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Biomedical subjects

A G Little

Publications and source records attributed to A G Little.

At least 19 recordsLinked to original sources
PubMed2000

Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study.

BACKGROUND: The last two decades have seen changes in the prevalence, histologic type, and management algorithms for patients with esophageal cancer. The purpose of this study was to evaluate the presentation, stage distribution, and treatment of patients with esophageal cancer using the National Cancer Database of the American College of Surgeons. STUDY DESIGN: Consecutively accessed patients (n = 5,044) with esophageal cancer from 828 hospitals during 1994 were evaluated in 1997 for case mix, diagnostic tests, and treatment modalities. RESULTS: The mean age of patients was 67.3 years with a male to female ratio of 3:1; non-Hispanic Caucasians made up most patients. Only 16.6% reported no tobacco use. Dysphagia (74%), weight loss (57.3%), gastrointestinal reflux (20.5%), odynophagia (16.6%), and dyspnea (12.1%) were the most common symptoms. Approximately 50% of patients had the tumor in the lower third of the esophagus. Of all patients, 51.6% had squamous cell histology and 41.9% had adenocarcinoma. Barrett's esophagus occurred in 777 patients, or 39% of those with adenocarcinoma. Of those patients that underwent surgery initially, pathology revealed stage I (13.3%), II (34.7%), III (35.7%), and IV (12.3%) disease. For patients with various stages of squamous cell cancer, radiation therapy plus chemotherapy were the most common treatment modalities (39.5%) compared with surgery plus adjuvant therapy (13.2%). For patients with adenocarcinoma, surgery plus adjuvant therapy were the most common treatment methods. Disease-specific overall survival at 1 year was 43%, ranging from 70% to 18% from stages I to IV. CONCLUSIONS: Cancer of the esophagus shows an increasing occurrence of adenocarcinoma in the lower third of the esophagus and is frequently associated with Barrett's esophagus. Choice of treatment was influenced by tumor histology and tumor site. Multimodality (neoadjuvant) therapy was the most common treatment method for patients with esophageal adenocarcinoma. The use of multimodality treatment did not appear to increase postoperative morbidity.

Aged↗
PubMed1999

Intraoperative lymphatic mapping for non-small cell lung cancer: the sentinel node technique.

BACKGROUND: The purpose of the study was to determine the accuracy and role of the sentinel node technique in patients with non-small cell lung cancer. METHODS: This study was carried out on 36 consecutive patients undergoing lung resection. Peritumoral tissue was infiltrated with isosulfan blue dye and the first lymph node to stain was identified as a sentinel node. Sensitivity and specificity of the sentinel node in predicting the status of other lymph node stations were determined. RESULTS: Seventeen patients had sentinel lymph nodes. In 9 of these 17 cases neither the sentinel node nor any other lymph node contained metastatic carcinoma. In 5 cases the sentinel node was in the mediastinum and documented unexpected N2 disease. In 19 patients no sentinel node was found. Final lymph node statuses were N0 in 13 patients, N1 in 5, and N2 in 1. CONCLUSIONS: The use of isosulfan blue for intraoperative lymphatic mapping is feasible. The specificity in our experience was good; 9 of 9 patients with negative sentinel nodes were found to be N0 on the final pathology report. Unexpected N2 disease was found in 5 patients. The accumulation of further experience will determine the role of the sentinel node technique in patients with non-small cell lung cancer.

Adenocarcinoma↗
PubMed1999

Obesity correlates with gastroesophageal reflux.

Thirty morbidly obese patients presenting for bariatric surgery were evaluated for symptomatic and objective evidence of gastroesophageal reflux. Sixteen patients had heartburn while 14 were asymptomatic. All underwent esophageal function testing; manometry was performed in all patients, pH monitoring in 28. Patients with esophageal pH < 4 for more than 5% of observed time weighed more than those with normal acid exposure, 165.2 vs 129.8 kg (P < 0.01), and had significantly higher body mass indices, 56.5 vs 48.3 kg/m2 (P < 0.05). Similarly, morbidly obese patients with abnormal reflux scores weighed significantly more and had greater body mass indices than patients with normal scores (P < 0.05). Lower esophageal sphincter pressure was higher in patients with normal esophageal acid exposure than in those with abnormal findings, 15.5 vs 12.5 mm Hg (P < 0.05). This study demonstrates a correlation between both weight and body mass index with gastroesophageal reflux.

Adult↗
PubMed1999

The impact of nutritional status on the outcome of lung volume reduction surgery: a prospective study.

OBJECTIVES: To study the incidence and clinical significance of nutritional deficiencies in patients with emphysema undergoing lung volume reduction surgery (LVRS). DESIGN: Prospective observational study. SETTING: University-based teaching hospital. PATIENTS: Fifty-one consecutive patients with end-stage emphysema undergoing video-assisted thoracoscopic surgery for LVRS. INTERVENTIONS: All patients had their body mass index (BMI) and serum nutritional indexes (albumin, transferrin, total protein, cholesterol) measured preoperatively and postoperatively. Various clinical parameters were also compared between two groups. RESULTS: The BMI was normal in 24 patients (47%), and 27 patients (53%) had a below normal BMI. A preoperative analysis of the serum nutritional indexes revealed no clinically significant differences between the two groups, but postoperative levels were significantly lower in the low BMI group. Anthropometric measurements supported the designation of nutritional status by BMI. Clinically, 26% of the patients in the low BMI group required prolonged ventilatory support (> 24 h), compared to only 4% of the patients with a normal BMI. The hospital length of stay (LOS) also differed, averaging 15.9 days in the low BMI group, compared to an average of 11.8 days in the normal BMI group. CONCLUSION: Approximately 50% of patients undergoing LVRS for emphysema have a deficient nutritional status identifiable by BMI, but not by standard nutritional indexes. This impaired nutritional status is associated with increased morbidity following LVRS. We suggest that BMI is an accurate determinant of nutritional status in this patient population, and we speculate that preoperative repletion of nutritional deficiencies may decrease hospital morbidity, hospital LOS, and overall costs in the malnourished population undergoing LVRS.

Aged↗
PubMed1998

Metastatic squamous cell carcinoma of the mediastinum with unknown primary tumor.

Although metastatic carcinoma from an unknown primary tumor is known to occur, the combination of squamous cell carcinoma histologic findings and a mediastinal location is quite unusual. The evaluation of a case of a patient with a posterior mediastinal mass, eventually shown to be metastatic squamous cell carcinoma of the mediastinum with unknown primary tumor, is described herein. Resection of the lymph node mass was performed and was followed by chemoradiation for presumed lung cancer.

Carcinoma, Squamous Cell↗
PubMed1998

Pathogenesis and management of persistent postthoracotomy pain.

Persistent chest wall pain is common after thoracotomy and is usually caused by recurrence or progression of malignancy. It should prompt efforts to identify and treat the causative disease. A minority of patients experience persistent pain not related to neoplasm. This pain may last for years, but is usually not severe. A small subset of these patients experience persistent severe pain, which may be debilitating. The pain may be owing to various causes. Diagnosis and treatment should be individualized and directed toward the causes believed to be present. First-line pharmacologic therapies include NSAIDs, tricyclic antidepressants, antiepileptics, and low-dose opioids. Some patients require more sophisticated treatment from multidisciplinary pain-management clinics. This treatment may include nerve blocks, physical therapy, sympathectomy, cryoneurolysis, or long-term neuromodulation with epidural analgesia or spinal cord stimulation. Because of the severe pain these patients may experience and the difficulty and expense associated with treatment, prevention may be the best strategy for dealing with this problem. Recent laboratory and clinical studies indicate that minimizing perioperative pain can suppress certain alterations in the nervous system that may prevent the genesis and maintenance of chronically painful conditions. This suggests that strategies for avoiding PTPS may begin with aggressive perioperative anesthetic and analgesic techniques. More effective application of knowledge already available from laboratory studies awaits further clinical trials. New drugs such as NMDA inhibitors hold promise for more effective treatment in the future.

Algorithms↗
PubMed1996

Thoracoscopy: current status.

This article presents the current status of thoracoscopy in clinical practice. Aspects of its use in diagnostic, staging, and therapeutic areas are reviewed as regards diseases of the pleura, lung, and mediastinum. Controversies and evolving applications are identified.

Endoscopy↗
PubMed1995

Problem orientation is a new approach to surgical education.

BACKGROUND: There is increasing interest in educational methods that are loosely aggregated under the title of problem-based learning (PBL), but it remains unclear whether PBL is as successful as its conventional predecessor in transmitting factual information. MATERIALS AND METHODS: The authors designed and implemented a PBL curriculum for a third-year surgical clerkship, then prospectively compared that technique with the conventional format. Each student's subject-related knowledge was assessed with a specifically tailored 195-question written exam and correlated with National Board of Medical Examiners shelf exams. Student and faculty responses to the technique were also sought and tabulated. RESULTS: Student and faculty responses to PBL were uniformly positive. We were unable, however, to demonstrate effects on our evaluation instruments. Neither individual student performance nor grouped scores differed based on the mode of presentation. CONCLUSION: A PBL curriculum generates both student and faculty enthusiasm. Unfortunately, this does not translate into more efficient transmission of knowledge.

Clinical Clerkship↗
PubMed1995

Reduction pneumonoplasty for emphysema. Early results.

OBJECTIVE: The authors determined the role of Nd:YAG laser reduction pneumonoplasty for selected patients with diffuse emphysema. SUMMARY BACKGROUND DATA: The study is based on the concepts introduced 30 years ago by Brantigan regarding the value of lung reduction surgery in patients with emphysema. The authors used minimally invasive techniques with the hopes of providing appropriate clinical results with the least surgical morbidity. METHODS: Fifty-five patients with advanced symptomatic emphysema were treated with unilateral Nd:YAG laser reduction pneumonoplasty to achieve lung volume reduction. RESULTS: Patients experienced significant improvement in exercise capacity and relief of breathlessness. This correlated with improvement in objective measures of pulmonary function and with reduction in lung volume by radiographic and spirometric measures. Significant associated hospital morbidity and a 5.5% mortality were associated. CONCLUSIONS: These encouraging results with treatment of only one lung will be built on with both sequential lung and simultaneous, bilateral lung treatment protocols.

Humans↗
PubMed1994

Erythromycin strengthens the defective lower esophageal sphincter in patients with gastroesophageal reflux disease.

Motilin induces phase III activity of the gastrointestinal tract. Erythromycin has a motilin-like effect on the stomach and significantly increases the lower esophageal sphincter (LES) pressure in normal volunteers. This investigation was performed to evaluate the effects of erythromycin on esophageal function in patients with gastroesophageal reflux disease (GERD). Esophageal manometry was performed in 10 GERD patients before and after intravenous infusion of 500 mg of erythromycin. Values are expressed as mean +/- SEM. LES pressure increased from 13.9 +/- 2.9 mm Hg at baseline to 28.9 +/- 3.6 mm Hg after infusion of erythromycin (p < 0.01). The duration of contractions in the proximal, middle, and distal esophagus was significantly prolonged from 3.5 +/- 0.4 seconds, 3.8 +/- 0.4 seconds, and 4.1 +/- 0.5 seconds to 4.2 +/- 0.2 seconds, 4.6 +/- 0.5 seconds, and 5.6 +/- 0.6 seconds, respectively, after infusion of erythromycin (p < 0.05 for each comparison). Erythromycin did not effect esophageal body contraction amplitude or velocity, or the upper esophageal sphincter. Serum motilin decreased slightly after the administration of erythromycin. We concluded the following: (1) Erythromycin profoundly stimulates the defective LES in patients with GERD. This appears to be a direct motilin agonist-like effect rather than being mediated by release of endogenous motilin. (2) Erythromycin has less effect on the esophageal body, although it does prolong the duration of esophageal contractions.

Erythromycin↗
PubMed1994

Failed antireflux operations. Pathophysiology and treatment.

This article reviews the pathophysiology of failed antireflux operations and sets forth diagnostic and therapeutic strategies. Utilization of esophageal function tests is stressed. A thoracic rather than abdominal approach is recommended to provide all surgical options.

Gastroesophageal Reflux↗