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L J Faling

Publications and source records attributed to L J Faling.

At least 19 recordsLinked to original sources
PubMed1995

Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection.

The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection. The groups were similar in reference to history of pulmonary disease, preoperative pulmonary function, and pulmonary risk index score. The no-exercise patients were more likely to have a history of cardiac disease (64 vs 28%; p < 0.01) and had a higher CRI score (2.0 +/- 0.2 vs 1.4 +/- 0.1; p < 0.05). Cardiopulmonary postoperative complications (POCs) and mortality were more likely among those in the no-exercise group vs those in the exercise group (POCs, 79 vs 35%, p < 0.01; mortality, 21 vs 2%, p < 0.05). Among the eight no-exercise patients with a CPRI of 4 or more, all eight suffered a POC (100%) and three died (38%). Using multiple logistic regression analysis, both the CPRI score and the inability to exercise were independently associated with increased risk for POCs. We conclude that patients unable to perform even minimal preoperative exercise are at substantially increased risk for morbidity and mortality after lung resection. This results both from greater identifiable preoperative cardiopulmonary risk factors (as assessed by the CPRI) and from an independent effect related to the inability to exercise.

Aged↗
PubMed1995

Acute, reversible left ventricular dysfunction in status asthmaticus.

Three cases of rapidly reversible severe myocardial depression are described in patients with status asthmaticus. Initial echocardiograms obtained within 1 day of hospital admission revealed global left ventricular hypokinesis with ejection fractions of 11 to 34%. Follow-up echocardiograms obtained only 3 to 8 days later revealed marked improvement of left ventricular function. Possible mechanisms responsible for the observed rapidly reversible myocardial depression and the clinical implications of this finding are discussed.

Adult↗
PubMed1993

Bronchial stump disruption following inadvertent right mainstem intubation 9 years after pneumonectomy.

An 82-year-old man, with a history of right pneumonectomy 9 years prior to admission, was emergently intubated for respiratory failure resulting from rapid atrial fibrillation and congestive heart failure. Postintubation chest radiograph demonstrated the tube to be in the right bronchial stump. Over the next 48 hours gas exchange remained poor, endotracheal suctioning produced copious serosanguinous secretions, and chest radiographs showed increasing air, with air fluid levels, in the previously opacified right hemithorax. Bronchoscopy demonstrated air bubbling from the posterior wall of the right bronchial stump, consistent with a bronchopleural fistula. The authors conclude that right mainstem intubation, in the setting of a previous right pneumonectomy, can lead to disruption of the bronchial stump with drainage of fluid from the postpneumonectomy space into the functioning left lung with severe compromise of gas exchange.

Aged↗
PubMed1993

Controlled trial of a continuous irrigation suction catheter vs conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients.

Continuous irrigation-suction catheter (Irri-cath) is a double-lumen device that allows for simultaneous saline solution infusion and aspiration. This system may theoretically be more effective than conventional dry intermittent suction due to its vortex principle. To test this hypothesis, we performed 200 suction maneuvers in 20 ventilated patients. Identically shaped catheters were used in a randomized sequence. For the same individual, we used equal instilled saline solution volume (40 ml), vacuum pressure (-180 cm H2O), and ventilatory parameters. Effectiveness of suction was determined by measuring the total aspirated volume, the dry lyophilized weight of secretion, the corrected dry weight (dry weight-weight of instilled salt), and protein concentration. No difference in heart rate, respiratory frequency, O2 saturation, systemic blood pressure, peak inspiratory pressure, or patient discomfort was found when the two modalities were compared; however, the total volume of secretions collected, the dry weight, the corrected dry weight, and the protein concentration were significantly higher with continuous irrigation suction catheter when compared with the conventional method (p < 0.05). The suction time was shorter with the Irri-cath (p < 0.05). We conclude that the Irri-Cath is more effective than conventional intermittent suction catheter in clearing bronchial secretions in patients on mechanical ventilation.

Bronchi↗
PubMed1993

Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index.

Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] < 70 percent, and PaCO2 > 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p < 0.0001). We found that patients with a peak VO2 less than 500 ml/m2/min (body surface area) were 6 times more likely to experience a cardiopulmonary complication (p < 0.05). With multiple logistic regression analysis, peak VO2 was not an independent predictor of postoperative complications. Analysis also demonstrated that a CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.

Electrocardiography↗
PubMed1993

N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest.

Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan-Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.

Adenocarcinoma↗
PubMed1992

Polymicrobial bacterial pericarditis after transbronchial needle aspiration. Case report with an investigation on the risk of bacterial contamination during fiberoptic bronchoscopy.

A 63-yr-old man developed pericardial effusion with tamponade after transbronchial needle aspiration (TBNA) of a subcarinal mass. A diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobes and aerobes, organisms that constitute part of the normal upper respiratory tract flora. To examine the possibility that contamination of the transbronchial needle (TBN) could lead to purulent pericarditis by inoculation of bacteria into the mediastinum, quantitative cultures of the TBN content were performed in seven consecutive patients. Abundant growth of multiple anaerobic and aerobic organisms was demonstrated in all seven cultures. We conclude that subcarinal TBNA is another potential cause of purulent pericarditis. This results from upper respiratory tract contamination of the open distal end of the TBN as it passes through the suction channel of the bronchoscope.

Bacteria, Aerobic↗
PubMed1991

Computed tomography-guided minithoracotomy for the resection of small peripheral pulmonary nodules.

Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.

Adult↗
PubMed1987

Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location.

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.

Adult↗
PubMed1986

Staging with CT.

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Humans↗
PubMed1986

Pulmonary rehabilitation--physical modalities.

This review assesses the role of controlled breathing techniques (breathing training) and chest physical therapy (PT) in the management and rehabilitation of patients with chronic obstructive pulmonary disease (COPD). The review focuses on pursed lip breathing, the head-down and bending forward postures, slow deep breathing, and diaphragmatic breathing exercises as methods of breathing training, and on postural drainage, chest percussion and vibration, and controlled cough as techniques of chest PT. These modalities may be beneficial in selected patients with COPD.

Acute Disease↗
PubMed1985

The value of the bone scan and bone marrow biopsy staging small cell lung cancer.

The charts of 112 patients with small cell lung cancer were reviewed in a retrospective fashion in order to define the role of the radionuclide bone scan and bone marrow biopsy in the staging of this disease. Both a radionuclide bone scan and bone marrow biopsy were performed on all patients at the time of diagnosis. Sixty-one percent of patients had a negative bone scan and negative biopsy; 22% had a positive bone scan and negative biopsy; 8% had a negative scan and positive biopsy; and 9% had a positive scan and positive biopsy. In 21 of the 44 patients with osseous involvement, no other focus of distant metastasis was found. The bone scan showed greater than or equal to 3 areas of increased uptake in 15 patients, 2 areas of increased uptake in 13 patients, and 1 area in 7 patients. The number of patients with bone marrow biopsy results positive for tumor in these 3 groups were 5, 3, and 2, respectively. Our study shows a lack of correlation between bone scan and bone marrow biopsy results. The bone scan and bone marrow biopsy identify independent patterns of osseous metastasis. Both procedures should be performed in the evaluation of patients with small cell lung cancer.

Biopsy↗
PubMed1984

Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst.

A 53-year-old man entered the hospital with a large, right chronic pancreatitic pleural effusion. Computed tomographic examination of the abdomen and chest demonstrated a pancreatic pseudocyst that had extended into the mediastinum. After conventional closed-chest tube thoracotomy drainage failed to empty the pleural space, percutaneous abdominal pseudocyst drainage was instituted using computed tomographic guidance. The pleural effusion cleared promptly, and the pancreatic pseudocyst resolved gradually over seven weeks. Following termination of pseudocyst drainage, the patient has remained well for over two years with no recurrence of pancreatitis, pseudocyst, or pleural effusion. In contrast, three earlier patients with a chronic pancreatitic effusion managed conventionally had a complicated hospital course and required surgical intervention; two had recurrent pancreatitis following hospital discharge. Percutaneous catheter placement was unsuccessful in one of these three and, in retrospect, was infeasible in the other two. It is recommended that thoracoabdominal computed tomography be performed in all patients with a chronic pancreatitic pleural effusion, and that percutaneous abdominal catheter drainage be attempted in all patients with an accessible pancreatic or mediastinal pseudocyst. Such treatment may relieve respiratory insufficiency, minimize the risk of empyema or fibrothorax, and may promote pseudocyst closure without the need for surgery.

Chronic Disease↗
PubMed1984

Computed tomography of the lung, pleura, and chest wall.

Because of rapid technologic advances, clearly defined clinical indications, and widespread availability, computed tomography of the lungs, pleura, and chest wall has become increasingly important in the imaging and subsequent management of numerous thoracic disorders. This article describes the current indications, common findings, and potential controversies in CT of the lung, pleura, and chest wall.

Bronchi↗
PubMed1984

Computed tomography. An effective technique for mediastinal staging in lung cancer.

Computed tomographic scans of the chest were utilized to stage mediastinal disease in 148 instances of bronchogenic carcinoma considered for resection in 146 patients. Nodes greater than or equal to 1.5 cm in diameter were interpreted as abnormal. All nodes positive by computed tomography were evaluated by mediastinoscopy, anterior mediastinotomy, or thoracotomy. All patients with negative computed tomographic findings underwent thoracotomy without prior surgical staging. Patients undergoing thoracotomy were divided into two groups. In Group I (first 51 instances) routine mediastinal exploration was not carried out; in Group II (last 97 instances) the mediastinum was explored in every patient and nodes were submitted for histopathological study. The computed tomographic and pathological findings on the mediastinal lymph nodes were compared. The sensitivity, specificity, and accuracy of computed tomography in Group I were 88%, 94%, and 92%, respectively, in Group II 75%, 89%, and 86%, and in the combined group, 80%, 91%, and 88%. The positive predictive index in Group I, Group II, and in the combined group was 88%, 69%, and 77%, respectively. It was lower for central than peripheral lesions (74% versus 88%) and was lowest for lesions in the right upper and left lower lobes. The negative predictive index was greater than 90% for all groups and all tumor sites except the left upper lobe, where it was 89%. Ten patients had false-positive scans, three with old mediastinitis and seven with postobstructive pneumonia; nine of the 10 had central lesions, and seven of these lesions were located in the right upper lobe. Eight patients had false-negative scans; six had para-aortic, subaortic, or postsubcarinal nodes. These nodes would not have been accessible to mediastinoscopy. In only one patient with false-negative nodes would routine mediastinoscopy have prevented thoracotomy and resection. Computed tomographic staging of mediastinal disease is indicated for all patients with lung cancer in whom operation is contemplated. Computed tomography directs the most appropriate staging procedure for patients with positive findings and obviates invasive staging for patients with negative findings.

Adult↗