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Biomedical subjects

A J Wightman

Publications and source records attributed to A J Wightman.

16 recordsLinked to original sources
PubMed1996

A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses.

One hundred patients with carcinoma of the distal oesophagus or gastric cardia undergoing oesophagogastrectomy were randomized to receive either a stapled or handsewn oesophagogastric anastomosis. Five patients died in the early post-operative period at a mean of 16 days (in-hospital mortality 5%) allowing detailed follow up on the remaining 95 patients who were followed up to death or for a minimum of 36 months. A stapled anastomosis was quicker to perform (P < 0.001), resulting in a shorter operative time (P < 0.005) and was associated with decreased blood loss (P < 0.05). The number of anastomotic leaks, length of in-patient stay, stricture formation and survival in the two groups was not statistically different. A stapled oesophagogastric anastomosis fulfills all of the requirements for routine use in thoracic surgical practice when performing oesophageal resection for carcinoma of the distal oesophagus or gastric cardia. It is quick to perform allowing a shorter operating time and lower blood loss and does not appear to be associated with a previously noted increased incidence of benign anastomotic stricture formation when compared with handsewn anastomoses.

Aged↗
PubMed1995

Pulmonary actinomycosis--a master of disguise.

Three cases of pulmonary actinomycosis are described. In all three cases, an initial diagnosis of pulmonary malignant neoplasia was made. The correct diagnosis was made histologically after the three patients underwent either lobectomy or pneumonectomy. All patients recovered after appropriate therapy. Pulmonary actinomycosis should always be considered in the differential diagnosis of pulmonary neoplasia, especially in young adults.

Actinomycosis↗
PubMed1995

The value of radiographic assessment for oropharyngeal foreign bodies.

A double-blind, controlled study to assess the accuracy of interpretation of lateral soft tissue radiographs of 60 patients with suspected foreign body impaction in the oro/hypopharynx was carried out by 18 respondents from three different specialities. All the patients had endoscopy carried out and foreign bodies were present in 25. Of these, foreign bodies were diagnosed on the radiograph in only 38.3 per cent. False-positive diagnoses were made in a mean of 26.3 per cent of those patients who did not have a foreign body.

Double-Blind Method↗
PubMed1994

A prospective analysis of incidental paranasal sinus abnormalities on CT head scans.

A prospective analysis of the incidence of paranasal sinus opacification in 100 patients referred for cranial computerized tomography (CT) for non-sinus related problems is described. The findings were correlated with symptomatic assessment. Twenty-seven per cent of asymptomatic patients had sinus opacification. The study illustrates the importance of careful clinical correlation when interpreting CT scans of the paranasal sinuses.

Adolescent↗
PubMed1994

Management of allergic bronchopulmonary aspergillosis without maintenance oral corticosteroids: a fifteen-year follow-up.

Five non-smoking patients were diagnosed as having allergic bronchopulmonary aspergillosis in 1978/9. All have been treated since then with inhaled corticosteroids, using short courses of self-administered oral corticosteroids for symptomatic exacerbations. Over a mean 15 years of follow-up, they have required on average less than one course of oral drugs per annum. Regular monitoring of spirometry has shown no evidence of deterioration, and all have close to normal gas transfer. All have some localized bronchiectasis on CT scanning, in two cases probably occurring after treatment started, but in no case is there any respiratory disability. We conclude that this is a safe and effective method for the management of allergic bronchopulmonary aspergillosis when diagnosed before persistent hyphal colonization of the airways has occurred.

Administration, Inhalation↗
PubMed1991

Bronchial compression as a result of lung herniation after pneumonectomy.

A patient developed severe exertional dyspnoea and stridor eight months after a right pneumonectomy for a carcinoid tumour, with a progressive loss of lung function. These events were the result of compression of the left main bronchus against the vertebral column by the mediastinal contents, which had shifted into the right hemithorax with the herniated lung.

Adult↗
PubMed1991

The effect of posture on upper airway dimensions in normal subjects and in patients with the sleep apnea/hypopnea syndrome.

The effect of posture on upper airway dimensions was assessed for two reasons. First, some patients with untreated sleep apnea/hypopnea syndrome (SAHS) report they sleep better sitting upright. Second, to allow comparison of the differing techniques used to determine the site of maximal airway narrowing in awake patients with SAHS, as some are carried out in the erect and others in the supine posture. Lateral cephalometry was therefore carried out in 33 nonsnoring normal subjects and in 29 patients with obstructive SAHS (mean apneas plus hypopneas, 46 per hour; range, 17 to 103). In both normal subjects and patients, uvular width was increased (p less than 0.05) in the supine posture, and this was associated with significant narrowing of the retropalatal airway in the patients with SAHS (erect, 5.0 +/- SD 2.6 mm; supine, 3.6 +/- 2.8 mm; p less than 0.01). In both normal subjects and patients, the retroglossal hypopharynx widened (p less than 0.05) in the supine posture (e.g., in patients with SAHS, posterior airway space was: erect, 11.5 +/- 4.5 mm; supine, 13.4 +/- 4.8 mm; p = 0.003). In the supine posture there was anterior movement of the hyoid and neck flexion in both groups. However, a study of the effect of neck flexion in the erect posture showed that neck flexion produced no changes in airway caliber. Thus, posture is an important determinant of upper airway dimensions.

Adult↗
PubMed1990

A comparison of cobalt (57Co) bleomycin scanning and contrast-enhanced CT scanning for assessment of the mediastinum in lung cancer.

Sixty patients with histologically proven lung cancer who had been accepted for mediastinoscopy or thoracotomy were prospectively entered into a study to evaluate computed tomographic (CT) scanning, 57Co-bleomycin scanning, and barium swallow in preoperative assessment of mediastinal lymph node metastasis. Fifty-six patients had thoracotomy at which all accessible lymph nodes were sampled. Twenty-four patients were found to have mediastinal tumor on histologic analysis of the resected mediastinal lymph nodes. Neither 57Co-bleomycin scanning nor barium swallow were clinically useful, with sensitivities of 21 percent and 11 percent respectively, whereas CT scanning was helpful. However, there was no clear cutoff point of node size to optimize sensitivity and specificity for CT scanning. When nodes greater than or equal to 15 mm were taken to indicate likely malignancy, the sensitivity was 58 percent and the specificity was 87 percent and when greater than or equal to 10 mm was used the sensitivity was 80 percent but the specificity was only 55 percent. There was no clear relationship between the size of the largest resected lymph node in each patient and the presence of malignant lymph nodes. Only 42 percent of patients with resected nodes greater than or equal to 2 cm had histologic evidence of metastases. We conclude that CT scanning should be used to indicate the presence and site of mediastinal lymph nodes, which, when visualized, should always be sampled and histologically examined prior to resection of primary tumor.

Aged↗
PubMed1984

Diagnosis of pulmonary emphysema by computerised tomography.

Eleven patients with peripheral bronchial carcinoma had computerised tomographic (CT) scans before operation. The resected specimens from six of these patients showed mild centri-acinar emphysema. Preoperatively the two groups had not differed significantly in spirometric findings or lung volumes. The frequency distribution curves of EMI numbers within the lung fields of patients who proved to have centri-acinar emphysema differed significantly from those of the group who did not, there being more pixels in the EMI range -450 to -500 in the emphysematous group (p less than 0.001). Detailed assessment of lung density by CT scanning may be useful in the diagnosis of emphysema in life.

Adult↗
PubMed1981

The changing pattern of laryngeal tuberculosis.

Laryngeal tuberculosis is now an uncommon disease in the United Kingdom. A series of ten cases is reported. In contrast to the pre-chemotherapy era, when the disease was associated with advanced cavitated pulmonary tuberculosis and was highly infectious, it now presents in a manner similar to laryngeal carcinoma except that painful dysphagia is a prominent symptom. All such patients should have a chest X-ray carried out as part of their initial investigation. Sputum is almost always positive for tubercle bacilli on direct films. Direct laryngoscopy and biopsy are necessary if a carcinoma is suspected. The change of pattern of the disease may be due to the fact that the larynx now usually becomes involved by haematogenous spread rather than by direct spread along the airways. Laryngeal tuberculosis is now no more infectious than pulmonary tuberculosis, and responds well to antituberculous chemotherapy. Symptoms resolve completely within three weeks if corticosteroids are given in combination.

Aged↗
PubMed1981

Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis.

One hundred and sixteen patients with proven bronchiectasis diagnosed at least five years previously were studied to determine the clinical outcome, change in pulmonary function, and degree of social disability. Twenty-two patients had died and the mean duration of follow-up in the survivors was 14 years. The patients who died were characterised by a poorer initial ventilatory capacity than the survivors and cor pulmonale was present in 37% at the time of death. The survivors showed a tendency for improvement in symptoms whether treated surgically or medically. Thirty per cent were better than at diagnosis while only 11% were worse. Measurements of FEV1 and FVC were made at diagnosis and at review, mild airways obstruction being the predominant abnormality. The change in pulmonary function was expressed as the decline in FEV1 in ml/yr. The decline in FEV1 was no greater than expected in 80% of patients and in a further 15% was of the order seen in cigarette smokers with mild airways obstruction. Poor ventilatory capacity was therefore not an important limitation in these patients. Of the survivors 77% had a good work record with less than two weeks loss of work annually from chest illness. The spouses of all married patients were interviewed at home by a trained social worker. Fifty per cent reported no social problem but 46% of spouses found the patient's cough distasteful and 29% of couples had experienced difficulties with normal sexual life. Seven per cent of the patients were severely disabled. While the overall prognosis of our patients was good a minority still have severe physical and social problems as a result of bronchiectasis.

Adolescent↗
PubMed1980

Intralesional injection of BCG using the fibreoptic bronchoscope in the treatment of bronchogenic carcinoma.

Current evidence suggests that the most effective administration of BCG immunotherapy is by the intralesional route. The new technique and complications of BCG intralesional injection of bronchogenic carcinomas via the fibreoptic bronchoscope is described. Seventeen patients with irresectable bronchogenic carcinoma have been treated with chemotherapy and BCG intralesional immunotherapy. Side-effects observed with intralesional BCG injection are: fever, hypotension and transient mild disturbances of liver function tests, and a single episode of granulomatous hepatitis. Early clinical improvement (nine patients) and radiological regression of the tumour (six patients) have been observed. Cavitation of the tumour has also been observed in three patients. Long term results are not yet available.

Adult↗
PubMed1978

Fluoroscopically controlled transbronchial biopsy of solitary peripheral pulmonary lesions using the fibreoptic bronchoscope.

Experience of fluoroscopically controlled transbronchial biopsy using the fibreoptic bronchoscope in 30 patients with solitary lesions in the peripheral lung fields beyond bronchoscopic vision is described. At the time of submitting this paper for publication (30 January 1978) no account of the technique has been reported in the British literature. In 21 patients with a final diagnosis of bronchial carcinoma a positive biopsy diagnosis was obtained in 14 (67%). Five of seven patients (71%) with a final diagnosis of an inflammatory condition showed evidence of acute or chronic inflammation on biopsy. There were no complications. The procedure is indicated when a definitive diagnosis is required for management planning in clinically inoperable patients, or when a tissue diagnosis is particularly desired in an attempt to obviate the need for thoracotomy. The relative safety makes this the biopsy technique of choice for the evaluation of isolated peripheral pulmonary opacities.

Biopsy↗
PubMedDate not supplied

Characteristics of coalminers who have suffered excessive loss of lung function over 10 years.

From a longitudinal study of respiratory health of coalminers, we have selected 29 smokers and 12 non-smokers with the greatest decline in FEV1 over a ten year period and have compared them with 29 smokers and 14 non-smokers with the least decline. In order to identify syndromes associated with rapid decline in FEV1, we made a clinical and physiological examination of these men five years after the end of the ten year period of measured FEV1 decline. There was no substantial difference in mean lung function between rapid and slow decliners at the time of examination. However, the rapid decliners as a group had an excess of respiratory symptoms, a significantly lower mid-expiratory flow rate and an excess of early and mid-inspiratory crackles on auscultation. Lung function was only abnormal by conventional standards in one third of the smoking rapid decliners. These men had either airflow obstruction (accompanied in three cases by evidence of emphysema) or a concentric reduction of both FEV1 and FVC. There was no excess of atopy nor of history of childhood respiratory illness in rapid decliners. We conclude that it is likely to be difficult to detect the rapid decliners among working men on the basis of a single examination and that at present detection must depend on serial measurements of FEV1.

Adult↗