Biomedical subjects

W D Byrne

Publications and source records attributed to W D Byrne.

8 recordsLinked to original sources

PubMed1998

Descending cervical mediastinitis.

Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. Tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.

Abscess↗

PubMed1997

Urokinase thrombolysis as initial therapy for acute and non-acute ischemic extremities.

Limb ischemia, both acute and chronic, presents a risk to life and limb with mortality rates from 3% to 37% and amputation rates of the same range. Our experience with urokinase thrombolysis as the initial therapy for acute and non-acute ischemic extremities over 57 consecutive cases of native arterial occlusion by either thrombus or embolus has resulted in no mortality and only 3.5% requiring amputation (2 of 57). In 74% of cases initial thrombolytic therapy was followed by either balloon angioplasty (35 patients) or surgery (7 patients) to relieve the underlying cause of obstruction (i.e., stenosis, occlusion or aneurysm). Thrombolysis alone was sufficient and effective treatment in the remaining 26% (15 patients).

Adult↗

PubMed1994

Stage II and III-A non-small cell cancer of the lung: results of surgical resection at Fairfax Hospital.

Carcinoma of the lung is the single leading cause of death in patients with cancer and is responsible for over a quarter of all such deaths. Encouraging survival rates have been demonstrated following surgical resection of local (Stage I) disease. This paper details the results achieved with surgical resection of 100 patients with more advanced local--regional non-small cell carcinoma of the lung (Stages II and III-A). Operative (30-day) mortalities were 2.4% for Stage II patients and 8.5% for Stage III-A patients. Respective, 5-year Kaplan-Meier survival estimates were 41% (+/- 10%) and 36% (+/- 7%) and included all deaths, cancer-related as well as unrelated. When patients were stratified by stage, neither gender, age, cell type, tumor size, nor extent of resection proved statistically significant relative to long-term survival. However, Stage III-A patients, classified T-3 with contiguous tumor involvement of mediastinum, suffered a higher operative mortality and a significantly lower probability of long-term survival (p = 0.04). Finally, the results and appropriateness of prospective, clinical trials utilizing adjuvant therapies in Stage II and III-A patients and neo-adjuvant therapies in Stage III-A patients are discussed.

Adenocarcinoma↗

PubMed1993

Aneurysm of an aberrant right subclavian artery: case report and review of the literature.

In this article, we describe a case of a surgically treated aneurysm of an aberrant right subclavian artery. The historical literature to date is summarized, as are the key concepts relative to the anatomy, embryology, diagnosis, and treatment of this uncommonly occurring entity. Although the topic might be expected to be of concern to only a few specialists, all physicians should be aware that a patient with an enlarging aneurysm of an aberrant subclavian artery may experience dyspnea, dysphagia, or sudden collapse from rupture as the initial manifestations. An asymptomatic patient may have a mediastinal mass detected by roentgenography. The diagnosis may be confirmed with computed tomography or magnetic resonance imaging. As with most aneurysms, surgical treatment is recommended, and the benefit-to-risk analysis depends on individual case factors.

Aneurysm↗

PubMed1993

Stage I non-small cell cancer of the lung results of surgical resection at Fairfax Hospital.

Between January 1, 1981 and December 31, 1989, 2003 patients were evaluated at Fairfax Hospital with a diagnosis of carcinoma of the lung. Of these, 214 with Stage I non-small cell carcinoma underwent surgical resection. Operative (30-day) mortality was 1.4%. Overall 5-year survival was 59%, inclusive of all deaths, cancer-related as well as unrelated. Noting stage was constant, when patients were analyzed by gender, age, cell type, tumor status and extent of resection, only age proved statistically significant relative to long-term survival. However, even patients 70 and older averaged a nearly 50% 5-year survival. Moreover, if deaths are related to cancer only, 5-year survival rates should be significantly increased over the rates when quoted to all causes of death.

Adenocarcinoma↗

PubMed1993

Resection for esophageal carcinoma at a Virginia hospital 1981-1989.

Between January 1, 1981 and December 31, 1989, 222 patients with carcinoma of the esophagus were seen at Fairfax Hospital. Fifty-eight (26.1%) underwent esophagogastrectomy. Operative (30-day) mortality was 8.6%. Follow-up was 98.3% complete. Of hospital survivors, 38 (76%) were resected for potential cure versus 12 (24%) for palliation. Consistent with the experience of others, a minority of patients (26%) presented with early (Stage I & II) disease; forty patients (69%) were noted to be Stage III or IV at time of resection and three patients (5%) were stage indeterminant. The five year Kaplan-Meier product limit survival estimate for Stage II patients was 52%, versus 22% for stage III, and 0% for Stage IV.

Adenocarcinoma↗

PubMed1992

Thoracic esophageal perforations at a Virginia hospital 1979-1990.

A study was made of all patients who underwent management for distal esophageal perforation at the Fairfax Hospital from September 1979 to September 1990. The study group consisted of 13 patients. Nine were male, four female. Mean age was 60.8 yrs, ranging from 36 to 83 yrs. In the group of nine patients diagnosed early (less than 24 hrs), hospital mortality was 22.2% versus 75% in the group of four diagnosed late (greater than 24 hrs). Of the six patients treated conservatively, either medically or surgically, only one survived, but all seven patients diagnosed early and aggressively operated upon survived. Thus the authors agree with others in espousing aggressive, definitive surgery for patients diagnosed early.

Adult↗

PubMed1976

The syndrome of bronchial atresia or stenosis with mucocele and focal hyperinflation of the lung.

Three cases of "the syndrome of bronchial atresia or stenosis with mucocele and focal hyperinflation of the lung" are added to 28 proven cases (26 with atresia and 2 with stenosis) previously reported in the English literature. One case is of particular interest since serial roentgenograms during the first week of life showed fetal lung fluid to be trapped distal to the atresia. The radiographic findings in this syndrome are reviewed and the presumed etiology and pathophysiology discussed.

Body Fluids↗