Clinical features of peritoneal tuberculosis.
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Adolescent↗
Biomedical subjects
R C Read
Publications and source records attributed to R C Read.
Management of nonsmall cell lung carcinoma with solitary brain metastasis.
Cushing's group, operating on metastatic brain tumors in the 1920s, was the first to point out that lung cancer (usually adenocarcinoma in an upper lobe) was the most common primary tumor. Excision of a solitary metastasis could result in long-term survival. Magilligan and coworkers (J Thorac Cardiovasc Surg 1976;72:690) introduced the modern era of large series of combined lung-brain resection with low mortality (3%) and a 5-year outcome of 21%. Our results (92 patients) confirm their experience. Presenting symptoms were pulmonary (53), synchronous (28), or neurologic (11). Nonsquamous cell (48) predominated. Pulmonary resections (45) were pneumonectomy (five), lobectomy (27), segmentectomy (five), and wedge biopsy (eight). Craniotomy (68) and irradiation resulted in recurrence in seven patients. There was no operative mortality. The survival rate after curative lung and brain resection (27) was 52% at 1 year, 35% at 2 years, and 21% at 5 years. Median survival in noncurative combined resection (eight), craniotomy only (27), thoracotomy only (eight), or no surgery (22) groups, with or without irradiation or chemotherapy, averaged 6.4 months. Every effort should be made to give patients with this syndrome the benefit of combined surgery, which was not offered or agreed on in more than a third of our cases.
Actuarial Analysis↗
Diameter, cell type, and survival in stage I primary non-small-cell lung cancer.
We analyzed 384 veterans who had "curative" (sometimes conservative) resection from 1966 through 1986 for stage I, non-small-cell primary lung cancer to identify significant variables influencing survival. Operative mortality was 3.1%, mainly from heart attacks. Most patients were asymptomatic, presenting with other diseases of smoking. Five-year survival was 43%; deaths from lung cancer only, 63% (T1, 73%; T2, 49%). Two hundred fourteen (57.5%) of the 372 operative survivors had T1 and 158 (42.5%) had T2 disease. Sixty-five percent had peripheral nodules (84%, T1; 38% T2). Pure squamous cell predominated, in 63% overall (T1, 55%; T2, 74%). Systemic metastases caused most cancer deaths. Within T1, diameter was highly significant. Cell type and time of operation (before or after Dec 31, 1980) were also significant. Under T2, only scarring and differentiation were significant. Veterans in this group live longer if they have small squamous cell tumors.
Adenocarcinoma↗
Rheumatoid arthritis and acromegaly--effect of growth factors on RA?
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Acromegaly↗
Pulmonary hypertensive effect of heparin and protamine interaction: evidence for thromboxane B2 release from the lung.
The characteristic pulmonary hypertensive effect of the heparin and protamine interaction has been studied in the isolated pig lung preparation using sequential autologous blood perfusate and dextran perfusate. A significant (p less than 0.001) increase in pulmonary artery pressure at constant flow was seen in 10 of 14 dextran and 12 of 15 blood perfusions. The average increase for dextran was 112 percent and for blood, 109 percent. Antihistamines did not inhibit the response. However, this was abolished in all 11 animals treated with aspirin. In 11 intact swine, thromboxane B2 blood levels increased significantly (p less than 0.01) from 0.46 +/- 0.38 ng/dl to 2.97 +/- 1.5 ng/dl. Thus, pulmonary hypertension associated with protamine reversal of heparinization is associated with prostaglandin release from the lung, and this does not require mediation of platelets or leukocytes.
Animals↗
The centenary of Bassini's contribution to inguinal herniorrhaphy.
One hundred years ago, Edoardo Bassini, a professor of surgery in northern Italy, pioneered the modern approach to inguinal repair. Today, the most common operation performed for hernia is one of the many modifications of the procedure he introduced. Since he reported his series from 1887 to 1894 in the Italian and German literature, and other surgeons soon claimed priority, most surgeons today are unfamiliar with the details and importance of Bassini's contribution. Therefore, his illustrious career is outlined and his papers regarding herniorrhaphy, along with previous biographies, are discussed. Pernicious and benign modifications of his operation are described, and the present status of his procedure is discussed in light of its revival as the Shouldice operation and amid the continuing criticism of its many modifications.
General Surgery↗
[Bassini's contribution to hernia surgery on the centennial of the operation. The view of an American surgeon].
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Hernia, Inguinal↗
111 In-labeled leukocytes in the detection of prosthetic vascular graft infections.
Making a clinical diagnosis of infection in prosthetic vascular grafts is difficult but when undiagnosed, this condition has a high mortality rate. Using Indium-111-labeled white-blood cells, 30 scans were performed in 21 patients suspected of having a prosthetic graft infection. The diagnosis of infected graft was confirmed by surgery in all cases, and lack of infection was established by resolution of symptoms with conservative therapy. Twenty-four hour scans of autologous Indium-111 leukocytes were obtained, and correlative CT studies were done in 11 cases. There were 13 infected grafts at surgery (purulent material present), and scans were positive in all (100% sensitivity); of 17 scans, there were 15 true negatives and two false positives (88% specificity). Using the criteria of gas or fluid around the graft, the sensitivity of CT was only 37% in a small subset of these patients. One-half of the cases in which infection was suspected clinically had no infection and had negative scans. Various types of grafts and graft materials were used, and there was no correlation with presence or absence of infection on the basis of the type of graft. Extragraft infection sites were found in five patients. In conclusion, use of Indium-111 leukocytes has been found to be an accurate and valuable diagnostic method for evaluation of suspected prosthetic vascular graft infection, and to have higher diagnostic accuracy than CT.
Aged↗
Segmental pulmonary resection for cancer.
Segmental pulmonary resection was employed in 61 patients with cancer whose ages ranged from 44 to 82 years (average 62 years). There were 39 patients in the curative group with disease staged T1N0M0, 9 patients in the limited group with residual thoracic disease, 8 patients in the palliative group with severe chronic obstructive pulmonary disease, and 5 patients in the metastatic group. Two patients died within 30 days after operation. Significant palliation was obtained in the limited and metastatic groups. Most patients in the palliative group died from emphysema within 1 to 2 years after resection. Early survival rates (64 percent after an average of 16 months) in the curative group were not as good as had been anticipated because small peripheral, asymptomatic, and predominantly scar adenocarcinoma spread systemically more than similar bronchogenic cancer. Furthermore, about half the deaths were related to the many other diseases of smoking. However, the local recurrence rate of 5 percent was low. Segmentectomy was well tolerated, even in patients with compromised pulmonary function.
Adenocarcinoma↗
Cardiovascular effects of protamine sulfate are dependent on the presence and type of circulating heparin.
Man's response to clinical doses of protamine is highly variable. We investigated the influence of circulating heparin in nine swine (mean age 6 weeks, weight 10 kg). Through a sternotomy we implanted an electromagnetic flow probe around the pulmonary artery for cardiac output determination and catheters into the ascending aorta, pulmonary artery, right atrium, and left atrium for pressure monitoring. Each animal was allowed to recover and was studied awake on 3 consecutive days. Protamine, 3 mg/kg, beef lung heparin, 300 U/kg, and pork mucosal heparin, 300 U/kg, followed by protamine, were given in rotation by intravenous bolus. Protamine alone had no effect. Beef lung heparin followed by protamine induced a marked increase in pulmonary artery pressure (mean 38 +/- 3 to 51 +/- 5 mm Hg in 3 minutes). Pulmonary vascular resistance doubled (mean 0.12 +/- 0.01 to 0.23 +/- 0.04 R within 4 minutes), returning to normal within 15 minutes. Cardiac index and aortic pressure changed minimally. Pork mucosal heparin followed by protamine induced a similar but greater increase in mean pulmonary arterial pressure; however, cardiac index fell significantly (p less than 0.05, 207 +/- 16 to 117 +/- 16 ml/kg/min-1 at 1 minute) despite a regular rhythm and adequate left atrial filling pressure. Thus cardiac contractility was depressed. Systemic hypotension occurred in three of nine pigs. Both mean pulmonary vascular resistance and systemic vascular resistance increased (0.12 +/- 0.01 to 0.67 +/- 0.25 R and 0.40 +/- 0.04 to 1.09 +/- 0.25 R, respectively), significantly (p less than 0.05) more with pork than beef heparin. These data demonstrate that cardiovascular response to protamine neutralization varies significantly in regard to the type of heparin used. Furthermore, circulating heparin is required to produce those effects previously attributed to protamine alone.
Animals↗
Abdominal aortic aneurysm, Leriche's syndrome, inguinal herniation, and smoking.
We previously found an increase in serum proteolytic activity in smokers with direct inguinal herniation and a similar imbalance in smokers with abdominal aortic aneurysm (AAA), but not in smokers with Leriche's syndrome (LS). If the protease imbalance in the blood of smokers with AAA or herniation is a causal factor, these conditions should be associated. Therefore, we determined whether this is true using patients with LS as control subjects. The frequency of inguinal herniation was significantly higher in the AAA population (N = 341; 25.8%) than in patients with LS (N = 417; 14.6%). In addition, patients with AAA had more severe herniation (direct, bilateral, recurrent, or earlier onset) and had more pronounced leukocytosis (9,000/cu mm v 8,190/cu mm). These data suggest that increased blood proteolytic activity may play a role in the development of both AAA and adult inguinal herniation but not LS. Men who smoke manifest different systemic effects.
Aged↗
Presidential address. Systemic effects of smoking.
Millions of people continue to smoke. Recent studies confirm the pioneering epidemiologic data that indicated that, despite the well-established effects on the lung, most of the hundreds of thousands of premature deaths annually result from extrapulmonary toxicity, particularly accelerated cardiac and vascular disease. As with lung cancer, abstention significantly reduces the risk, even after myocardial infarction or surgery for complications of vascular disease. Erythrocytosis, thrombocytosis, and leukocytosis, by increasing blood viscosity, aggravate ischemia. The neutrophils of smokers release excessive amounts of oxidants which damage tissue and antiproteases. Increased alveolar permeability enhances allergy. Lymphocytic suppressor cells increase, which leads to immunocompetence, increased infection, and cancer. Smokers lose weight and die at an earlier age, even after cancer chemotherapy and peptic ulcer surgery. Smoking prevents inhibition of gastric night acid secretion by histamine-blocking agents. Menopause occurs earlier and children are damaged in utero and after birth by passive smoking. Recent evidence indicates that nicotine releases endorphins, which account for the addiction. Surgeons need to do more to combat this menace. Many victims need professional assistance to stop the habit.
Aging↗
The development of inguinal herniorrhaphy.
The history of inguinal herniorrhaphy can be divided into pre- and post- Listerian eras. In this article Bassini's contribution is emphasized along with the preperitoneal approach, the saccular and acquired etiology of herniation, and the use of prostheses or relaxing incisions.
Europe↗
Evolution of bronchial sleeve resection for carcinoma of the lung with case report.
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Bronchi↗
Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations.
A cooperative Veterans Administration study of the septic complication rate during large-bowel surgery was undertaken in two groups of patients. The first group received oral neomycin and erythromycin base plus parenteral placebo; the second, the oral antibiotics plus parenteral cephalothin sodium. During a five-year period, 1,128 patients were studied. The overall septic complication rate was 7.8% in patients receiving only oral antibiotics, and 5.7% in patients receiving both oral and parenteral antibiotics. This difference was not significant. The only significant finding was a greater incidence of fever of unknown origin in patients receiving only oral antibiotics. None of those patients were treated with additional antibiotics, and all fevers cleared spontaneously. There seems to be no discernible benefit from adding parenteral antibiotic prophylaxis when performing elective colon surgery if appropriate mechanical cleansing and oral neomycin and erythromycin therapy are employed.
Administration, Oral↗
Fifteen years surgical experience with carcinoma of the lung.
This review has emphasized the need to manage carcinoma of the lung with a systematic approach. Diagnostic and staging procedures should be performed to prevent unnecessary thoracotomy. In patients with limited pulmonary reserve, segmentectomy or wedge resection is an acceptable procedure. A staging mediastinal node dissection should be included in every resection for lung cancer. Those patients with positive mediastinal nodes found in this manner should receive postoperative mediastinal irradiation.
Adenocarcinoma↗
Serum proteolytic and antiproteolytic activity in acute pancreatitis.
This study has demonstrated an imbalance between the blood proteolytic and antiproteolytic system in acute pancreatitis. Serum elastase activity is markedly increased and elastase inhibitory capacity is decreased in this disease as compared with those in chronic pancreatitis and the control values. We have found that a return to normal values represents better evidence of resolution than amylase determinations. These results offer the clinician a biochemical guideline for the medical management of acute pancreatitis.
Acute Disease↗
A randomized study of beef lung and pork mucosal heparin in cardiac surgery.
Beef lung heparin had substantially greater anticoagulant activity than pork mucosal heparin during a preoperative heparin tolerance test and also during cardiopulmonary bypass (CPB) in 100 randomized patients. Supplemental heparin was needed during CPB in many more of the patients receiving pork mucosal heparin. Heparin rebound was detected in 16 patients; this low incidence may result from a relatively high protamine:heparin ratio. There was notably less postoperative bleeding in those who received beef lung heparin. Platelet counts were not altered by either type of heparin. It is surprising that the preoperative tolerance curve only predicted heparin sensitivity during CPB in one-half of the patients. Blood activated coagulation time levels were increased markedly by hemodilution and further raised by hypothermia. These data demonstrate that beef lung heparin is better than pork mucosal heparin for CPB.
Animals↗