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Biomedical subjects

A N Thomas

Publications and source records attributed to A N Thomas.

At least 73 records · Page 4Linked to original sources
PubMed1978

Role of angiography in cervicothoracic trauma.

The role of angiography in cervicothoracic trauma is controversial. Since 1967 the policy at San Francisco General Hospital has been to use liberal indications for angiography in hemodynamically stable patients with either penetrating or blunt cervicothoracic trauma. The 304 patients in Group 1 had emergency angiographic evaluation: 102 had penetrating cervical wounds: 202 had thoracic injuries-71 penetrating and 131 blunt trauma. During the same time period, 72 patients (Group II) had cervical or thoracic vascular injuries and underwent operative treatment without preoperative angiography. Sixty-six patients in Group 1 had significant vascular injury. Thirty patients with penetrating cervical injury had 38 vascular lesions. Thirty-six patients with gunshot or blunt chest trauma had 43 vascular lesions. Group II patients had two main indications for operation: exanguinating hemorrhage (45 patients) or suspected vascular injury, usually associated with hemorrhage (27 patients). Angiographic results were useful whether abnormal or normal. In cases with adnormal findings operative treatment was specific and improper incisions were avoided. In cases with normal angiographic results, clarification of the vascular status avoided unnecessary operations and permitted concentration of therapeutic effort upon the main clinical problems of the patients.

Adolescent↗
PubMed1977

Radiographic appearance of the chest after pleural space reduction procedures: construction of a pleural tent and phrenoplasty.

Construction of a pleural tent and phrenoplasty are surgical procedures performed to reduce intrapleural dead space after partial lung resection. Both alter the radiographic appearance of the chest and may cause erroneous diagnosis including pneumothorax, subphrenic disease, subpulmonic effusion, diagphragmatic hernia, or diaphragmatic eventration. Radiologists should be aware of the potentially misleading appearance that these surgical procedures may present.

Air↗
PubMed1977

Diagnosis and treatment of hemorrhage in patients with hiatal hernia.

A retrospective study examined the clinical course of 32 patients with hiatal hernia in whom hemorrhage of the upper gastrointestinal tract was a prominent symptom. Hemorrhagic esophagitis was the most common source of bleeding. Duodenal ulcer, gastritis, and gastric ulcer of the herniated stomach were other less frequent causes of hemorrhage in these patients. Hemorrhage from esophagitis is usually mild and chronically recurrent. Surgical correction of the hiatal hernia and reflux is adequate treatment for the patient with hemorrhage from esophagitis or gastritis of the herniated stomach. Hemorrhage from duodenal ulcer as well as gastric ulcer requires a procedure directed at these lesions. Because of the association of upper gastrointestinal bleeding in hiatal hernia with lesions other than esophagitis, a vigorous diagnostic approach with endoscopy is essential.

Adult↗
PubMed1977

Pharyngogastrostomy for treatment of severe caustic stricture of the pharynx and esophagus.

Four cases of combined pharyngeal and esophageal stricture were managed by pharyngogastrostomy 4 months to 42 years after injury. The stomach was brought up to the neck via the posterior mediastinum after the esophagectomy. A thoracotomy was not used. The results were suprisingly good in 3 patients followed to 3 years. A fourth patient died 6 months after the operation. In those patients benefiting from the operation, regurgitation was minimal when a few precautions were observed. The patients have normal hunger pains and appetite. They are able to eat a full-sized meal. The advantages of stomach compared to colon replacement of the esophagus are discussed.

Adult↗
PubMed1976

Pharyngoesophageal caustic stricture. Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft.

Four cases of combined hypopharyngeal and cervical esophageal stricture secondary to caustic ingestion are presented. Although gastropharyngostomy has rarely been used for treatment of patients with caustic stricture of the pharynx and cervical esophagus, we believe that it is a useful procedure and has several advantages over use of the colon. We prefer total esophagectomy and posterior mediastinal transposition of the stomach to the neck followed by gastropharyngostomy in those patients who have minimal stomach involvement.

Adolescent↗
PubMed1976

Palliation for carcinoma of the esophagus.

From 1950 to 1973, 169 patients received irradiation for esophageal squamous cell carcinoma. The average survival time was 10 months, with 7% of the patients living 2 years or more. The median survival time was 7 months; palliation averaged 6 months. Most completing therapy (89%) achieved some palliation: 66% had significant relief of dysphagia for 2 months or longer. The anatomical location of the malignant obstruction did not influence therapeutic response; there was similar response in cases of upper, middle, and lower esophageal lesions. Thirty patients with progressive obstruction underwent endoesophageal intubation with Celestin tube placement; this procedure provided symptomatic relief with minimal morbidity.

Adult↗
PubMed1975

Control of respiratory therapy in flail chest.

Pulmonary mechanics and oxygenation were measured in 24 consecutive patients with posttraumatic flail chest requiring continuous mechanical ventilation. The mean duration of mechanical ventilation was fourteen days. Mortality was 38% for all patients, 29% if deaths from head injury are excluded. Pneumonia occurred in 4 patients (17%) and pneumothorax in 1 (4%). Vital capacity and maximal inspiratory force measurements were useful in assessing chest wall stabilization. Total lung compliance correlated negatively with fatal outcome from respiratory failure. The alveolar-arterial oxygen gradient was not useful in assessing chest wall stabilization.

Adult↗