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Biomedical subjects

Alex G Little

Publications and source records attributed to Alex G Little.

13 recordsLinked to original sources
PubMed2006

Determinants of quality of life in patients following pulmonary resection for lung cancer.

BACKGROUND: The purpose of the present study was to prospectively measure quality of life (QOL) before and after pulmonary resection for non-small cell lung cancer (NSCLC) and to determine which clinical perioperative variables predicted QOL. METHODS: Thirty-seven patients undergoing a curative resection for early-stage NSCLC were administered the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire serially. This was used to calculate a Trial Outcome Index (TOI), a measure of QOL. RESULTS: Perioperative variables associated with worse postoperative TOI included the presence of preoperative dyspnea (coefficient -7.89, 95% confidence interval -12.4 to -3.31, P = .01) and exposure to adjuvant chemotherapy (-14.7, -20.0 to -9.46, P = .001). CONCLUSIONS: Preoperative dyspnea and postoperative chemotherapy are associated with worse postoperative QOL among patients with resected, early-stage NSCLC. As adjuvant and neoadjuvant therapy protocols become more prevalent for these patients, QOL issues may assume greater importance.

Bronchoscopy↗
PubMed2006

Positron emission tomography in well differentiated fetal adenocarcinoma of the lung.

A 47-year-old woman with a 20 pack-year history of cigarette smoking presented with a chest x-ray demonstrating a left upper lobe lung density. Computed tomography of the chest showed a 3-cm lobulated mass in the apical left upper lobe. The lesion demonstrated intense focal uptake on FDG-PET scanning. The patient underwent left upper lobectomy. Pathology demonstrated the histologic and immunohistochemical findings of a well differentiated fetal adenocarcinoma (WDFA). The intense FDG-PET uptake and abundant glycogen stores associated with WDFA may be the result of its embryonic derivation and differential expression of glucose transporter proteins.

Adenocarcinoma↗
PubMed2005

Alcohol abuse predicts progression of disease and death in patients with lung cancer.

BACKGROUND: Few studies have examined long-term outcomes in alcohol-abusing patients with lung cancer. The purpose of this study was to examine the effect of alcohol abuse on the prognosis of patients with lung cancer. METHODS: The study was composed of 114 consecutive patients with nonsmall-cell lung cancer treated at a Department of Veterans Affairs Medical Center. An alcohol-abusing group consisted of 36 patients with one of the following at the time of lung cancer diagnosis: positive screening questionnaire, alcohol consumption more than 5 drinks or cans of beer a day, or criteria for a diagnosis of alcohol dependence/abuse according to the Diagnostic and Statistical Manual for Mental Disorders IV. The comparison group consisted of 78 nonabusing patients. RESULTS: Alcohol abusers, compared with nonabusers, had worse Kaplan-Meier overall survival (median 8.5 versus 17.5 months, p = 0.05) and progression-free survival (median 6.0 versus 15.5 months, p = 0.04). In multivariate analyses including alcohol abuse, Charlson comorbidity, pack-years smoking, performance status, and stage, only stage of disease, performance status, and alcohol abuse (odds ratio = 3.44, 95% confidence interval = 1.17 to 10.1, p = 0.02) predicted progression of disease or death within 12 months of diagnosis. Alcohol abuse was also an independent predictor of disease-specific survival (hazard ratio = 1.65, 95% confidence interval = 1.01 to 2.80, p = 0.05) and progression-free survival (hazard ratio = 1.79, 95% confidence interval = 1.12 to 2.86, p = 0.01) among patients with lung cancer. CONCLUSIONS: Alcohol-abusing patients with nonsmall-cell lung cancer have worse outcomes than nonabusing patients. The adverse prognosis associated with alcohol abuse is independent of comorbidity, performance status, or smoking history.

Aged↗
PubMed2005

Patterns of surgical care of lung cancer patients.

BACKGROUND: This survey was performed to determine the patterns of surgical care provided patients with non-small cell lung carcinoma (NSCLC). METHODS: In 2001, the American College of Surgeons carried out a patient care survey of 729 hospitals to retrieve information of NSCLC patients' history, evaluation, pathology, and surgical treatment. RESULTS: Inclusion criteria were met by 40,090 patients: of whom 11,668 (29.1%) were treated surgically; 74.2% alone and 25.8% as part of multimodality therapy. Of these patients, 59.5% were in stage I, 17.5% in stage II, 17.0% in stage III, and 6.0% in stage IV. Surgery patient demographics were the following: 55% male and 45% female; 46.8% 70 years or older; and 76.3% had significant comorbidities. Tumor characteristics: squamous 28%, adenocarcinoma 37.6%, other 34.4%. Staging: in addition to radiologic examinations, preoperative mediastinoscopy was performed in 27.1% of operated patients with node biopsy in only 46.6% of these procedures. OPERATIONS: wedge resection 15.6%, lobectomy 70.8%, pneumonectomy 13.6%. Surgical margins were positive in 7.8%, but only 65.2% had frozen section analysis. Perioperative mortality was 5.2%, but was 4.0% in nontransfused patients and 12.7% in transfused patients and was 3.2% in high-volume (more than 90 operations per year) versus 4.8% in low-volume hospitals (p < 0.001). CONCLUSIONS: (1) Patients being operated for NSCLC are elderly with significant comorbid conditions. (2) More patients than previously are female and have adenocarcinoma. (3) Mediastinoscopy is infrequently performed and lymph nodes are biopsied in less than 50% of them. (4) Lobectomy is the most common operation, and positive surgical margins are too frequent. (5) Operative mortality is reasonable but transfusion is a marker for increased risk and outcomes are superior in high-volume hospitals. (6) Hospitals with higher volume had fewer perioperative deaths.

Adolescent↗
PubMed2004

Video-assisted thoracic surgery sympathectomy for hyperhidrosis.

HYPOTHESIS: Video-assisted thoracic surgery sympathectomy is efficacious for patients with hyperhidrosis. DESIGN: An experience with patients undergoing bilateral video-assisted thoracic surgery sympathectomy was reviewed to evaluate the operative technique and to determine morbidity and outcomes. SETTING: Academic health center. PATIENTS: The cohort included 31 patients (22 women and 9 men). All but 2 patients were of Asian descent, and the average age was 24.9 years. All patients had palmar hyperhidrosis. Two patients also had craniofacial hyperhidrosis, and another 2 had pedal hyperhidrosis. INTERVENTIONS: Bilateral video-assisted thoracic surgery sympathectomy with resection of the second and third ganglia was performed in all patients. Small chest tubes were removed on the first postoperative day. In 30 patients, the procedures were simultaneous; and in 1, it was staged to accommodate lumbar sympathectomy for pedal disease. RESULTS: Perioperatively, no patients died. The only hospital complication was an intraoperative injury to an intercostal artery that required conversion to an open thoracotomy. The average hospital length of stay was 1.2 days (range, 1-3 days). No patient developed Horner syndrome. Long-term follow-up was 2.6 years (range, 3 months to 7 years). Both hands in all patients were warm and dry at the last follow-up, as were the face and scalp in the 2 with craniofacial hyperhidrosis. Ten patients (32%) experienced compensatory sweating, which improved within 6 months. CONCLUSIONS: In this experience, palmar hyperhidrosis is predominantly a disease of young Asian women. Simultaneous bilateral video-assisted thoracic surgery sympathectomy is effective and can be accomplished with minimal morbidity and a short hospitalization. Compensatory sweating occurs in a third of patients, but is generally self-limiting.

Adult↗
PubMed2002

The prognostic significance of lymph node size in patients with squamous esophageal cancer.

BACKGROUND: The prognosis of patients with esophageal cancer remains dismal, and their care poses a great challenge of customizing therapeutic strategies for individual patients. Lymph node staging is still less than ideal in esophageal cancer patients. Therefore, we investigated a new approach to lymph node analysis. METHODS: One hundred eighty-seven patients curatively resected for squamous cell cancer of the esophagus were studied. The long diameter of the largest metastatic lymph node (MLN) was measured on a histopathologic slide and was considered as the MLN size. RESULTS: Patient survival decreased with each millimeter increment in MLN size. By using MLN size as the lymph node classification criterion, patients with MLN <10 mm had both a significantly better overall and cancer-specific survival than those with MLN >or=10 mm. Patients with fewer than four MLNs were separated into prognostic groups according to the MLN size. Among the several prognostic factors, MLN size remained the strongest independent predictor of survival by multivariate analysis. This nodal analysis allowed stratification of patients into four stages with distinctly different survivals. CONCLUSIONS: This approach supplements traditional nodal staging strategies and therefore has potential for guiding the development of treatment strategies in this carcinoma.

Aged↗
PubMed2002

Sentinel node biopsy for staging lung cancer.

The importance and value of accurate clinical and pathological staging of lung cancer is emphasized. The philosophy, techniques, and general results of the sentinel node technique for lymphatic mapping are reviewed. The experience with this technique in patients with non-small cell lung cancer is discussed and the future use of lymphatic mapping is pondered.

Carcinoma, Non-Small-Cell Lung↗
PubMed2002

The influence of pulmonary staple line reinforcement on air leaks.

OBJECTIVES: Although uncommon, prolonged postoperative air leaks are a troublesome complication of lung surgery. This study was performed to determine if buttressing pulmonary staple lines would reduce air leakage at varying airway pressures, and if there was a difference between buttressing materials. METHODS: Using cadaver lungs, the development of air leak from staple lines was evaluated at incremental airway pressures. Unreinforced staples were compared to staples reinforced with bovine pericardium and staples reinforced with expanded polytetrafluorethylene (ePTFE). RESULTS: Unreinforced staple lines began to leak air at an airway pressure of 20 mm Hg, and > 90% leaked at a pressure of 35 mm Hg. Both bovine pericardium and ePTFE significantly reduced the incidence of air leak at these airway pressures. At higher airway pressures, ePTFE was superior to bovine pericardium. CONCLUSION: Staple line reinforcement with either material protects against air leak. Patients at risk for elevated airway pressures and/or postoperative ventilator support should be considered for utilization of these staple reinforcing materials.

Adult↗