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Biomedical subjects

G A Lillington

Publications and source records attributed to G A Lillington.

At least 19 recordsLinked to original sources
PubMed1993

Management of the solitary pulmonary nodule.

Large lesions are often malignant and call for prompt resection. Small lesions are likely to be benign but nonetheless raise difficult questions. For example, how to estimate the potential for malignancy? Or, how to weigh the possible effectiveness of an aggressive surgical approach against possible complications? Probability techniques can provide support for clinical judgment.

Biopsy↗
PubMed1993

Evaluation and management of solitary and multiple pulmonary nodules.

Solitary pulmonary nodules are malignant in 50% of cases. The 5-year cure rate after resection of a malignant nodule averages 50% and is even higher if the nodule is small. Stability for 2 years suggests benignity, and the presence of calcification in certain patterns indicates that the nodule is probably benign. Biopsy of the nodule may establish benignity. The "wait and watch" strategy may be advisable under certain circumstances. Multiple pulmonary nodules are usually due to metastatic spread from an extrapulmonary primary tumor. Biopsy is usually advisable because the nodules may be due to a curable benign process.

Biopsy↗
PubMed1991

Management of solitary pulmonary nodules.

The solitary pulmonary nodule (SPN), a single intrapulmonary spherical lesion that is fairly well circumscribed, is a common clinical problem. About half of SPNs seen in clinical practice are malignant, usually bronchogenic carcinomas. Some nodules are primary tumors of other kinds or metastatic. Virtually all benign SPNs are tuberculous or fungal granulomas. The standard management of the SPN of unknown cause is prompt surgical removal unless benignity is established by prior chest roentgenograms showing that the nodule has been stable (i.e., showing no growth) for 2 years or by the presence of a "benign" pattern of calcification. Less universally accepted criteria for benignity include (1) transthoracic needle aspiration biopsy (TNAB) showing a specific benign process, and (2) patient's age under 30 to 35 years. Bronchoscopy has a low diagnostic yield, particularly for benign nodules. SPNs usually grow at constant rates, expressed as the "doubling time" (DT). A nodule with a DT between 20 and 400 days is usually malignant. Benign nodules usually have a DT greater than 400 days. The prospective determination of DT by serial chest roentgenograms (the "wait and watch" strategy) is widely criticized but has clinical utility in special circumstances, particularly if the likelihood of malignancy is low and/or the anticipated surgical mortality is high. The presence and pattern of calcification are best shown by high-resolution thin-section computed tomography (CT). Diffuse, laminated, central or "popcorn" patterns of calcification indicate benignity. An eccentric calcium deposit or a stippled pattern does not rule out malignancy. CT densitometry will often show "occult" calcification in nodules that show no direct visual evidence of calcium deposition. The characteristics of the edge of the nodule correlate with the likelihood of malignancy. Nodules with irregular or spiculated margins are almost always malignant. The probability that the nodule is malignant (pCA) is related to the age of the patient, the diameter of the nodule, the amount of tobacco smoke inhalation, the overall prevalence of malignancy in SPNs, the nature of the edge of the lesion, and the presence or absence of occult calcification. It is possible by Bayesian techniques to combine these factors to calculate a more precise and comprehensive prediction of pCA in any given nodule. The 5-year survival after nodule resection depends on the size of the nodule at the time of surgery; it may be as high as 80% with nodules that are 1 cm in diameter. Lymph node involvement is uncommon with small tumors, and many authorities question the need for CT staging in such cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Biopsy↗
PubMed1986

Estimating the probability of malignancy in solitary pulmonary nodules. A Bayesian approach.

Decisions about managing solitary pulmonary nodules often involve estimates of the likelihood that the nodule is malignant. We used Bayes' theorem to devise a simple scheme for estimating the likelihood that a solitary pulmonary nodule is malignant based on the diameter of the nodule, the patient's age and history of cigarette smoking, and data on the overall prevalence of malignancy in solitary nodules. This method may improve the accuracy of estimating the likelihood of malignancy for individual patients with solitary pulmonary nodules.

Age Factors↗
PubMed1986

Managing solitary pulmonary nodules. The choice of strategy is a "close call".

The best approach to the initial management of solitary pulmonary nodules is controversial. Using decision analysis, we compared the average life expectancy produced by alternative strategies for managing the patient with a solitary pulmonary nodule: thoracotomy for diagnosis and potential resection (IMMEDIATE SURGERY); needle aspiration biopsy or bronchoscopy (BIOPSY) followed by either thoracotomy or extended observation, depending on the results of the biopsy; and serial chest films with thoracotomy if the nodule grows at a potentially malignant rate (OBSERVATION). IMMEDIATE SURGERY produced a slightly longer average life expectancy when the probability of cancer was very high; BIOPSY had a narrow advantage when the probability of cancer was intermediate; and OBSERVATION produced slightly longer average life-expectancy when the probability of malignancy was very low. But the differences between strategies were so small that, in most circumstances, the decision was a "close call." Therefore, when choosing between these management strategies, physicians should give greater weight to considerations besides life expectancy, and should encourage patients to actively participate in the decisions about how to manage their solitary pulmonary nodules.

Adult↗
PubMed1985

Pseudo-pseudo-pseudotumor of the lung.

Benign lesions may simulate bronchogenic carcinoma by virtue of radiologic appearance or false-positive cytologic studies. A lung opacity initially suspected to be malignant was, on review, considered to be a loculated effusion. Needle biopsy yielded cells which appeared malignant. The resected lesion was a benign infarct.

Biopsy, Needle↗
PubMed1984

Alcohol and the respiratory tract.

Possible mechanisms by which alcohol may adversely affect the respiratory system are considered. Alcohol ingestion impairs glottic reflexes, and alcoholics are predisposed to pneumonias and lung abscesses from aspiration of oropharyngeal bacteria. Alcohol intoxication also increases the frequency of sleep apnea and may result in respiratory failure from oversedation.

Adult↗
PubMed1984

Dyspnea in the elderly: old age or disease?

Suspect pulmonary or cardiac disease when dyspnea occurs with moderate exercise. Age-related reductions in pulmonary function almost never result in dyspnea at rest--or with such exercise as walking at a normal pace. Cardiac origin of pulmonary changes can often be recognized by the presence of cardiac abnormalities such as gallop rhythms, ECG changes, and concomitant signs of right ventricular failure. In some cases, the cardiac origin of the abnormality can only be established by right heart catheterization.

Aged↗
PubMed1982

Fibrosing alveolitis. Causes, characteristics, and consequences.

Fibrosing alveolitis may be cryptogenic (idiopathic) or secondary to a wide variety of disease processes. In almost all cases, acute and subacute inflammatory lesions progress to fibrosis and finally to a terminal state called honeycomb lung. Diagnosis is based on clinical and radiologic findings together with demonstration of typical pathologic changes on lung biopsy. The biopsy specimen should be large and taken from less severely involved lung areas to increase the probability that early, more specific lesions will be harvested. Prednisone is usually recommended for specific therapy. Therapy is a factor in duration of survival, although patient response varies.

Biopsy↗
PubMed1982

Bronchoscopic location of bronchopleural fistula with xenon-133.

Successful application of the technique of transbronchoscopic endobronchial occlusion of a persistent bronchopleural fistula requires an accurate determination of the segmental location of the air leak. This was achieved by injections of small boluses of Xe-133 into a number of segmental bronchi through a fiber-optic bronchoscope. Following the instillation of Xe-133 into the segmental bronchus leading to the fistula, there was a marked increase in radioactivity in the intercostal drainage tube.

Aged↗