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P Caushaj

Publications and source records attributed to P Caushaj.

8 recordsLinked to original sources
PubMed2005

Microsphere intestinal blood flow analysis during pneumoperitoneum using carbon dioxide and helium.

BACKGROUND: Pneumoperitoneum has been associated with a decreased flow in the superior mesenteric artery and portal venous system. Intestinal blood flow was studied during a 2-h pneumoperitoneum with carbon dioxide (CO2) or helium in a porcine model using colored microspheres. METHODS: For this study, 12 pigs were divided into two groups (6 CO2 and 6 helium). Different colored microspheres were injected directly into the left ventricle before, 40, 80, and 120 min after insufflation with either gas at a pressure of 15 mmHg. Microsphere concentration was measured in the mucosa and muscularis/serosa layers of the jejunum, cecum, and sigmoid colon to calculate blood flow. RESULTS: Intestinal perfusion initially increases with insufflation and returns to near baseline levels during pneumoperitoneum of 2 h. The effect of helium on tissue perfusion is similar to that of carbon dioxide. CONCLUSIONS: Intestinal perfusion does not change significantly during prolonged pneumoperitoneum at a pressure of 15 mmHg with CO2 or helium.

Animals↗
PubMed2005

Initial chest tube management after pulmonary resection.

Tube thoracostomy management with suction or water seal after anatomical pulmonary resection remains somewhat controversial. Initial chest tube management may influence the duration of pleural fluid drainage, duration of tube thoracostomy, and/or hospital length of stay following pulmonary resection. We hypothesized that initial chest tube management with water seal decreases time for chest tube removal and decreases time of hospital stay. A retrospective chart review was performed on 109 consecutive patients who underwent lobectomy or segmentectomy in Western Pennsylvania Hospital between December 1999 and December 2003. Comparison was made between chest tube management of water seal or suction in patients with and without air leak. Of the 109 patients, 78 (72%) had no air leak at the completion of surgery, and 31 (28%) had air leak. In the group without air leak (n = 78), water seal was used in 32 (41%) patients and suction in 46 (59%). In patients placed to water seal initially after surgery (n = 32), removal of chest tubes was on postoperative day (POD) 3.19 +/- 0.24 and hospital discharge was on POD 5.13 +/- 0.61. In patients placed to suction initially (n = 46), chest tubes were removed on POD 4.52 +/- 0.40. Hospital discharge was on POD 6.74 +/- 0.5. Both duration of chest tube (P < 0.007) and length of hospital stay (P < 0.04) were significantly lower in the water seal group. In the air leak group (n = 31), 7 (23%) patients were managed with water seal and 24 (77%) patients with suction. Both duration of chest tube (P = 0.001) and length of hospital stay (P < 0.05) were significantly lower in the water seal group. In patients without air leak, chest tubes should be managed with water seal following anatomical pulmonary resection, resulting in significantly shorter chest tube duration and hospital length of stay.

Adult↗
PubMed2001

Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications.

PURPOSE: Preoperative chemoradiotherapy followed by radical surgical resection has been the preferred treatment for patients presenting with locally advanced distal rectal carcinoma at our institutions. We postulated that chemoradiotherapy-induced pathologic response of the primary tumor would identify which patients would be candidates for local excision as definitive surgical therapy. METHODS: A retrospective analysis of 60 patients with palpable, locally advanced, distal rectal adenocarcinomas treated from 1995 to 2000 was performed. All patients received preoperative chemoradiotherapy consisting of 5-fluorouracil (325 mg/m(2)) and leucovorin (20 mg/m(2)) by bolus infusion on Days 1 through 5 and 29 through 33 delivered concurrently with at least 45.0 to 50.4 Gy of pelvic radiation, followed six to eight weeks later by radical surgery and then adjuvant chemotherapy. RESULTS: Among 60 patients (20 females) there was a mean age of 58.7 (28-84) years. Clinical staging was as follows: Stage II, 14 patients (23 percent); Stage III, 35 patients (58 percent); and Stage IV, 11 patients (18 percent). Pathologic examination revealed that negative margins were obtained in 58 patients (97 percent). Downstaging to T0-2N0 was achieved in 17 patients (28 percent), with five (8 percent) achieving a pathologically complete response. Lymph nodes were positive in 24 patients (40 percent) despite chemoradiotherapy. Pathologic node positivity was found in 0 of 5 pT0 patients, 9 (41 percent) of 22 pT1 or pT2, and 15 (45 percent) of 33 pT3. Clinical stage, tumor size, pathologic stage, and adverse histologic features could not reliably predict pN0 status, except pT0 (5 patients only). CONCLUSIONS: Preoperative chemoradiotherapy often downsizes and downstages locally advanced rectal carcinoma. Neither pretreatment clinical characteristics, response to preoperative chemoradiotherapy, or pathologic features reliably predict pN0 status. Therefore, local excision is not recommended as an alternative to radical surgery for locally advanced adenocarcinoma of the distal rectum regardless of the response of the primary tumor to preoperative chemoradiotherapy.

Adenocarcinoma↗
PubMed1996

Transanal endoscopic microsurgery. Initial registry results.

UNLABELLED: Transanal endoscopic microsurgery (TEM) was first used on a regular basis in the United States in 1990. Because there is a sole source of instrumentation, the surgeons who use this equipment are known to us. Thus, this earliest registry is a compilation of data based on most patients who underwent TEM in the United States from 1990 to 1994. METHOD: One hundred fifty-three cases were voluntarily registered by six surgeons. Pathology included 54 carcinomas, 82 adenomas, and 17 other entities. Most resections were full thickness. Fifty percent of cases were out of reach of standard instruments. Complication rate, hospital stay, and blood loss were recorded. Technical difficulties at time of surgery (9 percent), early complications (15 percent), and late complications (5 percent) have been tabulated. RESULTS: Recurrence rates for carcinoma were 10 percent for T1, 40 percent for T2, and 66 percent for T3 stages. Failures were treated by abdominoperineal resection or low anterior resection. Adenomas recurred in 11 percent, but these recurrences were small and easily treatable. CONCLUSION: TEM has a low complication rate. By carefully selecting small, superficial cancers and adenomas, TEM results in superior outcome over other approaches to the mid and upper rectum.

Adenoma↗
PubMed1994

A phase II multicenter, double-blind, randomized, placebo-controlled study of three dosages of an immunomodulator (PGG-glucan) in high-risk surgical patients.

OBJECTIVE: To examine the safety and efficacy of multiple doses of PGG-glucan (poly-[1-6]-B-D-glucopyranosyl-[1-3]-B-D-glucopyranose) in high-risk patients undergoing major thoracic or abdominal surgery. DESIGN: An interventional, multicenter, double-blind, randomized, placebo-controlled study. SETTING: Four university-affiliated medical centers. PATIENTS: Sixty-seven high-risk patients undergoing major thoracic or abdominal surgery. INTERVENTION: Patients were randomized in a 1:1:1:1 ratio to receive saline placebo or PGG-glucan at a dose of 0.1 mg/kg, 0.5 mg/kg, and 1.0 mg/kg or 2.0 mg/kg. One dose was administered before surgery and three doses were administered after surgery. MAIN OUTCOME MEASURES: To examine the safety and efficacy of PGG-glucan infusion and to identify potentially important factors for a planned phase III study. RESULTS: A dose-response trend with regard to infection incidence among patients who received PGG-glucan was observed. Serious infections occurred in four patients who received placebo and in three patients who received PGG-glucan at a dose of 0.1 mg/kg. However, only one patient who received PGG-glucan at a high dose had a serious infection. The incidence and severity of adverse events was comparable in all groups. CONCLUSIONS: PGG-glucan was generally safe and well tolerated, may decrease postoperative infection rates, and warrants further investigation in a planned phase III trial.

Adjuvants, Immunologic↗