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J P Sweeney

Publications and source records attributed to J P Sweeney.

At least 19 recordsLinked to original sources
PubMed2000

Initial report of a case of carcinosarcoma of the supraglottis.

Minor salivary gland carcinosarcoma is a rare malignancy with an ominous prognosis. This report recounts a single case of supraglottic minor salivary gland carcinosarcoma that was treated aggressively. We discuss the peculiarities of the histology, with special mention of the distinction that must be made between mucosal-origin and salivary-gland-origin carcinosarcoma. Carcinosarcomas are aggressive regardless of their origin, but differentiating their origin is important because the prognosis is worse for those that arise in salivary glands than for those that originate in the surface epithelium. This report adds to the literature a new case of minor salivary-gland-origin carcinosarcoma involving the upper airway. It is the first case we could identify in which the supraglottis was involved.

Adult↗
PubMed1997

Use of intravascular ultrasound in evaluating repeated balloon rupture during coronary stenting.

Balloon rupture during coronary angioplasty is a well-recognized complication of PTCA. Coronary angiography commonly fails to elicit the cause of balloon perforation. We present a case with multiple balloon rupture during additional high-pressure inflations of a Palmaz-Schatz stent where intravascular ultrasound was useful in revealing a calcified lesion protruding through the struts of the stent.

Aged↗
PubMed1996

Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment.

OBJECTIVES: To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy. PATIENTS AND METHODS: The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease-free and overall survival of the patients. RESULTS: The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease-free and overall survival than had those with symptomatic tumours (P < 0.05). CONCLUSIONS: The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies the follow-up.

Carcinoma, Renal Cell↗
PubMed1996

Applying the results of large clinical trials in the management of acute myocardial infarction.

Mortality from acute myocardial infarction has declined in recent years, largely due to the widespread application of new pharmacologic and mechanical interventions that have been tested in large, prospective, randomized clinical trials. For practicing generalists, we review the key data from such trials that have shaped the current management of patients with acute myocardial infarction. We discuss the roles of thrombolytic therapy, coronary angioplasty, nitrates, beta- and calcium channel blockers, angiotensin-converting-enzyme inhibitors, magnesium, and antiarrhythmic and antithrombotic agents. In addition, we highlight critical unanswered questions in the management of this disorder.

Angioplasty, Balloon, Coronary↗
PubMed1994

An unusual complication of appendectomy.

Intraabdominal abscess formation is a well-recognized complication of perforated appendicitis. Extraabdominal complications, however, are rare. The authors present the case of an 8-year-old boy who had an acute painful right-sided scrotal mass 2 days after an operation for perforated appendicitis. During exploration, an abscess within a previously undiagnosed patent processus vaginalis was found and successfully managed by drainage. This case demonstrates that a persistent patent processus vaginalis may predispose to scrotal pathology secondary to intraabdominal sepsis and represents a unique complication of perforated appendicitis.

Abscess↗
PubMed1994

Intraoperative thrombolytic therapy as a treatment of small vessel thrombosis: an experimental study.

OBJECTIVE: This paper studies the effect of three doses of Streptokinase infused intra-operatively into an animal model of small vessel thrombosis. EXPERIMENTAL DESIGN: This is a controlled trial of intraoperative infusion of thrombolytic agent into a thrombosed arterial segment compared to no infusion into the contralateral limb. EXPERIMENTAL SUBJECTS: 19 New Zealand White rabbits were stratified into 3 groups. INTERVENTIONS: Thrombosis was achieved by infusing a mixture of topical thrombin and autologous blood into individual iliac arteries of the New Zealand white rabbit. A randomly selected hind limb had an infusion of one of three doses of streptokinase (A = 2,500u; B = 5,000u; C = 10,000u) in saline over 20 minute period. Preinfusion and post infusion angiography was performed. MEASUREMENTS: Angiograms were ranked by a radiologist blinded to the side of infusion and clotting parameters were assessed. RESULTS: All limbs at all doses of streptokinase infusion (SK) showed significant clot lysis when compared to the non-infused limb(C). The percentage of improved segments is as follows: iliac: SK = 100%, C = 79%; femoral SK = 79%, C = 32%; tibial SK = 52%, C = 5%. Although there was an elevation in clotting time and a reduction in fibrinogen, levels remained within normal limits. CONCLUSIONS: Streptokinase infused directly into thrombus in arteries even in low doses significantly enhances thrombolysis of vessels which are too small to be cleared by mechanical means. No significant systemic complications were encountered.

Animals↗
PubMed1993

Management of ductal carcinoma in situ of the breast.

Ductal carcinoma in situ (DCIS) of the breast is thought to represent a number of biologically different processes, ranging in clinical presentation from a palpable mass to a mammographically-detected abnormality. The optimal management of DCIS is controversial. We reviewed our experience in 40 patients with DCIS, 26 with gross disease and 14 with microscopic disease. Treatment was by total mastectomy (n = 21), complete local excision (n = 16), and local excision followed by radiotherapy (n = 3). At a mean follow-up of 34 months (range 3-120), 35 patients (88%) are disease-free. All patients treated by mastectomy remained disease-free, but 3 patients (16%) treated by breast conservation surgery have had local recurrences. All local recurrences were in the same area as the original lesion, two manifesting the same subtype of DCIS and one an invasive carcinoma. The margins of excision were close to the resection margin in all cases that recurred. All four recurrences were successfully managed by mastectomy. Mastectomy is still the most secure and reliable management for DCIS, but pathologically verified wide local excision may be appropriate.

Breast Neoplasms↗
PubMed1990

Aneurysms of the inferior vena cava.

Aneurysms of the inferior vena cava are very rare. We describe a case of a saccular aneurysm of the inferior vena cava that thrombosed after vigorous exercise. This presented as deep venous thrombosis associated with a retroperitoneal mass. Laparotomy with biopsy confirmed the benign nature of this lesion, and symptoms gradually resolved. It is hypothesized that the increased intraabdominal pressure during exercise led to the thrombosis of what is presumed to be a congenital aneurysm of the inferior vena cava.

Adult↗
PubMed1989

Ultrasound with graded compression in the evaluation of acute appendicitis.

Acute appendicitis is the most common diagnosis made (in the Western world) in patients with an "acute abdomen." Although the mortality rate has been vastly reduced, the diagnostic inaccuracy rate of 15% to 20% has remained unchanged in the past 100 years. In this article, the authors report the ultrasonographic findings in 80 patients examined using a small linear-array transducer, which enables direct visualization of the inflamed appendix. During 22 months, 80 patients (28 males and 52 females; age range, 3 to 81 years; mean, 32.3 years) with equivocal clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 29 patients whose appendicitis was verified at surgery, ultrasonography was positive in 26, with an overall sensitivity of 90%. Of the 51 patients who did not have appendicitis, ultrasonography was negative in all, with a specificity of 100%. The authors concur with reports in the literature that ultrasonography is helpful in diagnosing appendicitis.

Abdomen, Acute↗
PubMed1989

Extra-anatomic bypass grafting: a rational approach.

To determine predictors of long-term patency in extra-anatomic bypass grafting, the authors studied retrospectively the charts of 134 patients who underwent bypass grafting (axillofemoral in 17, axillobifemoral in 32 and femorofemoral in 85). Of the study group, 64% were men; the mean age was 65 +/- 12 years (+/- SEM). The indications for grafting were limb salvage (102), claudication (27) and replacement of septic grafts (5), and for using the extra-anatomic route included high risk (83), sepsis (8) and unilateral disease (34). Operative mortality was 6% and the early graft occlusion rate 7.4%. The late death rate was 44%. At 3 years, the life-table patency rates for the various procedures were axillofemoral 52.5%, axillobifemoral 67.7% and crossfemoral 86.9%. Smoking significantly (p less than 0.05) decreased the patency rate, but diabetes did not. However, amputation was more frequent in diabetics. Indications for operation did not alter patency rates, but did affect operative mortality. The authors conclude that extra-anatomic bypass grafting is highly successful, but not as successful as anatomic bypass. When appropriate, the axillobifemoral graft is preferred to the axillounifemoral graft because of its increased patency. Crossfemoral grafts must be carefully monitored to ensure that no donor limb stenosis occurs and this procedure should not be attempted unless the disease is truly unilateral.

Adult↗
PubMed1988

Simple method of intraoperative blood collection and reinfusion during aortic surgery.

The increasing fear of acquired immune deficiency syndrome and other blood-transmissible diseases and increasing blood-bank shortages prompted a study of the safety and feasibility of a commercially available hand-held unit for collecting and reinfusing blood. The device was used on nine patients undergoing aortic surgery and permitted a mean saving of 2.6 units of banked blood. The reinfusion of collected blood did not result in any coagulation disturbances or changes in renal function. The hemoglobin and platelet levels were comparable to those in a group of patients receiving only banked blood. The unit does not require additional personnel or technical training for its use. The authors conclude that this autotransfusion device is a safe and feasible method of reducing the requirement for banked blood during aortic surgery.

Aorta↗
PubMed1987

The widened teardrop distance: a plain film indicator of hip joint effusion in adults.

The teardrop distance is defined as the distance from the lateral margin of the pelvic teardrop to the most medial aspect of the femoral head as seen on anteroposterior pelvic radiographs. The structure responsible for the teardrop is the anteroinferior portion of the acetabular fossa with contributions from the ischium and from the superior pubic ramus. Anteroposterior pelvic radiographs of 10 patients with documented cases of unilateral hip effusion were retrospectively evaluated for teardrop distance widening on the affected side. Proof of the presence of hip effusion was based on the results of percutaneous hip joint aspirations as described in the patient's medical records. A teardrop distance widening of 1 mm or more was always consistent with hip joint fluid. In addition, radiographs from 20 patients with no known hip abnormalities were reviewed as a control population. These showed side-to-side symmetry in 16 cases (80%) and widening of less than 1 mm in the remaining four cases (20%). Thus, hip joint effusion in adults can be accurately diagnosed from plain radiographs in the presence of a teardrop asymmetry of 1 mm or more and in the absence of degenerative joint disease.

Adolescent↗