Biomedical subjects
A A Conlan
Publications and source records attributed to A A Conlan.
Elective pneumonectomy for benign lung disease: modern-day mortality and morbidity.
This retrospective study of elective pneumonectomy for complicated inflammatory lung disease was done to define modern-day mortality and morbidity. One hundred twenty-four patients received elective pneumonectomy. Patient ages ranged from 6 months to 71 years. Past, recurrent, or new pulmonary tuberculosis was present in 107 patients (86.3%). Clinical presentation involved recurrent infections or severe suppurative sequelae (abscess, empyema). Forty-seven patients had chronic hemoptysis and 25 patients had past or recent massive hemoptysis (> 600 ml of hemoptysis fluid within 24 hours). Nutritional deficiencies were common. One hundred six patients (85.5%) had end-stage destroyed lungs. Evaluative bronchoscopy showed inflammatory endobronchial changes in 106 patients (85.5%), bronchial strictures in 4, and indolent endobronchial tumor in 2. Lung separation was by double-lumen tube in 96 patients, single lung-single tube in 6, bronchus blocker in 6, and prone posture in 9. Extrapleural pneumonectomy was done in 83 patients (66.9%). Fifty-seven of these procedures were left sided and 26 were right sided. Standard transpleural pneumonectomy was done in 41 patients (33.1%): 30 left sided and 11 right sided. Nine pneumonectomies were conducted with the patient in the prone position. Four patients had completion pneumonectomy. Hospital mortality was three deaths (2.4%). Morbidity included postpneumonectomy empyema in 19 patients (15.3%). Seven postoperative bronchopleural fistulas occurred. Empyema in most patients was managed by open pleural drainage (thoracostoma) and later space closure. Pneumonectomy proved effective therapy with low mortality but postpneumonectomy empyema posed serious morbidity.
Intraoperative whole-lung torsion producing pulmonary venous infarction.
Pulmonary venous infarction and whole-lung torsion are both rare, life-threatening complications of thoracic operations. A case of whole-lung torsion with resultant pulmonary venous infarction of the entire lung after a nonpulmonary thoracic operation is reported.
Extralobar pulmonary sequestration.
Explore the source record for details and available documents.
Unusual site of spontaneous first-rib fracture: case report.
Spontaneous fractures of the first rib are uncommon and are usually thought to be associated with a malignant process. However, fatigue fractures of the first rib are being encountered increasingly in association with various physical activities. Typically, the fractures occur at the subclavian groove, but in the 48-year-old woman described in this report the fracture was unexpectedly situated in the posterior portion of the rib and was the result of snow shovelling, which was a new activity for the patient.
Surgical management of the redundant transposed colon.
Redundancy of the transposed thoracic colon is not uncommon. Rarely, however, when accompanied by severe symptoms, it may necessitate surgical correction. We describe herein a surgical technique that allows the stretching and straightening of the redundant transposed organ.
Pulmonary aspergilloma--indications for surgical intervention. An analysis of 22 cases.
Surgical resection of aspergillomas has generally been associated with excess mortality and morbidity; 22 patients who had a resection of complicated mycetomas were studied retrospectively. Indications for surgery were serious haemoptysis (14), massive haemoptysis (6), and recurrent infection (2). Extrapleural pneumonectomy was required in 9 patients and extrapleural lobectomy in 12; thoracoplasty alone was done in 1 patient. There was 1 hospital death (4.5%); 4 patients developed postoperative empyemas (18%), 2 with associated bronchopleural fistulas. Two further patients (9%) had stable postresectional spaces. Surgery for complicated aspergilloma was associated with significant postoperative morbidity.
Avoidance of jejunostomy. A reliable method of naso-enteral tube placement after oesophageal surgery.
Nutritional maintenance after oesophageal surgery and during treatment of oesophageal disease is given high priority. A method of naso-enteral feeding tube placement suitable for these patient groups was evolved and studied prospectively. A standard nasogastric tube is used as a conduit for a guide-wire over which a soft, small-bone naso-enteral tube is threaded into position. Thirty patients underwent placement of such tubes postoperatively or during treatment of oesophageal disease. Placement and feeding was successful in all. Six patients developed controllable diarrhoea.
Resectable pulmonary nephroblastoma metastases presenting as chest wall lesions on radiography. A report of 2 cases.
Two children with pulmonary metastases from nephroblastomas showed the radiological features of chest wall tumour involvement. Diagnostic surgical exploration subsequently revealed pedunculated and fully resectable peripheral lung metastases. The mechanism by which these pedunculated lesions mimicked the classic 'D sign' of an extrapulmonary (pleural or chest wall) tumour is explained.
Pulmonary resection in the prone position for suppurative lung disease in children.
Lung resection for suppurative inflammatory disease is hazardous in children whose small airway diameter precludes the use of standard methods of bronchial separation. A prospective evaluation of the prone position for thoracotomy in 17 children referred for operation with severe inflammatory disease was done. Bronchography showed whole lung bronchiectasis eight, destroyed lung in three, and lobar bronchiectasis five. Pulmonary resections performed with the child prone included left pneumonectomy (nine), right pneumonectomy (four), lingulectomy with lower lobectomy (two), and other lobectomy (two). No endobronchial or intrapleural spillage occurred. One child required reexploration for bleeding and one child developed a postoperative empyema that ultimately caused death. The remaining 16 children were discharged within 8 days of operation, and follow-up of 1 to 18 months records favorable progress.
The microflora of chronic pleural empyema. An analysis of 89 patients.
Bacteriological cultures from 89 patients with chronic pleural empyema were studied. Seventy-nine patients had positive and 10 negative culture results. Forty-eight patients had a single isolate--pyogenic cocci in 32 and Gram-negative enteric bacilli in 16--and multiple organisms were grown in 31 patients. Anaerobic organisms were recovered in 6,2%. Our negative culture rate of 11,2% may reflect failure to recover anaerobes, but could represent sterilization of the empyema by prior use of antibiotics. The results of antibiotic sensitivity tests and the pathogenicity of the organisms recovered suggest that the choice of antibiotic combinations for chronic pleural empyema requires careful consideration.
Bronchiectasis in urban black children.
From July 1979 to July 1982, 29 cases of childhood bronchiectasis were encountered at Leratong Hospital. They were retrospectively divided into two groups: 16 patients underwent surgical intervention and the other 13 patients received medical treatment only. Symptoms and signs were reviewed and findings on bronchography were studied. The left lower lobe was the most common site of involvement, and the lingular segment was invariably also affected by bronchiectatic changes. Ten of the surgical patients (63%) underwent pneumonectomy. In 75% of the surgical group there was an excellent or good result after surgery, while a good result was achieved in 40% of those receiving medical treatment only. We have reviewed other large series to compare surgical and medical management, and discuss factors that may influence the outcome of surgical treatment.
Normovolaemic haemodilution using dextran 70 in thoracic surgery.
Normovolaemic haemodilution was undertaken in 10 patients requiring elective thoracic surgery. The resultant blood loss, cell loss, use of donor blood and acid-base changes were compared with those in 10 patients undergoing similar procedures who were anaesthetized in the standard manner. Normovolaemic haemodilution reduces the use of donor blood and provides more satisfactory acid-base status than that in controls. The known antithrombotic effect of dextran 70 (Macrodex; Saphar) did not affect the crude clotting time. The technique is a feasible alternative to use of donor blood, especially when difficulties in supply exist or there is a high risk of disease transmission.
Pleural sinography in the management of thoracic empyema. A study of 52 cases.
Pleural sinography is indicated in the management of empyema thoracis. The factors influencing the successful completion and interpretation of this procedure are discussed. A retrospective study of 86 sinograms from 52 patients with pleural empyema was undertaken to identify how the information obtained influenced management decisions and affected therapy. Pleural sinography is a valuable study within the limitations of correct performance and interpretation.
Massive hemoptysis--diagnostic and therapeutic implications.
Explore the source record for details and available documents.
Empyema thoracis--a prospective study on 73 patients.
A prospective study of empyema thoracis was conducted on 73 consecutive patients. The pathogenesis and bacteriological features of the condition and its clinical course and management are recorded and analysed. Pleural cultures revealed that the predominant pathogen was Staphylococcus aureus. Fifty of 65 patients had mixed isolates on pleural culture, with a 4:1 ratio of aerobes to anaerobes. Twenty per cent of the patients had anaerobic empyemas. The underlying lesion was parenchymal lung disease in 37 cases and an infected hemopneumothorax following penetrating injury in 26. The remaining 10 patients developed empyema after pulmonary resection. The empyema resolved completely in 81% of the patients.
Gastropericardial fistula presenting as acute cardiac tamponade. A case report.
A case of acute cardiac tamponade due to perforation of a benign gastric ulcer into the pericardium is presented. A high index of suspicion, early diagnosis and prompt surgical intervention resulted in a favourable outcome in this otherwise uniformly fatal condition.
Adult respiratory distress syndrome associated with miliary tuberculosis. A case report.
In this report we describe a patient with miliary tuberculosis who presented with the adult respiratory distress syndrome. The diagnostic problems are discussed and the value of transbronchial lung biopsy is emphasized. Our experience with this patient stresses the need for maintaining a high index of suspicion for treatable causes of adult respiratory distress syndrome.