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Biomedical subjects

E F Parker

Publications and source records attributed to E F Parker.

At least 19 recordsLinked to original sources
PubMed1997

Save the child's esophagus, Part II: Colic patch repair.

PURPOSE: In a previous report, the authors documented the procedures necessary to regain esophageal continuity in infants who had massive disruption of the suture line following esophagoplasty. As a corollary, this study shows the feasibility of preserving the esophagus in older children by using an esophageal patch. METHODS: Fifteen children ranging in age from 8 months to 16 years at the time of surgery had repair of esophageal strictures or tracheoesophageal fistulae by the use of a vascularized patch rather than esophageal resection and interposition with colon or stomach. The technique of "colonic-patch oesophagoplasty" was described by Hecker and Hollman in 1975. From 1976 to 1995, the authors have used a modification of their procedure in 14 children, and in one patient an intercostal muscle flap was interposed. The technique consists of esophagotomy through the area of stricture with application of a vascularized patch of colon to the resulting defect. RESULTS: Ten of the patients were boys and four were girls with an additional girl considered for the procedure at 8 months of age. However, during surgery, an intercostal muscle flap interposition was used. Eight children had esophageal stricture caused by lye ingestion; two from anastomotic stricture; two from gastroesophageal reflux; two from recurrent tracheoesophageal fistula; and one from long-term nasogastric intubation. Follow-up showed excellent results in nine patients who had the colic patch operation. All had good swallowing. A tenth patient, the child with the vascularized intercostal muscle flap, is currently eating a regular diet but it has only been 4 months since the operation. However, one of these excellent patients continues to have a small focus of Barrett's esophagus and another one was killed in an automobile accident one year after operation. Three children have good results but with occasional difficulty in swallowing boluses of meat or with continuing reflux. Two patients had poor results and both have undergone reoperation. In one of these children with Down's syndrome and diabetes, the colic patch worked well for 6 years but because of continuing reflux, distal esophageal scarring and obstruction eventually ensued. After reoperation for distal esophageal resection and colic interposition, the patient died of pulmonary failure. The second child with poor results has recently undergone reoperation to extend the esophagotomy through the distal scarred esophagus and to revise the colic patch. CONCLUSION: The use of a vascular colic patch for treatment of severe esophageal strictures is a viable alternative to esophageal resection and interposition. However, patients with continuing reflux or Barrett's esophagus, or both, may progress with distal esophageal scarring and obstruction and subsequent dilation of the patch. Those patients will require reoperation.

Adolescent↗
PubMed1993

Barrett's esophagus in children. Diagnosis and management.

OBJECTIVE: To determine the local prevalence and optimal therapy for children with Barrett's esophagus (BE), the authors studied children with esophageal strictures or gastroesophageal reflux (GER), or both, to diagnose BE and to follow after therapy. SUMMARY BACKGROUND DATA: Barrett's esophagus is seldom reported in children and therapeutic recommendations are unclear. Barrett's esophagus usually develops during the mucosal reparative process after acid-reflux injury to the esophageal mucosa. Risk factors for BE include conditions that are associated with GER such as mental retardation, esophageal stricture, esophageal atresia, and reversed gastric tube esophagoplasty. Barrett's syndrome increases the risk of esophageal adenocarcinoma by 30 to 40 times. METHODS: All children with the risk factors had repeated esophagoscopy and multiple mucosal biopsies before and after therapy. RESULTS: Eleven children have been documented with BE. The initial diagnoses were: GER, 5; esophageal atresia, 4; nasogastric intubation, 1; lye ingestion, 1. A gastric tube esophagoplasty had been performed in three patients with BE in the esophagus proximal to the anastomosis. Three children with mid-esophageal strictures and long segments of BE had total resection with colic interposition. An additional two patients with tight stricture were treated with colic-patch esophagoplasty without resection. The final three patients were treated with fundoplication alone. CONCLUSIONS: Barrett's esophagus can be caused by acid from gastric tubes but responds to H2 blockers and diet. Resection eliminates BE; esophagoplasty only controls the stricture and must be accompanied by fundoplication. Barrett's esophagus persists in patients with fundoplication alone if reflux control is incomplete. The authors conclude that acid reflux must be controlled to treat BE successfully or the involved segment must be resected. Esophagogastrostomy apparently predisposes to BE.

Adolescent↗
PubMed1989

Surgical resection for complications of pulmonary tuberculosis.

From 1975 through 1984, 24 patients at the Medical University of South Carolina underwent surgical resection for complications of pulmonary tuberculosis. The complications fell into three major categories: persistent or drug-resistant disease, bronchiectasis, and hemoptysis. The major indications for surgical intervention included hemoptysis (14 patients), drug resistance (5), possible neoplasm (3), and bronchiectasis (2). Impaired pulmonary function was common. Surgical therapy generally necessitated lobectomy, sometimes resulted in substantial blood loss, and had a total major and minor complication rate of 46%. Despite these problems, the long-term prognosis after successful resection is good.

Adult↗
PubMed1989

A comparison of endoesophageal tubes. Improved results with the Atkinson tube.

We reviewed our use of endoesophageal tubes for the palliation of patients with carcinoma of the esophagus from 1973 through 1986. Celestin tubes were implanted by means of laparotomy and traction. Proctor-Livingston tubes were implanted by pulsion with frequent laparotomy for staging. All Atkinson tubes were placed by means of the pulsion method without simultaneous laparotomy in any case. Patients with an Atkinson tube had fewer complications, including aspiration, sepsis, reflux, and pneumonia. Mean hospital stay was shortened to 4 days when the Atkinson tube was used, and hospital death rate was 6% versus 42% when either the Celestin or Proctor-Livingston tube was used. Mean long-term survival (108 days) was significantly lengthened when Atkinson tubes were used. A comparison of all patients receiving tubes revealed a less frequent prevalence of reflux when the distal end of the tube was positioned above the gastroesophageal junction. Laparotomy resulted in significantly more episodes of aspiration, sepsis, reflux, and pneumonia. Laparotomy was also associated with a 41% hospital death rate versus 17% when laparotomy was not performed. Hospital days were shortened to 7 versus 16 days when laparotomy was not performed. The Atkinson tube provided improved palliation and decreased morbidity and mortality in our hands. These benefits were probably the results of ease of insertion without the use of a laparotomy and the ability in most cases to position the distal end of the tube above the gastroesophageal junction.

Aged↗
PubMed1989

Chemotherapy, radiation therapy, and resection for carcinoma of the esophagus. Long-term results.

From May 1980 to May 1984, preoperative chemotherapy (mitomycin C and 5-fluorouracil) was added to radiation therapy in patients with potentially operable squamous cell carcinoma of the esophagus. Of 129 patients observed, 122 were followed up until death or to the present. Only 33 were able to complete preoperative chemotherapy and radiation and undergo resection. There were 28 men and five women, their ages ranging from 42 to 81 years (average 60 years). There were 22 black and 11 white patients. The location of the tumor was in the middle third in 70% of the patients. Among the 33 patients, the clinical TNM classification was as follows: T1 N0 M0, three patients; T2 N0 M0, 27 patients; T2 N1 M0, two patients; and T3 N0 M0, one patient. The length of the lesions when measurable in the absence of complete obstruction varied from 3 to 17 cm (average 7 cm). The operative mortality rate in this group was 12% (4/33). There was no viable residual tumor in the surgical specimen of the esophagus in 33% (11/33) of those patients completing triple therapy. However, in two of the 11 patients, left gastric nodes contained tumor and in one there was a minute esophageal perforation. The 2-year survival rate was 33% (11/33), and the 5-year survival rate was 15.4% (5/33). Among the 11 patients having 2-year survival, the surgical specimen was normal in six and abnormal in five. Of the five patients having 5-year survival, the surgical specimen was normal in three and abnormal in two. The absence of tumor in the surgical specimen did not appear to confer any better chance for long-term survival. Data were compared to our 1967-1975 series of 75 patients receiving only preoperative radiation and resection. There was no significant difference in survival rates at 2 years (20% [1975] versus 33% [1984], p = 0.2118) or at 5 years (10% [1975] versus 15.4% [1984], p = 0.5796). The addition of preoperative chemotherapy as an adjunct did not result in a statistically significant increase in 2-year or 5-year survival rates.

Adenocarcinoma↗
PubMed1988

The surgical management of esophageal stricture in children. A century of progress.

Early in this century all procedures performed on the esophagus were accomplished through its lumen. Ingestion of caustics was common and resulted in dense strictures for which complicated and ingenious methods of dilation were advised. Because obstructions usually recurred, by-pass operations were devised with conduits of skin or segments of the gastrointestinal tract. Now, in contrast, when burns occur, intensive steroid therapy usually prevents all but localized areas of stricture. These areas, if short, can be treated with hydrostatic balloon dilation under fluoroscopic control. If longer or resistant to dilation, these strictures can be managed by incision and insertion of a colic patch with excellent long-term results. To a previous series of children who have had esophageal patch with a vascularized segment of colon, now added is an experience with a free segment of small intestine with vascular anastomosis to an artery and vein in the neck and another case of a free patch of pericardium to the esophageal stricture.

Burns, Chemical↗
PubMed1985

Chemoradiation therapy and resection for carcinoma of the esophagus: short-term results.

The purpose of this report is to record the results of a treatment protocol for patients with carcinoma of the esophagus. In May, 1980, we initiated a program of chemoradiation therapy preliminary to resection in patients in whom the protocol was applicable. The chemotherapy consisted of mitomycin-C, 10 mg as a bolus intravenous injection on day 1, and 5-fluorouracil, 1,000 mg per square meter of body surface area in 1,000 ml of 5% glucose solution in distilled water given intravenously on each of days 1 through 4. The radiation therapy consisted of 3,000 rads in three weeks using cobalt 60 or 6 MeV or greater, with ports to cover the tumor and mediastinum. This protocol was given to patients with primary carcinoma of the esophagus whose disease remained or became operable during or following the course of the chemoradiation. Among the patients treated according to the protocol, the operability rate was increased. The resectability rate remained about the same as in our previous experience. The operative mortality was lessened appreciably. The percentage of resected specimens of the esophagus showing residual tumor decreased. However, the absence of any residual tumor in the surgical specimen has not conferred any improved chance of long-term survival to date. There has been a two-year survival of 33% (7/21) among the small group having chemoradiation therapy prior to resection, and this figure is roughly the same as that in our previously reported series of patients treated by preoperative irradiation (4,500 rads in three weeks) and resection without the chemotherapeutic adjunct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1982

Carcinoma of the esophagus. Observations of 40 years.

The long-term results of treatment of primary carcinoma of the esophagus continue to be poor, and attempts to improve them remain as challenging as any that exist in the field of malignant neoplasia today. Even so, there has been improvement, and this report contrasts age, race, sex, levels of involvement, methods of treatment, and results in our first series of 170 cases, seen between 1940 and 1951, with those in our last series of 300 cases, seen between 1967 and 1975. In the latter group, among those treated by megavoltage radiation as the sole theoretically curative method, the five-year survival rate was 1.0%. Among operable patients, there were 15 who had resection without preliminary radiation, with a mortality rate of 40% (6/15), a two-year survival rate of 13% (2/15), and a five-year survival rate of 7.0% (1/15). Also among operable patients, there were 75 who had resection following radiation therapy with a mortality rate of 19% (14/75), a two-year survival rate of 20% (15/75), and a five-year survival rate of 10% (7/75). These rates contrast with a five-year survival rate of 0.5% in the 1940-1951 series. Improvements in methods of treatment and adjuncts, such as nutrition, radiation, and operation, are cited. Even so, results in our last group did not show improvement over those in the 1962-1967 series. Therefore, we have begun a new program involving the use of chemotherapy in conjunction with radiation therapy and resection in those cases in which it may be applicable.

Adult↗
PubMed1980

Carcinoma of the lung: a clinical review.

Records of 702 patients with carcinoma of the lung seen from 1960 through 1970 were reviewed. The efficacy of various diagnostic and therapeutic procedures was assessed. Salient findings were as follows: Biopsy of nonpalpable ipsilateral supraclavicular lymph nodes was positive for carcinoma in 63 of 286 patients (22%). Even more surprising, biopsy of nonpalpable contralateral supraclavicular lymph nodes was positive for carcinoma in 9 of 38 patients (24%). Accordingly, the importance of biopsy of nonpalpable supraclavicular nodes is to be stressed. Squamous cell carcinoma was the most common type, but adenocarcinoma was more common in women and nonsmokers. Among the 702 patients, 48 (6.8%) were nonsmokers. The 5-year survival for 92 patients treated by lobectomy was 21%; the 5-year survival for 77 patients treated by pneumonectomy was 19%; the 5-year survival among 18 patients have resection of the chest wall in addition to resection of the primary lesion was 22%. Of 12 patients with small cell carcinoma of the lung treated by resection, there was 1 5-year survivor. The overall 5-year survival in the 702 patients was 6.6%.

Adenocarcinoma↗
PubMed1980

Control of hemoptysis by bronchial artery embolization.

Control of massive hemoptysis by embolization of bronchial arteries was achieved in two patients with bronchopleural fistula. Both patients would have been prohibitive risks for thoracotomy. The indications, contraindications, and technique of the procedure are presented as well as a review of the literature.

Aged↗