Esophageal fistula.
Explore the source record for details and available documents.
Esophageal Fistula↗
Biomedical subjects
J D Cooper
Publications and source records attributed to J D Cooper.
Technique for very long-term monitoring of intracranial pressure.
Explore the source record for details and available documents.
Adult↗
A simplified method of esophageal pH monitoring for assessment of gastroesophageal reflux.
We have found that 24-hour esophageal pH monitoring is clinically useful in the evaluation of reflux-related symptoms but that the application of this diagnostic tool is limited by lack of simplicity and easy portability of equipment, a time-consuming method for data analysis, and the necessity to hospitalize patients for the study. We have resolved the first two problems with the development of a lightweight, portable, solid-state system for recording and analyzing the data. To assess the feasibility of utilizing an 8-hour study applicable to outpatients, we studied 30 unselected patients referred for 24-hour pH monitoring. We separately analyzed the data from the first 8 hours of the study and the data from the entire 24-hour period. The correlation between the results obtained with each analysis was excellent, indicating that the 8-hour study can be used to quantitate reflux accurately. An 8-hour outpatient protocol was developed and applied to 25 healthy volunteers to determine the normal range of values. From this, a simplified scoring system was created for assessing the results of 8-hour pH studies.
Adult↗
Massive hiatal hernia with incarceration: a report of 53 cases.
Between 1960 and 1980, 53 patients with massive incarcerated hiatal hernia were treated surgically. In 24 of the 53 patients, there was an associated organoaxial volvulus. The following symptoms and signs, which are almost peculiar to massive, incarcerated hernias, were observed: postprandial precordial distress in 43 patients, upper gastrointestinal bleeding (manifest or occult) in 24 patients, severe dyspnea in 13 patients, and complete obstruction associated with organoaxial volvulus in 4. In only 1 of the 53 patients was the hernia of the true paraesophageal type with the esophagogastric junction remaining in its normal, intraabdominal location. The remainder were all believed to be advanced stages of an ordinary sliding hiatal hernia. Operative treatment consisted of gastroplasty and partial fundoplication in 36 patients, standard Belsey repair in 14, and transabdominal Nissen repair in 3. Gastroplasty and partial fundoplication were used much more frequently during the 1970s, when it was realized that there is a significant incidence of chronic peptic esophagitis and shortening in these patients. Postoperative complications were few in spite of the advanced age of many of the patients. There was one operative death. Only 1 patient was lost to follow-up, and of the 51 patients remaining for analysis, follow-up has extended from 1 to 16 years, with a mean of 6.2 years. No patient has developed recurrent precordial pain, evidence of upper gastrointestinal bleeding, iron deficiency anemia, or severe dyspnea. Seven patients have residual dysphagia; this condition is minimal in 5, and is significant in 2 who require interval esophageal dilation. Nine patients have symptomatic reflux, which is minimal in 5 patients, moderate in 2 patients, and severe in 2 others who were subsequently reoperated on. Contrary to popular concept, our observations indicate that almost all of these patients represent advanced degrees of sliding hiatal hernia with intrathoracic displacement of the esophagogastric junction. This implies a need for an adequate antireflux reconstruction in all patients undergoing operation, as well as an awareness that unanticipated cicatricial changes may be present in the distal esophagus and may prejudice the success of some of the standard hiatal repairs.
Adult↗
Thromboxane synthesis by sources other than platelets in association with complement-induced pulmonary leukostasis and pulmonary hypertension in sheep.
Infusion into sheep of plasma containing zymosan-activated complement produces leukopenia, pulmonary leukostasis, and pulmonary artery hypertension. We previously demonstrated a close relationship between the pulmonary vascular response and elevations of plasma thromboxane. We have investigated the source of thromboxane synthesis in this model. Plasma containing zymosan-activated complement added to whole blood did not stimulate thromboxane synthesis. This observation suggested that leukocytes do not synthesize thromboxane directly in response to complement added to whole blood did not stimulate thromboxane synthesis. This observation suggested that leukocytes do not synthesize thromboxane directly in response to complement. Sheep rendered severely thrombocytopenic by the administration of antiplatelet serum responded to complement infusion in the usual way. Pretreatment with aspirin (10 mg/kg) protected sheep against the pulmonary vascular response and completely blocked thromboxane synthesis. Transfusion of functional platelets did not restore these responses. Twenty-four hours after aspirin treatment, in vivo thromboxane synthesis was significantly greater than platelet thromboxane synthesis in vitro. Thromboxane is synthesized by a tissue which recovers cyclooxygenase enzyme activity at a rate that is more rapid than platelet turnover. Sheep lung synthesizes thromboxane actively in vitro. It is postulated that leukocytes exposed to activated complement components damage pulmonary vascular endothelial cells and stimulate synthesis of thromboxane A2 which causes pulmonary vasoconstriction.
6-Ketoprostaglandin F1 alpha↗
A rapid procedure for the simultaneous estimation of the anticonvulsant drugs, ethosuximide, phenobarbitone, phenytoin, and carbamazepine in serum using high-pressure liquid chromatography.
A rapid isocratic high-pressure liquid chromatography procedure for the analysis of ethosuximide, phenobarbitone, phenytoin, and carbamazepine in serum is described. The method employs a single extraction from serum; alumina treatment of this extract eliminates interference from fast-eluting compounds, allowing rapid chromatography. A linear response is obtained for drug concentrations up to three times the upper limit of the therapeutic ranges. Within-batch and between-batch precisions for the means of these ranges varied from 2.2 to 5.5% and from 3.1 to 7.5%, respectively.
Anticonvulsants↗
Reduction in local recurrence and improved survival in surgically treated patients with small cell lung cancer.
To assess the role of operation in the treatment and prevention of local recurrence in limited small cell lung cancer, we analyzed retrospectively 35 patients undergoing surgical resection for small cell lung cancer between 1976 and 1982. Twenty-eight patients underwent resection for presumed non-small cell histology. Seven later patients had planned combined modality therapy consisting of chemotherapy and prophylactic cranial irradiation followed by surgical resection and irradiation to the primary site. Twenty-four patients received adjuvant postoperative chemotherapy and/or radiotherapy. All patients have been treated and followed up for a minimum of 1 year. There were 19 patients in Stage I and 16 in Stages II and III. In 15 patients, relapse has occurred. The commonest site of first relapse was brain (7/15). Five of these patients had received prophylactic cranial irradiation. In only two patients was there a relapse locally in the hemithorax and/or mediastinum--one with NO disease and one with N1 disease. No local recurrence was noted in six patients with N2 disease. Only two relapses have occurred beyond 1 year--both in brain. In those patients surviving more than 2 years, no relapses have occurred. The median survival time for patients with Stage I disease is 158 weeks and for those with Stages II and III, 92.4 weeks. The median survival time for the whole group is 92.4 weeks with a projected 5 year survival rate of 24%. It appears that surgical resection may help to prevent local recurrence in small cell lung cancer, even in N1 and N2 disease. In our series, projected 5 year survival rates are similar to those seen in the surgical treatment of patients with non-small cell lung cancer. The eventual role of operation in the prevention of local recurrence and improvement in overall survival of limited small cell lung cancer awaits prospective randomized trials.
Adult↗
Improved bronchial healing in canine left lung reimplantation using omental pedicle wrap.
Bronchial complications are a major problem following lung transplantation. Ischemia of the donor bronchus is an important underlying cause of these complications. We have previously demonstrated the ability of an omental pedicle flap to revascularize the donor bronchus as early as 4 days following canine left lung reimplantation. In the present study, omental pedicle wraps markedly improved the healing of the bronchial anastomoses 23 days following canine left lung reimplantation. In dogs in which omentum was used (n = 6), the bronchial mucosal appearance was more normal and the degree of bronchostenosis was significantly less when compared with dogs without omental flaps (n = 10). These experiments suggest that the use of omental pedicle flaps may significantly reduce bronchial complications following lung transplantation.
Animals↗
A comparison between cyclosporin A and methylprednisolone plus azathioprine on bronchial healing following canine lung autotransplantation.
The effects of two low-dose immunosuppressive therapies upon the healing of the bronchial anastomosis and skin wounds following lung autotransplantation were evaluated. Autotransplantation was performed in three groups of dogs: Group 1 (nine dogs) received no immunosuppression, Group 2 (seven dogs) received postoperative immunosuppression with methylprednisolone (2 mg/kg) and azathioprine (1.5 mg/kg), and Group 3 (four dogs) received postoperative immunosuppression with cyclosporin A (20 mg/kg/day). Skin incisions 7 cm in length were made in the dorsal region of each dog. Dogs were put to death 23 days postoperatively, and the breaking strength of the bronchial anastomoses and skin wounds was evaluated with the Instron Universal Testing Machine, with a cross-head speed of 0.5 cm/min. Bronchial breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Skin breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Scanning electron microscopic (SEM) studies of both skin and bronchial wounds showed normal formation of collagen bundles in Groups 1 and 3 but a disorganized pattern in Group 2. Our results suggest that low-dose immunosuppression with methylprednisolone and azathioprine significantly affects wound healing and breaking strength of both bronchial anastomoses and healed skin incisions following canine lung autotransplantation. Immunosuppression with cyclosporin A had no adverse effect on either bronchial or skin healing.
Animals↗
Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula.
Postpneumonectomy empyema, with or without bronchopleural fistula, remains an infrequent but serious complication of pulmonary resection. We reviewed our experience with the Clagett procedure in 31 patients with postpneumonectomy empyema. Seven had empyema alone and 24 had empyema with bronchopleural fistula. Ten patients died of metastatic disease without attempted closure of the thoracostomy window. In eight patients the total Clagett procedure was completed; window closure was permanent in two patients, but the remaining six had recurrence of empyema (four of whom had persistent occult fistulas). In eight further patients, persistent infection prevented attempted closure of the window. Five patients refused further surgical procedures. In only two of 31 patients were we able to achieve permanent closure of the thoracostomy window. Based on this experience, we conclude that open window thoracostomy provides adequate drainage and an excellent interim or permanent treatment of the infected pneumonectomy space. However, the presence of persistent bronchopleural fistula prevents successful completion of the total Clagett procedure. In our series, there were no deaths related to empyema or the surgical procedures performed for it.
Anti-Bacterial Agents↗
One-stage reconstruction for pharyngolaryngectomy. Esophagectomy and pharyngogastrostomy without thoracotomy.
From 1969 to 1981, a total of 22 patients underwent laryngopharyngectomy and nonthoracotomy esophagectomy, with immediate pharyngogastrostomy, for hypopharyngeal or postcricoid carcinoma. Thirteen initially had been treated by high-dose radiotherapy, but the tumor had either persisted or recurred. Four patients underwent planned preoperative irradiation on the morning of the operation. Two patients had had previous high-dose local irradiation to the neck for other disease, and three patients had no irradiation. There was one operative death. Anastomotic leaks developed in four patients, but only one of the leaks was considered a serious problem. Three patients had transient dysphagia, but only one required dilatation. Transient delayed gastric emptying was a problem in three other patients. The average postoperative stay was 31 days, with 38% of patients being discharged by 21 days. All patients were discharged eating a normal diet. Fifty percent survived longer than 12 months, with an actuarial survival rate of 30% at 5 years. The patient surviving longest is disease free at 12 years. Palliation was considered excellent in all 21 operative survivors. Immediate pharyngogastrostomy via nonthoracotomy esophagectomy is a safe and excellent means of palliation in this group of patients, for whom palliation is often the only option.
Adult↗
The estimation of serum acid phosphatase using alpha-naphthyl phosphate as substrate: observations on the use of Fast Red TR salt in the assay.
The estimation of acid phosphatase (EC 3.1.3.2) in serum by reaction rate analysis, utilising alpha-naphthyl phosphate as substrate and a diazonium salt (Fast Red TR) for colour development is examined. In the absence of substrate the occurrence of a pseudo catalytic activity is shown to be due to the hydrolysis of the Fast Red TR with the subsequent production of 4-chloro-2-methylphenol. The 4-chloro-2-methylphenol reacts with the Fast Red TR to form an azo compound which absorbs at a wavelength of 340 nm. The production of 4-chloro-2-methylphenol during the reaction is first order with respect to the Fast Red TR concentration, is temperature dependent and is accelerated in the presence of human albumin or Triton X-100. Monitoring the reaction at a wavelength of 585 nm eliminates the need for substrate independent blank correction. The final reaction conditions are summarised, together with a comparison of the method with that of the Kind and King [9] procedure.
Acid Phosphatase↗
The value of adjuvant radiotherapy in pulmonary and chest wall resection for bronchogenic carcinoma.
Thirty-five patients, 29 men and 6 women, underwent pulmonary and chest wall resection for treatment of bronchogenic cancer which had extended into the chest wall. Anterior chest wall resection was performed in 6 patients, lateral resection in 2, and posterior resection in 27. Marlex mesh was employed as a prosthetic material in 13 patients. Radiotherapy was given as part of the planned therapeutic regimen in 13 patients. Three patients (8.5%) died in the postoperative period. There was 21 late deaths. Eleven patients are alive 7 months to 12 years after resection. The overall actuarial survival, including operative mortality, is 38% at 5 years. Actuarial survival of the 13 irradiated patients is 56% at 2 and 5 years. We believe that bronchogenic carcinoma with chest wall involvement is not hopeless, and that resection of the lung and chest wall can be performed with an acceptable mortality rate.
Aged↗
Cardiac tamponade as a complication of thin-needle aspiration lung biopsy.
Thin-needle aspiration lung biopsy has become an important diagnostic technique in chest disease. Complications, other than pneumothorax, are infrequent. We report a case of acute cardiac tamponade complicating biopsy of a lesion near the mediastinum. Caution should be exercised in selecting patients for, and in performing biopsies in, or close to the mediastinum.
Adult↗
Bronchial omentopexy in canine lung transplantation.
Explore the source record for details and available documents.
Animals↗
Successful revascularization of totally ischemic bronchial autografts with omental pedicle flaps in dogs.
In 10 dogs, the left lung was removed and a closed stump of bronchus, comprising the distal main and lobar bronchi, was reanastomosed to the main bronchus. This totally ischemic cul-de-sac of bronchus was wrapped by an omental flap in five of the 10 dogs. All dogs without an omental wrap died of graft necrosis within 5 days. Injection studies into the bronchial arteries failed to demonstrate any revascularization of the bronchial grafts. In contrast, those dogs with omental wraps, when put to death at 23 days, displayed healthy viable bronchial grafts with full revascularization from the omental vessels. In another three dogs the revascularization via the omentum was demonstrated as early as 4 days and well established at 8 days. The ability of the omentum to rapidly revascularize the bronchus may be of value in potentially ischemic bronchial anastomoses such as in lung transplantation.
Animals↗
Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung.
Explore the source record for details and available documents.
Carcinoma, Squamous Cell↗
Surgical management of pulmonary metastases.
Explore the source record for details and available documents.
Female↗