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Biomedical subjects

M Burt

Publications and source records attributed to M Burt.

At least 91 records · Page 5Linked to original sources
PubMed1992

Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography.

We undertook this study to characterize the postthoracotomy compartmental displacement and respiratory mechanical changes occurring during and after the performance of the incentive spirometry maneuver. We also evaluated the effect of recumbency angle on compartmental recruitment. Sixteen patients were randomized to perform incentive spirometry either at 30 degrees or 60 degrees recumbency angle. They were studied using respiratory inductance plethysmography to measure tidal volume, respiratory frequency, inspiratory time, rib cage motion/tidal volume ratio, inspiratory duty cycle, and inspiratory flow. Patients were studied before surgery and on postoperative days 1 and 3. Statistical analysis was accomplished using multiple measures ANOVA with post-hoc Student's t-tests when appropriate. Preoperative incentive spirometry augmented VT by increasing both VT/TI and TI. Postoperatively, the incentive recruitment of VT was reduced, a result of a decrease in TI and TI/TTOT; VT/TI was unchanged. There was postoperative decrease of AB and AB/VT during incentive spirometry, greatest in the 60 degrees group. Our results characterize the nature of the respiratory recruitment afforded by incentive spirometry, before and after thoracotomy. We also found evidence of postthoracotomy diaphragmatic derecruitment during incentive spirometry exacerbated by a high recumbency angle.

Female↗
PubMed1992

Resection of brain metastases from non-small-cell lung carcinoma. Results of therapy. Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff.

The treatment of patients with a solitary brain metastasis has been evolving, with most centers recommending resection in patients with good performance status. To evaluate the results of resection of brain metastases from non-small-cell lung cancer, we reviewed our 16-year experience with 185 consecutive patients undergoing resection of brain metastases from 1974 to 1989, inclusive. There were 89 men and 96 women; ages ranged from 34 to 75 years (median 54). Sixty-five (35%) had synchronous and 120 (65%) metachronous brain metastases. Discounting the brain metastasis, 68 patients (37%) had stage I, 13 (7%) stage II, 62 (33%) stage IIIA, 30 (16%) stage IIIB, and 12 (6%) stage IV carcinoma. There was no significant difference in age, locoregional stage (TN), or histologic features in patients with synchronous versus metachronous lesions. The overall survival rates (n = 185) were as follows: 1 year, 55%; 2 years, 27%; 3 years, 18%; 5 years, 13%; and 10 years, 7% (median 14 months). There was no significant difference in survival between patients with synchronous and metachronous lesions. To evaluate the impact of locoregional stage and treatment of the primary site, we analyzed only those patients with synchronous brain metastases. Multivariate analysis demonstrated that locoregional stage had no significant effect on survival (p = 0.97), but complete resection of the primary disease significantly prolonged survival (p = 0.002). Therefore complete resection, and not stage, of the locoregional primary lesion is the primary determinant of survival in patients undergoing resection of brain metastases from non-small-cell lung cancer.

Actuarial Analysis↗
PubMed1992

Desmoid tumors of the chest wall. A locally recurrent problem.

Desmoid tumors, in general, are known for their propensity to recur. To evaluate treatment and results, we reviewed the records of 32 patients admitted to our institution with a chest wall desmoid tumor from 1948 to 1988. There were 13 men and 19 women whose ages ranged from 12 to 67 years (median 36 years). Four patients had Gardner's syndrome. Treatment was wide resection. Median follow-up was 110 months. The overall 5-year survival was 93%; 5-year disease-free survival was 71%. The 5-year local recurrence rate was 29%. Since death from disease is uncommon after resection, but local recurrence is common, we recommend aggressive wide resection in patients who have desmoid tumors of the chest wall when seen initially.

Adolescent↗
PubMed1992

Transhiatal esophagectomy.

THE is a versatile procedure that has become indicated for a variety of disease processes over the past two decades; amongst these indications are to treat many benign and malignant esophageal diseases, as well as for use in restoring gastrointestinal continuity after extensive pharyngeal or laryngopharyngeal resections. Careful and meticulous handling, formation, and transposition of the gastric tube are essential to the development of a well-perfused neo-esophagus. Present studies indicate acceptable morbidity and mortality of THE compared with transthoracic resections for carcinoma of the esophagus. There appears to be no significant detriment in overall long-term survival when THE is used as primary resection therapy for malignant esophageal disease.

Anastomosis, Surgical↗
PubMed1991

Malignant esophagorespiratory fistula: management options and survival.

The development of a malignant esophagorespiratory fistula is a devastating complication. Data comparing various treatment options in a large group of patients are sparse. To assess the results of therapy, we reviewed our experience in 207 patients with malignant esophagorespiratory fistula. Records of 207 patients admitted to our institution with malignant esophagorespiratory fistula from 1926 to 1988 were reviewed and results of management analyzed. Age ranged from 21 to 90 years (median, 59 years); the male/female ratio was 3:1. Primary tumor site was esophagus in 161 (77%), lung in 33 (16%), trachea in 5 (2%), metastatic nodes in 4 (2%), larynx in 3 (1%), and thyroid in 1. Symptoms and signs of malignant esophagorespiratory fistula included cough in 116 (56%), aspiration in 77 (37%), fever in 52 (25%), dysphagia in 39 (19%), pneumonia in 11 (5%), hemoptysis in 10 (5%), and chest pain in 10 (5%). Respiratory location of fistula included trachea in 110 (53%), left main bronchus in 46 (22%), right bronchus in 33 (16%), lung parenchyma in 13 (6%), and multiple sites in 5 (2%). The percentage of patients alive at 3, 6, and 12 months by treatment modality was 13%, 4%, and 1% for supportive care (n = 104); 17%, 3%, and 0% for esophageal exclusion (n = 29); 21%, 14%, and 0% for esophageal intubation (n = 14); 30%, 15%, and 5% for radiation therapy (n = 20); and 46%, 20%, and 7% for esophageal bypass, respectively. Patients treated with radiation therapy and esophageal bypass had a significantly prolonged survival compared with patients treated with the other modalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

Multiple primary lung carcinomas: prognosis and treatment.

From 1955 to 1990, 111 patients have been treated for multiple primary lung carcinomas. Criteria for diagnosis were: (1) different histology (n = 44); or (2) same histology, but disease-free interval at least 2 years (n = 39), origin from carcinoma in situ (n = 19), or metachronous disease in different lobe (n = 9) with no cancer in common lymphatics or extrapulmonary metastasis at the time of diagnosis. The second cancer was synchronous in 33 patients (30%) and metachronous in 78 (70%). Metachronous disease developed at a median interval of 48 months. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 70% and 44%, and 10-year survival was 42% and 23%, respectively. Survival after the development of a metachronous lesion was 23% at 5 years. Survival from the time of initial diagnosis was significantly better for metachronous versus synchronous, late (24 month disease-free interval) versus early metachronous disease, and adenocarcinoma versus epidermoid carcinoma. The first cancer was completely resected in 103 patients (93%), but complete resection of a metachronous tumor was possible in only 54 patients (69%). Complete resection of second primary cancers resulted in significantly (p less than 0.0001) prolonged 5-year survival compared with incomplete resection (38% versus 9%). Excluding patients requiring pneumonectomy, initial resection limited subsequent resection in only 7 patients (9%) with metachronous disease. We conclude that patients surviving treatment of primary lung cancers require lifelong screening for multiple primary lung carcinoma, and complete resection is recommended whenever possible.

Female↗
PubMed1991

Unusual malignant neoplasms of the esophagus. Oat cell carcinoma, melanoma, and sarcoma.

Primary noncarcinomatous malignant neoplasms of the esophagus are uncommon and data concerning treatment and results are sparse. To evaluate the results of therapy in this group, we reviewed the records of 32 patients with primary esophageal malignant tumors of unusual histologic type. Thirteen patients (41%) had sarcoma, eight (25%) melanoma, and 11 (34%) had oat cell carcinoma. Dysphagia was present in 78% (25/32) of the patients for a median of 13 weeks before diagnosis. Location of the esophageal primary tumor was upper third in four patients (12%), middle third in 12 (38%), and lower third in 16 (50%). Treatment consisted of esophagectomy in 10 of 13 patients with sarcoma (77%), seven of eight with melanoma (88%), and three of 11 with oat cell carcinoma (27%). Patients not undergoing resection received chemotherapy or radiation therapy, or both. The 3- and 5-year survival rates were 46% and 23% for sarcoma (median 20 months), 13% and 0% for melanoma (median 5 months), and 0% and 0% for oat cell carcinoma (median 5 months), respectively. Distant disease was the initial form of recurrence in 73% (11/15) of patients undergoing curative therapy. Surgical resection appears indicated for localized primary esophageal sarcoma. Optimum treatment of primary esophageal melanoma is less clear, but surgical resection may be of benefit in selected patients. Esophageal oat cell carcinoma is a systemic disease necessitating systemic therapy with local therapy reserved for palliation of dysphagia.

Adult↗
PubMed1991

Inferior vena caval involvement by renal cell carcinoma. Use of venovenous bypass as adjunct during resection.

Venovenous bypass allows the safe conduct of operation during resection of renal cell carcinoma with inferior vena caval involvement by allowing venous return when the inferior vena cava is clamped, thus preventing hypotension. It obviates the heparin required for full cardiopulmonary bypass and therefore decreases postoperative bleeding. A blood retrieval system decreases the volume of banked blood required. A Moretz clip placed early on the intrapericardial inferior vena cava allows adequate venous return and prevents a massive pulmonary tumor embolism.

Adult↗
PubMed1991

Adjuvant brachytherapy for treatment of chest wall sarcomas.

Thirty patients treated with surgical resection and brachytherapy for chest wall sarcoma at Memorial Sloan-Kettering Cancer Center from 1980 through 1987 were reviewed. Patients selected to receive adjuvant irradiation were those for whom there was doubt as to the completeness of surgical resection. Overall 5-year survival and locoregional control after brachytherapy were 65% and 54%, respectively. Locoregional control was similar for tumors treated at initial diagnosis (12 patients), at the time of recurrence (13 patients), or for tumors that were metastatic to the chest wall (five patients). Six patients with tumors larger than 10 cm in maximum dimension had a locoregional recurrence rate of 69% versus a recurrence rate of 39% for 18 patients with smaller tumors (p = 0.27). Fifty-four percent of high-grade tumors recurred locoregionally versus 28% of low-grade tumors (p = 0.37). Bone invasion or the presence of positive resection margins was not clearly associated with a higher locoregional failure rate. Only one patient (1/28; 7%) was known to have had recurrence within the irradiated area. Eight patients (8/28; 37%) had recurrence adjacent to the implanted area, and the precise failure site could not be determined for the remaining two patients. Because of the relatively high risk of regional versus in-field recurrence, patients with chest wall sarcoma who receive adjuvant treatment should be treated primarily with external-beam irradiation to allow more generous coverage of the tumor bed. Brachytherapy could be used as a tumor bed "boost" treatment. In patients undergoing resection of recurrent tumor in a previously irradiated site, adjuvant brachytherapy, without external-beam irradiation, should be considered to reduce the risk of extensive soft tissue necrosis.

Adolescent↗
PubMed1990

Recurrence of resected esophagogastric adenocarcinoma: results of re-resection.

Isolated local recurrence following potentially curative resection for carcinoma of the esophagus or esophagogastric junction does not necessarily imply pending systemic disease and early demise. While radiation alone or in combination with chemotherapy is standard treatment for such patients, resection is another available option. Resection may also be a consideration should localized disease persist after non-operative therapy in the absence of metastases. A 5 year retrospective review was performed examining 204 resections performed prior to 1989. Only 5 patients underwent resection of locally recurrent esophagogastric (EG) adenocarcinoma during this period. No squamous carcinoma recurrences were resected. One patient is well 15 months later while another died at 18 months of other causes without recurrence. Recurrence after re-resection occurred at 8, 11, and 24 months in the 3 other patients. Although there were no postoperative deaths, major complications occurred in 4 patients. All 5 patients swallowed normally after operation.

Adenocarcinoma↗
PubMed1990

Neoadjuvant chemotherapy and surgery of cancer of the esophagus.

Neoadjuvant, or pre-operative, chemotherapy for esophageal cancer has become an area of increasing interest because of the failure of conventional therapy (surgery or radiation) to improve disease-free or overall survival. Several autopsy series have demonstrated that, in many symptomatic Western patients, esophageal cancer is a systemic disease. Neoadjuvant chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single-arm, phase II multi-modality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality has not been increased. Large-scale randomized trials, needed to evaluate the impact of this technique on disease-free and overall survival, have been designed and will shortly be activated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Preoperative therapy for esophageal cancer: a randomized comparison of chemotherapy versus radiation therapy.

Ninety-six patients with operable epidermoid cancer of the esophagus were entered into a phase III, random assignment study designed to compare the efficacy of two preoperative approaches (chemotherapy [CT] or radiation therapy [RT]). Major study end points were objective response rates, surgical outcome, and recurrence pattern. Patients were randomly assigned to receive either two cycles of cisplatin, vindesine, and bleomycin or 55 Gy of radiation before a planned surgical procedure. Postoperative crossover therapy (radiation to those receiving preoperative CT and vice versa) was given to patients with T3Nany or unresectable tumors. Objective response rates of the primary tumor to preoperative therapy were similar (RT 64%, CT 55%), as were operability rates (RT 77%, CT 75%), resection rates (RT 65%, CT 58%), and operative mortality (RT 13.5%, CT 11.1%). Significantly higher doses of CT could be administered when CT was given as initial therapy, rather than after RT/surgery. Local failure or persistence occurred in 33% of operable patients. The median survival for all patients was 11 months; 20% remain alive without disease (median follow-up, 34 months). Because of the crossover design, it was not possible to analyze survival according to the preoperative therapy arm alone. This study suggests that since CT is as effective in treating local tumor as RT, but can also potentially treat systemic disease, investigational programs using CT before surgery as part of initial treatment for localized esophageal cancer should continue. However, if a significant impact on overall survival is to be achieved, more effective chemotherapy regimens or schedules need to be identified. Outside of carefully designed clinical trials, surgery alone or radiation alone remain standard therapy.

Analysis of Variance↗
PubMed1989

Modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology.

We describe the surgical technique of modified open thoracic rhizotomy for treatment of intractable chest wall pain of malignant etiology. In a series of 14 patients, 9 (64%) had an excellent result, 4 (29%) had a good result, and 1 (7%) had a poor result. Successful palliation was made possible by identification with computed tomographic scan or magnetic resonance imaging of the nerve roots involved. Pain control lasted in most patients until death (median, 22 weeks; range, 6 to 45 weeks). The extrathecal procedure described has certain advantages over intradural transection of nerve roots. Indications for performing this procedure are discussed along with other therapeutic options.

Adult↗
PubMed1989

Superior sulcus tumors: CT and MR imaging.

Thirty-one patients with superior pulmonary sulcus tumors underwent a total of 32 sets of computed tomographic (CT) and magnetic resonance (MR) imaging examinations before receiving therapy. Prospective, independent, and blinded interpretations of the studies were compared with both the surgical findings (15 patients) and the patient's clinical symptoms (17 patients). Thin-section (5-mm) coronal and sagittal MR images proved more accurate than CT scans (.94 accuracy with MR imaging, .63 with CT) in evaluation of tumor invasion through the superior sulcus. The improved accuracy of MR imaging in this region appears almost certainly to be related to the improved display of the anatomy of the superior sulcus on thin-section coronal and sagittal images.

Adenocarcinoma↗
PubMed1989

Current diagnosis of acoustic tumors.

This article discusses the most direct and cost-effective means of diagnosing acoustic tumors. The sensitivity and specificity of current diagnostic tests are reviewed. Newer techniques, including magnetic resonance imaging (MRI), have changed the diagnosis of acoustic neurinomas. Our current recommendation is to do a screening auditory brainstem evoked response (ABR) if the neurotologic examination and audiometry indicate a possibility of tumor. If the audiogram and examination indicate a high probability of tumor, we may proceed directly to magnetic resonance scanning.

Evoked Potentials, Auditory↗
PubMed1980

The role of bone scans in assessing malignant melanoma in patients with stage III disease.

Two hundred abnormal bone scans of patients with a malignant melanoma were reread in a blinded fashion to identify osseous metastases. These findings were compared with serum calcium and alkaline phosphatase levels, skeletal surveys and survival curves of the same patients. Thirty-four of the 38 patients classified as positive for osseous metastases by bone scans ultimately supported that diagnosis. Three patients have probable, but not proved, osseous metastases, and one patient is classified as false-positive. Identification of osseous metastases by skeletal surveys never preceded bone scan identification. Skeletal surveys were most helpful in the identification of a benign condition which caused scan positivity. Serum calcium and alkaline phosphatase levels were never as sensitive or specific as either scans or surveys. In two patients with progressive osseous disease, the levels fell. We believe that radionuclide bone scans should be the first diagnostic procedure for suspected osseous metastases in patients with a malignant melanoma. It appears to be a more sensitive and specific test than skeletal surveys or serum calcium and alkaline phosphatase levels. We believe its use as a first test would save time, money and needless surgical procedures.

Adult↗