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Biomedical subjects

F G Pearson

Publications and source records attributed to F G Pearson.

At least 91 records · Page 5Linked to original sources
PubMed1977

Surgical treatment for pulmonary emphysema.

Three in-vivo observations stimulated interest in surgical treatment for emphysema: (a) the destructive changes are rarely generalized, (b) the central portions of the lungs are frequently less seriously affected, and (c) marginal folding produces obstructive change in the more normal lung tissue. If destroyed avascular space-occupying areas can be removed, the compressed lung tissue may be stretched to fill pleural space in a functionally effective fashion. Residual elastic tissue will them maintain patency of terminal bronchioles. Preoperatively the extent of the destructive change can be defined most accurately by pulmonary angiography, and zones of functioning capilary circulation can be identified. Forty-seven patients with multifocal space-occupying emphysematous change have been treated surgically. The postoperative mortality was 21% but worthwhile long-term improvement has been obtained in 45% of patients presenting with disabling dyspnea. In these patients, surgical treatment warrants consideration if significant space occupation accompanies the bullous disease, provided alveolar vascularization can be demonstrated in the compressed adjacent normal lung tissue. Limited resections that preserve all vascularized and potentially functioning lung tissue are preferable. It is essential that obliteration of the hemithorax be obtained promptly in view of the high incidence of postoperative complications requiring secondary operative procedures, if 'leaks' and residual spaces are allowed to persist. Postoperative care in a respiratory intensive care unit is mandatory.

Adult↗
PubMed1977

Intraoperative and postoperative esophageal manometric findings with Collis gastroplasty and Belsey hiatal hernia repair for gastroesophageal reflux.

The combination of a Collis gastroplasty with a Belsey Mark IV fundoplication has proved clinically effective in the management of certain patients with complications of gastroesophageal reflux. The present study measured the effect of gastroplasty and Belsey repair on intraluminal pressure changes in the gastroplasty and lower esophagus. Manometric studies were performed preoperatively, intraoperatively, and postoperatively. In each case the gastroplasty segment of the esophagus was found to function as a high pressure zone (HPZ). The pressure in this zone further increased following the fundoplication. It could be diminished with intravenous administration of Buscopan and augmented with intravenously given pentagastrin. The original lower esophageal sphincter in most instances was included in the upper segment of the gastroplasty tube, but the entire length of the gastroplasty tube functioned as an HPZ, and pressures in the tube were considerably higher than those originally present in the lower esophageal sphincter. These studies provide a physiological rationale for the effectiveness of gastroplasty and fundoplication.

Animals↗
PubMed1976

Reflux control following extended myotomy in primary disordered motor activity (diffuse spasm) of the esophagus.

We have previously reported the results of extended esophageal myotomy and Belsey hiatal hernia repair in 21 patients. Reflux was considered to be a late complication of this operation, and gastroplasty has subsequently been added. Thirty-four patients have now been surgically treated, 17 with myotomy and Belsey repair and 17 with myotomy, gastroplasty, and Belsey repair. Eight of the 17 with Belsey repair developed clinical and roentgenographic signs of reflux 6 to 27 months following operation without evidence of hernia recurrence; 5 of the 8 patients have required further operation, with the addition of gastroplasty for reflux control. Seventeen patients were treated primarily by extended myotomy, gastroplasty, and Belsey repair. None of the patients who underwent gastroplasty have reflux symptoms, and only 1 shows a trace of reflux radiologically.

Adult↗
PubMed1976

A manometric study of the upper oesophagus in the dog following cuffed-tube tracheostomy.

Intraluminal oesophageal pressures were measured in dogs after tracheostomy and intubation with either uncuffed or cuffed tracheostomy tubes. Possible explanations for disordered swallowing following tracheostomy were found in those animals intubated with cuffed tracheostomy tubes: (a) Increased intraluminal pressures were measured in the oesophagus at the level of the cuffs. (b) Significantly increased pressures were found also 5 and 10 cm below the pharyngo-oesophageal junction. (c) The upper oesophageal sphincter relaxed incompletely.

Animals↗
PubMed1976

Carinal resection. A report of two cases and a description of the anesthetic technique.

Two cases of carinal tumor managed by resection and primary anastomosis are presented. Their course is discussed and a description of an anesthetic technique which obviates the need for cardiopulmonary bypass is presented. The principles of carinal surgery are discussed, emphasizing expert anesthesia and resection line control by frozen-tissue examination.

Anesthesia, Endotracheal↗
PubMed1976

Long-term follow-up of peptic strictures managed by dilatation, modified Collis gastroplasty, and Belsey hiatus hernia repair.

Between 1964 and 1974, 277 patients with peptic esophagitis were managed by modified Collis gastroplasty and Belsey hiatus hernia repair. By adding a gastroplasty in patients with esophageal shortening, an antireflux repair can be done below the diaphragm, with elimination of tension on both the repair and the intrathoracic esophagus. Indications for repair in this series were peptic strictures, 102; recurrent hiatus hernia, 90; panmural esophagitis with stricture, 44; and reflux esophagitis associated with primary motor disorders, 41. Results of treatment are being evaluated by clinical history, esophagography, esophagoscopy and manometry; and generally they appear to be excellent. However, follow-up is too short in many of these patients to permit meaningful evaluation. A more critical analysis is provided by long-term follow-up of patients with the most severe pathology. This report reviews results in the 33 patients in the series, with peptic strictures, operated on more than 5 years ago. Five of the 33 patients died of unrelated disease before reaching their fifth year after operation, and two were lost to followup. Twenty-six patients have been followed 5 to 12 years since operation. Twenty-five patients had excellent results which were sustained during the period of follow-up. They take a regular diet without dysphagia, and none has symptomatic reflux. One patient, whose symptoms initially resolved, developed recurrent reflux due to peptic ulceration and pyloric stenosis. The functional results achieved with this operation are good and are maintained well beyond 5 years. Results reported with alternative, conservative operations for peptic stricture are reviewed.

Adult↗
PubMed1976

Preoperative assessment of esophageal pathology.

Panmural esophagitis results in esophageal thickening and shortening and prevents adequate reduction of a hernia. Twenty patients with panmural esophagitis, treated by Belsey repair, have been followed up for more than 5 years; 9 of them remain asymptomatic and 11 have symptomatic reflux, 7 of whom have required further surgery. Belsey also has reported a 45 per cent recurrence rate in patients with this type of disease. Preoperative recognition of panmural esophagitis allows a planned surgical approach and the use of a surgical technique designed for the management of an irreducible hernia. The ability to predict these changes was studied in 124 patients, who were evaluated by history, radiology, endoscopy, and manometry prior to transthoracic hernia repair. The esophagus was inspected at operation to determine the presence of panmural changes. History was of no value in assessment. Radiologically, a large and irreducible hernia was associated with panmural changes, but these changes also occurred in the absence of ulceration. Manometric studies allowed accurate prediction of mural changes. Over 90 per cent of patients with panmural esophagitis have more than 40 per cent disordered motor activity (DMA) in the distal part of the esophagus, and 75 per cent of such patients have more than 60 per cent DMA. Combining these investigative data allowed the accurate prediction of panmural changes in 90 per cent of the 124 patients.

Diagnosis, Differential↗
PubMed1975

The effects of preoperative irradiation on primary tracheal anastomosis.

Preoperative radiotherapy was used in the management of selected patients with cancer of the lung or trachea who might subsequently require segmental resection of bronchus or trachea and reconstruction by primary anastomosis. This study was designed to determine the effects of varying dosages of preoperative irradiation on anastomotic healing. Two rings were resected from the cervical trachea of 20 dogs following irradiation with varying doses of cesium. There were no important adverse effects on healing of the trachea or adjacent organs in dogs receiving up to 3,500 rads. All dogs receiving a higher dose than this developed some anastomotic stenosis, which was severe in 6 of 8 animals. Similar adverse effects were observed in 2 patients managed by preoperative radiotherapy (4,000 rads in three weeks) and tracheal resection with primary anastomosis.

Animals↗
PubMed1975

Innominate artery rupture. A major complication of tracheal surgery.

Innominate artery rupture is a life-threatening complication of tracheal reconstructive surgery. Early postoperative rupture of the innominate artery occurred in 8 of 100 consecutive patients undergoing tracheal resection and reconstruction (93, end-to-end anastomosis; 7, Marlex prosthesis). A premonitory transient hemoptysis occurred in 4 of the 8 patients. This sign may permit early diagnosis and effective treatment. When massive hemorrhage occurs, prompt arterial compression, control of the airway, and subsequent ligation of the artery may be lifesaving. Direct repair of the arterial defect is not recommended. If the innominate artery lies in direct contact with the suture line following primary anastomosis, soft tissue interposition is recommended.

Adolescent↗
PubMed1975

Tracheal size following tracheostomy with cuffed tracheostomy tubes: an experimental study.

In view of the severe damage caused by unyielding, low residual volume cuffs, various modifications to the cuff of an intratracheal tube have been introduced. The merits of two low-pressure cuffs were assessed in an experimental study in dogs; both cuffs produced little visible damage to the tracheal wall in dogs intubated continuously over a two-week period. A modified technique of producing tantalum tracheobronchograms without distrubing the mucous blanket or traumatizing the tracheal wall is described. These tantalum radiological studies demonstrated a progressive temporary increase in size of the trachea at cuff level over the period of intubation with these cuffs. The implications of such a progressive weakness occurring in the tracheal muscle are discussed.

Animals↗
PubMed1975

Experience with surgical salvage in pulmonary tuberculosis: application to general thoracic surgery.

The diminishing incidence of pulmonary tuberculosis and the increasing effectiveness of drug therapy have resulted in an almost complete disappearance of surgical problems in the management of patients with this disease. However, the lessons learned from the management of such problems should not be forgotten, for they are equally applicable to the management of disabling and life-endangering problems in general thoracic surgical practice. "Salvage" situations develop when therapeutic requirements for control of disease are combined with factors affecting a patient's health so as to increase the surgical risk beyond the range usually considered acceptable. Attempts to salvage patients are indicated when treatment has failed to arrest disease, when life expectancy is threatened, or when return to normal activity is imperiled. Risk may be increased because of age, inadequate cardiopulmonary reserve, or chronic toxemia; in tuberculosis, risk may be increased because of positive sputum culture or resistance of organisms. Experience with 146 tuberculous patients has provided a basis for evaluation of the indications for resection, prophylactic and therapeutic thoracoplasty, and closure of bronchopleural fistulas in general thoracic surgical salvage. Both infection in residual spaces and bronchopleural fistulas are serious complications that can be controlled by thoracoplasty and pedicled muscle grafts. Prophylactic use of osteoplastic thoracoplasty and intercostal muscle grafts warrant more serious consideration. In established complications a "tailored" thoracoplasty can also be combined with an intercostal muscle graft.

Bronchial Fistula↗
PubMed1975

Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves.

Resections at the cricoid level pose the problems of damage to the recurrent laryngeal nerve and loss of circumferential cartilaginous support. Strictures within the cricoid ring have usually been managed with keels or stents, whereas neoplasms have been managed by laryngectomy. This paper reports on 6 patients with lesions involving the cricoid who were successfully treated by segmental tracheal resection and removal of all but a thin shell of posterior cricoid plate. The distal trachea was anastomosed at the subglottic level within 1 cm. or less of the vocal cords. Two patients had traumatic transection at the cricotracheal level with disruption of cricoid cartilage and avulsion of both recurrent nerves. Of the other 4 patients with tracheal lesions involving the cricoid, 2 had postintubation strictures, another had chemical burns, and the fourth had adenoid cystic carcinoma. Primary healing and good clinical results were obtained in all 6 patients. In the 4 patients with intact recurrent nerves, nerve function was preserved. This technique provides a method for resection and reconstruction in one stage for selected lesions at the cricoid level.

Adolescent↗
PubMed1975

Surgery in pulmonary aspergillosis.

Pulmonary aspergillosis is a rare disease, most commonly presenting as secondary invasion of pre-existing cavitary disease. In Toronto General Hospital 24 patients have been recognized as having this disorder in the 10 years from 1965 to 1975. The most common presenting symptoms were cough, sputum production, and hemoptysis, with the hemoptysis occasionally being massive. Tuberculosis and bronchiectasis were the commonest pre-existing diseases. Thirteen of these patients were treated by surgical resection because of major complications or progression of the aspergillosis. Five of these patients died following surgery, all of these having had major complications prior to surgical intervention. Of the eight surviving patients seven are progressing well, but one had developed further extension of his disease.

Adult↗