Search PubMed⌕ Search

Biomedical subjects

C E Eastridge

Publications and source records attributed to C E Eastridge.

At least 19 recordsLinked to original sources
PubMed1996

Preoperative assessment of the high-risk patient for lung resection.

BACKGROUND: We wanted to determine if cardiopulmonary exercise testing could better identify the threshold where physiologic function is irreparably impaired for patients with borderline pulmonary function who are being considered for lung cancer resection. METHODS: We performed an open, prospective preoperative trial and a postoperative outcome evaluation with a combined medical, surgical, and exercise physiology evaluation at three university hospitals. All eligible patients had spirometry, lung volume determination, and quantitative perfusion scanning and performed a cardiopulmonary stress test, stair climbing, and a 12-minute walk for distance. Functional status was determined with an Eastern Cooperative Oncology Group score, a dyspnea score, and a cardiopulmonary risk index. RESULTS: We identified 12 patients who met strict criteria for borderline pulmonary function during a 1-year study period. The mean forced expiratory volume in 1 second (FEV1) was 1.38 L (48% of predicted). The mean predicted postoperative FEV1 based on pneumonectomy was 700 mL. Eleven of the patients did the stair climb and 10 passed. All 12 patients achieved a maximum oxygen consumption greater than or equal to 10 mL x kg(-1) x min(-1) (mean value, 13.8 mL x kg(-1) x min(-1)). Thirteen operations were performed on the 12 patients. Nine complications occurred in 7 patients. CONCLUSIONS: Patients with borderline pulmonary function can undergo resection safely if they have an FEV1 equal to or greater than 1.6 L or 40% of its predicted value, a predicted postoperative FEV1 of 700 mL or more, a maximum oxygen consumption of 10 mL x kg(-1) x min(-1) or greater, or stair climbing of three flights or more. Cardiopulmonary stress testing and stair climbing add valuable clinical information for patients with an FEV1 of less than 1.6 L.

Aged↗
PubMed1991

Delayed chest wall pain due to sternal wire sutures.

This report describes 18 patients with disabling chest wall pain due to one or more sternal wire sutures. The pain occurred from 2 to 84 months after a median sternotomy. The pain was described either as sharp and stabbing or as a deep-seated ache. The involved wires had an exaggerated fibrous tissue reaction surrounding the twisted portion. The adjacent noninvolved wires had minimal reaction. In the last 7 patients, serial sections of the fibrous tissue revealed entrapment of one or more sensory nerve fibers. In 6 of the 7 electrical potentials were measured and found to be elevated, indicating wire damage during twisting. Ferroxyl tests confirmed the collection of iron ions at this anodic point as a result of corrosion. Removal of the involved wires and the fibrous tissue surrounding this anodic point relieved the symptoms of pain and tenderness resulting from entrapped sensory nerves.

Bone Wires↗
PubMed1990

Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study.

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.

Adult↗
PubMed1987

Pleural aspergillosis diagnosed by computerized tomography.

As shown by the case we have reported, patients with a chronic pneumothorax and nodular, thickened pleura may have pleural aspergillosis. We recommend that when such patients have CT of the chest, the examiner use the alternate dependent position to look for mobile pleural debris.

Aspergillosis↗
PubMed1985

Spontaneous hemopneumothorax requiring thoracotomy.

A spontaneous pneumothorax complicated by severe bleeding presents a potentially grave emergency. If bleeding continues, thoracotomy becomes necessary to control the hemorrhage, to evacuate residual blood and clots, and to repair the break in the continuity of the lung.

Adult↗
PubMed1984

Lower esophageal ring: experiences in treatment of 88 patients.

The lower esophageal ring is an unusual clinical disorder of the esophagus and consists of a thin submucosal circumferential scar that forms in the lower esophagus. It is probably an acquired lesion resulting from repeated insults to the lower esophageal mucosa. The symptom of dysphagia results from esophageal obstruction, and the degree of obstruction is directly related to the internal diameter of the ring. Episodic aphagia results from impaction of food at the site of the ring. Since 1970, 88 patients have been seen with either dysphagia or episodic aphagia. Sixty-five with chronic limited reflux were treated primarily by oral dilation. Two of them required an antireflux procedure at a later date because of accentuation of reflux symptoms. Eighteen patients received surgical treatment initially because of severe reflux disease. Treatment consisted of interruption of the ring combined with an antireflux procedure. Five patients received no treatment. Lower esophageal ring may be managed satisfactorily through oral dilation, resulting in relief of dysphagia. If reflux disease is present or is accentuated by dilation and cannot be controlled medically, then the appropriate antireflux procedure should be done.

Adult↗
PubMed1984

Endobronchial lipoma.

We have described three cases of endobronchial lipoma, which is among the least common neoplasms found in the tracheobronchial tree. If these tumors, which occur most commonly in men, are not recognized early and removed, they may produce progressive bronchial obstruction and cause recurrent bouts of obstructive pneumonitis, irreversible bronchiectasis, and pulmonary damage. Endobronchial lipomas are usually accessible to endoscopic excision, preventing permanent lung damage.

Aged↗
PubMed1983

Squamous cell carcinoma of the thoracic esophagus.

Carcinoma of the esophagus, the fourth most common malignant tumor of the gastrointestinal tract, still has a dismal outlook. Since July 1960, we have collected data on 642 patients with this lesion. Adenocarcinomas (which might arise from gastric mucosa) have been excluded. Almost one-fifth of the patients were far-advanced and inoperable when first diagnosed. Time between onset of symptoms and diagnosis was deemed excessive in over half of the patients; physicians frequently accounted for much of this delay. Preoperative diagnosis proved accurate in 99 per cent of the cases. Evaluations of direct extensions and distant metastases and attention to nutritional status correction were of prime importance. Operative technique and indications for surgery have become "standardized," and while surgical mortality has remained about 20 per cent throughout the period, morbidity has decreased steadily. Comparisons of irradiation and surgery in relation to palliation indicate that palliation is probably better in the surgically treated patient. However, it is emphasized that this comparison, as well as comparison of other results, is not scientifically valid since the groups of patients are not comparable due to clinical selection.

Carcinoma, Squamous Cell↗
PubMed1979

Plasma and tumor ACTH in carcinoma of the lung.

Plasma and tissue contents of immunoreactive ACTH were determined in 100 patients undergoing surgical resection for lung cancer. ACTH was detectable (greater than 1 ng ACTH equivalent/g wet weight) tissue in 47 of 49 specimens of epidermoid carcinoma, in 15 of 17 specimens of adenocarcinoma and in 7 of 8 specimens of large cell carcinoma; the median concentrations in these three tumor types were 8, 3 and 9 ng/g, respectively. Patients with oat cell carcinoma were not considered candidates for curative resection and are not included in this series. ACTH was not detectable in 36 specimens of apparently normal lung tissue from the same lobe but distant from the tumor and ranged up to 6 ng/g in 14 other specimens. One-half of patients with epidermoid carcinoma but only one-quarter of those with adenocarcinoma had preoperative plasma levels exceeding 250 ng/L plasma. About 75% of patients survived for at least one year whether preoperative plasma levels were greater than 400 ng/L or less than 200 ng/L. In only 4 of 21 patients with preoperative levels greater than 300 ng/L did the plasma fall by at least one-half in the immediate postoperative period. It is concluded that measurement of preoperative and postoperative plasma immunoreactive ACTH does not have a prognostic value for remission or long term survival in lung cancer, probably because it is unlikely that the tumor per se is the sole source accounting for the elevated levels generally observed in this condition.

Adenocarcinoma↗
PubMed1979

Symptomatic lower esophageal ring: treatment of 24 patients.

The lower esophageal ring, or Schatzki's ring, consists of a thin, submucosal, circumferential scar which forms a thin incomplete diaphragm in the lower esophageal lumen. The symptoms may be either episodic aphagia or progressive dysphagia, and the severity of symptoms is related to the diameter of the ring. Between 1970 and 1978, we saw 24 patients with lower esophageal rings and complaints of episodic aphagia or progressive dysphagia. Symptoms of esophagitis were present in 20 of the 24. Twenty were treated surgically by interrupting the rings and repairing the sliding hiatal hernias. Two were treated by dilatation and two received no treatment to the ring. Hiatal hernias have recurred in two patients. In one, there is a recurrent ring and in the other, an acid peptic stricture. The ring has responded to dilatation and the peptic stricture to dilatation and repair of the recurrent hernia. Two patients without symptoms of esophagitis, treated by dilatation, are doing well but the follow-up period is so far too short to draw any conclusion.

Aged↗
PubMed1977

Adjuvant cancer chemotherapy after resection of carcinoma of the lung.

A prospective randomized trial was conducted by the Veterans Administration Surgical Adjuvant Group in an attempt to discern the value of prolonged intermittent courses of adjuvant cancer chemotherapy after a successful curative resection of a carcinoma of the lung in men. Four hundred and seventeen patients were randomized into three groups; 132 patients received cyclophosphamide (Cytoxan), regimen A; 142 patients received cyclophosphamide alternating with methotrexate, regimen b; and 143 patients received no additional therapy, the controls. The patients in the two treatment groups received an average of 7.1 drug courses. No drug mortality was noted, but toxic symptoms of varying severity were seen after 43.6% of the drug courses. Five-year survival in the two treatment groups was 24.9% (regiment A) and 25.7% (regimen B), respectively, and 23.5% in the control group. No treatment benefit was associated with adjuvant chemotherapy in this trial.

Adult↗
PubMed1977

Cushing's syndrome associated with bronchial adenoma.

A case of Cushing's syndrome associated with a bronchial adenoma treated eight years before with bilateral adrenalectomy was cured by surgical excision of the bronchial adenoma. A discussion of clinical and hormonal features of this lesion is presented. It is concluded that this tumor manifested a capability of synthesizing and releasing substances which are chemically and biologically similar to adrenocorticotropic hormone andmelanocyte-stimulating hormone (MSH). Stimulation of the adrenal cortex by this material results in hyperplasia and hypersecretion, and stimulation of the melanocytesy MSH resulted in excessive pigmentation. Acknowledgment: We are indebted to Doctors Wendell Nicholson, David N. Orth, and Grant W. Liddle of Vanderbilt University for determinations of ACTH and MSH levels and to Mrs. E.P. Jessup for assistance in preparation of statistical data for this manuscript.

Adenoma↗
PubMed1977

Massive pulmonary gangrene.

A 49-year-old man suffered massive necrosis of the lung subsequent to a pneumococcal lobar pneumonia. Development of massive hemoptysis required emergency lobectomy. The patient is doing well six months after surgery. Pulmonary gangrene is a rare but grave complication of the lobar pneumonia. Both pneumococcal and Klebsiella pneumonias may progress to massive pulmonary gangrene despite antibiotic treatment. Survival seems to depend on the surgical removal of the necrotic tissue, which removes the danger of sudden massive hemoptysis.

Gangrene↗