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Health Maintenance Organizations↗
Biomedical subjects
C G Lockhart
Publications and source records attributed to C G Lockhart.
Selective preoperative evaluation for possible N2 disease in carcinoma of the lung.
The efficacy of computed tomography and surgical mediastinal exploration in determining tumor resectability were retrospectively evaluated in 92 consecutive patients with non-small cell lung carcinoma. Status of mediastinal nodes was ultimately determined by surgical mediastinal exploration or thoracotomy. Patients were divided into three groups on the basis of chest roentgenography: Group I comprised 30 patients with peripheral T1 or T2 lesions with normal hilar and mediastinal shadows. Only one patient was found to have an involved node. Chest roentgenography had an accuracy rate of 96% and computed tomography, 93%. Thoracotomy is recommended without either computed tomography or surgical mediastinal exploration in this group. Group II comprised 47 patients with T1 or T2 lesions with an abnormal hilus, an abnormal mediastinal shadow, or either the hilus or mediastinum obscured by overlying parenchymal disease. Computed tomography revealed mediastinal nodes 1 cm or greater in size (abnormal node group) in 21 patients (45%) and smaller than 1 cm (normal node group) in 26 patients (55%). Surgical mediastinal exploration was performed in the abnormal node group and involved nodes were found in 17 of 21 patients (81%). In the normal node group, thoracotomy only was performed and no involved nodes were found. Computed tomography is recommended in all patients in Group II. Patients in the normal node group may be subjected to thoracotomy only and those in the abnormal node group should undergo surgical mediastinal exploration as the next diagnostic step before thoracotomy. Group III comprised 15 patients with grossly abnormal mediastinal shadows. Findings from computed tomography were abnormal in all 10 patients in whom it was done. Surgical mediastinal exploration was done in all 15 and yielded abnormal results in 14. It is recommended in this group that computed tomography is unnecessary and surgical mediastinal exploration should be the only diagnostic procedure. Thus, in potentially resectable non-small cell lung carcinoma, the use of computed tomography and surgical mediastinal exploration should be selective and should be determined by appropriate initial interpretation of the chest roentgenogram.
Carcinoma, Non-Small-Cell Lung↗
Experience with St. Jude Medical valve prosthesis in children. A word of caution regarding right-sided placement.
Thirty-six children aged 6 months to 18 years, underwent insertion of 37 St. Jude Medical cardiac prostheses. In 20, the valve was placed in the aortic or mitral position, and in 16 in the pulmonary or tricuspid position. There was one (2.8%) hospital death. All patients received maintenance doses of salicylates and dipyridamole after the operation. Follow-up data are available for all patients for 12 to 24 postoperative months. There was no incidence of valve dysfunction or thromboembolic complication in any of the 20 patients with valves in the systemic (left) side of the circulation, and all manifested improvement in their functional class. In contrast, six (37%) of the 16 patients with valves in the pulmonary (right) side of the circulation developed dysfunction of the prosthesis 1 to 6 months after insertion. Prosthesis failure was associated with fibrous tissue growing into the struts, leading to leaflet immobilization. At 2 years, the actuarial functional life was 100% for mitral and aortic valves and 70% for pulmonary and tricuspid valves. The data illustrate the excellent hemodynamic function of the St. Jude Medical valve in children. The absence of thromboembolic complications warrant continued implantation of the prosthesis in the left side without warfarin anticoagulation therapy, but the high incidence of valve dysfunction in the pulmonary position does not justify its continued use in the right side.
Adolescent↗
Detection of antibody to carcinoembryonic antigen by the hemolytic plaque assay.
A modification of the standard hemolytic plaque-forming cell assay is described. The conjugation of a soluble antigen, carcinoembryonic antigen, to the membrane of the sheep red blood cell was accomplished and used as the indicator system to detect antibody-forming cells. The specificity of the assay was determined by cross-reacting studies and competitive inhibition by antigen blocking.
Animals↗
Treatment of the ruptured abdominal aorta.
Prompt, well-conceived surgical intervention during the critical early minutes after rupture of the abdominal aorta is capable of increasing the salvage of this not uncommon emergency. The demanding intraoperative and postoperative complications must be anticipated and coped with effectively if the present plateau of survival is to be improved. Alternative technical approaches in controlling exsanguinating aortic blood flow are available and are worthwhile additions to the armamentarium of the surgeon. The advantages of the transthoracic approach for control of hemorrhage are emphasized and should be resorted to in selected patients.
Aorta, Abdominal↗