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Biomedical subjects

J C Harvey

Publications and source records attributed to J C Harvey.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1994

Management of malignant pleural effusions with pleuroperitoneal shunting.

Malignant pleural effusions are often debilitating conditions for the patient with advanced carcinoma. Traditionally, treatment has been repeated thoracentesis or tube thoracostomy with instillation of sclerosing agents. However, this required the patient to be hospitalized and to have pain and inconveniences of the chest tubes. The drainage also had to be low enough for sclerotherapy to be effective. In 1982, the pleuroperitoneal shunt became a feasible alternative to sclerotherapy. We began using the Denver pleuroperitoneal shunt in July 1991. Twenty shunts were inserted into 19 patients during a two year period ending June 30, 1993. All patients but one were relieved of dyspnea. The mean duration of patency was 26 months and fewer than 25 percent of the shunts clotted before the death of the patient. Our favorable experience with the shunt has resulted in us recommending the Denver pleuroperitoneal shunt for treatment of recurrent malignant pleural effusions and selectively as primary treatment.

Adult↗
PubMed1994

Surgical management of pulmonary metastases.

Pulmonary metastases, especially solitary ones, have been managed surgically over the past 50 years. Resection is recommended for multiple metastases in patients who are capable of tolerating the required procedure, in which all pulmonary metastases can be resected as long as the primary site and extrapulmonary metastases are controlled or controllable, unless there is better treatment offering the same chance of cure for superior palliation. Complete resectability is the most important prognostic indicator, but several authors have found that for some tumors the number of pulmonary nodules, disease-free interval, and tumor doubling time are also important.

Adolescent↗
PubMed1993

Intracavitary radiation in the treatment of advanced esophageal carcinoma: a comparison of high dose rate vs. low dose rate brachytherapy.

Twenty-two patients were irradiated using two different dose schedules of intracavitary irradiation for palliation of locally advanced or metastatic carcinoma of the esophagus. Irradiation was given solely with either manually afterloaded low/intermediate dose Cesium-137 (LDR) or high dose rate Iridium-192 (HDR) delivered via remote afterloader. This study was designed to test the effectiveness of HDR intracavitary brachytherapy in the relief of dysphagia and the maintenance of esophageal patency and to compare with our previous experiences with LDR intracavitary brachytherapy. Accelerated treatments were especially suited for patients with poor physical condition or short life expectancy unlikely to complete a full course of external beam irradiation without treatment interruption. Two thousand cGY in three fractions of LDR was compared with 1,250 cGY in one fraction HDR with essentially equal results.

Brachytherapy↗
PubMed1993

High dose rate intraluminal radiation in a combined modality treatment plan for carcinoma of the esophagus.

We have previously reported results for treatment of adenocarcinomas and squamous cell carcinomas of the mid and distal esophagus as well as the use of intraluminal high-dose rate radiation (HDR-RT) for palliation of carcinoma of the esophagus. In this report we describe the results of a chemotherapy/HDR-RT/esophagectomy management program. Examination of the surgical specimens revealed a complete response in only 13% of patients and locoregional recurrence was disappointing. There were no operative deaths nor were there major complications attributable to the preoperative treatment. Two-year survival was 33%, only slightly better than that previously achieved by us with either primary surgery or primary external beam radiation among "curative" candidates with locoregional disease. HDR in combination with our selected chemotherapy regimen is insufficient for locoregional control and must be supplemented either by esophagectomy or external beam radiation for even modest long-term survival.

Adenocarcinoma↗
PubMed1993

Utility of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for extensive pulmonary metastasectomy.

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been reported to have advantages in pulmonary resections including superior control of bleeding and air leak with relative sparing of pulmonary parenchyma. Extensive metastasectomies were performed in two patients with bilateral metastases who might have been excluded from surgery with other techniques. The patients were discharged within 8 days after uneventful postoperative courses. While this modality shows promise in permitting extensive metastasectomy, only long-term follow-up will demonstrate the ability to provide results comparable to those achieved with previous techniques.

Adult↗
PubMed1993

High dose-rate endobronchial irradiation in malignant airway obstruction.

We evaluated the effectiveness of high dose rate (HDR) endobronchial irradiation for palliation of malignant airway obstruction. Between May 1989 and February 1992, 39 patients were treated in our department. Thirty-two patients (82 percent) had primary lung neoplasms and 7 (18 percent) had metastatic disease. Thirty-three patients (85 percent) had prior external irradiation (either alone or in combination with chemotherapy), and 9 patients (23 percent) received laser excision before treatment. Of the 39 patients, 14 (36 percent) presented with hemoptysis, 20 (51 percent) with cough, 15 (38.5 percent) had dyspnea, and 15 patients (38.5 percent) had pneumonia or atelectasis. There were 57 applications performed in the 39 patients. Patients with hemoptysis had 93 percent complete response (CR), 20 percent with cough had CR; 60 percent improved (partial response [PR]); no response was seen in 20 percent. Atelectasis and pneumonia resolved in 20 percent of patients. Eighteen patients (46 percent) underwent a second procedure and were evaluated for objective response; 34 percent had CR, 44 percent had PR, and 22 percent did not respond. There were two acute (one bronchospasm, one pneumothorax) and three late (two strictures, and one exsanguination) complications. In our experience, HDR was highly effective in the palliation of airway symptoms caused by malignant tumors, with acceptable toxicity.

Adult↗
PubMed1993

Lung cancer.

Explore the source record for details and available documents.

Carcinoma, Non-Small-Cell Lung↗
PubMed1992

Iodine125 interstitial brachytherapy in the treatment of carcinoma of the lung.

In a prospective study, 14 patients with primary non-oat cell lung carcinoma were treated with intraoperative Iodine125 (I125) implantation of the lung tumor via lateral thoracotomy or median sternotomy. Staging mediastinal node dissection was performed in each case. Patients were selected when wedge or segmental resections were not technically feasible, such that lobectomy or completion pneumonectomy would have been required or pulmonary function studies were poor. Doses ranged from 8,000 cGy at the periphery to 20,000 cGy at the center. With a minimum 12 month follow-up, mean and median survivals were 16.7 and 15.1 months, respectively. Local control was achieved in 10 of 14 patients (71%) with all local failures occurring in pathologic stage III patients. When separated according to tumor size, local control was obtained in six of seven tumors of less than 3 cm and four of five tumors of 3-5 cm. Both cases with masses greater than 5 cm failed locally. There was one operative mortality and two postoperative complications. All other patients were discharged within one week of surgery. There was no radiation pneumonitis. I125 lung brachytherapy is an excellent alternative treatment for T1 and T2 tumors when medical conditions preclude curative resection.

Aged↗
PubMed1992

Enucleation of a secondary esophageal mural tumor.

Metastatic tumors to the esophagus have been described as having the imaging characteristics of benign mural tumors such as leiomyomata, but application of enucleation in treating such tumors has not been described. Our report describes long esophageal myotomy and enucleation of tumor for palliation of dysphagia due to a mural tumor originating from a lung primary.

Adenocarcinoma↗
PubMed1992

Tracheo-esophageal fistula complicating carcinoma of the esophagus.

In a 35-year review of 557 patients with esophageal carcinoma, 26 tracheal esophageal fistulas were encountered. Seventeen arose among patients with advanced disease or poor performance status and these patients were given comfort measures only. Treatment was attempted in 9 patients, 4 of whom died peri-operatively. The remaining 5 avoided early pulmonary deaths. In principle, esophageal exclusion and bypass should provide the best palliation in patients whose performance status permits it, but extensive surgical procedures are futile in patients with established pulmonary sepsis. For most patients, not candidates for exclusion procedures, endoprostheses are more appropriate.

California↗