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Biomedical subjects

E C James

Publications and source records attributed to E C James.

At least 37 records · Page 2Linked to original sources
PubMed1981

Epidural analgesia for post-thoracotomy patients.

Fifty-three patients underwent 55 post-thoracotomy bupivacaine epidural analgesia experiences for pain control. Hospital records of all patients were analyzed for effectiveness of pain relief, changes in vital signs, and complications. In most instances, pain relief was adequate and patients were able to move, cough, and deep breathe unusually well in the postoperative period. Correlations were tested among changes in blood pressure, pulse, respiration, the actual value for low blood pressure, and subsequent elevation, age, sex, thoracotomy side, primary diagnoses, a secondary diagnoses, metastases, and complications. Systolic blood pressure reduction was greater in older patients who received epidural bupivacaine, with a correlation coefficient which attained significance (p less than 0.04). Patients who underwent thoracotomies for chronic pulmonary inflammation (p less than 0.04) or patients who had previous myocardial infarctions (p less than 0.05) also demonstrated significant reduction in systolic blood pressure. However, the number of patients in each group (six and four, respectively) makes their significance questionable. Although there were no serious complications or deaths attributable to this technique of pain control, possible morbidity is discussed. Removal of the epidural catheters was without incident. There was no evidence of irritation, pain, or infection at the catheter placement sites.

Adult↗
PubMed1980

Treatment of esophageal carcinoma: a retrospective review.

Two hundred fourteen patients underwent treatment for carcinoma of the esophagus between January, 1950, and July, 1978, with an over-all 5 year survival rate of 1.9%. Forty-six patients (21.5% of series) underwent esophageal resection with either esophagogastrostomy (37 patients) or colon interposition (nine patients). The operative mortality rate was 18.9% for the esophagogastrectomy group and 33% for the colon interposition patients. "Curative" resections resulted in a 14.3% 5 year survival rate. One hundred twenty-seven patients (59.3% of series) were treated by irradiation therapy, with a mean survival time of 9.6 months for patients receiving "curative" dosage (over 4,500 rads). There were no 5 year survivors in this group. Palliative procedures, such as feeding gastrostomy and palliative (less than 4,500 rads) irradiation therapy, contributed little to patient comfort or survival. We favor a palliative approach to the treatment of esophageal carcinoma and believe that, when possible, esophageal resection with esophagogastrostomy is the preferable form of therapy and offers an occasional cure.

Adenocarcinoma↗
PubMed1980

Tracheal stenosis: an unusual presenting complication of idiopathic fibrosing mediastinitis.

Idiopathic fibrosing mediastinitis is a rare, obliterative, inflammatory process which is characterized by an abnormally exuberant proliferation of fibrous tissue within the superior mediastinum, resulting in the encroachment and occlusion of its contained structures. Usually, this is one of the low-pressure vascular structures, most often the superior vena cava. Airway obstruction as a primary presenting complication of this condition is rare with past treatment results usually being palliative at best. In this article, a patient with this complication is presented in whom emergent surgical treatment and tracheal decortication afforded permanent relief. The clinial presentation, morphology of the disease, and treatment are reviewed.

Adult↗
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↗
PubMed1976

Retained intrapulmonary bullet presenting with bronchial obstruction.

A patient is presented who demonstrated migration of a retained intrapulmonary bullet 7 years after injury. This resulted in bronchial occlusion and post-obstructive lung infection without apparent hemoptysis. Lobectomy is considered the operative procedure of choice for this condition.

Adult↗
PubMed1976

Sepsis complications in endoscopic retrograde cholangiopancreatography.

The overall complications rate with endoscopic retrograde cholangiopancreatography (ERCP) has been justifiably small. However, serious septic sequelae have resulted in extended morbidity and occasional mortality. This occurs following successful cannulation and the injection of contrast media in two clinical conditions: (1) when ductal obstruction impairs proper drainage and (2) when a pseudocyst is injected. The initial experience at Walter Reed and Madigan Army Medical Centers with 71 attempted ERCP procedures includes two cases of pseudocyst abcess. Although this represents only a 2.8 per cent overall incidence of infection, it constitutes a 33.3 per cent rate in the six patients with pseudocysts evaluated. Therefore, it is recommended that routine ERCP be contraindicated in suspected pseudocysts.

Abscess↗
PubMed1976

Treating perforated jejunal ulcer, a complication in the Zollinger-Ellison syndrome.

What is considered to represent the fourth case of perforated jejunal ulcer in association with the Zollinger-Ellison syndrome reported in the literature is discussed. Although documented in the original paper by Zollinger and Ellison, this remains a notably rare complication. Generalized peritonitis and related pathophysiological phenomena make initial definitive correction of the ulcer diathesis an extremely riskly undertaking and ill-advised. We submit that primary ulcer resection followed by total gastrectomy when the patient becomes a more suitable operative risk is the preferred method of management. The literature would appear to support this clinical view.

Adenoma, Islet Cell↗