosis is made by contrast gastrointestinal studies. Treatment requires an abdominal approach with interruption of the fistula at its duodenal origin and control of the inciting inflammatory process. With prompt diagnosis and treatment, thoracic drainage or pulmonary resection should not be needed.

Bronchial Fistula↗
PubMed1990

Esophageal motility in an adult with a congenital H-type tracheoesophageal fistula.

Congenital H-type tracheoesophageal fistulas (TEF) are rare. Long-standing respiratory symptoms are the most common presenting complaints. Patients with these fistulas have a congenital esophageal motor abnormality characterized by uncoordinated, low-amplitude peristalsis of the esophageal body; both low and normal lower esophageal sphincter pressures have been described. These findings persist despite fistula repair. A case history of an adult patient with congenital TEF is presented and the literature is reviewed. This patient is unusual in that esophageal symptoms (dysphagia) were more prominent than the usual respiratory symptoms.

Adult↗