PubMed Health⌕ Search

Biomedical subjects

J S McLaughlin

Publications and source records attributed to J S McLaughlin.

At least 73 records · Page 4Linked to original sources
PubMed1979

Open lung biopsy in diagnosing pulmonary infiltrates in immunosuppressed patients.

From July, 1973, to June, 1977, 25 patients in an immunosuppressed state from underlying reticuloendothelial neoplasm or associated chemotherapy, underwent open biopsy of the lung at the University of Maryland Hospital for diagnosis of unilateral diffuse pulmonary infiltrates. Eight patients were in marked respiratory distress, 13 in moderate distress, and 4 in little or no distress at the time of open lung biopsy. There were 3 postoperative deaths (12%). The operation-related morbidity was 1 out of 25 (4%). Two of the patients who died were found to have irreversible pulmonary fibrosis secondary to bleomycin drug therapy. The subsequent treatment of all 25 patients was influenced by the biopsy findings as follows: upgrading the disease stage or establishing treatment failure in 11 patients; establishing the presence of inflammatory disease in 3 patients; establishing the diagnosis of fibrosis associated with drug treatment without recurrent disease or infection in 11 patients. The preferability of open lung biopsy as opposed to transbronchial or percutaneous techniques is discussed.

Adolescent↗
PubMed1979

Pancoast's tumor: irradiation or surgery?

Seventy-three patients with Pancoast's tumor treated at the University of Maryland Hospital between 1955 and 1978 were reviewed. Three were 34 squamous cell carcinomas, 13 undifferentiated, 10 adenocarcinomas, 4 mixed adenosquamous, 1 alveolar cell, and 11 undetermined. Twenty-nine patients received irradiation, with 7% survival at 3 years; 19 patients underwent preoperative irradiation followed by en bloc resection of chest wall, with 23% survival at 3 years; 5 patients underwent extended resection, with 60% survival at 3 years; and 18 patients underwent operation followed by irradiation, with 7% survival at 3 years. Retrospective staging of 42 patients undergoing operation indicated that 22 (52%) were inoperable. Prognosis was related to staging of the disease, the extent of local invasion, nodal involvement, cell type, and adequacy of operation.

Adult↗
PubMed1979

Circular myotomy as an aid to resection and end-to-end anastomosis of the esophagus.

Segments ranging from 40 to 70% of the thoracic esophagus were resected in 80 mongrel dogs. End-to-end anastomosis was effected after circular myotomy either proximal or distal, or both proximal and distal, to the anastomosis. Among dogs undergoing resection of 60% of the esophagus, distal myotomy enabled 6 of 8 animals to survive, and combined proximal and distal myotomy permitted 8 of 10 to survive. Cineesophagography was performed in a majority of the 50 surviving animals and showed no appreciable delay of peristalsis at the myotomy sites. When these sites were examined at postmortem examination up to 13 months after operation, 1 dog showed a small diverticulum but none showed dilatation or stricture. It is concluded that circular myotomy holds real promise as a means of extending the clinical application of esophageal resection with end-to-end anastomosis.

Animals↗
PubMed1978

The use of chest wall muscle flaps to close bronchopleural fistulas: experience with 21 patients.

Nineteen patients with bronchopleural fistulas associated with tuberculosis and 2 patients with fistulas following resection for bronchiectasis underwent closure of the fistulas with pedicled flaps of chest wall muscle. The muscle grafting was combined with a limited thoracoplasty in 13 patients. The initial myoplasty produced prompt fistula closure in 15 patients and delayed closure in 2 others. A repeat myoplasty was successful in 2 patients in whom the initial myoplasty failed. Compared with other methods of treating bronchopleural fistulas used during the same period, muscle grafting carried a higher rate of successful fistula closure and a lower mortality rate.

Adult↗
PubMed1978

Bronchial adenoma--benign or malignant?

Bronchial adenomas grow slowly and are potentially malignant. Of the 45 cases reviewed, 36 were carcinoids, six were adenocystic carcinomas, two were mixed tumors, and one was mucoepidermoid carcinoma. The carcinoid group is subdivided into histologically typical 27(75%), atypical 9 (25%), and metastasizing 9 (25%) adenomas. There were 32 lobectomies, seven pneumonectomies, one sleeve resection, and two tracheal resections for adenocystic carcinoma. Ten-year survival rate was 88% for typical carcinoids, 66% for atypical carcinoids, and 44% for metastasizing carcinoids. In the cylindroma group, one patient was lost to follow-up, one died postoperatively, and one developed recurrence of the tumor eight years later. The only patient with mucoepidermoid carcinoma is alive without evidence of recurrence nine years after operation.

Adenoma↗
PubMed1978

The respiratory epithelium. V. Histogenesis of lung carcinomas in the human.

One hundred human primary lung carcinomas were studied by light and electron microscopy and by light microscopic histochemistry to demonstrate mucosubstances. The tumors were classified histogenetically and were grouped into three major categories depending on their cell of origin: 1) tumors from basal and/or mucous cells; 2) tumors from neurosecretory cells; and 3) tumors from Clara cells. Most carcinomas (88%) arose from basal and/or mucous cells. These were subdivided into epidermoid carcinomas (21%), combined epidermoid and adenocarcinomas (46%), and adenocarcinomas (21%). The criteria for epidermoid differentiation included the presence of tonofilament bundles, poorly developed endoplasmic reticulum and Golgi apparatus, and well-developed desmosomes. The criteria for adeno differentiation included well-developed endoplasmic reticulum and Golgi apparatus, poorly developed desmosomes, the presence of extracellular and/or intracellular alveoli, and/or other evidence of cellular secretion such as secretory granules. In adenocarcinomas with extracellular alveoli, typical junctional complexes were also present at the luminal aspect where the cell apexes bordered the alveolus. With these criteria, combined epidermoid and adenocarcinomas were the most common type of lung carcinoma. We anticipate that the new data will clarify categories such as small cell anaplastic carcinoma and large cell carcinoma of the World Health Organization classification. In addition, the histogenetic classification of lung tumors may be of value in the future in studies of risk factors, prognosis, prevention, and treatment of lung cancer.

Adenocarcinoma↗
PubMed1978

Bronchopleural fistula. Thirteen-year experience with 77 cases.

Bronchopleural fistula, although reduced in incidence in recent years, remains a grave complication of pulmonary disease and of pulmonary resection. In a series of 77 patients treated for bronchopleural fistula over a 13 year period, 49 of whom had postresection fistulas, only 44 (57.1 percent) were cured of the fistula and 15 (19.5 percent) died. Prevention assumes great importance. Key factors in prevention are avoidance of pulmonary resection in tuberculous patients with positive sputum; overzealous dissection of the bronchus; a long bronchial stump; tumor in the bronchial stump; contamination of the pleural cavity; and too little tissue left behind to fill the pleural space. Treatment should be surgical. In none of the six patients treated conservatively was the fistula obliterated. Seventy-one patients were treated surgically, and 133 operations were needed to effect fistula obliteration in the 44 patients (62 percent) in whom this was achieved. Adequate surgical drainage has always been the sine qua non of effective treatment, and yet this alone brought about closure of the fistula in only nine patients. Early resuture of the bronchial stump succeeded in only two of five patients. Thoracoplasty combined with drainage effected closure in seven of 11 patients. The highest rate of fistula closure with the lowest mortality occurred among the 20 patients who underwent myoplasty, usually combined with a limited thoracoplasty. In this group, the fistula was obliterated in 16 patients, with one death.

Bronchial Fistula↗
PubMed1977

Carcinoma of the esophagus: experience with a philosophy for palliation.

The preliminary results of a new therapeutic approach to carcinoma of the esophagus were reported in 1972. The primary objective of treatment should be palliation, with cure an important but secondary goal. Lesions in the upper third of the esophagus are treated by irradiation unless there is severe obstruction or tracheal involvement, in which case colon bypass is carried out. Limited resection and esophagogastrostomy is performed through a right thoractomy and midline laparotomy for middle-third lesions and through a left thoracotomy for lower-third carcinomas. Since 1969, 85 patients have been evaluated, of whom 65 (76%) have been treated according to the new protocol. Thirteen patients with upper-third carcinomas were treated primarily by radiation therapy and 6 by colon bypass. Resection was performed in 45 of the 46 patients with middle- and lower-third lesions. There were 5 operative deaths (9.8%). The quality and duration of palliation have been far superior to that achieved by previous methods of treatment and, perhaps surprisingly, survival rates have improved.

Adult↗
PubMed1977

Pericarditis with effusion complicating esophageal perforation.

Among 24 patients with esophageal perforation treated during the past 6 years, 3 patients developed pericarditis with effusion as a life-threatening complication. In the first patient pericarditis was found at autopsy, the diagnosis having been suspected but not proved during life. In the other 2 patients pericardial decompression was performed and both survived. Common denominators in the 3 patients were delayed diagnosis and treatment of the perforation, with resultant empyema. Further, the diagnosis of pericarditis with effusion was difficult and delayed, because mediastinitis and associated pleuritis and pneumonia obscured the cardiac silhouette on chest roentgenogram. It is recommended that a high index of suspicion of pericarditis be maintained in patients with esophageal perforation, especially in those in whom the perforation is diagnosed late.

Adult↗
PubMed1976

Pulmonary aspergillosis: an analysis of 41 patients.

During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.

Adult↗
PubMed1976

The value of thoracoplasty before extensive unilateral resection for pulmonary tuberculosis.

Among 24 patients who required extensive unilateral resection for tuberculosis, 17 underwent adequate thoracoplasty before resection and seven others received either no thoracoplasty before resection or an inadequate one. These two groups were comparable as to severity of disease and operative risk. The incidence of serious complications was 83 per cent in the latter group compared to 12 per cent in the former. While the number of patients in each group is too small for a statistically valid comparison, the results suggest that an adequate thoracoplasty before resection is of definite value in preventing pleural complications after extensive unilateral resection for tuberculosis.

Adolescent↗
PubMed1975

The association of carcinoma of the esophagus with achalasia.

Among 156 patients with achalasia who were treated during a 13 year period, two developed squamous cell carcinoma of the esophagus. The first, a 33-year-old man, developed a carcinoma of the upper third of the esophagus 2 years after the onset of symptoms of achalasia. He was treated by a Heller myotomy and radiation therapy and survived 16.7 months. The second, a 60-year-old man, had had symptoms of achalasia for 15 years. He is alive with suspected recurrence 6 months after undergoing esophagogastrectomy for a carcinoma of the middle and lower thirds. A summary of the literature regarding carcinoma complicating achalasia is presented. This indicates that carcinoma arises in at least 1 to 7 per cent of patients with achalasia. Delay in diagnosis is common. The treatment need not differ from that of carcinoma without a chalasia, but the prognosis is dismal. Since there is evidence that retention esophagitis is a premalignant condition, it should be possible to prevent the development of carcinoma in achalasia by early cardiomyotomy in cases in which hydrostatic dilatation is not completely effective. A plea is made for closer surveillance of patients with achalasia so that, if carcinoma supervenes, it may be detected at an early stage.

Adult↗
PubMed1975

Pulmonary tuberculosis and coexisting carcinoma: a 10-year experience and review of the literature.

Of 7,986 patients admitted to Mount Wilson State Hospital for Pulmonary Diseases between 1960 and 1970, 72 were proven to have coexisting pulmonary tuberculosis and bronchogenic carcinoma. The patients usually were in the older age group, and usually smoked. There was a high predilection for the tumor to occur in the upper lobes. Active tuberculosis was present in 50 per cent of the patients and tumor and tuberculosis was present in the same area 80 per cent of the time. Cell diagnosis was possible in 60 per cent of the patients without thoracotomy. Diagnosis was usually made late in the course of the disease and therapeutic results were poor. Only 13 patients were operable and only four are presently alive. Earlier recognition is vital to adequate treatment. A plan for earlier recognition based on a high degree of suspicion is presented.

Adenocarcinoma↗
PubMed1975

Surgical treatment of pulmonary infections caused by atypical mycobacteria.

Pulmonary disease caused by atypical mycobacteria frequently constitutes an indication for operative treatment, since these bacteria are usually resistant to most forms of chemotherapy. Since 1968 11 patients having pulmonary infection caused by atypical mycobacteria underwent pulmonary resection. All patients, except one who had bilateral disease, left the hospital with negative sputum status. Pulmonary resection is an effective means of therapy for atypical mycobacterial pulmonary infection. Such treatment can be carried out with low morbidity and mortality, and is indicated in cases of poor response to drug treatment or persistent residual lesions.

Adult↗