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Biomedical subjects

V F Trastek

Publications and source records attributed to V F Trastek.

At least 55 records · Page 3Linked to original sources
PubMed1995

Esophageal replacement by colon interposition.

Between 1985 and 1993, 32 patients (24 male and 8 female) underwent colon interposition for replacement of the esophagus at the Mayo Clinic. Median age was 58.5 years (range, 1 to 79 years). The colon was used because of an inadequate stomach in 27 patients (84%) and as the conduit of choice in 5 (16%). Esophageal cancer was present in 15 patients (47%). The left colon was used in 20 patients (63%) and the right, in 12 (38%). The colon was placed substernally in 19 patients (59%) and in the esophageal bed in 13 (41%). The operative mortality was 9%; cause of death was ischemic necrosis of right colon conduits in 2 patients and adult respiratory distress syndrome in 1 patient. Major complications occurred in 4 additional patients and included ischemic colitis of a right colon conduit, Roux-en-Y limb obstruction, chylothorax, and an anastomotic leak. Follow-up was complete for all patients and ranged from 15 months to 7 years (median follow-up, 2.3 years). Eleven patients died during follow-up. The cause of death was metastatic esophageal cancer in 9 patients, myocardial infarction in 1 patient, and respiratory failure in 1 patient. At last follow-up, 26 of the 29 operative survivors had little or no difficulty eating. Two patients had dumping symptoms, and 1 patient had severe dysphagia. Seven patients required dilation of the esophagocolonic anastomosis. We conclude that colon interposition for esophageal replacement provides acceptable long-term function; however, early morbidity and mortality are considerable.

Adolescent↗
PubMed1995

Esophageal resection for recurrent achalasia.

BACKGROUND: This study examined esophageal resection as treatment for recurrence or treatment complications of achalasia. METHODS: From 1976 through 1992, 37 patients (20 men and 17 women) underwent esophageal resection after initial surgical treatment for achalasia. The median age was 56 years (range, 19 to 84 years). Initial surgical treatment consisted of modified Heller myotomy in 28 patients, combined myotomy and antireflux procedure in 6, and antireflux procedure alone in 3. Twenty-six patients required an additional surgical procedure before esophageal resection (70.3%). Indication for esophageal resection was obstructive symptoms in 30 patients, cancer in 3, bleeding in 2, and perforation during dilation in 2. Reconstruction was established with the stomach in 26 patients, colon in 6, and small bowel in 5. Anastomosis was at the cervical level in 20 patients (54.1%) and intrathoracic in 17 (45.9%). RESULTS: There were two operative deaths (5.4%), both caused by intraoperative hemorrhage during transhiatal resection. Twelve patients (32.4%) had complications, which included cardiac dysrhythmia in 3, cervical anastomotic leak in 2, transient vocal cord paralysis in 2, pneumonia in 2, pulmonary embolus in 2, and reexploration for bleeding in 1. Follow-up was complete in all patients and ranged from 1.4 to 16 years (median, 6.3 years). Excellent or good long-term functional results were present in 32 patients (91.4%). CONCLUSIONS: Esophageal resection provides reasonable long-term functional results in patients with recurrence or treatment complications of achalasia. In our experience, transhiatal resection is associated with increased morbidity and mortality.

Adult↗
PubMed1995

Pathologic comparison of video-assisted thoracic surgical lung biopsy with traditional open lung biopsy.

Video-assisted thoracic surgical lung biopsy is an alternative to traditional open lung biopsy for diagnosis in patients with pleuropulmonary diseases. Between January 7, 1991, and August 3, 1993, 71 consecutive patients had video-assisted thoracic surgical lung biopsy and 42 patients had traditional open lung biopsy. A specific histologic diagnosis that correlated with the clinical findings was sought in each case and the yield was compared between the two groups. Procedure-related artifactual changes were also evaluated; the extent of traumatic hemorrhage and neutrophil margination as a result of tissue manipulation was significantly greater for patients in the video-assisted thoracic surgical lung biopsy group than for those in the open lung biopsy group, but the changes were generally minor and did not affect diagnostic yield. Complications developed in 11 (15%) of 71 patients in the video-assisted thoracic surgical lung biopsy group including 5 patients with prolonged air leakage (more than 10 days); 2 with pneumonia; and 1 each with bleeding, late pneumothorax necessitating readmission, mucus plug necessitating bronchoscopy, and a hypoxic episode necessitating mechanical ventilation. On the other hand, 7 (17%) of 42 patients in the open lung biopsy group had complications including 4 patients with prolonged air leakage (more than 10 days) and 3 with pneumonia. There were 6 (8%) operative deaths in patients who had video-assisted thoracic surgical lung biopsy and 7 (17%) in the open lung biopsy group; all had preoperative respiratory failure. We conclude that video-assisted thoracic surgical lung biopsy is an acceptable alternative to open lung biopsy for diagnosis of pulmonary infiltrates or indeterminate nodules.

Adult↗
PubMed1995

Analgesia after thoracotomy: effects of epidural fentanyl concentration/infusion rate.

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 micrograms/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-micrograms/mL concentration infused at a rate half that used in the 5-micrograms/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-microgram/kg initial dose and an initial infusion rate of 1 microgram.kg-1.h-1 in both the 5-micrograms/mL and 10-micrograms/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Extramedullary hematopoiesis manifesting as a symptomatic pleural effusion.

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.

Female↗
PubMed1995

Uncut Collis-Nissen gastroplasty.

Surgical treatment of gastroesophageal reflux because of an incompetent lower esophageal sphincter and obstructive symptoms owing to a partial or incomplete intrathoracic stomach has evolved tremendously over the past several decades. Currently, there are several different techniques to improve the abnormalities caused by these defects, of which the uncut Collis-Nissen gastroplasty is one. The operation has withstood the test of time and has low mortality, acceptable morbidity, and excellent short- and long-term results. More importantly, it is reproducible and is an operation that can be taught to others. The author believes the data continue to warrant the use of this procedure; however, it should be acknowledged that there is as yet no perfect procedure and continued modifications and analysis of long-term results are needed.

Follow-Up Studies↗
PubMed1994

Combined operation for lung cancer and cardiac disease.

From 1965 through 1992, 30 patients (23 men and 7 women) underwent pulmonary resection for primary lung cancer and a concomitant open heart operation (combined group). Median age was 68 years (range, 50 to 79 years). Coronary artery bypass was performed in 23 patients, mitral valve repair in 2, mitral valve replacement in 2, and other procedures in 3. Pulmonary resections included pneumonectomy in 1 patient, bilobectomy in 1, lobectomy in 21, and wedge excision in 7. Twenty-three patients were in postsurgical stage I. There were two operative deaths (6.7%), one from myocardial ischemia and one from pulmonary insufficiency. Overall 5-year survival was 34.9% and was not affected by the stage of the disease. During the same period, 15 other patients underwent an open heart operation (coronary artery bypass in 11, aortic valve replacement in 2, and other in 2) followed by pulmonary resection (pneumonectomy in 5, lobectomy in 9, and wedge excision in 1) for lung cancer 1 to 11 months later (median, 2 months) (staged group). There were no operative deaths. Six patients were in postoperative stage I. Overall 5-year survival was 53.0% (p = not significant), but it was significantly affected by the stage of lung cancer. Most important, a significant difference was observed in stage I survival between the two groups. Five-year survival for stage I patients in the staged group was 100.0%, compared with only 36.5% for the combined stage I patients (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Pulmonary resection of metastatic renal cell carcinoma.

Between 1965 and 1989, 96 consecutive patients (64 men and 32 women) underwent complete pulmonary resection for metastatic renal cell carcinoma. Median age was 63 years (range, 33 to 82 years). Median time between nephrectomy and pulmonary resection was 3.4 years (range, 0 to 18.4 years). Forty-eight patients had solitary metastasis, 16 had two, 18 had three, and 14 had more than three. Wedge excision was performed in 62 patients, segmentectomy in 3, lobectomy in 25, bilobectomy in 3, and pneumonectomy in 3. Fourteen patients had repeat thoracotomy for recurrent metastasis; 34 other patients also had complete resection of limited extrapulmonary disease. There were no operative deaths. Median follow-up was 3 years (range, 70 days to 19.0 years). Overall 5-year survival was 35.9%. Patients with solitary metastasis had a 5-year survival of 45.6% compared with 27.0% for patients with multiple metastases (p < 0.05). Patients with a tumor-free interval greater than the median of 3.4 years had a better survival (p = 0.05) than those with a tumor-free interval less than or equal to 3.4 years. Five-year survival for patients who underwent repeat thoracotomy or had complete resection of extrapulmonary disease did not differ from overall survival. We conclude that resection of renal lung metastasis is safe and effective, that patients with solitary metastasis have a better survival than those with multiple metastases, that resectable extrapulmonary disease does not necessarily contra-indicate pulmonary resection, and that repeat thoracotomy is warranted in selected patients with recurrent lung metastases.

Adult↗
PubMed1994

Results of surgical resection in patients with N2 non-small cell lung cancer.

From January 1982 to December 1986, 167 patients (121 men and 46 women) with non-small cell lung cancer and a clinically negative mediastinum were found to have N2 lymph node metastases at thoracotomy and underwent pulmonary resection. Ages ranged from 31 to 86 years (median, 66 years). Adenocarcinoma was present in 70 patients (41.9%), squamous cell carcinoma in 64 (38.3%), large cell carcinoma in 20 (12.0%), adenosquamous cell carcinoma in 7 (4.2%), and bronchoalveolar cell carcinoma in 6 (3.6%). Forty-seven patients (28.1%) underwent mediastinoscopy; all results were negative. Pneumonectomy was performed in 64 patients, bilobectomy in 4, lobectomy in 76, segmentectomy in 2, and wedge excision in 21. Twenty patients had an incomplete resection. Thirty-five patients (21.0%) had complications, and the operative mortality was 4.8% (8 of 167 patients). Sixty-seven patients (40.1%) received adjuvant radiation therapy. The 5-year survival for the 147 patients who underwent complete resection was 23.7%. In contrast, 19 of the 20 patients (95.0%) who underwent incomplete resection died within 3 years. Other factors that significantly affected the 5-year survival were the number and location of metastatic lymph node stations, age, type of resection, and whether adjuvant radiation therapy was administered. We conclude that, when N2 disease is found at thoracotomy, complete resection is warranted to achieve long-term survival.

Adult↗
PubMed1994

Pulmonary resection for metastatic breast cancer.

Between 1982 and 1992, 60 consecutive female patients underwent pulmonary resection for metastatic breast carcinoma. Median age was 58 years (range, 21 to 81 years). The median tumor-free interval after primary breast cancer operation was 2.2 years (range, 7 days to 20.6 years). Thirty-one patients (51.6%) had solitary pulmonary metastases. Forty patients (66.7%) had complete pulmonary resection, which consisted of wedge excision in 33, lobectomy in 6, and pneumonectomy in 1. The remaining 20 patients had incomplete resection, which consisted of wedge excision in all. Altogether, 8 patients (13.3%) had development of postoperative complications, which included pneumothorax, prolonged air leak, pulmonary embolism, retained secretions requiring bronchoscopy, atrial fibrillation, and chest tube site infection. There was one operative death (1.7%). Follow-up was complete in all patients and ranged from 23 days to 10.7 years (median, 3.5 years). Recurrence developed in 32 of the 39 survivors (82.1%) who had complete resection. Median disease-free interval after lung resection was 1.6 years (range, 23 days to 9.3 years). Overall 5-year survival was 37.8% (95% confidence interval, 25.1% to 50.5%). The 40 patients who had complete resection had a 5-year survival of 35.6% (95% confidence interval, 20.4% to 50.8%) as compared with 42.1% (95% confidence interval, 19.0% to 65.3%) for the 20 patients with incomplete resection (p = not significant). Although pulmonary resection is safe, we could not demonstrate improved survival after complete pulmonary resection of metastatic breast carcinoma in this highly selected group of patients.

Adult↗
PubMed1994

Lipothymoma with red cell aplasia, hypogammaglobulinemia, and lichen planus.

We describe a patient who had lipothymoma with red cell aplasia, hypogammaglobulinemia, and lichen planus. Parathymic syndromes described in association with lipothymomas also include myasthenia gravis, hyperthyroidism, lymphangioma, aplastic anemia, chronic lymphocytic leukemia, and Hodgkin's disease. The behavior of lipothymoma is generally benign, although local recurrence was noted in 1 patient who had an incomplete resection. Lipothymoma should be considered in the diagnosis of mediastinal tumors and parathymic syndromes, and also in patients with cardiomegaly, phrenic nerve palsy, and a widened mediastinum.

Adult↗
PubMed1994

Gossypibomas mimicking echinococcal cyst disease of the lung.

Gossypibomas, masses of retained cotton materials, may produce a variety of postoperative complications. This case report of hemoptysis of 18 months' duration and cavitating chest masses in a 62-year-old man with previous cardiac operations illustrates several salient features about the presentation, differential diagnosis, and management of gossypibomas.

Diagnosis, Differential↗
PubMed1994

Surgery in the management of mediastinal carcinoid.

Primary carcinoid tumors of the mediastinum were described for the first time in 1972 as thymic carcinoids. Our experience with 16 patients who underwent diagnostic and surgical procedures at the Mayo Clinic is presented. All of these patients had mediastinal carcinoid. The surgical procedures included node biopsy, anterior mediastinotomy (Chamberlain), median sternotomy and posterior lateral thoracotomy. Complete resection was possible in 9 (56.3%) patients, 3 (18.7%) had partial removal (debulking), and 4 (25%) had diagnostic biopsies only. The operative morbidity was 25%. There were no postoperative deaths. In resectable patients, the average disease free interval was 45.7 months. Five year and ten year survival was 47% and 22%, respectively. Local or distant metastatic spread developed in all patients (100%). Mediastinal carcinoids are a separate entity from other thymic and mediastinal neoplasms. (We suggest that) Surgical excision may be possible earlier in the disease and radiation and chemotherapy are of doubtful value.

Adult↗
PubMed1994

Barrett's esophagus.

The development of the columnar-lined lower esophagus, or Barrett's disease, is an acquired condition due to reflux of gastric and duodenal contents. The medical treatment of patients with reflux disease and Barrett's esophagus is currently the same as for patients with reflux without Barrett's disease which may indicate more aggressive antireflux control. Constant surveillance of the Barrett's mucosa remains important. The progression of squamous epithelium to Barrett's metaplasia and eventually invasive carcinoma in a subgroup of patients is well described and becoming more frequent. The discovery of this carcinogenic process is becoming extremely important as it may help improve the dismal long-term prognosis of patients with adenocarcinoma of the distal esophagus and gastroesophageal junction.

Barrett Esophagus↗
PubMed1994

Empyema following pulmonary resection.

Empyema after lung resection is an uncommon, but serious, complication. Its reported incidence varies from 1% to 5%, and it is frequently associated with a bronchopleural fistula. This article covers the prevention and treatment of empyema. Treatment requires the use of appropriate antibiotics, adequate drainage, obliteration of the pleural space, and closure of the fistula in order to achieve a long-term successful outcome.

Bronchial Fistula↗
PubMed1994

Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus.

Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 1985 and July 1992, 49 consecutive patients (38 men and 11 women) underwent extended esophagectomy for esophageal cancer where the neoplasm was mobilized through an initial right thoracotomy and then resected and reconstructed through an abdomino-cervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle third in five. Thirty-three patients had squamous cell carcinoma, 14 had adenocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in six, wound infection in five, and postoperative bleeding in one. Three patients required tracheostomy. There was one postoperative death (2.0%). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty-one patients were alive at the time this article was written, 28 without evidence of cancer. Cause of death was recurrent disease in 13 patients, unrelated to cancer in three, and unknown in one. Overall actuarial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-year survival for stage II disease was 44.6% as compared to 24.9% for stage III (p < 0.02). The presence of lymph node metastases significantly affected survival. Three-year survival for patients with N0 disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01). Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-term results are reasonable.

Adenocarcinoma↗