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Ken R Thomson

Publications and source records attributed to Ken R Thomson.

3 recordsLinked to original sources
PubMed2003

The potential for bronchoscopic lung volume reduction using bronchial prostheses: a pilot study.

STUDY OBJECTIVES: Significant morbidity and mortality offset the benefits of lung volume reduction surgery (LVRS) for emphysema. By contributing to distal lung collapse, bronchoscopic placement of valved prostheses has the potential to noninvasively replicate the beneficial effects of LVRS. The purpose of this study was to investigate the safety and feasibility of placing valves in segmental airways of patients with emphysema. DESIGN: Case series. SETTING: Tertiary hospital, severe airways disease clinic. PATIENTS: Ten patients aged 51 to 69 years with apical emphysema and hyperinflation, otherwise suitable for standard LVRS. Mean preoperative FEV(1) was 0.72 L (19 to 46% predicted), and 6-min walk distance was 340 m (range, 245 to 425 m). INTERVENTION: Apical, bronchoscopic, segmental airway placement of one-way valves (silicone-based Nitinol bronchial stent; Emphasys Medical; Redwood City, CA) under general anesthesia. Placement was over a guidewire under bronchoscopic and fluoroscopic control. RESULTS: Four to 11 prostheses per patient took 52 to 137 min to obstruct upper-lobe segments bilaterally. Inpatient stay was 1 to 8 days. No major complications were seen in the 30-day study period. Minor complications included exacerbation of COPD (n = 3), asymptomatic localized pneumothorax (n = 1), and lower-lobe pneumonia (day 37; n = 1). Symptomatic improvement was noted in four patients. No major change in radiologic findings, lung function, or 6-min walk distance was evident at 1 month, although gas transfer improved from 7.47 +/- 2.0 to 8.26 +/- 2.6 mL/min/mm Hg (p = 0.04) and nuclear upper-lobe perfusion fell from 32 +/- 10 to 27 +/- 9% (mean +/- SD) [p = 0.02]. CONCLUSION: Bronchoscopic prostheses can be safely and reliably placed into the human lung. Further study is needed to explore patient characteristics that determine symptomatic efficacy in a larger patient cohort.

Aged↗
PubMedDate not supplied

Factors affecting outcome after percutaneous renal artery stent insertion.

BACKGROUND: Renal artery stenosis is increasingly being treated with the percutaneous insertion of stents. Little data are available to help select patients most likely to derive benefit from the procedure. METHODS: Data were gathered on all patients treated with renal artery stent insertion at the Royal Melbourne Hospital prior to 1998, and who were followed-up for at least 6 months or until death. Multivariate regression analysis was used to identify factors associated with patient survival and renal survival (survival free of dialysis). RESULTS: Adequate data were available on 148 of 198 patients treated during this time (75%). A baseline creatinine over 0.15 mmol/L and age over 70 were strongly associated with worse patient survival (Likelihood ratio(LR) 9.96, p < 0.0001 and 3.4, p = 0.001 respectively) and renal survival (LR 7.8, p < 0.001 and 2.7, p < 0.01 respectively). The presence of diabetes was also associated with worse overall survival (LR 2.2, p < 0.05) but not renal survival, while the presence of another nephropathic disorder was associated with worse renal survival (LR 2.8, p < 0.01) but not overall survival. The use of ACE inhibitors after the stenting procedure was associated with a significantly better renal survival (LR 0.46, p < 0.05). CONCLUSIONS: Patients with baseline renal impairment, older age, diabetes or another coexistent renal disease have poor outcomes after renal artery stent insertion. A relatively conservative approach to revascularisation may be preferable in these patient groups. The use of ACE inhibitors after stent insertion is associated with a reduced likelihood of death or dialysis.

Adult↗