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Biomedical subjects

F J Podbielski

Publications and source records attributed to F J Podbielski.

At least 19 recordsLinked to original sources
PubMed2004

Esophagectomy in a patient with AIDS.

As the life expectancy of AIDS patients continues to increase due to improved anti-retroviral therapy less of these patients die of HIV-related illnesses. Dysphagia is a common complaint in AIDS patients and usually results from a fungal esophagitis. While cancer of the esophagus is occasionally found in AIDS patients, we report our experience with an AIDS patient diagnosed with a squamous cell esophageal malignancy who received pre-operative radiation and chemotherapy, followed by transhiatal esophagectomy. The patient is alive 16 months post-operatively. The transition of HIV/AIDS from an acute fulminant disease to a chronic condition mandates that these patients should receive full and standard therapy for their esophageal malignancies.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Malignant proliferating trichilemmal tumor.

Proliferating trichilemmal tumors are uncommon neoplasms that are usually benign, but characterized by frequent local recurrence. In this report, we describe a patient who sought treatment at our clinic for a right occiput scalp nodule measuring 1 cm in diameter. The subcutaneous lesion was mobile and without overlying skin ulceration. Excisional biopsy of the mass was performed and the pathologic diagnosis returned as malignant, proliferating trichilemmal (pilar) tumor. Resection margins were free of tumor. On further examination the patient had no evidence of metastatic disease. A schedule of routine follow-up visits was arranged to monitor the site for recurrent disease.

Epidermal Cyst↗
PubMed2001

Carcinosarcoma of the esophagus--pattern of recurrence.

Carcinosarcoma of the esophagus is a rare malignant neoplasm, predominantly affecting men in their seventh decade of life. While presenting symptoms and anatomic location of squamous cell and carcinosarcoma of the esophagus are similar, the latter often presents as a large intraluminal polypoid mass on barium esophagram. The more favorable prognosis associated with carcinosarcoma versus other esophageal neoplasms has been attributed to early onset of symptoms, resulting in prompt diagnosis, and a lower propensity for tumor invasion. We report the case of an elderly woman presenting with dysphagia who was initially diagnosed with esophageal leyomyosarcoma. Final tumor pathology showed esophageal carcinosarcoma.

Aged↗
PubMed2001

Prospective comparison of intraoperative angiography with duplex scanning in evaluating lower-extremity bypass grafts in a community hospital.

The gold standard for intraoperative evaluation of lower-extremity bypass grafts has been angiography. Limitations of this technique include inability to measure flow dynamics, violation of graft integrity, cost, and length of assessment time. The goal of this study was to evaluate duplex scanning as an alternative modality for intraoperative graft assessment. Our study group comprised of 19 consecutive patients undergoing infrainguinal bypass procedures at our institution between March 1999 and March 2000. Intraoperative angiography was compared with duplex scanning by evaluating parameters of assessment time, graft flow velocities, serum creatinine levels, and 30-day graft patency rates. Mean study times were the following: cut-film angiography, 22 +/- 1.8 minutes; real-time fluoroscopy, 17 +/- 2.5 minutes; and duplex imaging, 10.4 +/- 1.1 minutes. As noted duplex imaging times as compared with radiographic modalities were significantly shorter (P < 0.05). There was a substantial cost difference between angiography ($650) and duplex scanning ($350). A 100 per cent correlation of study findings was noted between angiography and duplex scanning. No significant change in pre- versus postoperative creatinine levels was found. We conclude that duplex scanning is an effective modality and provides reliable intraoperative vascular graft assessment data in a community hospital setting. Advantages include a shorter study time, lower cost, flow dynamic data acquisition, and avoidance of mechanical graft trauma.

Aged↗
PubMed2000

Intraoperative monitoring of recurrent laryngeal nerve function.

Intraoperative recurrent laryngeal nerve identification is sometimes difficult in reoperative cervical dissection or operation for inflammatory thyroid disorders. Three modalities have been described to intraoperatively assess nerve function: vocal cord visualization with fiberoptic bronchoscopy or direct laryngoscopy, electromyelographic surveillance of arytenoid muscle function, and cord function assessment with an electromyelogram-electrode endotracheal tube. Our study focused on patients requiring cervical dissection for thyroid or parathyroid disease in which intraoperative recurrent laryngeal nerve function was monitored by nerve stimulation with a concentric bipolar probe. Impulses were tracked via a specialized electrode-bearing endotracheal tube with signal transduction to a recording monitor. No operative nerve injuries occurred in the patients of our study group. This surveillance technique's several advantages include use of standard intubation techniques with no increase in operative time, nerve stimulation tracings that are quantifiable and reproducible with production of a permanent record, and less subjectivity due to observer variability. We believe these factors make the electromyelogram-electrode endotracheal tube approach to intraoperative recurrent laryngeal nerve assessment the optimal technique.

Electromyography↗
PubMed1999

Electrophysiological and clinical comparison of two temporary pacing leads following cardiac surgery.

Temporary pacing leads are invaluable in diagnosis and treatment of arrhythmia after cardiac surgery. The ideal lead possesses reliable pacing and sensing capabilities throughout the postoperative period. Ease of handling and a low complication rate are essential. This study compares a new lead (Medtronic model #6492) to a temporary pacemaker lead established in clinical use (Medtronic model #6500). One lead of each type was placed in the right atrium and ventricle in 33 patients undergoing elective coronary revascularization. Pacing function was measured on the first and fourth postoperative days. Lead complications were documented. On day 1, there was no statistical difference between lead types in terms of pacing (voltage threshold, current threshold), impedance, or sensing (P wave amplitude, R wave amplitude). On day 4, both leads showed an increase in pacing threshold and a decrease in sensing ability. The only statistical difference between lead types was in atrial sensing on day 4, as measured by the P wave amplitudes (1.95 +/- 0.18 V for model 6492 vs 1.40 +/- 0.14 V for model 6500, P < 0.05). Two leads of each model failed to pace in the ventricular position and one lead in each model in the atrial position. There were no complications attributable to either pacemaker lead. We found that both lead types were reliable and functioned well. The Medtronic Model #6492 lead demonstrated better long-term sensing, although in this study the difference was not clinically significant.

Arrhythmias, Cardiac↗
PubMed1998

Single-stage, bilateral, video-assisted thoracoscopic lung volume reduction surgery for end-stage emphysema.

The reintroduction of lung volume reduction surgery has provided functional improvement for selected patients afflicted with end-stage emphysema. Evolution of the operation from a median sternotomy approach to the two-stage video-assisted thoracoscopic surgical technique in our experience has resulted in a faster return to full activity. Nineteen patients underwent video-assisted thoracoscopic lung volume reduction surgery between July 1995 and August 1997. The 12 men and 7 women in the study had an average age of 63.7 years. All patients were evaluated preoperatively with computed tomography of the chest, radionuclide lung perfusion scan, left ventricular stress test, right heart catheterization, and a monitored rehabilitation program. In 15 patients the operation was performed as a bilateral single-stage procedure. The operation involved resection of wedges from the upper lobes and in 10 of these patients from the lower lobes as well. In all patients the estimated operative blood loss was less than 150 ml. The mean operative time was 177 minutes (range 115-235 minutes). The mean length of hospital stay was 10.8 days (median 11 days, range 5-24 days). At 2 to 3 months' follow-up increases were noted in the FEV1 (51%), PaO2 (27%), and 6-minute walk distance (18%); and there was a decrease in total lung capacity and respiratory volume. No significant change was observed in carbon monoxide diffusion in the lung. Morbidity included persistent air leaks in three patients and refractory supraventricular tachyarrhythmia in one. There were no perioperative deaths. We therefore recommend this technical modification to reduce operating time and blood loss without compromising surgical exposure or outcome.

Endoscopy↗
PubMed1998

Video-assisted thoracoscopic left ventricular thrombectomy and coronary artery revascularization.

Advances in video-assisted techniques in the fields of general and thoracic surgery have led to the application of this technology in experimental and clinical cardiac surgery. Visualization of intracardiac anatomy and pathology allows procedures to be performed without violation of ventricular muscle, thus preserving myocardial function. We present the case of a patient with a recent myocardial infarction, found to have a large left ventricular thrombus on echocardiogram. By applying thoracoscopic surgical technology we successfully removed the thrombus during emergency coronary artery revascularization and avoided myotomy.

Coronary Thrombosis↗
PubMed1998

What makes a coronary myocardial bridge symptomatic?

The clinical significance of coronary myocardial bridging has been debated and different interventional strategies proposed. We discuss the case of a patient who presented with the recent onset of symptoms of exertional chest pain, diaphoresis, and electrocardiographic signs of acute anterior myocardial wall ischemia. Cardiac catheterization demonstrated a segmental high-grade narrowing of the mid left anterior descending coronary artery during systole consistent with bridging. Intravenous fluid resuscitation and calcium channel blockade resulted in normalization of his electrocardiogram and complete resolution of his anginal symptoms and coronary angiographic systolic narrowing.

Administration, Oral↗
PubMed1997

Giant azygos vein varix.

Primary anomalies of the azygos vein generally result from intrathoracic tumor compression or inferior vena caval interruption with azygos vein continuation. Vascular malformations, although uncommon, can frequently mimic solid tumors and present as middle or posterior mediastinal masses. We present the case of an isolated giant azygos vein varix in an asymptomatic patient. Preoperative computed tomography and magnetic resonance imaging were not diagnostic in evaluating this patient's anatomy.

Aged↗
PubMed1997

Single-stage bilateral, video-assisted thoracoscopic lung volume reduction operation.

Lung volume reduction (LVR) produces significant clinical and objective improvement in selected patients with diffuse emphysema. Unilateral and bilateral approaches have been successfully employed. A median sternotomy approach is the standard for bilateral LVR, whereas video-assisted thoracoscopy has been used to perform unilateral LVR. Encouraging video-assisted thoracoscopic results with sequential, staged, bilateral LVR have been shown. This report describes an alternate technique of single-stage, bilateral LVR for end-stage emphysema.

Emphysema↗
PubMed1997

Pulmonary artery pseudoaneurysm after tube thoracostomy.

Pulmonary artery pseudoaneurysm has been described as a complication of Swan-Ganz catheterization and right heart catheterization. Isolated cases of this condition occurring in blunt and penetrating chest trauma have been reported. In this communication, we describe the case of a patient with intracranial hemorrhage who required positive-pressure ventilation and in whom subsequent pneumothorax developed, necessitating tube thoracostomy. A persistent opacification of the lung field resulted in evaluation with computed chest tomography and color-flow Doppler ultrasonography. A pseudoaneurysm of the lingular segmental artery was identified and successfully obliterated by Gelfoam coil embolization.

Aneurysm, False↗
PubMed1997

Inflammatory pulmonary pseudotumor in an adolescent.

Primary pulmonary neoplasia in youth is uncommon, but malignant entities of varied histology predominate. A case of primary inflammatory pulmonary pseudotumor of the lung in an adolescent with a huge lung mass is presented. This finding represents the preponderance of benign lung neoplasms found in children and adolescents and must be considered when only inflammatory cells are recovered at bronchoscopy.

Adolescent↗
PubMed1997

Lymphoma of the extrahepatic biliary ducts in acquired immunodeficiency syndrome.

Gastrointestinal neoplasia in acquired immunodeficiency syndrome (AIDS) frequently presents as a non-Hodgkin's lymphoma or Kaposi's sarcoma, at sites including the oral cavity, esophagus, small bowel, and mesenteries. Primary lymphoma of the biliary ducts, even in the setting of AIDS, is rare. This patient, an older male with no preoperatively known AIDS risk factors, presented with painless jaundice and radiographic findings of focal hepatic duct stenosis, suggesting either a Klatskin tumor or sclerosing cholangitis. Only after the pathologic diagnosis of a malignant large cell lymphoma from the en bloc tumor specimen was his human immunodeficiency virus status ascertained and noted to be positive.

Aged↗
PubMed1989

Plasma platelet factor 4 response in rhesus monkeys fed coconut oil.

Platelet factor 4 (PF 4), the low molecular weight polypeptide stored in the alpha granule, has been shown to be released from platelets during the process of activation. To examine the effects of known atherogenic food fats on platelet activation, as manifested in circulating PF 4 concentrations, groups of rhesus monkeys were fed diets enriched with varying quantities of different food fats. Plasma PF 4 levels were measured at set intervals during the experimental period. Platelet counts were performed and PF 4 values assayed using the radioligand binding technique. Animals given coconut-oil-enriched diets showed the greatest increase in PF 4 levels; while those fed corn, peanut and soybean-oil-containing rations showed small insignificant fluctuations of plasma PF 4 values. In this study the coconut oil effect on plasma PF 4 values increased with time; diluting the coconut oil with increasing quantities of corn oil led to progressive decreases in these values. These data indicate an increased incidence of platelet activation in animals fed coconut-oil-enriched diets, and suggest that corn oil counteracts this thromboactive effect of coconut oil.

Animal Feed↗
PubMedDate not supplied

Jejunal diverticulosis and gastrointestinal bleeding.

Occult gastrointestinal bleeding frequently frustrates clinicians' attempts to locate the source. Foci of hemorrhage within the small bowel are often found only at laparotomy and can be attributed to Meckel's diverticula, carcinomas, or less frequently, pulsion-type diverticula. We report our experience with two patients whose jejunal diverticula resulted in recurrent episodes of massive gastrointestinal hemorrhage.

Aged↗