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Biomedical subjects

T Hersh

Publications and source records attributed to T Hersh.

At least 37 records · Page 2Linked to original sources
PubMed1981

Colon interposition for advanced nonmalignant esophageal stricture: experience with 40 patients.

This report details our experience in 40 patients with benign strictures of the esophagus who underwent colon (or gastric) interposition with our without esophageal resection between 1972 and 1980. There were 23 men and 17 women ranging from 5 to 76 years old. Twenty-seven patients had fibrotic strictures secondary to reflux esophagitis including 12 after failure of antireflux procedures; 4 had caustic strictures; 3 had a Barrett's esophagus; 2 had systemic candidiasis; 2 had scleroderma; and in 2 the etiology was undetermined. the right colon was used in 27 patients, the left colon in 4, the transverse colon in 1, and the jejunum in 1. In 7 patients the stomach was employed because of vascular insufficiency of the colon. Three surgical approaches were utilized. Manometric studies were done post-operatively in 10 patients. Complications occurred in 7 patients: cervical leaks, 4; reflux colitis, 2; and a late cervical stricture, 1. There were 4 deaths, only 1 of which was related directly to technique. This report summarizes the beneficial effect of right colon interposition for long esophageal strictures. Its vasculature is adequate, and it functions properly to propel food into the stomach irrespective of the peristaltic orientation.

Adolescent↗
PubMed1981

Chronic intestinal pseudo-obstruction.

Intestinal pseudo-obstruction (IP) is an uncommon disorder of gut motility which must be differentiated from mechanical intestinal obstruction. We have seen 11 such patients over the last 5 years. Characteristic symptoms, shared by mechanical obstruction, include abdominal distention and pain, nausea, and vomiting. Radiologic studies reveal dilated loops of bowel with air fluid levels. In most patients a major differentiating feature from obstruction may be the presence of diarrhea rather than obstipation. Steatorrhea is secondary to an overgrowth of anaerobic bacteria in the motionless dilated loops of bowel. IP has been associated with various disorders: in our series two patients had scleroderma, one multiple small bowel diverticula, one systemic amyloidosis, one celiac disease, and one spinal cord injury; in only two patients was the disorder considered "idiopathic." Three patients had previously undergone a jejuno--ileal bypass for morbid obesity. During the acute episode, the patients were treated symptomatically with decompression by nasogastric or rectal tube with fluid and electrolyte replacement. Malabsorption treated with broad spectrum antibiotics reversing the steatorrhea but not episodes of pseudo-obstruction. Magnesium deficiency was present in seven patients and its correction resulted in amelioration of the symptom complex. In two patients episodes of pseudo-obstruction were markedly reduced by metoclopramide which was not effective in two others.

Adult↗
PubMed1981

Primary hyperparathyroidism and the gastrointestinal tract.

To determine the frequency of gastrointestinal symptoms in primary hyperparathyroidism, we retrospectively analyzed 100 consecutive patients seen at Emory University Hospital from Jan 1, 1977 through March 1, 1979. At the time of diagnosis, 28 patients complained of nausea, 19 of vomiting, 29 of abdominal pain, and 33 of constipation. One patient presented with acute pancreatitis and 14 had ulcer disease (two gastric and 12 duodenal ulcers). Hypercalcemia increases gastric acid secretion and may account for associated ulcer disease and the ulcer-like pain in primary hyperparathyroidism. The mechanisms causing the other gastrointestinal symptoms in hypercalcemia remain to be elucidated. These symptoms abate on correction of hyperparathyroidism.

Constipation↗
PubMed1981

Comparison of the barium test meal and the gamma camera scanning technic in measuring gastric emptying.

In 21 patients with nonresected stomachs and symptoms of delayed gastric emptying, obstruction was excluded by upper gastrointestinal series and upper endoscopy; all had abnormal results of barium test meal (BTM) study. Each had repeat BTM after the administration of 10 mg of metoclopramide. Each patient also had two gamma camera studies after a technetium Tc 99m sulfur colloid labeled meal; normal saline or metoclopramide was administered before each test in a blinded and random manner. Half-time (T1/2) and percentage of isotope remaining at six hours (GC6) were recorded. Ten asymptomatic controls had a gamma camera scanning study, and seven of these had a BTM. Nine of 19 patients had a T1/2 in the normal range, and in 12 of 19 patients the GC6 was in the normal range. The magnitude of retention of barium at six hours on the BTM did not correlate with the T1/2 (r = 0.076) or the GC6 (r= 0.296). Thus, these tests were not comparable in this study. By regression analysis, a significant reduction was shown in the amount of retained food and barium (P less than .01), the T1/2 (P less than .01), and the GC6 (P less than .01) after intramuscular administration of metoclopramide, indicating that both tests were able to evaluate the effects of this drug.

Adult↗
PubMed1981

Esophageal Manometry in Patients with Chest Pain and Normal Coronary Arteriogram.

Evaluation of the esophagus is helpful in determining the source of chest pain. Eighteen per cent of 72 patients with a normal coronary angiogram had esophageal disease as a source of chest pain. Eight had diffuse esophageal spasm, four had reflux esophagitis and one had an esophageal ulcer. Five of eight patients with diffuse esophageal spasm had relief of symptoms with nitroglycerin. Despite normal coronary arteriogram and normal esophageal manometry 42 of 49 other patients had relief of chest pain with nitroglycerin.

Adult↗
PubMed1980

Epidermoid splenic cyst occurring in an intrapancreatic accessory spleen.

This case describes a 40-year-old man with abdominal pain, nausea, and vomiting, who was found to have a cystic lesion in the tail of the pancreas. Distal pancreatectomy and splenectomy revealed a primary epidermoid cyst of the spleen lying in the substance of the tail of the pancreas. This represents the only report of a splenic cyst in an ectopic spleen that could be found in a search of the world literature.

Adult↗
PubMed1980

The surgical treatment of bile reflux gastritis: a study of 59 patients.

Fifty-nine patients underwent duodenogastric diversion for bile reflux gastritis. Sixty per cent of 37 patients who underwent measurement of solid food gastric emptying had delayed gastric emptying. Patients were also assessed in terms of the degree of gastritis present endoscopically. Fifty-six patients were available for follow-up of from six months up to six years. The results demonstrated the following: Patients with delayed gastric emptying and reflux gastritis fared poorly after duodenogastric diversion; the greater the severity of gastritis visible by endoscopy, the better the results of diversion. Only 47% of patients achieved a satisfactory result of duodenogastric diversion.

Adolescent↗
PubMed1980

Noncirrhotic portal vein thrombosis. Physiology before and after shunts.

Controversy exists concerning the proper therapy for bleeding gastroesophageal varices secondary to noncirrhotic portal vein thrombosis. Disparity of opinion exists regarding the significance of hepatic portal blood flow and the consequences of total portal-systemic shunts in this condition. One patient is presented who developed severe, crippling encephalopathy 20 years after a central splenorenal shunt. This was associated with loss of portal flow to the liver and marked nitrogen intolerance. Closure of the shunt resulted in restoration of hepatic portal flow via collateral veins (HPI 0.36), clearance of encephalopathy and return to near normal protein tolerance. An additional patient was studied with hyperammonemia and early suggestive signs of encephalopathy eight years following a mesocaval shunt. Four patients were evaluated before and after selective distal splenorenal shunts. All had "cavernous transformation" of the portal vein with angiographic evidence of portal flow to the liver. Postoperative angiograms revealed continued hepatic portal perfusion and a patent shunt in each patient. Radionuclide imaging postoperatively gave an estimated portal fraction of total hepatic blood flow (HPI) of .39 and .60 in two of the four patients. We conclude that 1) there is significant hepatic portal perfusion in noncirrhotic portal vein thrombosis (cavernous transformation), 2) loss of this hepatic portal flow following total shunts can lead to severe encephalopathy, 3) the selective distal splenorenal shunt maintains hepatic portal perfusion and is the procedure of choice when there is a patent splenic vein and surgical intervention is indicated.

Adolescent↗
PubMed1980

Antibiotic-associated colitis: a persistent clinical problem.

Examination of this series of 19 patients with antibiotic-associated pseudomembranous colitis revealed that most of the patients were given the antibiotics for trivial reasons. Many different antibiotics were identified as being related to the development of colitis. There were three deaths in this series; two of the 15 patients treated medically and one of the four treated surgically. The efficacy of all diagnostic procedures and medical therapies are discussed, and the role of surgery in treating patients with toxic state, sepsis, or perforation is presented.

Adult↗
PubMed1980

The effects of coherin on patients with idiopathic delayed gastric emptying.

Ten patients with idiopathic delayed gastric empyting were studied in a randomized double-blind fashion to examine the effects of coherin versus placebo upon their symptoms and objective measurements of gastric emptying. The results showed no significant effect of coherin on either symptom scores or gamma camera 99Technetium gastric emptying studies in this group of patients. There is a need to develop other agents in treatment of this poorly understood condition.

Adolescent↗
PubMed1980

Hepatic infarction in ulcerative colitis during pregnancy.

Acute hepatic failure developed at the time of parturition in a 27-yr-old woman. Liver biopsy demonstrated disseminated hepatic infarctions which were confined to the distal segments of the hepatic microcirculatory units. This episode of hepatic infarction was followed by persistent fever and cutaneous vasculitis, which resolved on prednisone therapy. The diagnosis of ulcerative colitis was made 5 mo after recovery from severe hepatic failure.

Adult↗
PubMed1980

Oxacillin-induced pseudomembranous colitis.

Pseudomembranous colitis has been reported as a complication of therapy with a number of different antibiotics. We present here a case of pseudomembranous colitis following therapy with oxacillin, in which the causative organism and the toxin it produces were isolated from the patient's stool. We believe this is the first documented case of oxacillin-induced pseudomembranous colitis.

Clostridium Infections↗
PubMed1980

Metoclopramide therapy in fifty-five patients with delayed gastric emptying.

Fifty-five patients with delayed gastric emptying and the symptoms of nausea, vomiting, postprandial bloating and early satiety were treated with metoclopramide. Obstruction was excluded by upper endoscopy and standard upper gastrointestinal series. None were on medication known to retard gastric emptying. All patients had an abnormal barium burger radiologic study. Twenty-one patients had had previous vagotomy and drainage procedure, five had diabetic gastroparesis and 29 had idiopathic delayed gastric emptying. Metoclopramide significantly decreased the symptom scores of the surgical and idiopathic patients. When all patients were analyzed together, there was a significant improvement in both the metoclopramide and placebo treated patients. When, however, the improvement on metoclopramide was compared to the improvement on placebo, there was a significant metoclopramide effect beyond the placebo effect. Thus, metoclopramide is an effective agent in treating the symptom-complex of patients with delayed gastric emptying.

Adolescent↗
PubMed1980

Anorectal manometry in the diagnosis of Hirschsprung's disease in adults.

Anorectal manometry is a useful tool in evaluating the cause of chronic constipation and is reliable in the diagnosis of Hirschsprung's disease. Two adult patients ages 35 and 69 with constipation since birth underwent anorectal manometry. Balloons positioned at the internal and external anal sphincters were connected to pressure transducers and their responses to a distention of rectal balloon were recorded. Both patients demonstrated failure of relaxation of the internal anal sphincter which is characteristic of Hirschsprung's disease. This diagnosis was confirmed at surgery by histologic examination failing to show ganglia. Anorectal manometry is a useful adjunct in the differential diagnosis of adult patients with megacolon.

Adult↗
PubMed1979

Metoclopramide therapy in patients with delayed gastric emptying: a randomized, double-blind study.

Twenty-eight patients with delayed gastric emptying as measured by an abnormal barium "burger" were treated with metoclopramide in a randomized, double-blind fashion. Five had diabetic gastroparesis, four had undergone vagotomy and pyloroplasty, and 19 were idiopathic. Patients received either metoclopramide or placebo for a three-week period and symptoms were scored prestudy, at weekly intervals, and at termination of the study. Ten of 17 patients on metoclopramide and four of 14 on placebo decreased their symptom score to a level below entry criteria, indicating a significant metoclopramide effect when compared to placebo. The mean total sumptom score for the metoclopramide group was 18.4 prestudy and 7.2 poststudy while for placebo was 19.1 prestudy and 12.9 poststudy. Although improvement on placebo was significant, these patients were still symptomatic. The improvement on metoclopramide was significantly greater than the improvement on placebo. Metoclopramide is an effective agent in treating the symptom complex of delayed gastric emptying.

Adult↗
PubMed1979

Nasogastric hyperalimentation through a polyethylene catheter: an alternative to central venous hyperalimentation.

We performed nasogastric hyperalimentation with polyethylene catheters and appropriate feeding solutions in 12 cachectic patients who had been referred as candidates for central venous hyperalimentation. Most patients had primary gastrointestinal disease. The duration of hyperalimentation averaged 31 days. Seven patients obtained rapid weight gain (average 0.3 kg/day) with the nasogastric hyperalimentation alone. An additional two were successfully repleted with the addition of parenteral fluids via peripheral veins. In the nine repleted patients, serum albumin rose by average 19%, 24-hr urine creatinine by average 21%, and triceps skinfold by average 46%. The nature of the weight gain in the nine successful cases was analyzed by the metabolic balance study technique. Average composition of the increment in weight was: 50% protoplasm, 48% extracellular fluid, 19% adipose tissue, and less than 1% bone. We conclude that nasogastric hyperalimentation can replace central venous hyperalimentation in a substantial proportion of patients now receiving the latter type of treatment.

Adult↗
PubMed1979

The effects of metoclopramide on postoperative ileus. A randomized double-blind study.

Metoclopramide or placebo was administered postoperatively in a randomized, double-blind fashion to 115 patients undergoing laparotomy. The effect of metoclopramide on postoperative adynamic ileus (PAI) was evaluated. The patients were stratified into two groups: Group A--those with laparotomy without a gastrointestinal anastomosis or ostomy procedure, and group B--those with laparotomy undergoing an anastomosis or ostomy procedure. Metoclopramide reduced nausea and emesis postoperatively. However, the only significant effect on postoperative adynamic ileus was an earlier return to tolerance of solid foods in the patients in Group A.

Adult↗