Biomedical subjects
Publications and source records attributed to J E Dussek.
A case of severe intractable angina pectoris with normal angiography is presented. Following video assisted thoracic sympathectomy the patient died of heart failure. Microvascular cardiac amyloidosis was diagnosed at the postmortem examination. This report alerts clinicians to this possible diagnosis when treating patients with severe angina when no cause is found and discusses the poor prognosis in such cases.
A 38-year-old man underwent an Ivor-Lewis esophagectomy for a squamous carcinoma at the lower third of his esophagus. On the fifth postoperative day one liter of turbid fluid appeared from the intercostal drain and there was a right-sided pleural effusion on the chest radiograph. A contrast swallow demonstrated a leak at the distal part of the gastric staple line. This leak was managed conservatively and subsequent contrast swallows failed to show any leakage despite the persistent drainage from the drain. At gastroscopy, the intercostal drain was seen to have eroded through the stomach wall. The drain was repositioned and the patient was discharged from hospital 5 days later. We believe this to be the first report of an intercostal drain migration into the stomach after an elective esophagectomy.
Surgical correction of pectus excavatum deformity with the use of a metal bar strut provides a good cosmetic result with a low complication rate. Reports of pectus bar migration are rare but we report three cases of bar migration which required thoracoscopic removal.
The purpose of this paper is to report the use and benefits of self-expanding metallic stents employed in pyloric dysfunction. Four patients treated with oesophagectomy and gastric pull-up for oesophageal carcinoma failed to respond to balloon dilatation for pyloric dysfunction. Three of the patients were thought to have residual tumour at sites remote from the pylorus prior to stenting, but the fourth, who had undergone surgery 8 years previously, was thought to be cured. All were treated with self-expanding metallic stents. All four patients responded well with resolution of their symptoms. Over a mean follow-up of 6 months there has been no recurrence of symptoms. Stent insertion represents a potentially valuable method of treatment in patients with post-surgical pyloric dysfunction in whom simple balloon dilatation has failed.
BACKGROUND: Surgical resection of lung cancer remains the treatment of choice in appropriately staged disease, but conventional imaging techniques have limitations. Positron emission tomography (PET) may improve staging accuracy. METHODS: We studied whole body and localized thoracic PET in staging lung cancer. Standardized uptake value was calculated for the primary lesion. Ninety-seven patients under consideration for surgical resection were included. PET, computed tomography, and clinical staging were compared to stage at operation, biopsy, or final outcome. Mean follow up was 17.5 months. RESULTS: PET detected all primary lung cancers with two false-positive primary sites. Sensitivity and specificity for N2 and N3 mediastinal disease was 20% and 89.9% for computed tomography and 70.6% and 97% for PET. PET correctly altered stage in 26.8%, nodal stage in 13.4%, and detected distant metastases in 16.5%. PET missed 7 of 10 cerebral metastases. PET altered management in 37% of patients. PET staging (p<0.0001) and standardized uptake value (p<0.001) were the best predictors of time to death apart from operative staging. CONCLUSIONS: PET provides significant staging and prognostic information in lung cancer patients considered operable by standard criteria. Routine use of PET will prevent unnecessary operation and may be cost effective.
Malignant thymomas are invasive and recur frequently, but noninvasive thymomas rarely do so. We report on a case of recurrent thymoma in a 50-year-old white man, 32 years after total excision of a stage I thymoma. We stress the importance of long-term follow-up in all patients.
Pericardial cysts are most commonly incidental radiologic findings of little clinical consequence. We present the unusual history of 2 patients in whom pericardial cysts were of massive sizes and caused significant symptoms; in 1, progression of the cyst size had been documented over 25 years. Diagnostic difficulties encountered and the utility of video-assisted thoracoscopy are described.
Because of its rarity and the similarity of its presentation to that of pulmonary thromboembolic disease, the diagnosis of pulmonary artery sarcoma is often not considered early in patients presenting with recurrent or chronic pulmonary emboli. We present a case of pulmonary artery sarcoma that was treated as pulmonary embolism for 3 years before surgical resection was carried out. Two years after the resection the patient is well with no clinical or radiologic evidence of recurrent or metastatic disease.
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A prospective follow up was carried out on 479 consecutive patients who underwent lung resection for non small cell primary bronchogenic carcinoma between 1980 and 1987 under the care of one surgeon at Guy's Hospital and Brook Hospital, London. The mean age of patients was 61.8 years; 16.9% were aged 70 years or over. Of the 479,237 patients had stage I disease, 108 patients stage II disease, and 134 patients stage III. Lobectomy was performed in 280 patients, pneumonectomy in 191, and wedge resection in 8. Operative mortality was 5% overall, 6.8% following pneumonectomy and 3.9% following lobectomy. There was no operative mortality following wedge resection. Old age did not affect operative mortality. Overall actuarial survival was 76.2% and 39.8% at 1 year and 5 years postoperatively, respectively (stage I: 86% and 55%; stage II: 77.8% and 35.5%; stage III: 57.5% and 16.2%). There were statistically significant differences in survival between the stages. Five-year actuarial survival was 45% for squamous cell carcinoma, 36.3% for adenocarcinoma, 31.9% for dimorphic carcinoma and a 21% for undifferentiated carcinoma. There were statistically significant differences in survival between undifferentiated carcinoma and each of the other cell types. The favourable survival in stage I disease lends weight to the concept that there is hope for cure in patients with early non small cell lung cancer.
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Review of an annual series of cases of empyema seen at a regional cardiothoracic unit showed that six out of 25 were due to Streptococcus milleri. The details of the cases are summarised. This organism is now an important cause of empyema, occurring much more commonly in men than in women; but since it is highly sensitive to penicillins permanent resolution can be achieved with antibiotic treatment combined with open or closed drainage.
Four cases of the triad of rheumatoid lung disease, spontaneous pneumothorax, and peripheral blood eosinophilia are reported. Cavitation of a rheumatoid lung nodule caused the pneumothorax in at least 1 case. The significance of eosinophilia and its value as a marker of extra-articular manifestations of rheumatoid disease are discussed.
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PURPOSE: To assess the efficacy of the Wallstent endoprosthesis in malignant tracheobronchial obstruction. METHODS: Seven patients with irresectable carcinoma of the bronchus were treated with nine Wallstent endoprostheses. The procedures were performed under endoscopic and fluoroscopic guidance. Wallstent endoprostheses ranging from 8-16 mm in diameter and 26-49 mm in length were deployed after balloon dilatation of the strictures. RESULTS: All stents were successfully deployed in the desired positions. There was one procedural complication and one procedure related death. Three patients showed significant improvement in respiratory status after stenting. At a mean follow-up of 5.1 months, there has been no stent migration, fracture, or collapse. One patient had proximal tumor overgrowth that was treated with additional stent insertion. One patient died after a bout of massive hemoptysis 3 months poststenting and it was difficult to tell whether this was related to the endoprosthesis. CONCLUSION: The use of the Wallstent endoprosthesis in malignant tracheobronchial obstruction is technically feasible.