Biomedical subjects
J Borrie
Publications and source records attributed to J Borrie.
Evolutions in medicine.
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Peripheral early stage lung cancer: superiority of six-monthly over random chest films.
An analysis of 100 biopsy-proven lung cancers found by chance chest films and treated by resection have been collected over a 20 year period. Data relating to sex of patients, smoking habits, age groups, lung and lobar sites, cell type, treatment and survival are stated and discussed in relation to the findings of a known planned study for detecting early stage lung cancer by chest films. It is concluded that, if a person at lung cancer risk is genuinely interested in having regular checks to catch early, operable disease, then his chances are best with six-monthly chest films.
William Henry Blinman Bull.
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James Alfred Jenkins.
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Obituary: Kenneth Aird Ross.
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Localized pulmonary Wegener's granuloma simulating lung cancer: report of four cases.
Clinical features suggesting lung disease in three patients and a chance chest radiograph in the fourth led to films showing localized lung lesions with some characteristics of neoplasms. Two were heavy smokers, two were non-smokers. In two the lesion was peripheral, in one lobar (RUL), and in the fourth it crossed the interlobar fissure (apical and posterior segments LUL and apical LLL). Malignant cells were not seen on sputum cytology examination in any, but in one, atypical cells were reported. All four patients had lung resection for suspected cancer, two by pneumonectomy, one by lobectomy, and one lingulectomy. All patients recovered, and their clinical course has so far been uniformly benign. Two have been followed long term (16 and 10 years), one 2 1/2 years, and one a year. Pathologically, the lesions appeared to be strictly limited without extra-pulmonary involvement, except that the patient followed for one year has developed hyporegenerative anaemia responsive to prednisone therapy. The pathological features of focal necrosis, granulomatous inflammation, and vasculitis were sufficiently striking, although often focal, to suggest that incisional biopsy from frozen-section histological diagnosis could be useful to prevent extensive lung resection for lesions not positively diagnosed before thoracotomy.
Columnar cell-lined esophagus: assessment of etiology and treatment. A 22 year experience.
Among 1,000 patients with hiatal hernias were 45 who had biopsy-proved columnar-lined esophagus (CLE). Twenty-one were male and 24 female, with bimodal age ranges peaking at zero to 10 and 48 to 80 years. Of the first decade patients, all boys, 2 were brothers. While 44 had dysphagia, one third also had iron-deficiency anemia. All had x-ray-proved sliding hiatal hernias, with esophageal stricturing at the squamous cell-columnar cell interface. In 43 cases this area was 35 cm. or less from the upper jaw. The epithelial histology showed simple, tubular, mucus-secreting glands (45 cases), goblet cells (7 cases), no goblet cells (38 cases), and gastric-type epithelium with parietal cells (19 cases). In 2 cases CLE was rising up the esophagus from 35 to 30 cm. in 3 years and from 40 to 23 cm. in 10 years. No stricture became neoplastic. Clinical evidence supports the view that CLE has a double etiology: It is congenital in children but acquired, akin to "intestinalization of the stomach," in adults with sliding hiatal hernias; in the latter instance, CLE occurs as an alternative end-point to reflux esophagitis. Treatments and long-term results are discussed. All patients had initial stricture dilatation with biopsy. In 17 this was the sole treatment. In 16 cases a later transthoracic herniorrhaphy was performed to reduce the hiatal hernia and prevent further stricturing. Fifteen patients had transmural strictures. For this group, our experience with Roux-Y esophagogastrostomy and esophagojejunogastrostomy, with stricture excision, and also with mere bypass of the stricture is stated. For the young, after stricture excision, eosophagojejunogastrostomy with pyloroplasty, performed in the second decade, is favored. In the elderly, especially after unsuccessful hiatal herniorrhaphy, eosophagojejunogastrostomy with stricture bypass proved satisfactory 3 years after the operation.
Letter: Mass radiography and lung cancer.
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Lung cancer diagnosis: evaluation of diagnostic techniques.
In 200 patients with histologically proven lung cancer, retrospective analysis of the relative diagnostic value of sputum cytology, bronchial washings cytology, bronchial biopsy, scalene node biopsy, mediastinoscopy and thoracotomy was undertaken. Bronchial biopsy proved positive in 80 percent of patients with central tumours (those lying between the origin of a main brochus and the origins of lobar segmental bronchi) against 35 percent of patients with peripheral tumours (those lying distal to the origins of the lobar segmental bronchi). Sputum cytology was positive in 27 percent of patients so investigated and bronchial washings cytology in 14 percent--both techniques being more effective with central tumours. Thoracotomy, as the sole method of obtaining histological confirmation of the clinical diagnosis, accounted for 20.5 percent of all cases, being used more often in patients with peripheral tumours. In 15 percent the first histologically positive result came from distal spread. The relative indications for needle biopsy and endobronchial fibroscopy are discussed.
Surgical management and problems of heart pacing.
Experience with 40 patients and 150 pacemakersss is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications. The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resion fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by 'demand' units in large electromagnetic fields.