Attila Dubecz

Publications

• 0.85

  Impact points

  Management of ERCP-related small bowel perforations: the pivotal role of physical investigation.

  Attila Dubecz, Jürgen Ottmann, Michael Schweigert, Rudolf J Stadlhuber, Marcus Feith, Volkmar Wiessner, Herbert Muschweck, Hubert J Stein

  Canadian journal of surgery. Journal canadien de chirurgie. 04/2012; 55(2):99-104.

  Background: Management of endoscopic retrograde cholangiopancreatography (ERCP)-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. Methods: A retrospective chart review was conducted to identify patients treated at our instit... [more] Background: Management of endoscopic retrograde cholangiopancreatography (ERCP)-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. Methods: A retrospective chart review was conducted to identify patients treated at our institution for ERCP-related duodenal perforations. Study variables included indication for ERCP, clinical presentation, diagnostic procedures, time to diagnosis and treatment, location of injury, management, length of stay in hospital and survival. Results: Between January 2000 and October 2009, 12 232 ERCP procedures were performed at our centre, and perforation occured in 11 patients (0.08%; 5 men, 6women, mean age 71 yr). Six of the perforations were discovered during ERCP; 5 required radiologic imaging for diagnosis. Three perforations were diagnosed incidentally by follow-up ERCP. In 1 patient, perforation occurred 3 years after the procedure owing to a dislocated stent. Four of 11 perforations were stent-related; in 2 pa tients ERCP was performed in a nonanatomic situation (Billroth II gastroenterostomy). Free peritoneal perforation occurred in 4 patients; 1 was successfully managed conservatively. Four patients (36%) were treated surgically and none died. Five patients were managed conservatively with a successful outcome, and 2 patients died after conservative treatment (18%). Operative treatment included hepaticojejunostomy and duodenostomy (1 patient), suture of the perforation with T-drain (1patient) and suture only (2 patients). The mean length of stay in hospital for all patients was 20 days. Conclusion: Post-ERCP duodenal perforations are associated with significant morbidity and mortality. Immediate surgical evaluation and close monitoring is needed. Management should be individually tailored based on clinical findings only.
• 2.40

  Impact points

  Management of anastomotic leakage-induced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion.

  Michael Schweigert, Attila Dubecz, Martin Beron, Herbert Muschweck, Hubert J Stein

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 02/2012;

  OBJECTIVES: Tracheobronchial fistulas are rare but life-threatening complications after oesophagectomy. Leakage of the oesophagointestinal anastomosis with inflammatory involvement of the tracheobronchial tree is the predominant reason for postoperative fistulization between the airways and the oeso... [more] OBJECTIVES: Tracheobronchial fistulas are rare but life-threatening complications after oesophagectomy. Leakage of the oesophagointestinal anastomosis with inflammatory involvement of the tracheobronchial tree is the predominant reason for postoperative fistulization between the airways and the oesophagus or the gastric tube. Successful management is challenging and still controversially discussed. After promising results in the treatment of intrathoracic anastomotic leaks, we adopted endoscopic stent implantation as the primary treatment option in patients with anastomotic leak-induced tracheobronchial fistula. The aim of this study was to investigate the feasibility, the limits and the results of this procedure. METHODS: Between January 2004 and December 2010, 222 consecutive patients underwent oesophageal resection mainly for oesophageal cancer. An anastomotic leak-induced tracheobronchial fistula was bronchoscopically verified in seven patients. Four patients received endoscopic implantation of either a self-expanding tracheal or oesophageal stent or both as primary treatment. Surgical re-exploration was mandatory in 2 patients because of necrosis of the pulled-up gastric tube or gangrene of the airways. One patient was conservatively managed. RESULTS: Endoscopic stent placement was successfully accomplished in all 4 patients. Two patients received an oesophageal stent, one patient a tracheal stent and one patient both an oesophageal and a tracheal stent. Closure of the fistula was achieved in all cases and 3 patients finally recovered while one died by reason of respiratory failure. In both surgical re-explored patients resection of the gastric tube was performed, and in one patient, because of subtotal gangrene of the right bronchial tree, emergency pneumectomy was also mandatory. Both patients died due to severe sepsis and respiratory failure. The one conservatively treated patient died from severe pneumonia. CONCLUSIONS: Treatment of anastomotic leak-induced tracheobronchial fistulas by means of oesophageal and tracheal stent implantation is feasible. If stent insertion is limited by gastric tube necrosis or bronchial gangrene, the prognosis is likely to be fatal.
• 0.75

  Impact points

  Video-Assisted Thoracoscopic Surgery for Posttraumatic Hemothorax in the Very Elderly.

  Michael Schweigert, Martin Beron, Attila Dubecz, Rudolf Stadlhuber, Hubert Stein

  The Thoracic and cardiovascular surgeon. 01/2012;

  Objective Thoracic injury is a life-threatening condition with advanced age being an independent risk factor for both higher morbidity and mortality. Furthermore, elderly patients often have severe comorbidity and in case of chest trauma with rib fractures and hemothorax, their clinical condition is... [more] Objective Thoracic injury is a life-threatening condition with advanced age being an independent risk factor for both higher morbidity and mortality. Furthermore, elderly patients often have severe comorbidity and in case of chest trauma with rib fractures and hemothorax, their clinical condition is likely to deteriorate fast. Aim of this study is to investigate the feasibility and results of video-assisted thoracoscopy for the treatment of posttraumatic hemothorax in very elderly patients of 80 years or more.Methods The outcomes of 60 consecutive patients who received video-assisted thoracoscopic surgery for posttraumatic hemothorax in a German tertiary referral hospital between 2006 and 2010 were reviewed in a retrospective case study. Patients older than 80 years were identified. Results There were 39 male and 21 female patients. The median age was 63.2 years. The in-hospital-mortality was 1.7% (1/60). Fifteen of the 60 patients were 80 years or older (80-91). Main reason for hemothorax was blunt chest trauma. Altogether 23 patients had fractures of three or more ribs including six octogenarians. Elderly patients suffered from preexisting cardiopulmonary disease and were often referred to the thoracic surgeon with considerable delay. Video-assisted thoracoscopic surgery was feasible and all octogenarian patients finally recovered well without in-hospital-mortality. Conclusions Video-assisted thoracoscopic surgery for treatment of posttraumatic hemothorax shows excellent results in very elderly patients of 80 years or more. Despite severe comorbidity and often delayed surgery all patients recovered. We therefore conclude that advanced age is no contraindication for surgical management of posttraumatic hemothorax by means of video-assisted thoracoscopy.
• 4.55

  Impact points

  Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis.

  Attila Dubecz, Isabell Gall, Norbert Solymosi, Michael Schweigert, Jeffrey H Peters, Marcus Feith, Hubert J Stein

  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 12/2011; 7(2):443-7.

  To assess long-term temporal trends in population-based survival and cure rates in patients with esophageal cancer and compare them over the last 3 decades in the United States. We identified 62,523 patients with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2007 from the... [more] To assess long-term temporal trends in population-based survival and cure rates in patients with esophageal cancer and compare them over the last 3 decades in the United States. We identified 62,523 patients with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2007 from the Surveillance, Epidemiology, and End Results database. Long-term cancer-related survival and cure rates were calculated. Stage-by-stage disease-related survival curves of patients diagnosed in different decades were compared. Influence of available variables on survival and cure was analyzed with logistic regression. Ten-year survival was 14% in all patients. Disease-related survival of esophageal cancer improved significantly since 1973. Median survival in Surveillance, Epidemiology, and End Results stages in local, regional, and metastatic cancers improved from 11, 10, and 4 months in the 1970s to 35, 15, and 6 months after 2000. Early stage, age 45 to 65 years at diagnosis and undergoing surgical therapy were independent predictors of 10-year survival. Cure rate improved in all stages during the study period and were 73%, 37%, 12%, and 2% in stages 0, 1, 2, and 4, respectively, after the year 2000. Percentage of patients undergoing surgery improved from 55% in the 1970s to 64% between 2000 and 2007. Proportion of patients diagnosed with in situ and local cancer remains below 30%. Long-term survival with esophageal cancer is poor but survival of local esophageal cancer improved dramatically over the decades. Complete cure of nonmetastatic esophageal cancer seems possible in a growing number of patients. Early diagnosis and treatment are crucial.
• 2.40

  Impact points

  Cholecystectomy in the very elderly--is 90 the new 70?

  Attila Dubecz, Miriam Langer, Rudolf J Stadlhuber, Michael Schweigert, Norbert Solymosi, Marcus Feith, Hubert J Stein

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 12/2011; 16(2):282-5.

  Nonagenarians are the fastest growing sector of population across Western Europe. Although prevalence of gallstone disease is high, elective cholecystectomy is still controversial in this age group. A retrospective chart review was conducted of cholecystectomies done in patients over 90 years of age... [more] Nonagenarians are the fastest growing sector of population across Western Europe. Although prevalence of gallstone disease is high, elective cholecystectomy is still controversial in this age group. A retrospective chart review was conducted of cholecystectomies done in patients over 90 years of age at our institution between 2004 and December 2009. During this period, a total of 3,009 cholecystectomies were performed on patients of all ages. Data collected included demographics, patient comorbidities, indications for surgery, type of surgery performed, intraoperative findings, histology, perioperative morbidity and mortality. Twenty-two nonagenarians (18 females) underwent cholecystectomy during the study period. Of these patients, 19 patients (86%) had diabetes, 16 (73%) had hypertension, and 10 (45%) had coronary artery disease. Twenty patients (91%) underwent an emergency procedure. In two patients, cholecystectomy was indicated for non-resolving pain after attempted conservative therapy, only two patients were operated electively. Laparoscopic cholecystectomy was attempted in 13 patients (59%), 3 patients needed a conversion, and 9 patients (41%) considered unfit to undergo a laparoscopic approach had an open procedure. Mean operation time was 83 min. Histology showed gangrenous cholecystitis in six (27%) patients. The mean length of stay was 10 days (4-23 days). Two patients (8.3%) required intensive care following surgery. There were no common bile duct injuries, one patient had a cystic stump leak. One patient died in the postoperative period (4.6%). All patients with an emergency operation were classified as at least ASA III. Conversion rate, percentage of open procedures, percentage of advanced histology, ASA score, and hospital stay were significantly higher when compared to all patients. Our study demonstrates that in unselected nonagenarians,cholecystectomy is safe with acceptable perioperative morbidity and mortality even as an emergency procedure. However, our data also suggests that cholecystitis appears to be a neglected condition in this age group.
• 3.64

  Impact points

  Modern history of surgical management of lung abscess: from Harold Neuhof to current concepts.

  Michael Schweigert, Attila Dubecz, Rudolf J Stadlhuber, Hubert J Stein

  The Annals of thoracic surgery. 12/2011; 92(6):2293-7.

  Harold Neuhof was one of the pioneers of thoracic surgery in the early decades of the last century. Inspired by his preceptor Howard Lilienthal he proposed an entirely new concept for surgery on acute lung abscess. The aim of his one-stage procedure was adequate drainage of the abscess cavity. His a... [more] Harold Neuhof was one of the pioneers of thoracic surgery in the early decades of the last century. Inspired by his preceptor Howard Lilienthal he proposed an entirely new concept for surgery on acute lung abscess. The aim of his one-stage procedure was adequate drainage of the abscess cavity. His approach proved to be the first major breakthrough in the treatment of acute lung abscess. Therapy of pulmonary abscess was again radically changed by the advent of antibiotics in the late 1940s. However, the basic principles of Neuhof's concept still influence modern-day management of putrid lung abscess.
• 3.64

  Impact points

  Esophageal stenting for malignant and benign disease: 133 cases on a thoracic surgical service.

  Attila Dubecz, Thomas J Watson, Daniel P Raymond, Carolyn E Jones, Alexi Matousek, Julie Allen, Renato Salvador, Marek Polomsky, Jeffrey H Peters

  The Annals of thoracic surgery. 12/2011; 92(6):2028-32; discussion 2032-3.

  Esophageal stenting is increasingly being utilized to treat a variety of benign and malignant esophageal conditions. The aim of our study was to review our experience with self-expanding metal, plastic, and hybrid stents in the treatment of esophageal disease on a thoracic surgical service. The stud... [more] Esophageal stenting is increasingly being utilized to treat a variety of benign and malignant esophageal conditions. The aim of our study was to review our experience with self-expanding metal, plastic, and hybrid stents in the treatment of esophageal disease on a thoracic surgical service. The study population consisted of 126 patients undergoing placement of 133 stents at a single institution from 2000 to 2008. Data were reviewed retrospectively for patient characteristics, indications, complications, reinterventions, and efficacy. Most stents were placed for palliation of dysphagia due to advanced esophageal cancer (90 of 133; 68%) or extrinsic compression from lung cancer (13 of 133; 9.8%). A total of 123 self-expanding metal stents (SEMS), 7 self-expanding plastic stents (SEPS), and 3 hybrid stents were placed. Of the SEMS, 57 were uncovered and 66 were covered. Malignant obstruction was typically palliated with SEMS, while covered stents were chosen for perforations or anastomotic leaks. The median length of stay was 1 day. Complications occurred in 38.3% of stent placements, with a single perioperative mortality resulting from massive hemorrhage on postoperative day 4. Most complications resulted from stent impaction (12.8%), migration (9.7%), or tumor ingrowth (5.3%). Tumor ingrowth was uncommon with uncovered stents (2 of 57; 3.5%). Stent migration was common with SEPS (4 of 7; 57%), or hybrid stents (2 of 3; 67%). Survival was short in patients with underlying malignancy (median 104 days for esophageal cancer and 48 days for lung cancer), with 20% of patients surviving less than 1 month. Esophageal stent placement is safe and reliable. The goals of therapy are typically met with a single intervention. The majority of patients require no further interventions, though life expectancy often is short and patient selection may be difficult. Most complications are due to stent obstruction, though stent migration is an issue particularly with SEPS and hybrid stents. Esophageal surgeons should be adept at stent placement.
• 3.64

  Impact points

  Risk of stent-related aortic erosion after endoscopic stent insertion for intrathoracic anastomotic leaks after esophagectomy.

  Michael Schweigert, Attila Dubecz, Rudolf J Stadlhuber, Herbert Muschweck, Hubert J Stein

  The Annals of thoracic surgery. 05/2011; 92(2):513-8.

  Intrathoracic anastomotic leakage after esophagectomy is associated with high morbidity and mortality. Because of disappointing results after surgical reexploration endoscopic stent implantation was introduced as primary treatment option with improved outcome. Aortoesophageal fistula is a very rare ... [more] Intrathoracic anastomotic leakage after esophagectomy is associated with high morbidity and mortality. Because of disappointing results after surgical reexploration endoscopic stent implantation was introduced as primary treatment option with improved outcome. Aortoesophageal fistula is a very rare complication and has thus far only anecdotally been reported after esophagectomy. The aim of this retrospective study was to investigate if endoscopic stent implantation increases the incidence of postoperative aortoesophageal fistula by reason of stent-related erosion of the thoracic aorta. Between January 2004 and October 2010, 213 patients underwent esophageal resection mainly for esophageal cancer. An intrathoracic esophageal anastomotic leak was endoscopically verified in 25 patients. Seventeen patients received endoscopic implantation of a self-expanding stent as primary treatment. In 8 patients a rethoracotomy was mandatory. After successfully accomplished endoscopic stent placement, complete closure of the anastomotic leak was radiologically proven in all 17 patients. In 13 cases, definitive closure and healing of the leak was achieved and the stent could subsequently be removed. In 1 patient, because of early recurrence of very malignant small cell cancer, the stent remained in situ. Three patients developed an erosion of the thoracic aorta with subsequent massive hemorrhage. The mean time between stent insertion and occurrence of aortoesophageal fistula was 26 days. All 3 patients died of exsanguination with severe hypovolemic shock. Postmortem examination confirmed an aortoesophageal fistula in each case. While endoscopic stent implantation seems to be effective in the control of intrathoracic anastomotic leakage, nevertheless the incidence of aortoesophageal fistula caused by stent-related aortic erosion exceeds the thus far reported numbers. Awareness of this life-threatening complication after stent insertion is therefore mandatory.

• Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation.

  Michael Schweigert, Attila Dubecz, Rudolf J Stadlhuber, Herbert Muschweck, Hubert J Stein

  Interactive cardiovascular and thoracic surgery. 02/2011; 12(2):147-51.

  Intrathoracic anastomotic leakage in patients with esophagectomy is associated with high morbidity and mortality. Until recently surgical reexploration was the preferred way of dealing with this life-threatening complication. But mortality remained significant. After the first successful reports we ... [more] Intrathoracic anastomotic leakage in patients with esophagectomy is associated with high morbidity and mortality. Until recently surgical reexploration was the preferred way of dealing with this life-threatening complication. But mortality remained significant. After the first successful reports we adopted endoscopic stent implantation as a primary treatment option. The aim of this study was to investigate the feasibility and the results of endoscopic stent implantation. Between January 2004 and December 2009, 167 patients underwent an esophageal resection. Surgery was mainly the result of esophageal cancer. An intrathoracic esophageal anastomotic leak was endoscopically verified in 17 patients. Twelve patients received an implantation of a self-expanding stent as a primary treatment. An endoscopic stent placement was accomplished in all 12 patients. In nine patients a definitive closure of the leak was achieved and the stent could subsequently be removed. Two patients died due to severe sepsis in spite of sufficient stent placement. Because of early recurrence of very malign small cell cancer the stent remained in situ in one patient. In conclusion, stent implantation for intrathoracic esophageal anastomotic leaks is feasible and compares favorable with the results of surgical reexploration. It is an easily available minimally-invasive procedure which may reduce leak-related mortality and morbidity.
• 28.90

  Impact points

  Cholecystectomy in a trial of adjuvant chemotherapy after pancreatic cancer resection.

  Attila Dubecz, Jens Köhler, Hubert J Stein

  JAMA : the journal of the American Medical Association. 12/2010; 304(23):2590; author reply 2590-1.
• 3.65

  Impact points

  Surgical resection for locoregional esophageal cancer is underutilized in the United States.

  Attila Dubecz, Boris Sepesi, Renato Salvador, Marek Polomsky, Thomas J Watson, Daniel P Raymond, Carolyn E Jones, Virginia R Litle, Juan P Wisnivesky, Jeffrey H Peters

  Journal of the American College of Surgeons. 10/2010; 211(6):754-61.

  Although esophagectomy provides the highest probability of cure in patients with esophageal cancer, many candidates are never referred for surgery. We hypothesized that esophagectomy for esophageal cancer is underused, and we assessed the prevalence of resection in national, state, and local cancer ... [more] Although esophagectomy provides the highest probability of cure in patients with esophageal cancer, many candidates are never referred for surgery. We hypothesized that esophagectomy for esophageal cancer is underused, and we assessed the prevalence of resection in national, state, and local cancer data registries. Clinical stage, surgical and nonsurgical treatments, age, and race of patients with cancer of the esophagus were identified from the Surveillance, Epidemiology and End Results (SEER) registry (1988 to 2004), the Healthcare Association of NY State registry (HANYS 2007), and a single referral center (2000 to 2007). SEER identified a total of 25,306 patients with esophageal cancer (average age 65.0 years, male-to-female ratio 3:1). HANYS identified 1,012 cases of esophageal cancer (average age 67 years, M:F ratio 3:1); stage was not available from NY State registry data. A single referral center identified 385 patients (48 per year; average age 67 years, M:F 3:1). For SEER data, logistic regression was used to examine determinants of esophageal resection; variables tested included age, race, and gender. Surgical exploration was performed in 29% of the total and only 44.2% of potentially resectable patients. Esophageal resection was performed in 44% of estimated cancer patients in NY State. By comparison, 64% of patients at a specialized referral center underwent surgical exploration, 96% of whom had resection. SEER resection rates for esophageal cancer did not change between 1988 and 2004. Males were more likely to receive operative treatment. Nonwhites were less likely to undergo surgery than whites (odds ratio 0.45, p < 0.001). Surgical therapy for locoregional esophageal cancer is likely underused. Racial variations in esophagectomy are significant. Referral to specialized centers may result in an increase in patients considered for surgical therapy.
• 6.71

  Impact points

  Endoscopic versus surgical therapy for early cancer in Barrett's esophagus.

  Attila Dubecz, Hubert J Stein

  Gastrointestinal endoscopy. 10/2009; 70(4):632-4.
• 3.65

  Impact points

  A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry.

  Renato Salvador, Attila Dubecz, Marek Polomsky, Oliver Gellerson, Carolyn E Jones, Daniel P Raymond, Thomas J Watson, Jeffrey H Peters

  Journal of the American College of Surgeons. 06/2009; 208(6):1035-44.

  BACKGROUND: The development of high-resolution (HRM) catheters and software displays of manometric recordings in color-coded pressure plots has changed the diagnostic assessment of esophageal disease. HRM may offer advantages over conventional methods, including improved identification of motility d... [more] BACKGROUND: The development of high-resolution (HRM) catheters and software displays of manometric recordings in color-coded pressure plots has changed the diagnostic assessment of esophageal disease. HRM may offer advantages over conventional methods, including improved identification of motility disorders, hiatal hernia, and outflow obstruction, and ease interpretation. STUDY DESIGN: HRM studies were obtained in 50 healthy volunteers and 106 patients. HRM was performed using a 36-channel catheter, with sensors spaced at 1-cm intervals. Manometric findings were classified into abnormalities of the gastroesophageal barrier and those of the esophageal body and validated by comparison with endoscopic and radiographic diagnostic methods. RESULTS: The mean time for HRM was significantly lower than that for a conventional method (8.1versus 24.4 minutes; p < 0.0001). A structurally defective lower esophageal sphincter (LES) was present in 53 (57.3%) patients, a hypertensive LES in 6 (7.8%), and impaired LES relaxation in 17 patients (16.7%). Validating the LES findings, 86.3% (44 of 51) of patients with a defective sphincter by HRM had radiographic or endoscopic evidence of a hiatal hernia, and 80% (41 of 51) had a positive pH study, endoscopic erosive esophagitis, or Barrett's esophagus. Evidence of a hiatal hernia by HRM was seen in 33 (56%) patients; a hiatal hernia was seen in 91% (30 of 33) of these on endoscopy and 81% (17 of 21) on barium swallow. Fifty-eight patients (54.7%) had an abnormal body motility. CONCLUSIONS: HRM studies are shorter than those using conventional methods. Interpretation is image based, and correlation with objective endoscopic and physiologic findings confirms the accuracy of interpretation. The introduction of HRM is a significant advance in the outpatient evaluation of esophageal function.
• 7.90

  Impact points

  The Origins of an Operation: A Brief History of Transhiatal Esophagectomy.

  Attila Dubecz, Levente Kun, Rudolf Stadlhuber, Jeffrey Peters, Seymour Schwartz

  Annals of surgery. 04/2009; 249(3):535-540.
• 3.65

  Impact points

  Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis.

  Marek Polomsky, Kristina A Siddall, Renato Salvador, Attila Dubecz, Laurence A Donahue, Daniel Raymond, Carolyn Jones, Thomas J Watson, Jeffrey H Peters

  Journal of the American College of Surgeons. 04/2009; 208(4):562-9.

  BACKGROUND: Modern-day concepts about the pathogenesis of an intrathoracic stomach include crural diaphragm muscular deterioration, loss of phrenoesophageal ligament integrity, and presence of abdominothoracic pressure gradients. The role of spinal abnormalities has received little attention. Based ... [more] BACKGROUND: Modern-day concepts about the pathogenesis of an intrathoracic stomach include crural diaphragm muscular deterioration, loss of phrenoesophageal ligament integrity, and presence of abdominothoracic pressure gradients. The role of spinal abnormalities has received little attention. Based on clinical observation, we hypothesized that kyphosis and other spinal diseases are components of the pathophysiology of an intrathoracic stomach. STUDY DESIGN: The study population consisted of 98 patients (men, n = 22; women, n = 76; mean age 69.4 years) undergoing operations for type III or IV hiatal hernia with an intrathoracic stomach. Twenty-four age- and gender-matched control patients without hiatal hernia undergoing pulmonary or pleural procedures were used for comparison. Chest radiographs were assessed for spinal abnormalities, including degree of kyphosis, measured from superior T4 to inferior T12 (modified Cobb method), spinal fractures, osteoporosis, and scoliosis. Statistical analyses included two-sample t-test and Fisher's exact test. RESULTS: Patients with intrathoracic stomach had a greater degree of kyphosis than control patients (Cobb angle, 50.2 degrees versus 39.7 degrees; p < 0.001). This difference was most pronounced in women (Cobb angle, 51.7 degrees versus 40.4 degrees; p < 0.001), although the difference in men was not significant (Cobb angle, 45.0 degrees versus 38.1 degrees; p = 0.25). Patients with an intrathoracic stomach had significantly more vertebral fractures (37 of 98 [38%] versus 3 of 24 [13%]; p < 0.05). There was no difference in prevalence of degenerative changes (51 of 98 [52%], versus 13 of 24 [54%]), osteopenia (30 of 98 [31%] versus 6 of 24 [25%]), and scoliosis (27 of 98 [28%] versus 6 of 24 [25%]). CONCLUSION: Patients with an intrathoracic stomach have a higher degree of kyphosis and more vertebral fractures than age- and gender-matched controls. These data suggest that change in spinal curvature can be important in the pathogenesis of the intrathoracic stomach, a growing problem of our aging population.
• 6.01

  Impact points

  Eosinophilic Esophagitis With Severe GERD.

  Attila Dubecz, Mark Mentrikoski, Jeffrey H Peters

  The American journal of gastroenterology. 02/2009;
• 2.56

  Impact points

  Modern surgery for esophageal cancer.

  Attila Dubecz, Daniela Molena, Jeffrey H Peters

  Gastroenterology clinics of North America. 01/2009; 37(4):965-87.

  Primary treatment of carcinoma of the esophagus and cardia rests on surgical resection. Although recent advances have shown the suitability of endoscopic treatment in selected patients with very early cancers, and preliminary studies have suggested that responders to primary chemoradiation may be eq... [more] Primary treatment of carcinoma of the esophagus and cardia rests on surgical resection. Although recent advances have shown the suitability of endoscopic treatment in selected patients with very early cancers, and preliminary studies have suggested that responders to primary chemoradiation may be equivalent to resection in selected patients with squamous cell carcinoma, surgical resection remains the mainstay of therapy, as it has for the past 50 years. Various changes support highly individualized treatment decisions, in which each patient receives the treatment with the best chance of eliminating all disease.
• 3.64

  Impact points

  Franz John A. Torek.

  Attila Dubecz, Seymour I Schwartz

  The Annals of thoracic surgery. 05/2008; 85(4):1497-9.

  Franz John A. Torek (1861 to 1938) is one of the pioneering surgeons in thoracic surgery. The son of German immigrants, he worked in the German (now Lenox Hill) Hospital in New York City. In 1913 he performed the first thoracic esophagectomy for cancer, and the patient survived for 12 years. We desc... [more] Franz John A. Torek (1861 to 1938) is one of the pioneering surgeons in thoracic surgery. The son of German immigrants, he worked in the German (now Lenox Hill) Hospital in New York City. In 1913 he performed the first thoracic esophagectomy for cancer, and the patient survived for 12 years. We describe the surgical work and private life of Torek and recall the details of the groundbreaking operation.

• [New possibilities provided by the internet in medicine]

  Bertalan Meskó, Attila Dubecz

  Orvosi hetilap. 12/2007; 148(44):2095-9.

  The importance of the internet and some new generation services of the web (so-called web 2.0) is exponentially growing. As web 2.0 is based on collaboration, feedback and communities, it can ease the work of physicians. The authors give a short overview of the web 2.0 tools created for physicians. ... [more] The importance of the internet and some new generation services of the web (so-called web 2.0) is exponentially growing. As web 2.0 is based on collaboration, feedback and communities, it can ease the work of physicians. The authors give a short overview of the web 2.0 tools created for physicians. The new tools of web 2.0 can save time for physicians, it makes it easier to share knowledge and experience; and to follow your field of interest. The authors conclude that physicians, medical workers should take control of publishing medical information on the internet.

• [Internet, Medline, other web-sites, blogs--in surgery]

  Attila Dubecz

  Magyar sebészet. 60(3):191-2.