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Biomedical subjects

J B Mark

Publications and source records attributed to J B Mark.

At least 91 records · Page 5Linked to original sources
PubMed1983

Advantages of a new polyvinyl chloride double-lumen tube in thoracic surgery.

Double-lumen endobronchial tubes offer many advantages during thoracic operations. However, technical problems with tube placement and potentially life-threatening complications have discouraged widespread use of standard double-lumen tubes. Some of these problems may be reduced with a new polyvinyl chloride (PVC) double-lumen tube. A total of 214 intubations were undertaken in 204 patients using one of three endobronchial tubes. The cases of these patients were reviewed to determine differences in the complications associated with the Carlens, Robertshaw, and PVC tubes. Complications included unsuccessful or difficult intubation, tube dislodgment, unsatisfactory lung deflation, tube malposition, and hypoxemia. In 8 of 16 intubations with the Carlens tube and in 14 of 62 intubations with the Robertshaw tube, there were complications. In all, 22 of 78 intubations (28%) using conventional double-lumen tubes were complicated compared with 5 of 136 (4%) using the PVC tube. The technical problems and risks of endobronchial intubation were reduced significantly with the PVC double-lumen tube.

Adolescent↗
PubMed1982

Lye ingestion. Clinical patterns and therapeutic implications.

Conventional treatment of caustic esophagitis consists of early endoscopy to the first site of injury followed by antibiotic and steroid therapy, with early mechanical dilatation to prevent stricture formation. The failure of this approach in two recent patients led us to review our overall experience with the management of patients who had ingested lye or other caustic substances. Of 42 patients treated at the Santa Clara Valley Medical Center between 1970 and 1980, seven sustained severe esophageal burns. All had intractable strictures despite steroids, antibiotics, and, in three cases, attempts at dilatation. We conclude that patient survival should not be jeopardized by overly aggressive attempts to salvage an extensively damaged esophagus. Such attempts will probably prove both futile and dangerous, and effective re-establishment of oral-intestinal continuity is now possible by a variety of techniques.

Adolescent↗
PubMed1981

Pneumothorax: a therapeutic update.

The traditional treatment of pneumothorax has been with a chest tube and hospitalization. A series of 35 patients with 41 pneumothoraces treated on an outpatient basis is presented here. A no. 12 chest tube connected to a Heimlich valve led to successful treatment in 88 percent of the cases. Failure of treatment requiring hospitalization occurred in 12 percent of cases and was due only to persistent air leaks. No complications occurred.

Adolescent↗
PubMed1981

Bronchoscopic diagnosis and treatment of bronchial stump suture granulomas.

Eight patients in whom new respiratory symptoms developed following pulmonary resection have been evaluated. The bronchial stumps in all of these patients had been closed with Tevdec suture material. The total number of pulmonary resections using Tevdec suture from January, 1971, to January, 1980, was 180, yielding an incidence of the complication of 4.4%. No patient had empyema or bronchopleural fistula. Symptoms included nonproductive cough (eight patients), hemoptysis (five patients), wheezing (two patients), and coughing up suture material (two patients). The underlying disease necessitating pulmonary resection was carcinoma in five patients, carcinoid adenoma in one patient, tuberculosis in one patient, and bronchiectasis in one patient. The median time interval between resection and development of respiratory symptoms was 18 months, with a range of 8 to 57 months. The chest roentgenograms showed no change from earlier postoperative films. Bronchoscopy under general anesthesia was performed in all eight patients. Granulation tissue around loosened Tevdec sutures was present in all patients so examined. No residual tumor or specific infection was identified. Immediate and sustained relief of symptoms was obtained in seven of eight patients by removal of the loosened sutures. One patient has had recurrence of minor hemoptysis 18 months following suture removal but has refused further endoscopy. Stainless steel staples have been used for bronchial stump closure in over 100 pulmonary resections since 1977 and no such complications have been seen.

Adult↗
PubMed1980

The use of thoracoscopy in the diagnosis of pleural disease.

Seventeen patients (ten male and seven female) between the ages of 21 and 76 years underwent thoracoscopy from 1976 through 1978 by the Stanford University University Thoracic Surgical Service. There was no morbidity or mortality. This technique was used when other conventional methods such as thoracentesis and pleural biopsy failed to obtain a diagnosis of suspected thoracic pathology. Thoracoscopy was diagnostic in 16 of 17 cases. The diagnosis of malignancy was made in 11 cases, whereas benign disease was found in the remaining six cases. Of the latter group, there was one false-negative result, which on subsequent thoracotomy was diagnosed as recurrent Hodgkin's disease. The current revival of thoracoscopy as a diagnostic entity is proving to be very valuable in the evaluation of thoracic disease. An increased awareness of the tool and its use should decrease the number of major thoracotomy procedures.

Adult↗
PubMed1980

Recurrent major haemoptysis: progression to pneumonectomy.

A 50-year-old white man with recurrent major haemoptysis is described. The main problem in management was in detecting the aetiology and source of the haemoptysis. Rigid bronchoscopy is essential in the evaluation and treatment of patients with massive haemoptysis, and once the site of bleeding has been established, pulmonary resection offers the best chance of survival. The operation performed is usually lobectomy, although pneumonectomy, as with our patient, may be necessary.

Bronchoscopy↗
PubMed1978

Recurrent mediastinal bronchogenic cyst. Cause of bronchial obstruction and compression of superior vena cava and pulmonary artery.

The recurrence of a benign mediastinal bronchogenic cyst 20 years after partial excision precipitated potentially serious vascular and pulmonary complications. Aggressive total surgical excision should be feasible in the majority of cases. An approach via a median sternotomy offers distinct advantages in certain cases and should be considered. Computerized axial tomographic scanning promises to provide improved definition of mediastinal anatomic features and should be a valuable noninvasive diagnostic method in selected cases.

Bronchial Diseases↗
PubMed1978

Pulmonary resection in children with metastatic osteogenic sarcoma: improved survival with surgery, chemotherapy, and irradiation.

Twelve consecutive unselected patients (aged 6 to 18 years) with osteogenic sarcoma underwent 19 thoracotomies for resection of pulmonary metastases. Wedge excisions of 41 metastatic nodules, one bilobectomy, and one pneumonectomy were performed. Six patients each required one thoracotomy, five patients underwent two thoracotomies, and one patient required three. Serious surgical complications were limited to one patient who required reoperation for closure of a bronchopleural fistula following bilobectomy. Initial pulmonary metastasis occurred 9 months (mean) after amputation (range 1 to 21 months). Complete excision of all identifiable metastatic tumor was possible in 17 of 19 thoracotomies. All patients received intensive cyclical chemotherapy after initial definitive amputation, after thoracotomy, or both. Tumor doubling time (TDT) during chemotherapy (mean 74 days) was significantly prolonged (p = 0.017) compared to TDT during intervals of no therapy (mean 22 days). Five patients received pulmonary radiotherapy prior to thoracotomy and five after thoracotomy. Four patients died during the observation period, having survived 10 to 30 months after amputation. Two patients are alive with known extrapulmonary metastases. Six patients are free of disease. The survival rate is 91.7 percent 1 year after amputation, 82.5 percent at 2 years, and 57.8 percent at 3 years. These results suggest improved survival when aggressive surgical resections of pulmonary metastases are combined with chemotherapy and radiotherapy. Thoracic surgical procedures in this group of patients are safe and associated with a low incidence of complications despite the potentially increased risks owing to antecedent chemotherapy and pulmonary irradiation.

Adolescent↗
PubMed1978

The role of bronchoscopy and needle aspiration in the diagnosis of peripheral lung masses.

Sixty patients underwent flexible fiberoptic bronchoscopy and percutaneous needle aspiration of peripheral lung lesions with fluoroscopic monitoring. A single general anesthetic was used. We found that percutaneous needle aspiration was the more accurate of the two procedures in establishing a diagnosis but that flexible fiberoptic bronchoscopy proved complementary in some instances. The incidence of pneumothorax was 27% but aspiration was needed in only 8%. There were no other complications. In 84% of patients with primary carcinoma of the lung presenting as a peripheral lesion, the diagnosis was established by these procedures. The accuracy was less in metastatic lesions and considerably less in benign lesions.

Biopsy, Needle↗
PubMed1976

Diagnosis of cytomegalovirus pneumonia in compromised hosts.

Sixteen patients with cytomegalovirus pulmonary infection are described. In 11 the diagnosis was made antemortem by lung aspirate or biopsy, and in five the diagnosis was made at postmortem by typical lung histology and positive viral lung cultures. All patients were immunosuppressed by both their underlying diseases and treatment with corticosteroids and other chemotherapy. Although other pathogens were identified at lung biopsy in most patients (73 per cent), primarily Pneumocystis carinii, evidence is offered to demonstrate that cytomegalovirus can cause significant pulmonary disease alone, leading to respiratory failure and death.

Aged↗