Pulmonary artery-bronchial fistula during lymphoma treatment.
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Adult↗
Biomedical subjects
B K Temeck
Publications and source records attributed to B K Temeck.
Pulmonary metastatic disease in ameloblastoma.
Ameloblastoma is a rare disease of odontogenic origin with indeterminate metastatic potential. The first site of metastatic disease is usually the lung. We report aggressive surgical treatment of a patient with bilateral disease with five subsequent recurrences. A review of the literature suggests that in the absence of effective chemotherapy or radiation, surgery should be considered the treatment of choice for metastatic ameloblastoma confined to the lung.
Adult↗
Wedge resection for bronchogenic carcinoma in high-risk patients.
At the Veterans Administration Medical Center in Washington, DC, 73 patients with bronchogenic carcinoma had pulmonary wedge resection from February 1967 to March 1988, with a 1.4% perioperative mortality and a 4.1% morbidity. Mean age of the patients was 63 years. Patients were considered poor risk with a mean Goldman index of 9 +/- 4 (class II), mean ASA physical status classification II, mean 1-second forced expiratory volume (FEV1) of 1.25 liters (42% predicted), ratio of FEV1 to forced vital capacity 30% predicted, and maximum voluntary ventilation 24% predicted. Staging of the bronchogenic carcinomas indicated 68% stage I, 15% stage II, and 17% stage III, and histology showed 41% epidermoid, 40% adenocarcinoma, 12% bronchoalveolar, 3% large cell, and 4% small cell type. For the 72 patients eligible for follow-up, data were available on 62 for a period ranging from 4 months to 15 years. Survival was 94% at 1 year, 55% at 3 years, 29% at 5 years, 5% at 10 years, and 2% at 15 years. Within 5 years, 21% of the patients had died of causes other than bronchogenic carcinoma. The rate of recurrence was 16%. Analysis by each stage of lung cancer showed local recurrence in 4% of patients with stage I disease, in 9% of those with stage II disease, and in 59% of those with stage III disease. We conclude that wedge resection provided acceptable surgical treatment in a group of high-risk surgical patients.
Carcinoma, Bronchogenic↗
An approach to reoperative median sternotomy.
Cardiac reoperations using a previous median sternotomy incision are becoming more common as the population of patients who have had cardiac surgery increases. Repeat median sternotomy can be complicated by major hemorrhage and secondary myocardial ischemia. A standard approach to reoperative median sternotomy has been developed over the past several years at Georgetown University. Details of the method are presented. From January 1, 1980 through April 30, 1988, 179 patients underwent repeat median sternotomy. The technical approach to the operation became standard as of July 1,1983. Two of 66 patients operated before this date sustained major hemorrhage requiring emergent institution of cardiopulmonary bypass. One mortality in the group was directly related to hemorrhage at the sternotomy. No episode of major hemorrhage and no mortality related to the sternotomy occurred in 113 patients who underwent repeat sternotomy after July 1, 1983. Reoperation for bleeding occurred in 8.4% of the patients. We believe the technical considerations presented increase the safety of reoperative cardiac surgery.
Blood Loss, Surgical↗
Race as a risk factor in the severity of infragenicular occlusive disease: study of an urban hospital patient population.
We retrospectively studied the arteriograms of 135 men admitted for evaluation of lower extremity ischemia to examine whether race influences the severity of infragenicular occlusive disease. The scoring system prepared by the Ad Hoc Committee on Reporting Standards for the Society for Vascular Surgery and the International Society for Cardiovascular Surgery was used to grade the severity of stenosis in each of the upper, middle, and lower thirds of the anterior and posterior tibial and peroneal arteries (collectively called "infragenicular" arteries). The patients were divided into two groups: 83 blacks (140 arteriogram limbs) and 52 whites (87 arteriogram limbs). Disease severity scores between the groups were compared, and the existence of five known risk factors for atherosclerosis were considered for poststratification adjustment. Results showed that higher disease scores, indicating more severe disease, were found in the black population in every segment of the infragenicular arteries. The mean (+/- SE) score for all the infragenicular segments in blacks was significantly higher than that in the whites (2.08 +/- 0.05 vs 1.57 +/- 0.06, p less than 0.001). The black and white groups were comparable in terms of age (65.2 vs 64.6 years), prevalence of diabetes (20% vs 25%), smoking history (93% vs 90%), and hypercholesterolemia (51% vs 63%). Hypertension was more prevalent among the black patients (51% vs 27%, p less than 0.001). When only the non-hypertensive patients in both groups were considered, however; the mean severity score was still significantly higher in blacks (2.10 +/- 0.06 vs 1.42 +/- 0.06, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Black or African American↗
Epidural anesthesia in patients undergoing thoracic surgery.
Epidural anesthesia has been reported to exert beneficial effects in surgical procedures. Over the past 3 years at the Veterans Administration Medical Center in Washington, DC, thoracic surgical procedures have been done using a combined technique of epidural anesthesia with light general anesthesia. A retrospective review of this experience from January 1984 to November 1987 was done in 90 consecutive patients. Postoperative extubation of patients was accomplished immediately in 32%, within 1 hour in 34%, within 3 hours in 28%, within 18 hours in 4%, and was prolonged in only 1% of patients. Mortality was 2% and morbidity was 3%. This analysis indicates that the technique of epidural anesthesia with light general anesthesia provided satisfactory anesthesia with low mortality and morbidity in a high-risk group of patients undergoing surgery.
Adult↗
Transient ("hole-in-one") occlusion of the mitral valve orifice by a free-floating left atrial ball thrombus: identification by two-dimensional echocardiography.
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Adult↗
A retrospective analysis of 10-year survivors from carcinoma of the lung.
From 1949 to 1972, 4732 patients with carcinomas of the lung were seen. Of these, 118 patients were found alive at 10 years from their initial diagnosis and treatment. This number represents only 2.5% of all lung cancers seen because many have been lost to follow-up within the first ten years, and their true status is not known. The authors attempted to look at the patient characteristics that might have influenced long-term survival. A case-matched study was also done of patients with carcinoma of the lung who lived less than 2 years and who had the same age, sex, histology, and year of diagnosis. In the long-term survivors, the median age was 57 years, 2 of 3 had epidermoid carcinoma, 86% were smokers, 76% were symptomatic, and 70% had one or both parents alive at age 70 years or older. There was no difference in these variables in the case-matched group. Of the 118 long-term survivors, 91 were men and 27 were women. Sixty-seven percent had Stage I disease, 13% Stage II, and 20% Stage III. None had distant metastasis at presentation. Of the 118 patients, 115 had surgery. Eighteen of the 115 surgically treated patients also had postoperative external radiation. Three patients with Stage III disease received radiation without surgery. None had recurrence of their cancer, 27 developed new cancers, and 70% of these were new lung cancers. Although the majority of the long-term survivors had Stage I cancers, a third had Stage II or III disease. No long-term survivor died of his original disease, suggesting that a 10-year survival is adequate proof of cure in carcinoma of the lung.
Adult↗
Surgically debulked malignant pleural mesothelioma: results and prognostic factors.
BACKGROUND: We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients with MPM on phase I-III trials since 1990. A debulking resection to a requisite, residual tumor thickness of < or = 5 mm was required for inclusion. METHODS: Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy (n = 39) or extrapleural pneumonectomy (EPP; n = 39) was performed. Seventeen patients could not be debulked. Preoperative EPP platelet counts (404,000) and mean tumor volume (491 cm3) were greater than that seen for pleurectomy (344,000, 114 cm3). RESULTS: Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that for unresectable patients 5.0 months. Arrhythmia (n = 14; 15%) was the most common complication, and there were two deaths related to surgery (2.0%). Tumor volume of > 100 ml, biphasic histology, male sex, and elevated platelet count were associated with decreased survival (p < 0.05). Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%], respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (p2 = 0.013). CONCLUSIONS: Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated.
Adult↗
Somatostatin analogue in the localization and treatment of bronchial carcinoid tumours.
Octreotide scanning is increasingly being used to detect tumours with somatostatin receptors. Moreover, there is growing interest in the use of somatostatin analogues for the treatment of tumours with somatostatin receptors. This review documents the use at our institution of the octreotide scan in three patients with intrathoracic pathology, and comments on overall experience in the literature with this technology.
Adult↗