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Biomedical subjects

L P Faber

Publications and source records attributed to L P Faber.

At least 19 recordsLinked to original sources
PubMed1999

Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.

BACKGROUND: Optimal management of cardiac tamponade resulting from pericardial effusion remains controversial. METHODS: Cardiac tamponade in 117 patients was treated with either subxiphoid pericardiostomy (n = 94) or percutaneous catheter drainage (n = 23). Percutaneous catheter drainage was used for patients with hemodynamic instability that precluded subxiphoid pericardiostomy. Effusions were malignant in 75 (64%) of 117 patients and benign in 42 (36%) of 117. RESULTS: Subxiphoid pericardiostomy had no operative deaths and a complication rate of 1.1% (1 of 94). In contrast, percutaneous drainage had significantly (p < 0.05) higher mortality and complication rates of 4% (1 of 23) and 17% (4 of 23), respectively. Patients with an underlying malignancy had a median survival of 2.2 months, with a 1-year actuarial survival rate of 13.8%. In comparison, patients with benign disease had a median survival of 42.8 months and a 1-, 2-, and 4-year actuarial survival rate of 79%, 73%, and 49%, respectively (p < 0.05). Effusions recurred in 1 (1.1%) of 94 patients after subxiphoid pericardiostomy compared with 7 (30.4%) of 23 patients with percutaneous drainage (p < 0.0001). CONCLUSIONS: Benign and malignant pericardial tamponade can be safely and effectively managed with subxiphoid pericardiostomy. Percutaneous catheter drainage should be reserved for patients with hemodynamic instability.

Cardiac Tamponade↗
PubMed1998

Breast carcinoma metastases.

With careful selection of patients, complete resection of pulmonary metastases from breast carcinoma may be a useful therapeutic option. Such a treatment appears to offer a significant survival benefit when compared with medical treatment alone, or with incomplete resection.

Antineoplastic Agents↗
PubMed1997

Postoperative bronchopulmonary complications in stage III lung cancer patients treated with preoperative paclitaxel-containing chemotherapy and concurrent radiation.

We previously observed encouraging results and acceptable toxicity in phase II trials testing preoperative split-course thoracic radiation and simultaneous cisplatin, etoposide, and 5-fluorouracil in stage III non-small cell lung cancer patients. We decided to delete 5-fluorouracil and to incorporate paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) into our combined-modality treatment. The first group of patients received carboplatin dosed at an area under the concentration-time curve of 4 on day 2, etoposide 50 mg orally days 1 to 5 and 8 to 12, cisplatin 50 mg/m2 on day 21, and paclitaxel 35 mg/m2 escalated to 45 mg/m2 on days 1 and 8. Group 2 patients received carboplatin dosed at an area under the concentration-time curve of 4 on day 1, etoposide 45 mg/m2 intravenously daily on days 2 to 5, and paclitaxel 80 mg/m2 (escalating to 120 mg/m2) on day 1. Patients in group 3 received carboplatin dosed at an area under the concentration-time curve of 4 on day 1 and paclitaxel 120 mg/m2 (escalating to 140 mg/m2) on day 1. Each patient received radiation 2 Gy daily on days 1 to 5 and 8 to 12, and a total of two cycles was given at 28-day intervals. Twenty-one patients received preoperative chemoradiotherapy: group 1, five patients; group 2, 11 patients; and group 3, five patients. Thoracotomy was not done in five patients due to cerebrovascular accident in one and progressive tumor in four. The remaining 16 patients had the following procedures: pneumonectomy, eight; lobectomy, six; chest wall resection, one; and no resection, one. Postoperative complications included bronchopleural fistula in one patient each in groups 1 and 3, hypoxia in one patient in group 1, pulmonary hypertension in one patient in group 2, pneumonia in one patient in group 2, and adult respiratory distress syndrome in one patient in group 3, which proved lethal. Thus, six of 16 patients had serious postoperative complications. The relatively high incidence of postoperative bronchopulmonary complications suggests that the use of preoperative paclitaxel-containing chemotherapy and simultaneous thoracic radiation may not be feasible.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Retreatment of recurrent invasive thymoma with platinum, doxorubicin, and cyclophosphamide.

Invasive thymoma recently has been shown to be sensitive to combination chemotherapy and in some cases to be relatively indolent. Two cases of extensive thymoma which responded to primary treatment with a combination of a platinum compound (carboplatin or cisplatin), doxorubicin (Adriamycin), and cyclophosphamide (or PAC) are described. Tumor progression occurred 14 (case 1) and 60 months (case 2) after completion of initial PAC therapy and was treated with the same regimen resulting in a second remission, which lasted 6 months in case 1 and is continuing at 8 months in case 2. Similar reports of secondary responses using the same chemotherapy have been described in breast, lung, and ovarian cancers, as well as in Hodgkin's lymphomas. Our observations suggest that retreatment with the same platinum-based regimen should be considered in patients who have progressive thymomas following a previous chemotherapeutic response and a disease-free interval of greater than 12 months.

Adult↗
PubMed1996

Historical developments in the management of empyema.

The diagnosis and treatment of empyema was first described by Hippocrates over 2000 years ago. Virtually nothing else pertaining to this disease was recorded until the early 18th century. Since that time, numerous treatments have been described including open and closed tube drainage, thoracentesis, and thoracoplasty.

Drainage↗
PubMed1996

Escalating paclitaxel doses combined with carboplatin/etoposide and thoracic radiotherapy as preoperative or definitive treatment for stage III non-small cell lung cancer.

We have evaluated escalating doses of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in combination with carboplatin, cisplatin, etoposide, and concurrent thoracic radiotherapy in patients with stage III non-small cell lung cancer. Dose-limiting toxicity was observed at paclitaxel 90 mg/m2. Subsequent modifications resulted in a new regimen, which consists of a 3-hour paclitaxel infusion on day 1 (three dose levels: 80, 100, and 120 mg/m2), etoposide 40 mg/m2 intravenously over 1 hour daily on days 2 to 5, and carboplatin given at an area under the concentration-time curve of 4 mg/mL x min on day 1 after paclitaxel. Treatment courses were repeated every 28 days. Eleven patients considered eligible for surgery received two courses. Nonsurgical patients (five) received three courses. No episodes of grade > or = 3 nausea and vomiting, dermatitis, anorexia, esophagitis, or thrombocytopenia were observed. The dose-limiting toxicity (grade 4 granulocytopenia) occurred in three of five patients at 120 mg/m2 paclitaxel (level 3). Grade 3 radiation pneumonitis was observed in three patients. Nine patients have undergone pulmonary resection: four pneumonectomies, four lobectomies, and one segmental resection. No operative deaths, respiratory insufficiency, or cardiovascular complications were observed. Clinical partial remissions have been observed in 11 of 16 patients overall, and two histologic complete remissions were achieved in nine surgical patients. Our preliminary results show that pulmonary resection is feasible following treatment with radiation and concurrent paclitaxel-containing chemotherapy. Although the maximum tolerated paclitaxel dose in the present study was relatively low, favorable initial responses warrant further study of paclitaxel-containing combination chemotherapy and concurrent radiation. We next plan to delete etoposide from our chemoradiotherapy regimen and escalate the paclitaxel dose.

Agranulocytosis↗
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

Sleeve lobectomy.

Sleeve lobectomy is the alternative procedure to pneumonectomy. It can be an operation of choice for lung cancer, if technically feasible, and is the ideal procedure for low grade pulmonary malignancies and inflammatory bronchial strictures. Precise radiologic bronchoscopic assessment defines the need and probability for sleeve lobectomy. Close adherence to precise technical principles will achieve excellent clinical results with a low morbidity and mortality.

Anesthesia, Inhalation↗
PubMed1995

Carboplatin/etoposide/radiation plus escalating doses of paclitaxel in stage III non-small cell lung cancer: a preliminary report.

Large randomized studies have shown superior survival results for sequential chemoradiotherapy compared with radiation alone in stage III non-small cell lung cancer. Similarly, chemotherapy followed by surgery was associated with longer survival than surgery alone in small randomized trials. Despite these results, disease recurs in most stage III patients. To improve these results, we are studying escalating doses of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) combined with platinum/etoposide and simultaneous thoracic irradiation as preoperative and curative therapy. Initially, paclitaxel was given at a starting dose of 35 mg/m2 intravenously (i.v.) over 24 hours on days 1 and 8; carboplatin (area under the concentration time curve) 4 mg/mL.min) i.v. was given on day 2 and etoposide 5 mg/d orally on days 1 to 5 and 8 to 12; cisplatin 50 mg/m2 i.v. was given on day 23, and radiation 2 Gy was given on days 1 to 5 and 8 to 12. Courses were repeated every 28 days. Four of five patients treated at the second paclitaxel dose level (90 mg/m2) experienced grade 4 toxicity. The treatment regimen was changed to paclitaxel given at a starting dose of 80 mg/m2 i.v. over 3 hours on day 1, carboplatin (area under the concentration time curve 4 mg/mL.min) i.v. given immediately after paclitaxel, etoposide 40 mg/m2 i.v. given over 1 hour on days 2 to 5, and radiation 2 Gy given on days 1 to 5 and 8 to 12. No grade 4 toxicity was observed in five patients treated at the first paclitaxel dose level (80 mg/m2). After two courses, pulmonary resection (lobectomy and pneumonectomy) was performed without fatalities in five patients. Although more data are needed, pulmonary resection appears feasible following treatment with this paclitaxel-containing regimen. Patient accrual is continuing to determine the maximum tolerated dose of paclitaxel.

Administration, Oral↗
PubMed1994

Postthoracotomy pain management using continuous epidural analgesia in 1,324 patients.

Continuous epidural analgesia consisting of an opioid with or without a local anesthetic agent is a commonly employed technique for pain relief after thoracotomy. In this study, we prospectively evaluated the use of continuous epidural analgesia in 1,324 patients undergoing elective thoracotomy between 1987 and 1993. Epidural pain management was continued for 1 to 3 postoperative days. Patients experienced excellent pain relief, with mean visual analog pain scores of 2.4, 1.7, and 1.4 on postoperative days 1, 2, and 3, respectively. Side effects occurred most frequently in the first 24 hours postoperatively; the incidence of pruritus was 14.1%; nausea, 11.2%; hypotension, 4.3%; sedation, 3.3%; and numbness, 1.1%. Respiratory depression (< 8 breaths per minute) occurred in 1 patient who received 16 mg of supplemental morphine sulfate over a 2-hour period. The incidence of inadequate analgesia (a visual analog pain score of 7 or more persisting for 1 to 2 hours after an epidurally administered bolus) was 3.8%. The results from this study support the use of standard protocols for dosing guidelines, the treatment of inadequate analgesia, and the management of side effects. Daily evaluation by a team member of the postoperative analgesia services section of the Department of Anesthesiology enhances patient care and minimizes adverse effects.

Adult↗
PubMed1994

Transhiatal stapled esophagojejunostomy without a pursestring suture in patients with previous gastric resection.

Previous gastric resection complicates alimentary tract reconstruction after esophagectomy. Colonic interposition is the standard conduit in this circumstance, but has substantial mortality and morbidity, especially important when treatment goals are to provide effective alimentation and minimize hospital stay. This report details the technique of a transabdominal, intrathoracic, stapled esophagojejunostomy created without a pursestring suture, which was used to reconstruct the esophagus in 3 patients who had previously undergone partial gastrectomy. This technique avoids both colon interposition and thoracotomy, thereby minimizing the associated complications.

Aged↗
PubMed1994

Clinical experience with Montgomery salivary bypass stents in the esophagus.

Thirty-seven patients with locally advanced malignancy (18, esophageal obstruction; 19, esophageal fistula formation) underwent attempted placement of a Montgomery salivary stent in the esophagus. This was unsuccessful in 3; in 2, because of inability to dilate, and, in 1, because of perforation. After dilation of the esophagus, there was no detectable underlying stricture in 11 patients; none of these patients experienced stent migration. Overall, there was 100% success in obliterating the fistulous tract, an 8.1% incidence of retrograde migration, no incidence of prograde migration, and no incidence of stent obstruction after discharge. Of the 34 patients with successfully placed stents, 27 were discharged from hospital, and were able to eat and drink without the need for intravenous supplementation or gastrostomy tube feedings. The survival in patients presenting with obstruction ranged from 1 to 13 months (mean, 8.0 months); the survival in patients presenting with a fistula ranged from 2 to 7 months (mean, 5.3 months).

Esophageal Fistula↗
PubMed1994

Current status of neoadjuvant therapy for non-small cell lung cancer.

Any program of therapy for clinically advanced non-small cell lung cancer (NSCLC) that would increase the incidence of local tumor control and decrease the likelihood of distant metastatic disease would be of obvious benefit. The objective of neoadjuvant therapy is to eradicate the primary tumor and micrometastatic disease. In the past 10 years, many trials have been completed to evaluate neoadjuvant therapy and they have included sequential chemoradiotherapy, concurrent chemoradiotherapy, chemotherapy/surgery, and chemoradiation/surgery. These trials have predominately been phase 2 trials and have demonstrated that chemotherapy is generally well tolerated, surgery is technically feasible, and operative morbidity and mortality are not excessive. Long-term survival for patients with clinically advanced NSCLC is improved when compared with historic controls. These trials have demonstrated a greater than 50% clinical response rate and in approximately 20% of patients who have undergone resections, the tumor is sterilized. This latter group of patients demonstrate significantly improved survival. Cost-benefit ratios and quality of life have yet to be evaluated. Final determination of the effectiveness of neoadjuvant therapy for NSCLC awaits completion of phase 3 trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Malignant pleural mesothelioma. Extrapleural pneumonectomy and pleurectomy.

Diffuse malignant pleural mesothelioma is an uncommon, uniformly fatal malignancy. Controversy continues to surround the optimal surgical procedure, both extrapleural pneumonectomy or pleurectomy, which should be utilized in conjunction with post-operative chemotherapy and/or radiotherapy. This retrospective study reviews a single institution's experience with extrapleural pneumonectomy and pleurectomy in the multimodality treatment of diffuse malignant pleural mesothelioma.

Aged↗