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Biomedical subjects

R W Postlethwait

Publications and source records attributed to R W Postlethwait.

At least 37 records · Page 2Linked to original sources
PubMed1983

Complications and deaths after operations for esophageal carcinoma.

In a series of 908 patients with squamous cell carcinoma of the esophagus, 512 operations were performed on 503 of the patients. Postoperative mortality was the highest after bypass operations, being 41.5%. After palliative resection, mortality was 22.7% and after curative resection, 12.8%. Overall resection in 283 patients resulted in a 17% mortality. The postoperative mortality for all resections for carcinoma at the three levels was as follows: cervical and thoracic inlet, 17.6%; upper thoracic, 16.9%; and lower thoracic, 16.9%. The most frequent causes of death were anastomotic leak and pulmonary complications. Nonfatal complications occurred in 13.3% of the 512 operations.

Carcinoma, Squamous Cell↗
PubMed1983

Colonic interposition for esophageal substitution.

Sufficient information has now accumulated to permit a better definition of the role of colonic interposition for substitution of the esophagus. For children and young adults with a long life expectancy, the interposed colon provides a well-functioning and durable conduit. When the stomach cannot be used, the colon is the best alternative in most patients. Necrosis of the colon remains the most frequent fatal complication; leakage and stenosis of the proximal anastomosis remain problems. Although results of the usual radiologic examinations with barium show that the colon empties by gravity, manometric results may demonstrate progressive peristalsis, particularly in response to stimulus from a bolus of dilute acid.

Adolescent↗
PubMed1983

Pseudosarcoma of the esophagus: barium swallow and CT findings.

Two new patients with pseudosarcoma of the esophagus are presented with the first report of the findings on computerized tomography (CT). The radiographic appearance in the two patients, with 24 previously reported, is reviewed. Barium esophagograms typically demonstrate a large, elongated polypoid mass in the middle or lower third of the esophagus that distends the lumen at the level of the lesion, but does not produce marked obstruction. There are no specific CT characteristics which differentiate pseudosarcoma from squamous cell carcinoma of the esophagus.

Barium Sulfate↗
PubMed1982

Marginal ulcer. A difficult surgical problem.

One hundred sixty-six patients with documented recurrent or marginal ulcers following previous ulcer operations were seen at Duke Medical Center and the Durham VA Hospital from 1950 through 1980. Patients with the diagnosis of gastrinoma were excluded from the series. Evaluation of initial operation for recurrent ulcer showed that the highest recurrence rate occurred following non-acid-reducing operations. Analysis of the symptom-free interval following initial ulcer operation showed a significantly longer interval prior to recurrent ulcer development following gastroenterostomy than other procedures, while resection and Billroth I reanastomosis showed a significantly shorter symptom-free interval than did other procedures. Endoscopy proved 85% sensitive in making the diagnosis of marginal ulcer, while upper GI series was 71% sensitive. Surgical treatment of 132 patients resulted in a 20.4% recurrence rate of second marginal ulcer, with a 2.3% mortality rate and a 10.6% morbidity rate. Second operation for recurrent ulcer in 24 patients yielded no deaths, a 12.5% morbidity rate, and a 29.2% recurrence rate. Average follow-up for the series was 12.3 years, and ultimate outcome of treatment showed, of patients not lost to follow-up, a 58.2% satisfactory to excellent rating, while 42.8% of patients had an unsatisfactory result of treatment.

Adult↗
PubMed1981

Caustic burns and carcinoma of the esophagus.

A history of caustic injury was obtained in 12 of 846 patients with squamous cell carcinoma of the esophagus. The average age was 52.8 years; the interval from injury to development of carcinoma was 45.8 years. Nine of the 12 carcinomas were in the midthoracic segment. Resection was possible in nine patients, with two surviving over ten years. A survey of reported series with this association confirms the increased resection rate and probability of long survival compared with the usual carcinoma of the esophagus.

Adolescent↗
PubMed1981

Granular cell myoblastoma of the esophagus.

Twenty-seven cases of granular cell myoblastoma of the esophagus have been reported. We describe two additional cases. The clinical aspects are analyzed briefly. Although the malignancy potential is low, invasion does occur, and these lesions should be removed.

Adult↗
PubMed1980

Esophageal carcinoma: a survey of populations at risk.

Carcinoma of the esophagus is found more commonly in association with head and neck tumors, lye stricture, achalasia, and Barrett esophagus than in the general population. Our experience with these associated entities in a population of 680 patients with carcinoma of the esophagus is reviewed. Carcinoma of the esophagus has traditionally had a very poor prognosis which continues to the present. Routine periodic use of double contrast esophagography is advocated to screen populations containing these associated high-risk entities. This may ultimately increase survival through diagnosis of earlier stages of carcinoma of the esophagus.

Adult↗
PubMed1979

Technique for isoperistaltic gastric tube for esophageal bypass.

There has not been described a uniformly successful method for palliation of inoperable carcinoma of the esophagus, especially malignant tracheoesophageal fistula. A gastric tube formed from the greater curvature of the stomach is being evaluated for these patients. The blood supply is based on the right gastroepiploic vessels. Using a stapler, one can form a gastric tube sufficiently long to reach the hypopharynx. Placed substernally, anastomosis to the cervical esophagus is performed. In 30 patients postoperative mortality has been 13%. No tube necrosis has occurred, but anastomotic leakage has been a problem. In those patients who had esophageal bypass for palliation and were discharged from the hospital, swallowing function has been satisfactory and the average survival has been 5.2 months.

Esophageal Fistula↗
PubMed1979

Five year study of tissue reaction to synthetic sutures.

Sutures were implanted in the abdominal wall muscles of rabbits and specimens recovered at intervals from six month to five years. Tissue reaction around Nylon and Dacron was minimal. The reaction of Teflon coated Dacron was increased because of shedding of the Teflon. The polypropylene sutures showed fragmentation in 4% of the sutures examined and the perisutural formation of bone, cartilage or both in 2.6%.

Abdominal Muscles↗
PubMed1979

CT of the esophagus. II. Carcinoma.

Thoracoabdominal computed tomography (CT) scanning was performed prior to treatment on 30 patients with proven carcinoma of the esophagus. Operative, bronchoscopic, and/or autopsy data were reviewed and showed that CT correctly identified the extent of medistinal spread in 27 patients and intraabdominal metastases in 22 patients. The ability of CT to reliably predict the extent of disease should help the surgeon and radiation oncologist plan optimal therapy.

Abdominal Neoplasms↗
PubMed1979

Retrospective study of operations for peptic ulcer.

Over a period of 20 years, 1,109 operations were performed for peptic ulcer. The site was duodenal in 873, gastric in 161 and marginal in 75. Eighty-three closures of perforations resulted in eight deaths and 28 second operations. Excluding closure of perforation and operation for marginal ulcer, the definitive operations and postoperative mortality were 446 gastric resections and 3.5 per cent; 181 truncal vagotomy with gastric resection and 1.6 per cent, and 326 truncal vagotomy with drainage and 3.2 per cent. Recurrence after operation for gastric ulcer was 5.3 per cent and for duodenal ulcer, 7.2 per cent. Based on the total number of operations for duodenal ulcer, a recurrence occurred after 348 gastric resections, 9.2 per cent; after 146 vagotomy with resection, 2.0 per cent, and after 309 vagotomy with drainage, 7.4 per cent.

Adult↗
PubMed1978

Mucoepidermoid carcinoma of the esophagus: a case report.

The eighth reported case of mucoepidermoid carcinoma of the esophagus is described by light microscopic and ultrastructural examination. The reason of such a paucity of reports, the probable origin, and the natural history of this neoplasm are examined through our observations and reference to the literature.

Carcinoma↗
PubMed1977

Radiologic aspects of Beck gastric tube in esophageal reconstruction.

Over a 28 month period, 19 patients underwent esophageal reconstruction using the Beck tube fashioned from the greater curvature of the stomach. Eighteen had unresectable carcinoma of the esophagus and one had a benign stricture secondary to reflux esophagitis. The degree of palliation was considered good in 13 cases. The surgical aspects of the Beck gastric tube are described and radiologic features in both uncomplicated and complicated cases are illustrated. Early experience with the procedure is encouraging.

Esophageal Diseases↗
PubMed1977

Motor function of the esophagus after repair of esophageal atresia and tracheoesophageal fistula.

Eleven patients with previous esophageal atresia repair (TEF) underwent esophageal motility studies and were compared to 10 normal patients. The upper sphincters (UES) in the two groups did not differ in resting pressure, contraction pressure, or coordination. UES relaxation, was 100% in normal patients and 83+/-8% in the TEF patients (p less than 0.05). In the proximal esophagus, 100% of the TEF group showed a normal peristaltic wave, coupled with an abnormal nonperistaltic wave. The normal group did not show this type of contraction. In the middle esophagus, the mean peak pressure of 30.5+/-2.0 mm Hg was greater in controls than the 14.6+/-1.0 in the TEF group (p less than 0.001). Coordination was observed in 97+/-1% of the controls, while present in only 27+/-4% of the TEF patients (p less than 0.001). In the distal 10 cm of esophagus, peak contraction pressures were 43.3+/-1.6 in controls and 21.3+/-1.1 in the TEF group (p less than 0.001). Coordination was 94+/-1% in normal subjects and 66+/-4% in the TEF patients (p less than 0.001). The resting pressure in TEF patients was significantly higher at all three esophageal levels (proximal, mid, distal) than in normal patients. In both groups lower esophageal sphincter function did not show any significant difference, except for closing pressure, which was significantly higher in controls (39.9+/-6.8 mm Hg) than in the TEF groups (21.3+/-3.0 mm Hg) (p less than 0.02). These studies suggest that marked motility abnormalities occur in the repaired esophagus after atresia. These abnormalities are distinctly different from other motor disorders of the esophagus.

Adolescent↗