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Biomedical subjects

A Yellin

Publications and source records attributed to A Yellin.

At least 91 records · Page 5Linked to original sources
PubMed1989

Localized fibrous mesothelioma of the mediastinum devoid of pleural connections.

Localized fibrous mesothelioma of the pleura is an uncommon neoplasm. Very rarely (there have been three previous cases) it may occur as an isolated mediastinal tumour. Such a tumour was present for at least 3 years in a 47 year old man, causing shortness of breath and superior vena cava syndrome. A mass weighing over 600 g was completely resected through a median sternotomy. The pertinent literature is reviewed.

Humans↗
PubMed1989

Chylopericardium as a complication of mitral valve replacement.

A patient developed chylopericardium after mitral valve replacement. Although there was early relapse with cardiac tamponade it eventually resolved with conservative management consisting of tube drainage initially and a medium chain triglyceride diet for two months.

Adult↗
PubMed1988

Aneurysmal bone cyst of the rib: a review and report of two cases.

Aneurysmal bone cyst (ABC) is a benign lesion and generally occurs in the long bones and vertebral column. ABC of the rib is an uncommon entity. Two cases of ABC involving the rib are reported. Its occurrence in the eight decade of life as manifested in one of our patients is extremely rare. The aetiology, clinical manifestations, pathology and treatment are briefly discussed. En bloc resection of the lesion is curative, and offers a good cosmetic and functional result.

Adult↗
PubMed1988

Bronchoscopic evaluation of peripheral lung tumours.

The results obtained from fibreoptic bronchoscopy preformed under fluoroscopic guidance were evaluated in a prospective study of 71 consecutive patients with a peripheral lung lesion more than 2 cm in diameter on the chest radiograph. A peripheral lung lesion was defined as a lesion that was not seen within the bronchial tree at fibreoptic bronchoscopy. Small volume washings, bronchoalveolar lavage, transbronchial biopsy, and bronchial brushings were carried out and fluid or tissue was sent for cytological or histological examination as appropriate. Of the 71 patients, 51 were subsequently shown to have malignant disease. In 38 of the patients the diagnosis of malignancy was made by bronchoscopy, from histological specimens alone or in conjunction with cytological specimens in 33, from brushings alone in two, and from bronchoalveolar lavage fluid alone in three patients. There were no important complications. Thus fibreoptic bronchoscopy in conjunction with fluoroscopic screening appears to be an effective and safe method for the initial investigation of a peripheral lung lesion more than 2 cm in diameter.

Adult↗
PubMed1988

Castleman's disease. An uncommon computed tomographic feature.

A case of localized intrathoracic Castleman tumor demonstrated, on CT scan, calcifications in a circumferential distribution. The prevalence of calcifications in Castleman's disease and the differential diagnosis of the above unusual CT findings are discussed.

Adult↗
PubMed1987

Surgical management of lymphomas involving the chest.

The efficacy of surgical judgments in the management of thoracic lymphoma was studied through review of 34 patients with primary mediastinal lymphomas, 30 patients who needed one or more thoracic operations after treatment of extrathoracic lymphomas, and 5 patients with primary lymphocytic infiltrates (PLI) of the lung. In all patients with primary lymphocytic infiltrates of the lung, thoracotomies were required in order to establish the correct diagnosis. Patients with primary mediastinal lymphoma required 74 surgical procedures (2.2 per patient) to establish the correct diagnosis. In retrospect, 40 operations were not beneficial. The procedures that provided diagnostic samples were 15 anterior mediastinotomies, 8 full thoracotomies, 3 median sternotomies, and 8 lesser procedures such as mediastinoscopy. Patients who needed thoracic procedures after treatment of extrathoracic lymphomas had 41 thoracic operations (1.37 per patient). Five operations were needed to manage complications of thoracic lymphoma or its therapy. To evaluate new radiographic findings, there were 35 operations (1.3 per patient) at a mean interval of 5.0 years following initial treatment; the findings were recurrent lymphoma in 62% and new lesions in 38% of patients. Among new lesions, there were 2 bronchogenic cancers; 9 enlarging mediastinal-pleural masses were not caused by lymphoma. The accurate diagnosis of thoracic lymphoma or new thoracic lesions in patients with lymphomas usually requires enough tissue for immunophenotyping. Providing adequate tissue samples and treating new lesions that are not lymphomas often require major thoracomediastinotomies for immunophenotyping.

Adolescent↗
PubMed1987

Pharmacokinetics and therapeutic efficacy of gentamicin in an experimental pleural empyema rabbit model.

The pharmacokinetics and therapeutic efficacy of gentamicin were investigated in an experimental pleural empyema rabbit model. Pleural effusion was induced by the intrapleural administration of turpentine, and empyema was induced by direct inoculation of the effusion with Klebsiella pneumoniae. Pleural empyema compared with effusion was characterized by lower pH, oxygen tension (PaO2), and glucose levels and higher leukocyte count, lactic acid concentration, and PaCO2. After a single administration, gentamicin was first detectable in the pleural fluid at 60 min, whereas peak levels in empyema were observed at 180 min. Gentamicin persisted in the empyema longer than in blood. Animals treated with gentamicin only had 60% bacterial cure on day 7; those treated with gentamicin in an oxygen chamber had 100% cure on day 5 (P = 0.004). Low oxygen tension diminished the antibacterial efficacy of gentamicin in this model. An increase in oxygen tension improved the therapeutic results without alteration of the pharmacokinetics of gentamicin.

Animals↗
PubMed1987

Selective surgical therapy of the Budd-Chiari syndrome provides superior survivor rates than conservative medical management.

The Budd-Chiari syndrome is an unusual form of portal hypertension caused by hepatic vein occlusion, which results in centrilobular congestion and necrosis. Its overall mortality rate exceeds 50% at 2 years, and optimal treatment remains controversial. To determine optimal therapy on the basis of clinical and angiographic data, we retrospectively analyzed 30 patients with this disease treated at the University of California, Los Angeles or the University of Southern California School of Medicine between 1955 and 1985. Twelve patients were treated conservatively with diuretics, anticoagulants, paracentesis, and/or peritoneal-venous shunt. Eighteen patients were treated by definitive surgery: side-to-side portocaval shunt (four), mesocaval shunt (four), side-to-side splenorenal shunt (one), liver transplantation (two), transatrial membranotomy (TM) (two), TM followed by inferior vena cava reconstruction (IVCR) (one), TM followed by mesocaval shunt (one) simultaneous IVCR and side-to-side portocaval shunt (one), IVCR (one), and azygousatrial shunt followed 4 years later by a splenopulmonary shunt (one). Overall the surgical group had survival rates superior to the medical group, with a 2-year survival rate of 54% for the surgical group vs. 9% for the medical group (p less than 0.089). On the basis of these data we conclude that surgical therapy is superior to medical therapy for the Budd-Chiari syndrome. However, the operation must be tailored to treat the specific anatomic and clinical abnormality. Guidelines to select the proper surgical procedure are given.

Actuarial Analysis↗
PubMed1986

Results of a randomized trial of end-to-side portacaval shunt and distal splenorenal shunt in alcoholic liver disease and variceal bleeding.

Since 1976, we have compared the end-to-side portacaval shunt (PCS) with the distal splenorenal shunt (DSRS) in patients with alcoholic liver disease and recurrent variceal bleeding. Fifty-four patients were randomly assigned to receive either shunt procedure. There were 27 patients in each group and both groups were highly comparable in clinical and laboratory characteristics. Median follow-up was 31 mo in each group. Postoperative complications and operative mortality (7% after PCS, 12% after DSRS) were comparable. Spontaneous portasystemic encephalopathy developed in 32% of the patients at risk after PCS and in 39% after DSRS. Rebleeding from varices occurred in 4% of the patients after PCS and in 27% after DSRS. Cumulative survival was not significantly different between groups (5-yr survival: 31% after PCS, 43% after DSRS). We have failed to demonstrate superiority of DSRS in our patients with alcoholic liver disease with respect to postoperative encephalopathy or survival, and have experienced an unusually high rate of variceal rebleeding after DSRS.

Adult↗
PubMed1986

Pneumothorax associated with lymphoma.

Pneumothorax in patients with lymphoma has rarely been reported. We have encountered 8 patients with lymphoma with 17 episodes of pneumothorax; these episodes occurred 3 months to 8 yr in 7 patients after the diagnosis of Hodgkin's disease (HD) and in 1 patient with non-Hodgkin's lymphoma (NHL). The observed incidence of pneumothorax among 1,977 patients with lymphoma was 10-fold higher than expected; this included a significantly higher incidence in patients younger than 30 versus those older than 30 yr of age (1:552 versus 1:5,788 patient-years, p less than 0.001), and a higher incidence in patients with HD than in those with NHL (1:708 versus 1:5,072 patient-years, p less than 0.005). There was a strong suggestion of increased risk for pneumothorax in patients treated with radiotherapy as compared with patients treated without irradiation (1:1,016 versus 0:1,963 patient-years, p = 0.065). Apparent additional contributing factors in 6 patients were lung involvement with lymphoma (n = 2), radiation fibrosis (n = 3), and infection (n = 1). Pneumothorax was persistent in 5 patients, bilateral in 4, and recurrent in 2. The occurrence of pneumothorax in 2 patients heralded death. Management commonly required placement of chest tube (n = 9) or major surgical procedures (n = 5). We conclude that pneumothorax may be more common among patients with lymphoma than previously appreciated. Young age, HD, and probably radiotherapy are predisposing factors. The pneumothoraces associated with lymphoma are more complex and ominous and more difficult to manage than the usual spontaneous pneumothorax. In patients with lymphoma, pneumothorax is likely to be secondary to underlying abnormality of the lung.

Adolescent↗
PubMed1986

Bronchogenic carcinoma associated with upper aerodigestive cancers.

Of 1,450 patients with upper airway cancers, 189 (13%) had additional cancers. There were 60 cases in which lung cancer occurred after upper airway cancer and a single case in which it preceded upper airway cancer. The occurrence of upper airway plus lung cancer in 61 patients was referred to as multiple airway cancers. The overall incidence of multiple airway cancers was 4.1%, or 1:112 patient-years at risk. The highest incidence of lung cancer was 1:70 patient-years, and this was associated with laryngeal cancer. The mean diagnostic interval between upper airway and lung cancers was 6.1 (0 to 23) years, including nine cases (14.8%) in which the two were synchronous. Triple endoscopy revealed occult lung cancer only once. The use of mediastinoscopy (n = 9) and other surgical staging procedures (n = 9) was limited, because previous treatment of upper airway cancers made such procedures impractical and also because interpretation of findings would have been difficult. Past reports have indicated that lung cancer in association with upper airway cancer is almost invariably squamous cell and almost always develops in men. By contrast, among our 61 patients, the incidence of adenocarcinomas was 24%, and 16 patients or 26% were women. Among patients whose records could be evaluated in this regard, symptoms were present in 27 of 55 (49%); the cancers were in Stage III at presentation in 51%. Outcome was related to symptomatology and to lung cancer stage. The median survivals for symptomatic and asymptomatic patients were 6 and 25 months, respectively (p less than 0.001); the median survivals for patients with Stage I, II, and III lesions were 26, 9, and 6 months, respectively (p less than 0.05). Post-thoracotomy management after surgical-radiation therapy of upper airway cancers (n = 22) was inordinately challenging because of preexisting impairment of the upper airways. We have reached the following conclusions: Patients with upper airway cancer are at high risk for lung cancer of all cell types. When multiple airway cancers occur together, the prognosis is poor; nonetheless, cure of each cancer can be achieved if it is completely and adequately treated. When multiple airway cancers occur synchronously, the more life-threatening cancer should be treated first. When the option exists, the lung cancer should be treated before the upper airway cancer to avoid the impact of previous irradiation and/or surgical treatment of the upper airway cancer upon post-thoracotomy management.

Adenocarcinoma↗
PubMed1985

Percutaneous tube drainage: the treatment of choice for refractory lung abscess.

During the years 1978 to 1982, 48 patients with primary lung abscess were seen in the Sheba Medical Center in Israel. Seven of them (14%) did not respond to conservative treatment and were candidates for operation. All were successfully treated by percutaneous tube drainage initiated under local anesthesia, and all recovered completely. There were no relapses after a follow-up period of 2 to 5 years. During this period, we did not perform pulmonary resection for primary lung abscess. Three patients with malignant abscesses were also treated initially by transthoracic drainage but eventually required surgical intervention. We conclude that percutaneous transthoracic drainage is an efficient and safe mode of treatment, and we recommend transthoracic drainage as the treatment of choice for long-standing, refractory primary lung abscesses.

Adult↗
PubMed1985

Sarcoidosis: a cause of bilateral hilar lymphadenopathy after excision of malignant melanoma of the arm.

Bilateral hilar lymphadenopathy developed in a patient one year after excision of a malignant melanoma of the left arm. There were no signs of distant metastases. Hilar lymph node biopsy specimen obtained by mediastinoscopy showed multiple noncaseating granulomas consistent with sarcoidosis, without evidence of tumor cells. Sarcoidosis developing in the course of a preexisting neoplasm is rare, but must be considered in order to establish a proper diagnosis and withhold unnecessary treatment.

Adult↗