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Biomedical subjects

P R Walbaum

Publications and source records attributed to P R Walbaum.

9 recordsLinked to original sources
PubMed1992

Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial.

One-hundred-and-seventy-six patients with potentially operable squamous cell carcinoma or adenocarcinoma of the middle or lower thirds of the oesophagus were randomly assigned to preoperative radiotherapy or surgery alone. Patients assigned to the radiotherapy arm received 20 Gy in 10 treatments over 2 weeks, using parallel opposed 4 MV beams. The preoperative radiotherapy was not associated with any significant acute morbidity or any increase in operative complications. The median survival of the overall group of 176 patients was 8 months, and the 5-year survival was 13%. There was no significant difference in the survival of the 90 patients who received preoperative radiotherapy and the 86 who were managed by surgery alone. Proportional hazards analysis identified lymph node involvement, high tumour grade and male sex as significant adverse prognostic features, but the treatment option assigned had no prognostic significance. It was concluded that low dose preoperative radiotherapy offered no advantage over surgery alone.

Adenocarcinoma↗
PubMed1992

Management of chylothorax complicating extensive esophageal resection.

Between January 1983 and May 1987, 255 esophagectomies were performed for carcinoma of the middle (40 patients) or lower (215 patients) esophagus. All patients were operated upon through a left thoracolaparotomy and underwent a radical en bloc resection of the tumor along with all palpable mediastinal nodes. Ten patients had chylothorax develop postoperatively. There were seven men and three women with a mean age of 65.7 years (range of 37.0 to 81.0 years). Parameters that were statistically evaluated for possible correlation to increased incidence of chylous fistula were age, sex, site and size of tumor, histologic type, mediastinal lymphatic involvement and elective prophylactic ligation of the major thoracic duct (MTD) at the conclusion of the procedure. It was found that elective ligation of the MTD was associated with a lower occurrence of chylothorax (2.1 per cent) as compared with those with no routine ligation (9 per cent), p less than 0.05. The leak was successfully treated by repeated thoracotomy and mass ligation of the MTD in eight patients, while one patient underwent closed tube thoracostomy. In one instance, only a pleuroperitoneal shunt was performed. The over-all hospital mortality rate from chylothorax was 10 per cent and there was a late death because of pneumonia. We recommend prophylactic ligation of the MTD in all instances of extensive esophageal resection for the prevention of chylothorax, as well as early thoracotomy for the management of established leaks.

Aged↗
PubMed1979

Surgical management of bronchial carcinoma invading the chest wall.

In a 20-year period (1958-77) 43 patients underwent combined pulmonary and chest wall resection for bronchial carcinoma with local invasion of the thoracic wall. The clinical data, symptoms, surgical procedures, pathology, and results are reviewed. Pain was the usual presenting symptom. The operative mortality was 16%, respiratory complications causing most of the postoperative morbidity and mortality. These complications were less common after pneumonectomy. Long-term survival was achieved in only three cases with a corrected three-year survival rate of 10%. The survivors had certain pathological and operative features in common that may have prognostic significance. Recurrent carcinoma was responsible for most late deaths. Despite the poor overall prognosis, surgical management provided reasonable palliation and occasionally resulted in prolonged disease-free survival.

Adult↗
PubMed1978

Aetiology of unresolved pneumonia.

Preoperative histological or cytological confirmation of a diagnosis of bronchogenic carcinoma is not always possible, so occasionally non-neoplastic lesions are resected. Of these lesions a significant number are described by pathologists as 'unresolved pneumonia'. We studied the case notes and histopathology of 30 patients from whom lung had been resected and which had been classified as pneumonia. Other non-neoplastic lesions, such as pulmonary infarction, bronchiectasis, and tuberculosis, were excluded. All had a preoperative diagnosis of probable bronchial carcinoma. On review very few appeared to be the consequence of an infective, pneumonic episode. In 11, foreign material was identified, including one typical example of a paraffinoma. Aspiration of foreign material may lead to a localised lesion which simulates carcinoma of the bronchus both clinically and radiographically.

Bronchial Neoplasms↗
PubMed1978

Intrathoracic neural tumours.

The experience of one regional thoracic surgical unit in managing intrathoracic neural tumours over a 25-year period is presented. Neural tumour was diagnosed in 55 patients, of whom 41 were asymptomatic. In 11 patients complete resection was not achieved--the reasons for this and its effect on the outcome of the patient are discussed. There were 52 posterior mediastinal and three lateral chest wall tumours. The pathological distribution was as follows--benign nerve sheath tumours (neurofibroma, neurilemoma) 39, ganglioneuroma 13, and neuroblastoma 3. One neurofibroma recurred as a neurosarcoma six years after its apparently complete resection and was removed by an extensive resection at reoperation. One neuroblastoma recurred within the spinal canal four years after incomplete excision at thoracotomy--this patient died subsequently of widespread metastatic neuroblastoma. No other tumour is known to have recurred.

Adolescent↗
PubMed1978

Development of left ventricular--coronary sinus fistula following replacement of mitral valve prosthesis.

The features and course of a patient in whom a fistula developed between the left ventricle and the coronary sinus following replacement of a faulty mitral valve prosthesis are described. The subsequent deterioration of her condition was associated with a pansystolic murmur and periprosthetic regurgitation. Replacement by a third prosthesis was complicated in addition by tricuspid regurgitation. The fistula was not suspected until the fourth operation, when the right atrium was opened for tricuspid annuloplasty. The fistula was repaired successfully, and the woman has made good progress postoperatively.

Adult↗
PubMed1976

Hypertrophic pulmonary osteoarthropathy and its occurrence with pulmonary metastases from renal carcinoma.

The literature of hypertrophic pulmonary osteoarthropathy is reviewed with special reference to its occurrence with pulmonary metastases from extrathoracic tumours. The present theories on aetiology are discussed, and the relationship to finger clubbing and bronchogenic carcinoma is reviewed. A case is reported of hypertrophic osteoarthropathy as the presenting feature of pulmonary metastases from renal carcinoma, and of its relief by pulmonary resection.

Aged↗
PubMed1976

The malignancy of bronchial adenoma.

The literature on bronchial adenoma has been reviewed and controversy found to exist about certain aspects of these tumors, particularly their malignancy. A retrospective study of 79 cases managed in Edinburgh since 1946 is presented. Seventy-one were of the carcinoid type, 7 were adenoid cystic carcinomas, and there was a single example of mucoepidermoid carcinoma. All types show a definite malignant potential, greatest in the rare mucoepidermoid tumor and least in the common carcinoid variety. Adenoid cystic carcinoma occupied an intermediate position in frequency and malignancy.

Adenoma↗