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Biomedical subjects

J I Miller

Publications and source records attributed to J I Miller.

At least 91 records · Page 5Linked to original sources
PubMed1986

The thoracic surgical spectrum of acquired immune deficiency syndrome.

The acquired immune deficiency syndrome has presented a complex and, as yet, unsolvable spectrum of pulmonary disease characterized by bizarre infections, pneumothoraces, respiratory distress, and death. Thirty-eight patients underwent 49 surgical procedures during 42 months. Ages of the patients ranged from 24 to 56 years. Surgical procedures included tracheostomy, closure of air leaks, mediastinoscopy, lobectomy, open lung biopsy, and esophagogastrectomy. Hospital mortality was 10 of 38 (24%); the 1 year survival rate was 13 of 38 (34%). Pulmonary infections included Pneumocystis carinii, cytomegalovirus, Microbacterium avium, toxoplasmosis, candidiasis, and Cryptococcus neoformans. Open lung biopsy and surgical closure of air leaks can be accomplished safely with low morbidity. Tracheostomy and ventilatory support should be avoided at present in the majority of patients with this syndrome, as the mortality has been 100% when that stage of the disease is reached.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Combined treatment approach in surgical management of carcinoma of the esophagus: a preliminary report.

Surgical management of squamous cell carcinoma of the esophagus continues to be a controversial area in thoracic surgery. In a series of 20 patients, 15 received preoperative chemotherapy with cis-platinum (cisplatin), 2 received cisplatin plus 5-fluorouracil, and 3 received cisplatin plus vinblastine sulfate. Eighteen patients underwent en bloc esophagogastrectomy and postoperative radiation therapy. All patients were staged preoperatively by thoracoabdominal computed axial tomographic scan, bone scan, bronchoscopy, esophagoscopy, and barium swallow. Patients with liver or bone metastasis were excluded. The majority of patients received preoperative enteral hyperalimentation. Eighteen of the 20 patients completed the study with a follow-up of 12 to 24 months. There was 1 operative death, and 3 patients were in the hospital for more than three weeks after operation before they were discharged. Fourteen of the 18 patients survived for a year, and 11 survived for 12 to 24 months. Substantial reduction in mucosal disease and tumor burden based on preoperative barium swallow and endoscopy was evident in 11 of 18 patients, but in no patient was the tumor completely eradicated by preoperative chemotherapy. Although follow-up is short, this treatment regimen involving a combined treatment offers hope in the palliation of this disease.

Adult↗
PubMed1984

Transdiaphragmatic adrenal biopsy.

The adrenal gland is a common site of metastasis from carcinoma of the lung. In selected patients, especially those in whom the adrenal mass is on the ipsilateral side of the lung lesion, the adrenal gland can be biopsied by a transthoracic transdiaphragmatic approach. Our technique of transdiaphragmatic adrenal biopsy in the staging of carcinoma of the lung is described.

Adrenal Gland Neoplasms↗
PubMed1984

Single-stage complete muscle flap closure of the postpneumonectomy empyema space: a new method and possible solution to a disturbing complication.

The management of postpneumonectomy empyema remains a disturbing and controversial area in the field of thoracic surgery. Many methods have been described and have had varying degrees of success. We present a series of 5 consecutive patients who underwent single-stage complete muscle flap closure of the pneumonectomy space with extrathoracic muscle flaps and omental grafts between October, 1981, and April, 1983. Two men and three women ranging from 37 years to 64 years old underwent such a closure from 3 to 13 months after original resection. Two patients had associated bronchopleural fistula. Prior to closure, 3 patients were managed with chest tubes and 2 with a modified Eloesser procedure. All operations were single-stage procedures, and all wounds closed primarily, with no permanent tubes or chest wall openings. There was no morbidity or mortality, and no subsequent operation has been required. Single-stage complete muscle flap closure of the postpneumonectomy empyema space has not been described previously, and we think it offers a possible solution to this potentially fatal complication.

Abdominal Muscles↗
PubMed1984

Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma.

Computed tomography has become an important diagnostic modality in the preoperative staging of patients with bronchogenic carcinoma. The adrenal glands represent one of the most frequent sites of metastasis. Therefore, an isolated adrenal mass discovered on preoperative thoracoabdominal CT poses a diagnostic problem. Three hundred thirty patients with histologically proved nonsmall-cell bronchogenic carcinoma were evaluated. Thirty-two had adrenal masses without further evidence of disease in the abdomen. Eight of these 32 masses were metastases, 17 were proved adenomas, and seven did not undergo biopsy. Thus, in the patients with nonsmall-cell bronchogenic carcinoma, an isolated adrenal mass is more likely benign than metastatic, and biopsy is advocated prior to withholding potentially curative surgery.

Adolescent↗
PubMed1984

Myocardial infarction complicated by Boerhaave's syndrome.

Spontaneous rupture of the esophagus can simulate a variety of disease processes. Ours is the first reported case in the English literature of Boerhaave's syndrome occurring concomitantly with acute myocardial infarction.

Diagnosis, Differential↗
PubMed1982

Pericardiectomy: current indications, concepts, and results in a university center.

During a 7 1/2-year period, 102 patients underwent pericardiectomy in the Emory University Affiliated Hospitals for a wide variety of pericardial disease. Seventy-six patients had predominantly effusive pericardial disease, and 26 patients had constrictive pericarditis. Nineteen cases of constrictive pericarditis developed in patients who had undergone previous open-heart operations. Hospital mortality at six weeks was 8.8%. The surgical approach was a left anterior thoracotomy in 72 patients; median sternotomy in 26 patients; and a subxiphoid approach in 4 patients. Only 2 patients required cardiopulmonary bypass. A detailed discussion of each subgroup of patients with pericardial disease requiring pericardiectomy is given.

Heart Neoplasms↗
PubMed1982

Median sternotomy T incision for thymectomy in myasthenia gravis.

Controversy exists over the surgical approach for thymectomy for myasthenia gravis. Opinion is divided between transcervical thymectomy and transsternal thymectomy performed through a median sternotomy. A technique that combines the advantages of a small, cosmetic T incision with good visualization through a partial sternotomy is presented. We have utilized this technique in more than 35 patients during the past ten years with excellent results.

Humans↗
PubMed1981

Complications of intrathoracic Nissen fundoplication.

This report details our experience with 30 patients who had Nissen fundoplication. Six underwent transabdominal Nissen fundoplication, and 10 had transthoracic Collis-Nissen with the gastric wrap in a subdiaphragmatic position. Ten patients had a transthoracic Nissen with the wrap in a supradiaphragmatic position. Four patients had a transthoracic Thal-Nissen procedure. In 1 of 4 patients with a Thal-Nissen procedure, intrathoracic rupture of the stomach with gastro-bronchial fistula developed and necessitated left lower lobectomy. Four of 10 patient in whom the gastric wrap was left in the chest experienced severe complications: in 1 patient a lesser curvature ulcer developed and required hemigastrectomy; 1 patient had herniation of the fundoplication with gastric outlet obstruction and required operation for its correction; 2 patients had intrathoracic rupture of the gastric wrap and ultimately died. The 6 patients with transabdominal Nissen and the 10 with transthoracic Collis-Nissen with wrap placed in the abdomen did well This experience severely condemns the practice of leaving the fundoplication above the diaphragm.

Aged↗
PubMed1981

Colon interposition for advanced nonmalignant esophageal stricture: experience with 40 patients.

This report details our experience in 40 patients with benign strictures of the esophagus who underwent colon (or gastric) interposition with our without esophageal resection between 1972 and 1980. There were 23 men and 17 women ranging from 5 to 76 years old. Twenty-seven patients had fibrotic strictures secondary to reflux esophagitis including 12 after failure of antireflux procedures; 4 had caustic strictures; 3 had a Barrett's esophagus; 2 had systemic candidiasis; 2 had scleroderma; and in 2 the etiology was undetermined. the right colon was used in 27 patients, the left colon in 4, the transverse colon in 1, and the jejunum in 1. In 7 patients the stomach was employed because of vascular insufficiency of the colon. Three surgical approaches were utilized. Manometric studies were done post-operatively in 10 patients. Complications occurred in 7 patients: cervical leaks, 4; reflux colitis, 2; and a late cervical stricture, 1. There were 4 deaths, only 1 of which was related directly to technique. This report summarizes the beneficial effect of right colon interposition for long esophageal strictures. Its vasculature is adequate, and it functions properly to propel food into the stomach irrespective of the peristaltic orientation.

Adolescent↗
PubMed1981

Pulmonary function test criteria for operability and pulmonary resection.

Pulmonary function criteria for pulmonary resection, other than pneumonectomy, have not been previously described. A series of 500 consecutive pulmonary resections to which specific pulmonary function criteria were applied in determining the amount and the extent of feasible resection of the lung are presented. By application of these criteria, an accurate assessment of the type and extent of pulmonary resection a patient can tolerate without expected mortality can be made. With utilization of these criteria, the operative mortality for segmental resection was 0.2 per cent; for lobectomy, zero per cent, and for pneumonectomy, 4.4 per cent.

Adolescent↗
PubMed1980

Carcinoma of the lung: five-year experience in a university hospital.

A review of 161 patients who underwent a curative surgical resection for carcinoma of the lung in a University Hospital during a five-year period is presented. Particular reference is made to importance of preoperative staging of lesions; the group of patients with Pancoast's tumor; the group of patients 70 years or older, and the group of patients with impaired pulmonary function.

Adult↗
PubMed1979

Carcinoma of the superior pulmonary sulcus.

From January, 1971, to January, 1977, 26 patients underwent surgical resection of a carcinoma of the superior pulmonary sulcus. They ranged from 33 to 77 years old. All but 1 had symptoms characteristic of Pancoast's syndrome. The site of involvement was the right superior sulcus in 17 patients and the left superior sulcus in 9. All patients were treated by lobectomy and extended en bloc resection. Twenty-five patients survived operation. There was 1 early postoperative death. Twenty-two patients had been followed for at least 3 years, and 8 had survived for 5 years, at the time of writing. Nine patients died of recurrent disease from five months to 3 years after operation. Important considerations in postoperative care include routine use of continuous positive airway pressure and intermittent mandatory ventilation.

Adenocarcinoma↗
PubMed1979

Further evaluation of the sutureless, screw-in electrode for cardiac pacing. Experience with first 300 implantations.

This report details our experience with 300 sutureless epicardial electrode implantations performed in the past 6 years. Indications for pacing, surgical approaches, implantation sites and complications are presented. The subxiphoid approach was valuable in obtaining safe, reliable, and long-term impulse generation. Complications have been few and of short duration. In general, pacing thresholds have been lower and sensitivity thresholds higher with left ventricular implantation than with right ventricular implantation. Endocarcial pacing is reserved for the very aged and debilitated patients, patients requiring implantation within 4 to 6 weeks of acute myocardial infarction, and for atrial or atrioventricular sequential pacing.

Adolescent↗