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Biomedical subjects

D W Moores

Publications and source records attributed to D W Moores.

18 recordsLinked to original sources
PubMed2000

Self-expanding esophageal metallic stents in the treatment of esophageal obstruction.

Esophageal obstruction from any cause is debilitating. In patients with malignant obstruction palliation to relieve pain and dysphagia is the primary goal. Conventional endoluminal prostheses allow variable palliation. Covered expandable metallic stents with an 18-mm lumen allow improved deglutition. From December 1994 through December 1998, 59 patients underwent placement of self-expanding silicone-covered esophageal stents for esophageal obstruction. There were 36 men and 23 women ranging in age from 41 to 94. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation placement of the stent was performed under fluoroscopic control. Follow-up was complete in all patients. Technical success was achieved in all patients. There was one postoperative death (bronchopulmonary fistula), one migration of the stent requiring removal, and one recurrent obstruction. The remaining stents were well tolerated even in the cervical region (four patients). All patients returned to a diet of solid foods. We conclude that covered self-expanding esophageal metallic stents are technically simple and safe to insert and appear to provide durable excellent palliation of esophageal obstruction due to either benign or malignant conditions.

Adult↗
PubMed1998

The diaphragm.

Explore the source record for details and available documents.

Diaphragm↗
PubMed1996

Treatment of esophageal obstruction with covered, self-expanding esophageal Wallstents.

BACKGROUND: Conventional endoluminal plastic prostheses used for relieving esophageal obstruction allow variable palliation. Covered, expandable metal stents provide an 18-mm lumen to allow improved deglutition. METHODS: From December 1994 to December 1995, 20 patients underwent placement of self-expanding, silicone-covered Wallstents (Schneider, Plymouth, MN) for esophageal obstruction. Fifteen patients had obstruction secondary to carcinoma and 5 patients had benign esophageal stricture. There were 13 men and 7 women, ranging in age from 54 to 94 years. All patients underwent esophageal dilation using a flexible gastroscope and Savary bougies. After dilation to 42F or 45F, placement of the stent was performed under fluoroscopic control. RESULTS: Follow-up was complete in all patients, ranging from 4 weeks to 12 months. Technical success was achieved in all patients. There was one postoperative death (bronchoesophageal fistula) and one migration of the stent requiring removal (peptic stricture). The remaining stents were well tolerated, even in the cervical region (4 patients). All patients successfully intubated were able to eat well, including solid foods. CONCLUSIONS: Covered, self-expanding esophageal Wallstents are technically simple and safe to insert and appear to provide durable, excellent palliation of esophageal obstruction due to either benign or malignant conditions. A larger patient population is required to make firm conclusions.

Aged↗
PubMed1995

Subxiphoid pericardial drainage for pericardial tamponade.

As a result of recent reports and enthusiasm for video-assisted thorascopic pericardiectomy, we reviewed our experience with subxiphoid pericardial drainage. From August 15, 1988, to June 7, 1993, 155 patients underwent subxiphoid pericardial drainage for pericardial effusion associated with pericardial tamponade. The group comprised 85 female (55%) and 70 male patients whose ages ranged from 5 weeks to 88 years. The procedure was carried out with general anesthesia in 113 patients (72%) and with local anesthesia and sedation in 42 patients. Underlying cancer was present in 82 patients; 73 patients had benign disease. Follow-up is complete in all patients. The overall 30-day mortality was 20%; in patients with cancer it was 32.9% (27/82) versus 5.4% (4/73) for patients with benign disease. No postoperative death was attributed to the surgical procedure. Recurrent pericardial tamponade necessitating further surgical intervention occurred in four patients (2.5%), two with cancer (2.4%) and two with benign disease (2.7%). Median survival after subxiphoid pericardial drainage in patients with benign disease was more than 800 days versus 83 days in patients with cancer (p < 0.01). Median survival after pericardial drainage in patients with cancer who had malignant pericardial effusion was 56 days compared with 105 days for patients with cancer who did not have tumor in the pericardium (p < 0.05). We believe that subxiphoid drainage is the procedure of choice for patients with pericardial tamponade. It is accomplished quickly, is associated with minimal morbidity, and prevents recurrent tamponade in 97.4% (151/155) of patients.

Adolescent↗
PubMed1995

Pericardial drainage procedures.

Pericardial drainage is generally required for diagnosis and treatment of patients with pericardial effusion, and often for associated cardiac tamponade. Various effective techniques of drainage are available, each with different advantages and disadvantages; no single technique is optimal for all patients and circumstances. Pericardiocentesis or percutaneous tube drainage may be useful for patients with acute tamponade, although these carry significant risks and are safest when done under controlled conditions in the catheterization laboratory. Our preferred method of pericardial drainage in the majority of patients is the subxiphoid approach. This technique allows rapid access to the pericardium and is associated with low morbidity and excellent long-term results. Patients with infectious pericarditis should be monitored closely following pericardial drainage, and early pericardiectomy may be required, especially in children with H. influenzae. Extensive pericardiectomy by either sternotomy or thoracotomy should be reserved for patients with pericardial constriction or failures of pericardial window.

Cardiac Tamponade↗
PubMed1994

The adverse effect of perioperative blood transfusion in lung cancer.

Perioperative blood transfusion appears to increase the risk of recurrence and death in patients with surgically resected lung cancer. This finding is consistent with that in other cancers and several studies in lung cancer report similar risk elevations. We have reanalyzed the Lung Cancer Study Group data relevant to this question, assessing the potential confounding effects of some prognostic factors not examined previously. The results are nearly identical to those reported earlier, suggesting that increased risk is attributable to blood transfusion and not to confounding by known prognostic factors.

Carcinoma, Non-Small-Cell Lung↗
PubMed1994

Management of the malignant pleural effusion.

The proper management of a pleural effusion in a patient with malignancy is based on an understanding of the normal anatomy and physiology of the pleural space and the ways in which they are altered by disease. The major challenge in diagnosing and treating a cancer patient who develops a pleural effusion is determining the cause of the effusion accurately and quickly and choosing a treatment that is best suited to the individual patient. Careful selection of the treatment for pleural effusions, however, relieves symptoms in the vast majority of patients with little accompanying morbidity.

Antineoplastic Agents↗
PubMed1991

Malignant pleural effusion.

Malignancy is the most common cause of exudative pleural effusion in patients over the age of 60 years. Control of the effusion significantly reduces morbidity and improves quality of life. Tube thoracostomy with subsequent chemical pleurodesis is the treatment of choice for patients with tumors that are relatively insensitive to systemic chemotherapy. The agents most commonly used for chemical pleurodesis are tetracycline and bleomycin. A 13-center randomized trial compared tetracycline 1 g and bleomycin 60 U. Median time to recurrence or progression of the malignant effusion was 32 days for tetracycline and more than 46 days for bleomycin (P = .037). The recurrence rate within 30 days of instillation was 36% for bleomycin (10 of 28 patients) and 67% (18 of 27 patients) for tetracycline (P = .023). At 90 days, the recurrence rate was 30% (11 of 37) for bleomycin, and 53% (19 of 36) for tetracycline (P = .047). From this study, the authors concluded that intrapleural bleomycin appears superior to tetracycline for controlling malignant pleural effusions. Selected patients who fail tube thoracostomy and chemical pleurodesis should be considered for pleuroperitoneal shunting or pleurectomy.

Bleomycin↗
PubMed1990

Nuclear scan-guided rib biopsy.

The bone scan is a sensitive screening device that is frequently used to stage the condition of patients with known or suspected malignant disease. Abnormal findings on bone scan are associated with corresponding normal findings on radiographs in approximately 50% of cases. Definitive tissue diagnosis of the bone lesion is often needed to determine optimal therapy, but localization of the lesion is imprecise unless it is palpable. Use of the nuclear scan to localize and mark the rib enhances the precision of the biopsy procedure. Thirty-three consecutive patients with cancer who had bone scans suggestive of rib abnormalities underwent nuclear scan-guided biopsy. Each patient had a repeat localizing scan with a maximum permissible dose of technetium 99m radionuclide on the day of the planned biopsy. The site of abnormality was marked with methylene blue injected into the skin overlying the lesion and down to the periosteum at the specific site. The patient was then taken to the operating room and the marked area was excised through a small incision. Pathologic abnormality was identified in all but one of the resected specimens, an accuracy rate of 97%. Despite a presumed or proved diagnosis of cancer in 33 patients, 16 specimens (48%) were benign. There were no complications associated with this technique, which reduces the morbidity and increases the precision of rib biopsy.

Biopsy↗
PubMed1989

Effect of perioperative blood transfusion on outcome in patients with surgically resected lung cancer.

Three hundred thirty patients with non-small cell lung cancer were evaluated to assess the effect of perioperative blood transfusion on overall survival and time to recurrence. One hundred sixty-nine patients received blood products during the perioperative period, and 161 received none. The mean length of follow-up was 3.6 years. There were 90 recurrences, including second primaries, and 99 deaths in the group receiving transfusion; in the group without transfusion, recurrent cancer developed in 74 patients, and 68 died. Survival comparisons, adjusted for stage and cell type using the stratified log-rank statistic, showed significant reduction in survival (p = 0.007) for patients receiving transfusion. Time to recurrence was shorter for patients receiving transfusion (p = 0.035), but became less significant when adjusted for both cell type and stage (p = 0.11). Blood transfusion within the perioperative period appears to have an adverse effect on survival and recurrence in patients undergoing surgical resection for lung cancer.

Blood Transfusion↗
PubMed1987

Treatment of stage I lung cancer (T1N0M0, T2N0M0).

Patients with stage I lung cancer can be offered surgical treatment with an excellent prognosis for recovery and long-term cure. The recent revision of the staging definition has rearranged the prognostic categories, further improving the prognosis in Stage I disease by eliminating patients with a higher risk of recurrence. The most vexing issues remaining are the infrequency of diagnosis of lung cancer at this stage and the increasing incidence of lung cancer of all stages, even among nonsmokers. Economical screening, abolition of cigarette smoking, control of airborne environmental carcinogens, and the continued search for effective systemic treatment remain challenges for the future.

Carcinoma, Small Cell↗
PubMed1983

One-stage reconstruction for pharyngolaryngectomy. Esophagectomy and pharyngogastrostomy without thoracotomy.

From 1969 to 1981, a total of 22 patients underwent laryngopharyngectomy and nonthoracotomy esophagectomy, with immediate pharyngogastrostomy, for hypopharyngeal or postcricoid carcinoma. Thirteen initially had been treated by high-dose radiotherapy, but the tumor had either persisted or recurred. Four patients underwent planned preoperative irradiation on the morning of the operation. Two patients had had previous high-dose local irradiation to the neck for other disease, and three patients had no irradiation. There was one operative death. Anastomotic leaks developed in four patients, but only one of the leaks was considered a serious problem. Three patients had transient dysphagia, but only one required dilatation. Transient delayed gastric emptying was a problem in three other patients. The average postoperative stay was 31 days, with 38% of patients being discharged by 21 days. All patients were discharged eating a normal diet. Fifty percent survived longer than 12 months, with an actuarial survival rate of 30% at 5 years. The patient surviving longest is disease free at 12 years. Palliation was considered excellent in all 21 operative survivors. Immediate pharyngogastrostomy via nonthoracotomy esophagectomy is a safe and excellent means of palliation in this group of patients, for whom palliation is often the only option.

Adult↗