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Biomedical subjects

M W Flye

Publications and source records attributed to M W Flye.

At least 235 records · Page 13Linked to original sources
PubMed1979

The role of thoracotomy in the management of pulmonary metastases from malignant melanoma.

Thirty-three patients over a 21-year period underwent thoracotomy for resection of suspected pulmonary metastases from malignant melanoma. Eleven patients were found to have nonmalignant disease (Group 1); 10 were found to have unresectable disease (Group 2); and 12 were rendered disease-free (Group 3). Of the patients found to have melanoma, 20 of 22 received post-operative chemotherapy. The median survival of the patients in Group 2 was 10.5 months (3 to 20 months); in Group 3 it was 12 months (3 to 35 months). There were no 5-year survivors. No factors distinguished the three groups preoperatively. Surgical resection still offers the greatest chance for long-term survival, based on reports of patients in the literature who have survived longer than 5 years following resection of pulmonary metastases from melanoma. Thoracotomy is especially useful for staging purposes in those patients found to have no metastatic disease.

Follow-Up Studies↗
PubMed1979

The treatment of recurrent malignant pleural effusion.

Effective control of a recurrent malignant pleural effusion can greatly improve the quality of life of the cancer patient. At least a dozen different techniques have been advocated for controlling this common complication of malignant disease. The present review collects and examines the clinical results of all techniques designed to treat this problem. The pathophysiology and diagnostic evaluation of the effusion are also discussed. On the basis of comparisons involving effectiveness, morbidity, and convenience, we recommend intrapleurally administered tetracycline with thoracostomy drainage as the technique of choice. Instillation of a talc suspension with thoracostomy drainage is also a safe and effective technique and should be employed when tetracycline fails or is contraindicated.

Drainage↗
PubMed1979

An enzymatic method permitting early determination of histocompatibility in mixed lymphocyte culture.

The standard mixed lymphocyte culture assay, which measures the incorporation of [3H]thymidine into DNA, usually requires 5 days. We describe a more rapid assay based on changes in the activity of ornithine decarboxylase. An increase in the activity of ornithine decarboxylase was observed in mixed lymphocyte cultures from genetically defined, major histocompatibility complex (MHC)-nonidentical miniature swine as early as 18 hr after plating. No increase was found in mixed cultures from inbred MHC-identical animals. Similar results were obtained with the enzyme S-adenosylmethionine decarboxylase with the increase in activity starting at about 32 hr. There was a good correlation between the ornithine decarboxylase values at 18 hr and the results of the [3H]thymidine incorporation assay on day 5. Preliminary experiments with human lymphocytes revealed similar results.

Adenosylmethionine Decarboxylase↗
PubMed1979

Transplantation in miniature swine. VI. Factors influencing survival of renal allografts.

Renal allografts were performed between and among animals from three herds of miniature swine that were selectively inbred to homozygosity at the major histocompatibility complex, MSLA. The results suggest several genetic factors which influence the survival of renal allografts in these animals. As expected, the major histocompatibility complex (MHC) was of dominant importance, and all MSLA-mismatched grafts were rejected promptly (12 +/- 3.7 days). Some MSLA-matched grafts were also rejected (30 +/- 15.0 days), indicating that non-MSLA loci also determine antigens which can lead to kidney rejection. Other MSLA-matched grafts were accepted indefinitely. At least one immune response gene that determined ability to reject kidneys across non-MSLA differences seemed to be segregating in our swine population. Animals that had accepted MSLA-matched renal grafts for extended periods demonstrated markedly prolonged survival of subsequent donor skin grafts compared to skin graft survival across the same non-MSLA difference in normal animals. This finding suggests that failure to reject kidneys across non-MSLA differences indicates systemic tolerance, and that there may be a relationship between the induction of such tolerance and the proposed immune response gene controlling rejection.

Animals↗
PubMed1979

Transplantation in miniature swine. VII. Evidence for cellular immune mechanisms in hyperacute rejection of renal alografts.

Renal allografts were performed in miniature swine that were identical at their major histocompatibility locus and were presensitized by skin grafts from their prospective renal donors. All of these renal grafts were rejected in a hyperacute or markedly accelerated manner compared to the survival of comparable grafts in nonsensitized animals. Studies directed at the mechanism of this rejection revealed no circulating recipient antidonor antibodies by several serological assays. In contrast, mixed lymphocyte cultures (MLCs) and cell-mediated lympholysis (CML) assays demonstrated marked recipient antidonor lymphocyte reactivity that appeared after skin grafts, diminished during the tenure of the renal graft in the host circulation, and reappeared after removal of the rejected kidney. These results suggest that cellular immune mechanisms may plan a role in the accelerated rejection of major histocompatibility complex (MHC)-identical renal allografts.

Animals↗
PubMed1979

Treatment of osteogenic sarcoma. II. Aggressive resection of pulmonary metastases.

Thirty-nine patients with osteogenic sarcoma were treated in a prospective protocol involving the use of adjuvant high-dose methotrexate, frequent screening for pulmonary metastases, and aggressive resection of all metastatic disease whenever possible. Twenty-two of these 39 patients have had recurrence and in 20 patients evidence of metastatic disease was confined to the lungs. Eighteen of the patients had thoracotomy, and in 11 patients all known disease was resected. Although four of these patients have required further thoracotomies, all 11 patients have no evidence of disease. Thus, of the original 39 patients, 30 (76.9%) are now alive and 28 (71.8%) have no evidence of disease, with a median followup of 27 months. Survival is significantly improved compared to historical control patients (P less than 0.001; one-sided Kruskal-Wallis test).

Antineoplastic Agents↗
PubMed1979

Diagnostic and therapeutic aspects of the surgical approach to Wegener's granulomatosis.

Over a 16 year period, 47 patients with Wegener's granulomatosis were treated at the National Institutes of Health. Age at the onset of disease ranged from 15 to 75 years with a mean of 42.2 years. The group was evenly divided between male and female subjects. With seven exceptions, all patients had the classic form of Wegener's granulomatosis, with upper airway and pulmonary disease and glomerulitis. The most consistently abnormal laboratory test was an elevated erythrocyte sedimentation rate. Most of the patients were treated with cyclophosphamide alone or in combination with prednisone. In 37 patients the disease now is well controlled or in complete remission from 1 to 9 years after the onset of symptoms. Of the 10 patients who died, only two were considered treatment failures. Forty-one of the 47 patients had chest x-ray changes at some point in their clinical course. Nineteen had bilateral involvement and 22 unilateral disease. Three of 11 patients with nodular disease had cavitation, and four of 21 with less discrete infiltrative disease demonstrated cavitation. Four patients had an associated pleural effusion and another four had pleural thickening. As part of the diagnostic procedure, 24 patients underwent an open lung biopsy. Two patients had a lobectomy for presumed neoplastic disease. In one patient the diagnosis of Wegener's granulomatosis was made by endobronchial biopsy. In the remaining patients the diagnosis was made by biopsy of another site. Endobronchial involvement is being seen with the increasing patient survival. Three patients had subglottic tracheal stenosis necessitating tracheal dilatations. One of the three also had multiple areas of bronchial stenosis responding to cyclophosphamide therapy. A fourth patient had progressive left main-stem bronchial stenosis which necessitated a sleeve resection. Five patients had pericarditis secondary to Wegener's granulomatosis.

Adolescent↗
PubMed1978

A three year experience using modified bovine arterial heterografts for vascular access in patients requiring hemodialysis.

Between January 1974 and December 1976 28 arteriovenous fistulae were created in 25 uremic patients using modified bovine arterial heterografts. Bovine grafts were inserted only if the patient's own vessels were deemed inadequate to permit the development of a useable Brescia fistula. Graft patency by the life-table method was 92% at three months and 75% at one year. Complications leading to graft failure included late thrombosis, inadequate healing of skin flaps, and graft disruption secondary to faulty cannulation. Ten patients died; none of the deaths were graft-related. At the end of the period of observation all patients requiring hemodialysis had functioning bovine grafts. It is felt that for this purpose the modified bovine arterial heterograft is superior to any other currently available vascular conduit. The location of these grafts should be planned so as to make maximal use of distal vasculature and allow multiple sequential access procedures in the same extremity. An idealized approach which encompasses these principles is presented.

Adolescent↗
PubMed1978

Incidence of anatomical variants in renal vasculature in the presence of normal renal function.

This report defines the incidence of variations in the renal vascular pedicle in a group of patients with normal renal function as determined by standard laboratory criteria. The study group consisted of 166 patients undergoing renal arteriography as potential renal allograft donors. Ninety-seven patients were male and 69 were female. Ages ranged from 18-54 years, median age being 37 years. All patients underwent preliminary screening tests including blood chemistries, creatinine clearance, urinalysis, culture and excretory urography. If these studies were normal, renal arteriography was performed utilizing flush aortogram and, in 20% of cases, selective renal arteriography. The most common anomaly was the presence of multiple renal arteries supplying the same kidney, occurring in 32% of cases. Prehilar segmental branching was the second most common variation, occurring in 17% of patients. Other variations included fetal lobulation (4%), significant stenosis at origin of the renal artery (2%), fibromuscular dysplasia (2%), microaneurysms (0.5%), true aneurysms (1%) and dromedary hump (0.5%). Less than one-half of the patients demonstrated the simplest vascular pedicle, namely, single artery and vein bilaterally. The incidence of anatomical variations in the renal vascular pedicle is greater than attributed to normal subjects in previous reports. Anomalies determine the choice of kidney in renal allografting and may disqualify a potential donor, even in the face of ostensibly normal renal function. Routine arteriography should be considered a standard prerequisite in the evaluation of potential living related renal donors.

Adolescent↗
PubMed1978

Comparison of computed and conventional whole lung tomography in detecting pulmonary nodules: a prospective radiologic-pathologic study.

Whole lung computed tomography (CT) was performed on 25 patients with clinical diagnoses including osteogenic sarcoma. Ewing's sarcoma, rhabdomyosarcoma, fibrosarcoma, and melanoma in whom conventional tomography had revealed from one to four parenchymal nodules in one lung deemed resectable for either staging or treatment purposes. Thoracotomy was performed within 3 weeks after conventional and computed whole lung tomography. All palpable nodules were resected, measured at the time of surgery, mapped by anatomic segment, and submitted for individual histologic evaluation. CT defined more nodules than conventional tomography in 48% of cases. The additional nodules were usually pleural or subpleural and 3--6 mn in diameter. CT identified 78% of all resected nodules greater than 3 mm in diameter, compared to 59% using conventional tomography. CT was also of value in detecting bilateral nodules earlier than conventional tomography and in documenting small nodule growth on successive examination. However, 60% of the additional nodules defined by CT and resected proved to be benign granulomas and pleural-based nodes at thoracotomy.

Adolescent↗
PubMed1976

Spectrum of pulmonary sequestration.

Bronchopulmonary sequestration was diagnosed in 17 patients ranging in age from newborn to 64 years. The sequestration was intralobar in 14 patients and extralobar in 3. The spectrum of symptoms could be divided into three patterns: no symptoms (6 patients), respiratory problems (8 patients), and cardiovascular problems (3 patients). Cardiovascular problems usually manifest themselves in the first few weeks or months of life and often have a respiratory component. In older patients the sequestration is first manifested by recurrent pulmonary infections or, if it remains uninfected, an asymptomatic density on chest roentgenogram. The definitive diagnostic study is arteriography. Operative treatment for the intralobar variety consists of segmental resection or, if the inflammatory process is more extensive, lobectomy. An extralobar sequestration may simply be excised.

Adolescent↗
PubMed1976

The sutureless aortic valve prosthesis: experience with and technical considerations for replacement of the early model.

Reoperation was performed in seven (16%) of 43 patients with early models of Magovern sutureless aortic valve prostheses, because of thromboembolism and ball variance. All patients survived reoperation with no major complications. Removal of the sutureless prosthesis was not difficult when an insertion tool of proper size was used. A scarred annulus remained which was favorable for the suturing of a new prosthesis. The incidence of disabling thromboembolism (42%) and poppet failure (21%) is high with these early models. When these complications occur, replacement of the prosthesis is recommended to prevent death or recurrent embolic episodes.

Adult↗
PubMed1975

Diffuse spasm of the esophagus.

During the past ten years 7 men and 15 women with diffuse esophageal spasm have been seen at the Duke University Medical Center. Dysphagia and severe substernal pain were the two characteristic symptoms. Eleven of the 22 patients were treated with a long esophageal myotomy. Two had a diverticulum of the lower esophagus excised in addition, while 6 had an associated sliding hiatal hernia repaired. Three patients in whom the diagnosis was made retrospectively all had an epiphrenic diverticulum excised without a myotomy; in 1 an esophageal leak occurred. These 3 patients still have mild symptoms of their diffuse esophageal spasm. The results of myotomy have been satisfactory. Although this operation does not correct the cause of the disorder, the improvement in symptoms makes it worthwhile in selected patients.

Adult↗
PubMed1975

Pulmonary aspergilloma. A report of its occurrence in 2 patients with cyanotic heart disease.

This is an account of our experience with 2 patients with congenital cyanotic heart disease who developed pulmonary aspergillomas. Neither patient had a demonstrable cavity in the lung before the appearance of the fungus ball. Both patients had pulmonary artery-to-superior vena cava shunts, but the aspergilloma was in the ipsilateral lung in one and the contralateral lung in the other. Repeated life-threatening hemoptyses made excision of the lung containing the cavity and fungus ball necessary in both patients.

Adult↗