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Biomedical subjects

A G Little

Publications and source records attributed to A G Little.

At least 91 records · Page 5Linked to original sources
PubMed1985

Large cell carcinoma of the lung. Ultrastructural differentiation and clinicopathologic correlations.

Light microscopic biopsy specimens from 48 patients were reviewed by two independent pathologists and classified as large cell carcinoma of the lung by 1981 World Health Organization (WHO) criteria. Sites of primary disease were hilar/mediastinal in 26 patients, large mid-lung field in 17, and peripheral lung in 5. All material was examined by electron microscopy (EM) for evidence of squamous ("squamous": 15 patients), glandular ("adenocarcinoma": 17 patients), or nonspecific ("large cell": 14 patients) ultrastructural differentiation. Two patients had mixed adenosquamous features. There were 6 patients with Stage I tumors; 5, Stage II; 24, Stage IIIM0; and 13, Stage IIIM1. Of the 14 patients with large cell by EM, 11 had unresectable Stage IIIM0 or metastatic disease. Only 3 of 27 patients not undergoing resection responded to combined modality therapy. There were two long-term survivors free of disease in the resected Stage IIIM0 patient category. Overall median survival by stage was analyzed, with no statistically significant difference between several of the stage groupings, suggesting a worse prognosis for the entire group overall compared to all patients with non-small cell lung cancer. The median survival by EM subgroup was also without significant difference, both overall and within various stage groupings, despite more patients in the large cell category with advanced disease. These data support the unique behavior of patients with large cell carcinoma on light microscopy, but fail to demonstrate that ultrastructural differentiation is of prognostic importance for response or survival.

Adenocarcinoma↗
PubMed1985

Effect of pneumonectomy on extravascular lung water in dogs.

The effect of pneumonectomy in dogs on extravascular lung water (EVLW) was studied using a double-indicator (iced indocyanine green dye) dilution technique. The EVLW was measured in five dogs before and after a left pneumonectomy while left atrial pressure was increased in 5-mm Hg increments from 10 to 25 mm Hg by serially inflating a left atrial Foley balloon. There were no significant differences in hematocrit, total protein, or plasma oncotic pressure before or after pneumonectomy. Prepneumonectomy EVLW was adjusted to reflect right lung EVLW alone. Both before and after pneumonectomy there was a significant increase in EVLW when left atrial pressure was increased to 25 mm Hg. However, EVLW values were similar before and after pneumonectomy at each level of left atrial pressure. We conclude that pneumonectomy does not acutely increase susceptibility to EVLW formation caused by a hemodynamic challenge. This implies that following pneumonectomy, if left heart filling pressures are normal, there is no clinical benefit to excessive fluid restriction.

Animals↗
PubMed1985

Malignant superior vena cava obstruction reconsidered: the role of diagnostic surgical intervention.

The cases of 42 patients with malignant superior vena cava (SVC) obstruction were reviewed to evaluate clinical dogmas of prohibitive risk for invasive diagnostic procedures and need for urgent radiotherapy. Thirty-nine had carcinoma (35, bronchogenic and 4, other), and 3 had lymphoma. Lung cancer histology was squamous cell in 11, adenomatous in 10, large cell in 7, and small cell in 7. The SVC obstruction was always symptomatic, usually causing facial or cervical swelling, but there was no instance of SVC obstruction causing life-threatening problems such as cerebral or laryngeal edema. Twenty-two patients underwent bronchoscopy (11 flexible and 11 rigid) prior to radiotherapy without respiratory complications, and diagnostic tissue was obtained in 8. Also prior to radiotherapy, 29 invasive diagnostic procedures were performed: thoracotomy (1), mediastinotomy or mediastinoscopy (11), supraclavicular or scalene node biopsy (15), and percutaneous lung needle biopsy (2). Neither excessive blood loss nor serious complications occurred, and diagnostic tissue was obtained in 22 patients who received individualized therapy. Eight patients had urgent radiotherapy, which delayed diagnosis and specific therapy for two weeks to 6 months. For the 33 patients who underwent radiotherapy after development of the SVC obstruction, the obstruction clinically resolved spontaneously within fourteen days, independently of whether radiotherapy was begun immediately or was delayed. Median survival was 5.0 months and was not influenced by the dose or timing (early or late) of radiotherapy. We reached the following conclusions. First, although a grim prognostic sign, SVC obstruction is rarely life-threatening and typically resolves spontaneously, probably by development of venous collaterals.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoscopy↗
PubMed1985

Current concepts in the management of postoperative chylothorax.

Thirteen patients required pleural drainage for postoperative chylothorax with an average duration of leakage of 36.9 days. Total protein and albumin levels, body weight, and peripheral lymphocyte counts all decreased substantially during the period of chylous leakage. Only 3 chylothoraces resolved with tube drainage and dietary management alone. Six patients required eight operations for control of chylothorax, and 4 patients, all of whom had cancer, died with a persistent leak. chylothorax is a debilitating postoperative complication resulting in an impaired immune system and nutritional state. Because it is associated with a 50% mortality in patients with cancer, early reoperation should be considered. Patients with benign underlying disease can be managed conservatively for longer periods. Control of potential chylous leaks at the time of original operation is vital, especially in patients with malignancies who have a predisposition toward leakage from sites other than the main thoracic duct.

Adolescent↗
PubMed1985

Esophageal emptying and acid neutralization in patients with symptoms of esophageal reflux.

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. We compared results of 24-hour pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) in 26 symptomatic patients to determine which of the components of acid clearance is better correlated with gastroesophageal acid reflux (GER). Seven of eight patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in nine of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, is the predominant component of abnormal acid clearance in patients with GER. RIS is superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition.

Esophagogastric Junction↗
PubMed1985

Fibromyxoma of the trachea. A review of benign tracheal tumors.

A 59-year-old woman presented with asthmatic symptoms. A fibromyxoma obstructing her trachea was surgically removed. Benign tracheal tumors are rare lesions usually misdiagnosed as asthma. Histologically, the majority are soft-tissue-type tumors of mesenchymal origin. They are more frequently located in the lower third of the trachea with the exception of benign mixed tumor and granular cell myoblastoma that arise more frequently in the upper third. Though endoscopic removal of some tumors has been successful, complete cure without recurrence is better accomplished by segmental tracheal resection with end-to-end anastomosis.

Female↗
PubMed1985

Diagnosis and management of synchronous lung cancers.

The findings in 28 patients with synchronous lung cancers are reviewed. Mediastinoscopy and systemic staging were performed to exclude the possibilities that one pulmonary lesion was metastatic from the other or that both represented systemic metastases from another tumor. Nineteen patients underwent resection of both tumors. Median survival was 25 months for four patients with definite Stage I synchronous cancers (no nodal involvement; different cell types, bronchoscopically separate endobronchial lesions or arising from separate foci of carcinoma in situ) and was 27 months for seven patients with possible synchronous Stage I cancers (no nodal involvement; similar cell types; located in separate lobes). Median survival was 11 months for 16 patients having Stage II or III lung cancer accompanied by a second synchronous lung cancer. In the absence of hilar or mediastinal nodal involvement and systemic metastases, synchronous tumors should be considered separate primaries when located in different lobes, even if they have similar histologic features. Prognosis of synchronous cancers is related to the presence or absence of nodal metastases. Pneumonectomy is the operation of choice for synchronous unilateral tumors. With bilateral tumors, sequential resection starting with the most advanced lesion is appropriate. Preservation of lung tissue without compromising the cancer operation is critical.

Adenocarcinoma↗
PubMed1985

Management of unintentional extubation during left pneumonectomy.

Unintentional extubation can occur during pneumonectomy. Reintubation is sometimes difficult due to the position of the patient. Satisfactory ventilation can be achieved by means of an endotracheal tube inserted into the open bronchial stump, allowing elective reintubation to be performed transorally.

Humans↗
PubMed1984

Esophageal carcinoma with respiratory tract fistula.

An experience with 27 patients with malignant respiratory tract fistula (RTF) is presented. The RTF was related to carcinoma of the thoracic esophagus in all the patients, involved the trachea in 11, left main bronchus in 7, right main bronchus in 3, and was more distal in 6 patients. Metastases were detectable in only four patients (15%) at the time of RTF diagnosis. Bronchoscopy examination in 13 patients prior to RTF development showed tracheobronchial invasion or impingement in all. The RTF was present at initial presentation in 11 patients (Group I), and developed after/during radiation therapy (RT) in 16 patients (Group II). Median survival from tumor diagnosis was 17 weeks in Group I and 37 weeks in Group II, while survival from RTF diagnosis was 16 weeks in Group I and II weeks in Group II.

Adult↗
PubMed1984

Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy.

Fifteen patients with a paraesophageal hernia were studied with 24 hour esophageal pH monitoring and esophageal manometry to clarify the physiologic aspects of the cardia and resolve controversies over the type of surgical repair. The results were compared with those obtained in 34 randomly selected patients with a sliding hernia and 18 normal control subjects. Sixty percent of the patients with a paraesophageal hernia had an incompetent cardia on 24 hour pH studies which was associated with a lower esophageal sphincter of normal pressure, short overall length, and a small segment exposed to abdominal pressure. In comparison, 70 percent of patients with a sliding hernia had an incompetent cardia which was associated with a lower esophageal sphincter of low pressure, normal overall length, and a short segment exposed to abdominal pressure. With either type of hernia, symptoms were not helpful in determining the competency of the cardia. When urgent surgery is necessary, repair should include an antireflux procedure. If facilities and time permit, more specific evaluation of the cardia can be performed, and if competent, the repair should be limited to reduction of the stomach and closure of the defect.

Adult↗
PubMed1984

The use of serum albumin for further classification of Stage III non-oat cell lung cancer and its therapeutic implications.

The use of the preadmission serum albumin level for predicting survival was evaluated in 81 patients with Stage III disease, 59 with unresectable and 22 with resectable primary tumors. A serum albumin of less than 3.4 gm/dl in a patient with unresectable Stage III disease indicates a poor prognosis with an accuracy that supersedes that obtained from a clinical assessment of the anatomical extent of disease. Seventeen of the 22 patients with resectable Stage III disease had a preadmission level of albumin of 3.4 gm/dl or greater. The median survival was 20.5 months, which was statistically longer than 9.9 months for 12 patients with unresectable Stage III M0 disease and an albumin level of 3.4 gm/dl or greater (p less than 0.05). Five of the 22 patients who underwent resection had a preadmission albumin level of less than 3.4 gm/dl. The median survival for these patients was 9.7 months compared with 20.5 months for those with a level of 3.4 gm/dl or greater. These findings suggest that resection of Stage III disease in patients with an albumin level of 3.4 gm/dl or greater prolongs survival. Another group of 5 patients with resectable Stage III disease and an albumin level of less than 3.4 gm/dl were force-fed an elemental diet while undergoing a regimen of preoperative radiation therapy. There was no improvement in survival, and 3 died of the disease prior to resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Bronchogenic↗
PubMed1984

Operation for diagnosis and treatment of pericardial effusions.

UNLABELLED: An experience with 32 consecutive patients with pericardial effusions is reviewed and presented. Malignant effusions: Twenty patients had underlying malignancy. Five had no symptoms, nine had ambiguous symptoms, and six had pericardial tamponade. Initial treatment in eight was pericardiocentesis, which provided diagnosis and treatment in one but was clinically unsuccessful in seven and caused right ventricular puncture in one. Subxiphoid pericardial window in 19 patients showed malignant involvement in six but documented a nonmalignant effusion in 13. There were no operative complications, and no effusions have recurred with long-term follow-up. Only two patients with true malignant effusions had significant long-term survival as compared with 11 of 13 with benign effusions. Uremic effusions: Six patients with renal failure required intervention, three for hemodynamic compromise and one for possible infection. Diagnostic pericardiocentesis documented a sterile effusion in one patient. Five patients had subxiphoid pericardial window without recurrence of effusion. One patient required reexploration for rectus muscle bleeding. Other effusions: All six patients had hemodynamic compromise. Pericardiocentesis was successful in three of four patients but effected resolution in none. Subxiphoid pericardial window was performed in all. The effusion recurred in a patient with periarteritis nodosa, and a patient with viral myocarditis developed a left ventricular pseudoaneurysm that required operation. CONCLUSIONS: Subxiphoid pericardial window provides definitive diagnosis and treatment for pericardial effusions of all causes with low morbidity rates whereas pericardiocentesis is safe but usually ineffective/unproductive; many effusions in patients with cancer are not related to malignant pericardial involvement and documentation is important for treatment planning.

Adolescent↗
PubMed1984

Duodenogastric reflux and reflux esophagitis.

Twenty-seven patients with gastroesophageal reflux were prospectively investigated to define the role of duodenogastric reflux in the development of reflux esophagitis. Duodenogastric reflux was detected and quantified by pH monitoring of the gastric environment 5 cm distal to the distal esophageal sphincter. Alkaline duodenogastric reflux was identified by the occurrence of spontaneous, intense gastric alkalinization during fasting periods. Patients with reflux with esophagitis were distinguished from those without esophagitis by having fewer of these episodes and, consequently, more acid stomachs than had patients without esophagitis. As previously shown, refluxers with esophagitis also had more frequent acid gastroesophageal reflux and prolonged gastric emptying. These findings suggest that refluxers with esophagitis have a functional gastropyloric disturbance resulting in delayed gastric emptying, decreased frequency of alkaline duodenogastric reflux episodes, and more frequent acid gastroesophageal reflux than do refluxers without esophagitis.

Adolescent↗
PubMed1984

Thoracic trauma in children.

A 20-year experience at The University of Chicago in dealing with chest injuries in pediatric patients has been reviewed. The clinical presentation, including results of diagnostic measures, and the initial and definitive management of thoracic trauma in children are discussed. The condition of the majority of patients was stable at time of presentation. The most frequent surgical intervention performed was intercostal tube placement. Thoracotomy was infrequently required and laparotomy for associated injuries was more common. Trends in the causes and epidemiology of thoracic trauma in an inner city environment over this 20-year period were noted: Blunt trauma, which is increasing in frequency, most commonly involves the younger age group and is usually related to automobile accidents. Penetrating injuries are generally seen in older patients within the pediatric age groups and are similar to those seen in the adult population.

Accidents, Traffic↗
PubMed1984

Use of the pulmonary artery for left ventricular venting during cardiac operations.

Data relating to the hemodynamic efficaciousness and mechanism of action of a pulmonary artery catheter or vent used for left ventricular venting during cardiac operations are presented. The pulmonary artery vent is a plastic sump catheter that is introduced into the main pulmonary artery through a purse-string suture and connected via a roller pump to the venous reservoir of the heart-lung perfusion machine. Placement and removal require only a few minutes. The pulmonary artery vent retrieved 85% of a 99mtechnetium-labeled solution placed in the left atrium during aortic cross-clamping, and there was no detectable radioactivity in peripheral or aortic root blood samples. Pulmonary artery vent return during cardiopulmonary bypass in 10 patients undergoing coronary artery bypass averaged 12.5 L. The effectiveness of left ventricular decompression was evaluated in 20 patients also undergoing bypass grafting. Use of the pulmonary artery vent consistently and significantly decreased left heart pressures, compared to the control situation with the vent off, with the aortic cross-clamp applied, and in both the fibrillating and beating heart in the early postischemic reperfusion period. We reached the following conclusions: (1) The pulmonary artery vent withdraws left heart blood via the pulmonary vasculature, in addition to returning right heart spillover and retrieving bronchial flow. (2) Left heart pressures are reduced to levels which reduce oxygen demands and preserve endocardial perfusion, therefore protecting myocardium, during fibrillation and during coronary reperfusion of the beating heart. (3) Because of its effectiveness and safety, especially the impossibility of introducing air into the left ventricle, the pulmonary artery vent is recommended for routine left ventricular venting.

Adult↗
PubMed1983

Barrett's esophagus. Functional assessment, proposed pathogenesis, and surgical therapy.

Esophageal function was assessed with manometry and 24-hour pH monitoring of the distal esophagus in 22 patients with histologically proven Barrett's esophagus (BE), 31 consecutive patients with endoscopic grade 2 or 3 esophagitis, and 33 normal volunteers. Patients with BE had less lower esophageal sphincter (LES) pressure, but similar length of sphincter exposed to the abdomen, than patients with esophagitis. Both groups had significantly less LES pressure and abdominal length than normal subjects. Patients with BE had statistically more esophageal acid exposure than patients with esophagitis, and both differed markedly from normal subjects. They also had a greater number of reflux episodes lasting longer than five minutes than patients with esophagitis, suggesting that the severity of acid exposure was due to a defect in esophageal clearance. The extent of Barrett's mucosal change was related to the level of LES pressure and the number of reflux episodes that were five minutes or longer in duration. We concluded that BE is related to a mechanical incompetency of the cardia and a decrease in esophageal clearance that requires reconstruction of the cardia for effective therapy.

Adult↗