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Biomedical subjects

E C James

Publications and source records attributed to E C James.

At least 19 recordsLinked to original sources
PubMed1992

Prognostic value of positive lymph nodes in rectal cancer.

Abdominal "curative" resections for rectal cancer in 109 patients with positive lymph nodes were prospectively studied. The best subdivision of patients for predicting outcome was into 1-3 and greater than 3 positive lymph node groups. Comparison with patients with greater than 3 positive lymph nodes demonstrated that patients with 1-3 positive nodes had less local (35.0 percent vs. 13.0 percent; P = 0.007) and less distant recurrence (45.0 percent vs. 26.0 percent; P = 0.04) and had much better crude five-year survival (58.2 percent vs. 17.0 percent; P less than 0.0001). For predicting postsurgical outcome in patients with positive lymph nodes, the results justify subdividing patients into the following two prognostic subgroups: 1) those with 1-3 involved lymph nodes and 2) those with metastatic tumor in four or more lymph nodes.

Adult↗
PubMed1991

Snowmobile trauma: an eleven-year experience.

Records of 88 patients with snowmobile injuries from 1977 to 1987 were reviewed to identify the types of trauma. Data collected included age, sex, method and degree of injury, use of safety attire, and risk factors. There were 77 males and 11 females. Seventeen (19.3%) were children under the age of 16. Poor driving judgment involved in the hitting of obstacles led to the majority of injuries. There were 106 fractures in 71 patients. Eighteen patients (25%) had more than one fracture. Eleven patients had loss of consciousness. Eighty-eight other injuries resulted for a total of 205 injuries. There were three fatalities. Results indicate that inexperience, prior use of alcohol, driver carelessness, excessive speed, and poor adherence to manufacturer recommendations were the leading contributors to the accidents.

Adolescent↗
PubMed1990

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures. One of the 10 patients had moderate renal insufficiency at follow-up. We present herein an additional 19 patients who underwent LRV division predominantly for aneurysmal disease of the abdominal aorta. Sixteen patients were available for follow-up. Three patients died in the intraoperative and early postoperative periods. Multivariate analysis of variance of preoperative, postoperative, and follow-up laboratory data--serum creatinine and BUN--showed no significant change in renal function as assessed.

Aged↗
PubMed1989

Cyclic-AMP in human lung preparations.

Cyclic-AMP levels in unaffected and affected cancerous portions of human lung preparations were determined by measuring displaced 3H-cyclic-AMP from the specific binding protein by unlabeled ligand. The levels of cyclic-AMP in unaffected portions of human lungs ranged between 52-116 pmoles/g protein. Significantly higher levels of cyclic-AMP were found in lung samples affected with squamous cell carcinoma, adenocarcinoma and malignant melanoma with the mean values being 251, 290, and 509 pmoles/g protein, respectively. On the other hand, a decrease in the level of cyclic-AMP to 39 pmoles/g protein was observed in portions of lungs affected with granuloma. These results suggest that the level of cyclic-AMP in lung tissue may reflect the malignant or benign nature of the pulmonary disease.

Adenocarcinoma↗
PubMed1979

Upper limb ischemia resulting from arterial thromboembolism.

Acute ischemia of the upper limb is commonly caused by trauma and embolic arterial occlusion. However, primary atherosclerotic thrombosis is found infrequently and concern regarding its incidence, recognition, and treatment prompted a review of our clinical experience. Of 36 patients with acute ischemia of the upper limb, 17 (47.2 per cent) had embolic occlusion, 9 (25 per cent) iatrogenic thrombosis in the brachial artery, and 10 (27.8 per cent) primary arterial thrombosis. Of the total group, noncardiac arterial emboli (two patients) and primary atherosclerotic thrombosis (six patients) accounted for 8 of 36 (22.2 per cent) ischemic limbs. Including 2 additional patients who had atherosclerotic thrombosis associated with trauma, the total number represented 10 of 36 (27.8 per cent). An aggressive approach to the undiagnosed patient with acute ischemia of the upper limb is warranted, including the use of arteriography in most cases. In patients with iatrogenic thrombosis in the brachial artery, we believe that the routine use of intraoperative arteriograms may improve the operative results.

Adolescent↗
PubMed1978

Penetrating wounds of the neck and upper thorax.

During the past decade, a method utilizing individual case assessment has been employed in the treatment of 51 patients with penetrating wounds of the neck and upper thorax. Only those wounds penetrating the platysma are included. Thirty-five patients (68.6%) underwent neck exploration; 16 patients (31.4%) were managed nonoperatively. Overall, five patients died, four patients following operative treatment and one treated nonoperatively, for a mortality rate of 9.8%. In the nonoperative group, a mortality of 6.2% (one death) compares favorably with an operative mortality of 11.4% (four deaths). Ten patients (29%) in the neck exploration group exhibited significant later morbidity compared to seven patients (44%) in the patients not explored. Therefore the morbidity from a negative neck exploration was only 2% (one of 20 patients). The techniques for exploring the neck are discussed. Adequate surgical exposure is largely dependent on the possibility of vascular injury, the most common cause of death in this series.

Adult↗
PubMed1978

Treatment of massive gastrointestinal hemorrhage from aortoenteric fistula.

Massive hemorrhage of the upper part of the gastrointestinal tract presents a formidable crisis in surgical management. The preoperative diagnosis should be suspected in patients with a vascular prosthesis or primary abdominal aortic aneurysm. The characteristic signs and symptoms represent the triad of a pulsatile mass in the upper part of the abdomen, intermittent hemorrhage in the upper part of the gastrointestinal tract and severe epigastralgia not relieved by antacids. No ideal operative technique has evolved for correcting the abnormal physiopathologic condition. Our recent experience with three patients highlights the problems of unremitting sepsis and recurrent fistulization.

Aged↗
PubMed1978

Division of the left renal vein: a safe surgical adjunct.

Ten patients have undergone surgical division of the left renal vein (LRV) during operations on the abdominal aorta. Nine were elective procedures performed during the resection of a complicated abdominal aortic aneurysm (six patients) or treatment of complete infrarenal aortic occlusion (three patients). The first patient in this series underwent emergency LRV ligation at the renal hilum for the control of hemorrhage incurred during an elective aneurysmectomy. This patient survived postoperative renal failure and myocardial infarction, but died 21 months later from another myocardial infarction. At the time of death, he had moderate renal insufficiency. None of the remaining nine patients undergoing elective LRV division experienced any apparent renal dysfunction, as measured by urine sediment, serum creatinine, blood urea nitrogen, and intravenous pyelography. Although not recommended as a routine maneuver, division of the LRV is advocated as a safe adjunct for surgical exposure in difficult aortic procedures.

Adult↗
PubMed1977

The current status of chemodectomas.

An analysis of the current status of chemodectomas including the report of two additional cases is presented. One patient with a rare malignant intrathoracic tumor failed to survive palliative pneumonectomy. To our knowledge, this represents the seventeenth histologically proved case. The other patient had the more common carotid body tumor which was managed satisfactorily by subadventitial carotid excision. Comments are made regarding the clinical recognition and treatment of chemodectomas in general. Historical, anatomic, physiologic, and pathologic features are emphasized.

Adult↗
PubMed1977

Technique for intraoperative arteriography after arterial reconstruction of the lower extremity.

A simple technique for performing intraoperative arteriography to assess the adequacy of arterial reconstruction of the lower extremity has been devised. All arterial reconstructive procedures are readily visualized using undiluted Renografin 60. Unnecessary time delays are avoided with the optimum co-operation between the surgeon and the Radiology Department. Excellent quality arteriograms are obtained using basic materials without the need for more sophisticated arteriographic equipment.

Angiography↗
PubMed1977

Soft tissue necrosis and gangrene complicating treatment with the coumarin derivatives.

Skin and soft tissue necrosis, in association with the coumarin derivatives, characteristically afflicts females between the third and tenth days of treatment. Anatomic regions abundant in subcutaneous fat are most commonly affected. Many of these patients have underlying serious medical problems. Three additional patients with tissue infarction complicating coumadin therapy are presented. Possible etiologic mechanisms are discussed, but the basic physiopathologic condition remains an enigma. Venous thrombosis can be a related clinical phenomenon. Treatment perspectives are outlined.

Adult↗
PubMed1976

Preferred surgical treatment for alveolar cell carcinoma.

An analysis of our experience with 48 patients having bronchiolar or alveolar cell carcinoma is reported. The remarkable biological variability of this peripheral tumor has important surgical implications. Basically, two dominant clinical presentations occur. In the less common diffuse or multinodular form, prolonged survival is infrequent regardless of the therapeutic approach. Often these patients die from respiratory compromise due to the tumor itself. In the more common localized or solitary form the prognosis for cure is good, approximating 47% or higher. Based on the material presented, lobectomy is the preferred method of surgical treatment. In patients manifesting multinodular disease, surgical resection rarely seems warranted. The concept of preserving pulmonary tissue is stressed.

Adenocarcinoma, Bronchiolo-Alveolar↗