PubMed Health⌕ Search

Biomedical subjects

P A Kvale

Publications and source records attributed to P A Kvale.

17 recordsLinked to original sources
PubMed1990

Role of brachytherapy in the management of pulmonary and mediastinal malignancies.

Brachytherapy, the permanent or temporary implantation of radioactive sources, has been performed in limited numbers of patients with lung cancer over the last 50 years. Because of renewed interest in this modality, we reviewed our experience with 103 patients treated over a 7-year period. The mean age of this group was 55.5 years (range, 1 to 84 years). Primary lung cancer accounted for 82 patients (79.6%); metastatic lesions to the lung, 13 (12.6%); and mediastinal malignancies, 8 (7.8%). Indications for brachytherapy included mediastinal and chest wall invasion in 42 patients (40.8%), unresectable tumors and mediastinal adenopathy in 30 (29.1%), medical contraindications to extensive pulmonary resection in 20 (19.4%), and irradiation of excised lymph node beds in 11 (10.7%). Seeds labeled with radioactive iodine 125 alone were used in 65 patients (63.1%), afterloading catheters containing iridium 192 sources in 25 (24.3%), and both in 13 (12.6%). There were no operative deaths. With a mean follow-up of 18.6 months, the mean and median survivals for the entire group were 17.3 and 14.0 months, respectively. The 1-year, 2-year, and 3-year survivals for the entire group were 67.9%, 38.7%, and 27.8%, respectively. In summary, brachytherapy offers a useful surgical approach in patients in whom unresectable pulmonary or mediastinal malignancies are found at the time of thoracotomy or in patients previously treated with other modalities for whom limited therapeutic alternatives exist.

Adolescent↗
PubMed1990

Can computed tomography of the chest stage lung cancer? Yes and no.

To determine the accuracy of computed tomography (CT) of the chest in the staging of lung cancer, we studied 418 patients with primary pulmonary carcinoma between 1979 and 1986. Each had a preoperative scan performed before detailed operative staging. Each CT scan was analyzed for components of the current TNM staging system. Computed tomography sensitivity and specificity for mediastinal lymph node metastasis were 84.4% and 84.1%, with corresponding positive and negative predictive accuracies of 68.7% and 92.9%, respectively. When TNM stages were derived from CT scans, only 190 of 418 (45.4%) completely agreed with operative staging. An additional 53 of 418 (12.7%) predicted the correct stage, although components of the TNM system were incorrect. In 94 of 418 scans (22.5%) CT overestimated the stage, whereas in 81 (19.4%) CT downgraded the stage. Computed tomography suggested metastatic lesions in liver, lung, adrenal gland, bone, or abdominal lymph nodes in 40 of 373 scans (10.7%); only five of 40 (12.5%) had documented metastasis. In summary, CT of the chest cannot accurately stage primary lung carcinoma according to the TNM classification. Because the negative predictive accuracy for mediastinal lymph node metastasis remains high (92.9%), invasive staging can be deferred for definitive thoracotomy when no lymphadenopathy is evident on CT. The high negative predictive accuracy for scans of the chest and upper abdomen makes CT a useful tool for exclusion of metastatic disease.

Adenocarcinoma↗
PubMed1989

Pleural effusion in Michigan caused by Coccidioides immitis after travel to an endemic area.

Primary coccidioidal disease is rarely diagnosed in the midwest in the nonimmunocompromised host. Since coast-to-coast travel is common today, many patients may become exposed to Coccidioides immitis while traveling in endemic areas. We present a case of acute coccidioidal pleural effusion in a Michigan woman who had recently visited northeastern Arizona. Her travel history was the single most important factor in the eventual diagnosis of coccidioidal pleural effusion.

Arizona↗
PubMed1986

Initial combination therapy with YAG laser photoresection and irradiation for inoperable non-small cell carcinoma of the lung. A preliminary report.

Patients presenting with inoperable non-small cell carcinoma of the lung and major symptomatic bronchial obstruction were treated initially with debulking of the airways by YAG laser, followed by conventional external-beam radiotherapy. The former method was used to minimize postobstructive pneumonitis or respiratory failure (or both) that often complicates major brochial obstruction and also to lessen the burden of tumor to be treated by radiotherapy. The preliminary results of 19 patients treated in this manner are reported, emphasizing the impact of this combined method on morbidity and mortality.

Adenocarcinoma↗
PubMed1986

Broncholith removal using the YAG laser.

An 85-year-old woman presented with a broncholith in the intermediate bronchus that could not be extracted with either flexible or rigid bronchoscopes. A YAG laser was used to fragment this broncholith so that it could be removed in pieces through a bronchoscope. Chemical composition and morphology of the broncholith were determined. Fragmentation of the large, impacted broncholith with the laser eliminated the necessity for a thoracotomy in this elderly woman.

Aged↗
PubMed1985

YAG laser photoresection of lesions obstructing the central airways.

Some patients with cancer and others with benign lesions which obstruct the central airways (larynx, trachea, major bronchi) can be treated with a laser. Ninety-nine patients were considered for treatment during the first 18 months of experience with a YAG (yttrium aluminum garnet) laser at Henry Ford Hospital; 55 patients were treated 82 times. Results were satisfactory (surgery was avoided) in eight of ten patients with benign lesions. Satisfactory results (doubling of airway size with relief of dyspnea/drainage of obstructive pneumonia) were obtained in 12 of 13 patients with bronchogenic carcinoma managed initially with the laser, and in 22 of 32 (69 percent) patients with recurrent malignancies. There were five minor and seven major complications, including two deaths. We conclude that laser treatment can relieve central airways obstruction with its associated symptoms of dyspnea and infection. Avoidance of complications requires a skillful approach, careful anesthetic management, and availability of back-up posttreatment intensive care.

Anesthesia, Endotracheal↗
PubMed1979

Spirometric evaluation of acute bronchial asthma.

Spirograms were obtained before and after emergency therapy in 85 episodes of acute bronchial asthma in 82 patients. The clinical status of all patients after emergency treatment was reevaluated 48 hours later. Patients could be divided into three groups: I) admissions; II) patients discharged but with later respiratory problems; and III) patients who were discharged and did well. The mean pre- and posttreatment one second forced expiratory volume (FEV1.0) was significantly different among all three groups. FEV1.0 less than or equal to 0.6 liter before treatment, or an FEV1.0 less than or equal to 1.6 liter after emergency treatment, was associated with an unfavorable course. Eighty-eight percent of Group I patients (admissions) had either an initial FEV1.0 less than or equal to 0.6 liter, or a posttreatment FEV1.0 less than or equal to 1.6 liter. Among all patients whose initail FEV1.0 was less than or equal to 0.6 liter, 80% were either admitted or had subsequent respiratory problems; 75% of all patients whose posttreatment FEV1.0 was less than or equal to 1.6 liter were either admitted or developed subsequent respiratory problems. Moreover, 90% of patients who had both a pretreatment FEV1.0 less than or equal to 0.6 liter and a posttreatment FEV1.0 less than or equal to 1.6 liter were admitted or had subsequent significant airway obstruction. We conclude that spirometry can identify asthmatic patients who require admission or who will have significant airway obstruction within 48 hours after discharge from the emergency department.

Acute Disease↗
PubMed1979

Diagnosis of tuberculosis: routine cultures of bronchial washings are not indicated.

During a five-year period, cultures of bronchial washings for Mycobacterium tuberculosis were obtained almost routinely (859 of 1,012 bronchoscopic examinations.). This practice proved costly, and the diagnostic yield was extremely low. Only three cases were diagnosed solely by this method (0.35 percent). Five other cases were false-positive. Additionally, 39 patients with known active pulmonary tuberculosis had false-negative cultures of bronchial washings; 13 of these 39 patients were receiving antituberculosis drugs at the time of their bronchoscopic examinations. The inhibitory effect of local anesthetics upon the growth of M tuberculosis is the possible cause for the remaining 26 false-negative cultures. We conclude that bronchoscopic examination and culture of bronchial washings are not the best sources for diagnosis of pulmonary tuberculosis and that cultures of sputum and/or gastric washings are usually sufficient. The practice of obtaining routine cultures of bronchial washings in known pulmonary tuberculosis is of questionable value, when nearly two-thirds may be false-negative.

Aged↗
PubMed1979

Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy.

Ninety-seven consecutive peripheral lung lesions were evaluated by biplane fluoroscopically guided flexible fiberoptic bronchoscopy and analyzed to define features that predict diagnostic yield. The overall diagnostic accuracy was 56 percent (63 percent for malignant and 38 percent for benign lesions). The most important characteristic associated with a positive cyto- or histopathologic diagnosis was size of the lesion; the yield was 28 percent when the diameter was less than 2.0 cm compared to 64 percent if the diameter was greater than or equal to 2.0 cm (P = 0.0035). The diagnostic yield was similar for lesions located in the outer and middle third of the lung if the diameter was greater than 2.0 cm; inner one-third lesions were correctly diagnosed more frequently, related in part to the larger size of these lesions. There was no significant difference in diagnostic yield for the following: segmental location, greatest distance from carcina on either the posteroanterior or lateral radiograph, or radiographic characteristics of the lesion. We conclude that biplane fluoroscopically guided flexible fiberoptic bronchoscopy is a reasonable diagnostic procedure for peripheral lesions greater than or equal to 2.0 cm in diameter, but that alternative procedures should be used for lesions under 2.0 cm in diameter.

Adult↗
PubMed1977

Pulmonary resection.

Seventy-seven patients who had elective pulmonary resections were enrolled in a prospective double-blind study to assess the role of prophylactic antibiotics in preventing postoperative infections. Criteria for infection were strictly defined. A five-day course of a cephalosporin (2 gm/day in divided doses) was compared to an identical placebo. There were 17 infections in the 34 patients in the placebo group (50%), compared to only eight infections in the 43 patients in the antibiotic group (19%) (P = .005). When infections unrelated to thoracotomy and minor infections were excluded, the advantage of prophylactic antibiotics proved even more evident. Fourteen thoracic infections occurred in the placebo group (41%) compared to only two thoracic infections (4.7%) in the antibiotic group (P = .0002). No relationship of infection rate to the extent of pulmonary resection was found. A history of smoking, the presence or absence of chronic bronchitis, spirometric abnormalities, and obesity were all analyzed; none was related to the development of infection. We conclude that the routine use of perioperative antibiotics is indicated to prevent postoperative infections in pulmonary resection.

Abscess↗
PubMed1976

Diagnostic accuracy in lung cancer; comparison of techniques used in association with flexible fiberoptic bronchoscopy.

Flexible fiberoptic bronchoscopic examination was performed 254 times in 228 patients in a prospective study to determine what specimens would give the greatest yield in the diagnosis of lung cancer. In addition, we questioned whether postbronchoscopic sputum specimens were still the most accurate method of diagnosing lung cancer, as they had been when only the rigid bronchoscope was available. Material for cytopathologic examination was obtained from bronchial brushings, bronchial biopsy, bronchial brushings in saline solution, bronchial washings, and three postbronchoscopie sputum specimens. In the latter part of the study, patients with peripheral tumors were studied with the aid of biplane fluoroscopic techniques. Bronchial brushings and bronchial biopsy each yielded the highest percentage of positive specimens (65 percent); postbronchoscopic sputum specimens were less frequently positive (40 percent). The combination of bronchial brushings and bronchial biopsies gave the optimum overall accuracy (79 percent). Bronchial washings and postbronchoscopic sputum specimens did not add significantly to diagnostic yield, and we conclude that they should no longer be part of the diagnostic procedures routinely ordered. In peripheral lesions, diagnostic accuracy was greatly enhanced in the cases where biplane fluoroscopic techniques were employed.

Biopsy↗
PubMed1975

Effect of gas density and ventilatory pattern of steady-state co uptake by the lung.

The steady-state uptake of carbon monoxide was measured in five normal subjects to study stratified inhomogeneity of gases in the pulmonary airways. An attempt was made to assess the effect of stratified inhomogeneity by varying the physical properties of the inspired gases and the depth and rate of ventilation by the subjects. Twelve different controlled patterns of breathing were followed by each subject on each of three gas mixtures (20% O2 with N2, He and SF6 plus 0.04% CO in each case). The experimental results show that CO uptake was significantly different when breathing the different density gases but that it was always greatest from the most dense gas SF6 and least from He. If the uptake of CO from the inspired gas across the alveolar membrane were controlled by simple molecular diffusion then as gas density decreases uptake would increase. As inspiratory flow rate was increased there was an almost linear increase in CO uptake for each gas mixture with a difference in uptake between the different-density gases which became most marked at the higher flow rates. Flow rate was increased in two ways: by maintaining tidal volume and altering breathing frequency or by maintaining frequency and altering tidal volume. The results for the two extremes, helium and SF6, indicated a difference between these methods of increasing flow rate. In the case of SF6, doubling the flow rate by increasing breathing frequency gave an uptake only marginally lower than doubling the depth of penetration. With helium, however, it was necessary to treble the frequency to obtain the increment of CO uptake achieved by doubling the depth of penetration. The experimental observations are explained by the use of a model based on Taylor dispersion in the conducting airways. The conclusion is that the results confirm the presence of significant stratified inhomogeneity in the airways of the lung.

Carbon Monoxide↗