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Biomedical subjects

J C Harvey

Publications and source records attributed to J C Harvey.

At least 19 recordsLinked to original sources
PubMed1997

Acute colonic diverticulitis in the young.

BACKGROUND: Colonic diverticulitis in the young has been considered to have a virulent course, high morbidity, and high operative rate. As a result, elective resection of the involved colonic segment after the first clinical episode has been the usual practice. PURPOSE: This study presents our experience with acute diverticulitis in the young. METHODS: In the last nine years, 63 patients younger than 45 years were treated for acute diverticulitis at our institution. A retrospective review was performed to determine the clinical course and outcome of these patients. RESULTS: Clinical presentations, radiographic tests, operative findings, and pathology results revealed that 57 patients had a pericolonic contained disease (Hinchey State I). Two patients had a large pelvic abscess (Hinchey Stage II), and four patients had a diffuse peritonitis (Hinchey Stage III). Forty-one patients (65 percent) were successfully treated medically with antibiotics and bowel rest. Of 22 patients (35 percent) who underwent emergent operations, 12 patients' diseases had been erroneously diagnosed preoperatively (9 "appendicitis"). CONCLUSION: Diverticulitis at a young age does not have a specific aggressive nature. Although, it is associated with a high rate of emergency operations, many of these are performed for a mistaken diagnosis. The recommendation for routine elective resection following the first episode of diverticulitis should be reassessed.

Acute Disease↗
PubMed1997

Completeness of case ascertainment in a Scottish regional cancer registry for the year 1992.

To assess completeness of case ascertainment by the Scottish Cancer Registry for the year 1992, we assembled a collection of databases containing potential registrations (excluding non-melanoma skin tumours and non-invasive neoplasms) from 14 separate sources relating to the population covered by one of the five regional registries. Apparently missed registrations were identified by linkage of these databases to cancer registration records. Their eligibility for registration was determined by reference in medical records, or when these were unavailable, by reference to the local Community Health Index (to establish residency at the time of diagnosis) in conjunction with the text of the original pathology report and/or the original death certificate. Misclassifications of site or incidence year were not regarded as missed cases. Of 517 apparently missed cancer registrations, 66 cases (3.5% of the revised total number of registrations of malignant neoplasms other than non-melanoma skin tumours for the study area in 1992) should have been registered as new independent primary malignant neoplasms, giving an overall estimate of completeness of 96.5%. The fact that so many apparently missed registrations were not eligible for registration illustrates the limitations of passive registration. Ascertainment of cases by the Scottish Cancer Registry appears to be high for most sites and compares favourably to the figures reported by registries outside Scotland.

Humans↗
PubMed1996

Early thoracic duct ligation for postoperative chylothorax.

Four cases of postoperative chylothorax occurring at this institution over the past 5 years, as well as an extensive review of the world literature, are presented. Of the four cases, three occurred after resection of carcinoma of the lung and one after resection of recurrent chondrosarcoma of the chest wall. These patients were treated nonoperatively for varying periods of time ranging from 2 days to nearly 3 weeks. Subsequently, all patients underwent ligation of the thoracic duct. Early reoperation for ligation of the thoracic duct resulted in no morbidity or mortality. In one case of delayed thoracic duct ligation, after an attempt at ligation of minor lymphatic vessels, the single mortality occurred. In view of the experience with these patients and that reported in the literature, we propose that not only is thoracic duct ligation superior to nonoperative management, but that it should be undertaken without delay.

Adult↗
PubMed1996

Malignant tracheo-esophageal fistula: use of esophageal endoprosthesis.

Malignant tracheo-esophageal fistula (TEF) is a serious complication of cancer arising usually in the esophagus, lung, or tracheobronchial tree. Repeated aspiration and pneumonia lead to rapid deterioration and death. The prognosis is dismal and curative resections are curiosities. Surgical bypass of the lesion has been performed but is associated with 25-61% mortality. Other treatments have been employed, such as enterostomies, esophageal endoprostheses, and supportive care. The reported mortality of palliative procedures using endoprostheses, surgical bypass, or exclusion in almost identical. A retrospective review of the data over the past decade revealed a trend toward insertion of endoprostheses. Insertion of endoprostheses can be performed in an endoscopy suite, under sedation, and has fewer major complications than occur with a surgical approach. The periprocedure mortality rate for these patients is 15%, compared to a 29-47% perioperative mortality for patients undergoing surgery. Even so, patients after surgical procedures could survive for 8 months or more, which is better than survival after endoprosthesis intubation. We conclude that insertion of an esophageal endoprosthesis should be the usual preferred option for palliative treatment of malignant TEF. However, for special candidates a surgical procedure is a valid option.

Esophageal Neoplasms↗
PubMed1996

Benefits and limitations of pathology databases to cancer registries.

In order to assess the benefits and limitations of pathology databases to cancer registries, computerised pathology records of malignant neoplasms diagnosed during 1992 were obtained for a defined area of Scotland for which pathology data were not routinely being used for cancer registration. Apparently 'missed' cancer registrations were identified by computerised probability matching with cancer registration records and their eligibility for registration was determined by reference to medical records, or when these were unavailable, by reference to the text of the original pathology report in conjunction with the local Community Health Index (to establish residency at the time of diagnosis). Misclassifications of site or incidence year were not regarded as 'missed' cases. Of 218 apparently 'missed' cancer registrations identified from computerised pathology records, 133 (5.7% of the revised total number of registrations for the study area in 1992) should have been registered. A further 14 cases were already registered but with misclassified site, morphology and/or behaviour codes. Ascertainment of cases by the Scottish Cancer Registration Scheme seems to be high for most sites. Pathology databases represent a useful additional source of cases but the fact that 71 apparently 'missed' cases were found to be ineligible for registration as independent primary malignant neoplasms suggests that unverified computerised pathology data should not be used uncritically nor independently for cancer registration purposes.

Databases, Factual↗
PubMed1996

Diaphragmatic hernia following transhiatal esophagectomy.

Transitional esophagectomy (THE) has been advocated as an alternative to the classic transthoracic approach. A variety of complications have been previously described with THE however, these can be avoided with meticulous detail to its technique. We report a patient who developed a complete small bowel obstruction secondary to a diaphragmatic hernia following transhiatal esophagectomy. Techniques to prevent such a rare complication is described.

Adenocarcinoma↗
PubMed1995

Early experience with videothoracoscopic hydrodissection pleurectomy in the treatment of malignant pleural effusion.

Parietal pleurectomy is our preferred procedure for management of malignant pleural effusion. However, the morbidity of a major thoracotomy has precluded all but highly selected patients from the conventional (open) procedure. Recently, we have been able to perform parietal pleurectomy by means of a video-assisted, thoracoscopic technique. We have retrospectively analyzed the results of this procedure performed on 11 patients between March 1993 and February 1995. These patients ranged in age from 40 to 87 years of age, with a mean age of 61.5 years. Primary tumors were non-small cell lung cancer (5), breast cancer (4), mesothelioma (1), and unknown (1). There was one operative mortality (9.1%). All were relieved of symptoms of pleural effusion. Median survival was 128 days. Early experience indicates we are accomplishing an operation equivalent to that formerly performed by "open" technique. If continued results are similar to our initial experience, we will be able to offer this superior palliation of malignant pleural effusion to a wider range of patients.

Adult↗
PubMed1995

Surgical treatment of non-small cell lung cancer in patients older than seventy years.

Surgical treatment of non-small cell lung cancer has been reported to be associated with increased mortality, especially when pneumonectomy has been employed. A 9-year review of 81 patients treated surgically, with a policy of avoiding pneumonectomy and using internal radiation and wedge excisions rather than lobectomy among patients with impaired reserve, resulted in an operative mortality of 4.9% compared with an overall mortality of 2.1%. Three of the four deaths were among patients older than 80 3/17 (17.6%) years so that mortality of patients 70 < age < 80 was not significantly different from overall mortality. Two of the four deaths were related to pulmonary emboli but there have been no such deaths since routine use of mini-heparin was initiated in 1990. Five-year survival was 42% overall, 65% for stage 1, and 24% for stages II-IIIB. We conclude that surgical treatment of patients 70 < age < 80 may be accomplished with similar mortality and survival as the overall population. Heparin prophylaxis may be especially important among patients older than 80 years.

Age Factors↗
PubMed1995

Aortoesophageal fistula after reconstruction of the thoracic spine.

Aortoesophageal fistula is a rare complication after neurosurgical repair of the thoracic spine. We report an instance of a lethal aortoesophageal fistula caused by a pseudoaneurysm that developed after long contact between the prosthetic material from a spinal reconstruction procedure and the thoracic aorta. Pathologic examination showed that the mesh formed the roof of the pseudoaneurysm and was the most probable cause of the lesion.

Adenocarcinoma↗
PubMed1995

Pneumonectomy.

Success in pneumonectomy, or any pulmonary surgery, depended upon learning the principles of positive pressure ventilation with endotracheal intubation, management of the pleural space, and confirming the advantage of anatomic dissection in individual ligation of hilar structures. The earliest successful pneumonectomies were performed for suppurative disease, but eventually became the procedure of choice for treatment of lung cancer until it became known that lobectomies would result in the same cure rate but with a decreased complication rate. At the present time, pneumonectomy is reserved for patients whose cancers require complete pneumonectomy for cure and for selected suppurative problems. Accepted techniques for conventional, intrapericardial and extrapleural pneumonectomies are described along with indications for the particular procedures.

Dissection↗
PubMed1994

Absorbable mesh in placement of temporary implants.

PURPOSE: To evaluate absorbable mesh for the suturing of afterloading catheters in patients with tumors involving the chest wall. METHODS AND MATERIALS: Patients underwent thoracotomy and resection of tumor; a layer of absorbable mesh was then sutured to the tumor bed. Nylon flexiguide afterloading catheters were sutured into the mesh at about 1.5 cm distance from each other. A second layer of mesh was then sutured on top of the catheters. The chest wall was closed. Orthogonal radiographs and CT scans of the area of implants were done to verify catheter position in each patient on day 1 and on the last day of implant. Computer dosimetry by digitization of dummy sources was performed on each set of radiographs. The same seed for both sets of films was chosen as the origin of digitization. All seed coordinates were compared directly to offset for any rotation of the patient during the two sets of films. The distances were calculated from all seed positions to the origin, then tabulated and compared. RESULTS: The distances agreed within a few millimeters (7-8 mm). The differences may be attributed to the patient's breathing and to the localization uncertainty. The resulting dose alteration was negligible. CONCLUSION: This technique appears to provide adequate anchorage of catheters with resulting constant seed position and dose distribution in areas of scant tissues or in surgical beds of considerable size.

Aged↗
PubMed1994

Complications of transhiatal esophagectomy.

A total of 23 papers published between 1981 and 1992, reporting a total of 1,353 patients, were reviewed for intraoperative and postoperative complications of transhiatal esophagectomy. Intraoperative complications included massive bleeding, tracheal injuries, cardiac arrhythmias, and incidental splenectomies. Even though the chest was not opened, the commonest postoperative complications were pulmonary. Leakage from the cervical anastomosis was seen in as many as 15% of all patients, but almost all resolved spontaneously. Postoperative benign strictures were seen in almost as many patients. Hoarseness due to recurrent laryngeal nerve injury, symptomatic gastro-esophageal reflux, chylothorax, Horner's syndrome, subphrenic abscess, hiatal hernia, and biliary cutaneous fistula were some of the other postoperative complications. An overview of these complications is presented, along with suggested methods of avoiding them and their treatment. The overall mortality for the 1,353 patients was 7.17%.

Esophageal Neoplasms↗
PubMed1994

A response to euthanasia initiatives.

The outcome of the physician-assisted suicide and euthanasia debate will profoundly influence physicians' role in society, the kind of society we become, and the way physicians and patients relate to one another. Three forces account for the move to physician-assisted suicide and euthanasia: an abuse of scientific advancement, a new political philosophy, and the erosion of religious consensus. The relationship between patients and physicians has often been understood as a convenant with rights on patients' part and duties on physicians' part. Physicians' duties in this covenantal relationship are to act for patients' good (a positive duty) and to do no harm (a negative duty). Euthanasia and assisted suicide are morally wrong because, as the Judeo-Christian ethic teaches, human beings are creatures of God and have only stewardship, not dominion, over life. But in our pluralistic society, which seems to lack consensus on religion, on communal responsibility, and on common values, one cannot argue against mercy killing and assisted suicide on theological grounds. Our society generally agrees, however, that a discussion of values may take place in the language of moral philosophy, a language that expresses right reason.

Beneficence↗