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M J Krasna

Publications and source records attributed to M J Krasna.

84 records · Page 5Linked to original sources
PubMed1988

Vascular and neural invasion in colorectal carcinoma. Incidence and prognostic significance.

The incidence and significance of histologic vascular and/or neural invasion in 77 patients with colorectal carcinoma treated over a 6-year period were analyzed retrospectively. Vascular invasion was found in 37.6% of patients and neural invasion in 14.3%. The following three types of vascular invasion were identified: tumor lining epithelium, tumor thrombi, and destruction of the vessel wall. The incidence of metastases in patients with vascular invasion was 60% as opposed to 17% in those without vascular invasions (P less than 0.0001). Survival in these patients was 29.7% and 62.2%, respectively (P less than 0.003). Metastases were found in 72.7% of patients with neural invasion, as opposed to 27% of those without neural invasion (P less than 0.01). Survival was 29.6% as opposed to 57.7% in those without neural invasion (P less than 0.003). Even among patients in the same Dukes' stage, prognosis, as determined by incidence of recurrence, metastases, and survival, was worse significantly among those patients demonstrating vascular invasion (P less than 0.03). Examination of patients with colorectal carcinoma for the presence of vascular and neural invasion may provide useful information for determining future treatment and prognosis.

Colonic Neoplasms↗
PubMed1988

Gastrointestinal complications after cardiac surgery.

Gastrointestinal (GI) complications after cardiac surgical procedures are infrequent but severe. Thirty-three GI complications were identified in 25 patients who underwent cardiac surgery during a 7-year period (2.0% incidence). The mortality rate for patients having these GI complications was 44%. Acute acalculous cholecystitis was the most lethal complication (86%). Acute pancreatitis was the most common complication (eight patients). Most patients responded well to conservative measures. Five patients had upper GI hemorrhage and three had lower GI bleeding that required more than 2 U of packed red blood cells. All patient conditions were diagnosed endoscopically and none necessitated operation. Of the remaining patients, one was operated on because of perforated duodenal ulcer, one because of perforated diverticulitis, and one because of pseudo-obstruction of the colon, and one patient underwent diagnostic laparotomy and showed negative results for presumed acalculous cholecystitis. Liver failure was fatal in all three patients in whom it occurred. GI complications correlated significantly with advanced age, prolonged bypass times, valve surgery, and the female sex. We conclude that septic GI complications--particularly acute acalculous cholecystitis and perforated viscus--after cardiac surgery are uncommon but lethal. Clinical features are often subtle, and a high index of suspicion is necessary for an early diagnosis and the institution of appropriate treatment.

Acute Disease↗
PubMed1987

Use of tubes and radiographs in the management of small bowel obstruction.

During the past 10 years 311 consecutive patients were admitted with 342 episodes of small bowel obstruction (SBO). There were 193 cases of partial small bowel obstruction (PSBO) and 149 cases of complete small bowel obstruction (CSBO) as determined by interpretation of the abdominal radiographs done on admission. The purpose of this review was to determine the reliability of the admission plain abdominal radiographs and subsequent upper gastrointestinal (UGI) contrast studies in predicting the need for operative intervention. The use of nasogastric tubes (NGT) versus nasointestinal (long) tubes (NIT) was correlated with the following outcome variables; length of hospital stay (LOS), timing of operative intervention, incidence of postoperative complications, and duration of postoperative ileus. Long tubes (NIT) were used in 64 episodes of PSBO and 81 episodes of CSBO, whereas nasogastric tubes (NGT) were used in 116 cases of PSBO and 68 cases of CSBO. Thirty-eight of 193 (19%) patients with PSBO required operation (20 of 116 with NGT and 18 of 64 with NIT), whereas 125 of 149 (84%) patients with CSBO required operation (60 of 68 with NGT and 65 of 81 with NIT). Need for operation was not correlated with whether or not long tubes passed beyond the pylorus; 50 passed versus 33 not passed in operative groups (p = 0.15). Twelve of 83 patients with NIT had operation within 24 hours versus 52 of 80 patients with NGT (p less than 0.001). In six of 64 patients who had surgery within 24 hours, complications developed versus in 39 of 99 patients operated on more than 24 hours after admission (p less than or equal to 0.001). In 29 of 83 patients treated with NIT, postoperative complications developed versus in 16 of 80 patients with NGT (p less than or equal to 0.04). The mean duration of postoperative ileus in patients with NIT was 7 days versus 4.1 days for NGT patients (p less than 0.001). The mean LOS was 12.2 days for NGT patients versus 21 days for patients with NIT (p less than 0.001). Barium UGI contrast studies were performed in 57 patients to establish the presence of obstruction. In 34 of 57 patients the UGI disclosed mechanical obstruction that required operative intervention. In the remaining 23 patients no obstruction was demonstrated, and all 23 patients recovered without operation. In conclusion, there is no inherent superiority of NIT versus NGT in the treatment of SBO.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1987

The vastus lateralis myocutaneous flap.

Four case reports of decubiti treated with vastus lateralis myocutaneous flaps are presented. The operative technique is described in detail. This method, closing the donor site primarily over Hemovac drains and eliminating the use of skin grafts, can be used to cover defects in a variety of locations.

Adult↗
PubMed1987

Clinical experience with the Jahnke-Barron heart support.

The Jahnke-Barron heart support has proven to be a useful adjunct to coronary artery surgery by allowing an easy access to the coronary arteries while maintaining a quiet operating field. Further, the use of this device eliminates the need for a surgical assistant or a heart holder.

Coronary Artery Bypass↗
PubMed1986

Electrocardiographic changes in cardiac patients with acute gallbladder disease.

Acute cholecystitis or biliary colic may be associated with angina pectoris, arrhythmias, or nonspecific ST-T wave changes on the electrocardiogram. A vagally mediated cardio-biliary reflex is the presumed cause of these changes. Three cases of acute exacerbation of biliary tract disease in patients with known coronary artery disease associated with transient electrocardiographic changes and no concurrent cardiac complaints or abnormalities are reported. The signs and symptoms of gallbladder and heart disease may overlap, making diagnosis difficult. These patients underwent extensive workups of both their cardiac and biliary disease, which did not document any acute cardiac problem. In patients with known coronary artery disease and acute cholecystitis, the surgeon should not be discouraged from cholecystectomy merely because of a "questionable" electrocardiogram. Undue delay in treatment while awaiting the results of the cardiac screen may result in both cardiac and septic complications.

Acute Disease↗
PubMedDate not supplied

The use of concurrent chemotherapy with high-dose radiation before surgical resection in patients presenting with apical sulcus tumors.

PURPOSE: Patients presenting with apical sulcus tumors have historically been treated with preoperative radiotherapy followed by surgical resection. Since 1991, we have delivered an induction regimen consisting of combination chemotherapy and high-dose radiation in an attempt to improve tumor responses and increase survival for this patient population. PATIENTS AND MATERIALS: This retrospective analysis consisted of 23 (13 men and 10 women) consecutive patients who completed trimodality therapy. The median age was 53 years. Histologies included adenocarcinoma (nine patients), squamous cell (five patients), large cell (three patients), and undifferentiated non-small cell lung carcinoma (six patients). Pretreatment stages were T3NO (14 patients), T3N2 (two patients), T3N3 (one patient), T4NO (five patients), and T4N2 (one patient). Preoperative therapy consisted of daily radiotherapy (median dose, 59.4 Gy) delivered at 1.8 Gy/day and concurrent combination chemotherapy consisting of either two cycles of cisplatin and etoposide or weekly carboplatin and paclitaxel. Surgical resection typically included lobectomy with chest wall resection. RESULTS: All 23 patients were available for analysis of response and survival. The median follow-up was 53 months. The median number of days between completion of induction therapy and surgery was 56 days. Postoperative complications included prolonged atelectasis (two patients), pulmonary embolism (one patient), subarachnoid-pleural fistula (one patient), and deep vein thrombosis in the subclavian vein (one patient). The pathological complete response rate to induction therapy was 46% for the entire group. An additional 38% had evidence of tumor regression at the time of surgery. The 5-year disease-free and overall survivals were 36% and 49%, respectively. The median overall survival was 33 months. The median overall survival for those who achieved a pathological complete response has not been reached. Analysis of factors including age, sex, histology, differentiation, stage of disease, and radiation dose failed to identify any predictors of response or survival. CONCLUSION Concurrent chemotherapy and high-dose radiation can be safely delivered before surgery in patients presentingwith apical sulcus tumors. Our results compare favorably to other institutional series and support the further investigation of this approach in prospective trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Accurate lymph node assessment prior to trimodality therapy for esophageal carcinoma.

PURPOSE: The diagnosis of esophageal carcinoma has historically been associated with a poor prognosis. Recently, investigators have reported improved outcomes for this patient population with the use of trimodality therapy. These results have fueled the debate regarding which patients may benefit from this aggressive treatment course. This retrospective analysis was conducted in order to evaluate the importance of regional lymph node involvement, determined by surgical staging before the initiation of therapy. PATIENTS AND MATERIALS: Between July 1991 and June 1999, 45 patients underwent surgical staging with thoracoscopy and/or laparoscopy followed by induction chemoradiation and surgical resection. All patients underwent consultation in our thoracic multidisciplinary clinic. Thoracoscopy included nodal sampling from American Thoracic Society levels 5, 6, 8, and 9 within the mediastinum. Laparoscopy included inspection of the liver and nodal sampling from the lesser curvature and the celiac axis. Preoperative chemoradiation consisted of two cycles of 5-fluorouracil (1000 mg/M2) and cisplatin (100 mg/M2) weeks 1 and 4 with 50.4 Gy. Radiotherapy was delivered at 1.8 Gy/fraction with 39.6 Gy being delivered to the large-field and 10.8 Gy to a small-field boost. The routine surgical procedure was an Ivor-Lewis esophagectomy performed 4 to 6 weeks after completion of induction therapy. RESULTS: The median follow up was 24 months for all patients. The median overall survival was 23 months, with 1-, 2-, and 3-year survivals of 64%, 42%, and 34%, respectively. Thirty patients had pathological evidence of lymph node disease before therapy. The pathological complete response rate for the entire group was 51%. Node-positive patients had a path complete response rate of 14%, as compared with 59% for those who were NO. The median survival for these two groups was 15 months versus 35 months. Patients whose nodes were cleared by chemoradiation had a 3-year survival of 40%, whereas all patients with persistent nodal disease were dead by 2 years. Twenty-one patients have experienced recurrence of their disease. Thirteen patients had evidence of distant metastasis only, three local only, and five with both. CONCLUSION: Trimodality therapy offers patients with esophageal cancer an opportunity for long-term survival. Our experience has shown that minimally invasive pretreatment surgical staging provides useful information that can predict complete response and can help in the selection of appropriate patients for aggressive therapy.

Adenocarcinoma↗
PubMedDate not supplied

Video assisted thoracoscopic biopsy for interstitial lung disease.

At the University of Maryland Medical Systems, 356 consecutive thoracoscopic procedures were performed including 147 lung resections for various indications. Forty-nine patients underwent thoracoscopy for the diagnosis of interstitial lung disease. Two patients underwent bilateral procedures after a gap of more than six months for suspected malignancy. There were 28 females and 21 males. Age ranged from 23 to 75 years. The mean length of operation was 45 minutes and the mean length of chest tube duration 1.3 days. There were no deaths, no re-explorations or need to convert to an open thoracotomy. Staphylococcal pneumonia developed in one patient postoperatively requiring admission and intravenous antibiotics. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. All patients, except two ventilator dependent patients, were intubated with a double lumen tube. CO2 insufflation at the rate of 2 L/min and pressure of 10 mmHg was used in all patients. Biopsy of at least two lobes was performed in all patients with resection of grossly abnormal lung. A single chest tube was left at the end of the procedure. The tissue diagnosis was interstitial fibrosis in 19 patients. Bronchiolitis obliterans with organizing pneumonitis (BOOP) was seen in 7 patients. Foreign body granulomas were seen in 8 patients. Allergic alveolitis was diagnosed in 4 patients. Emphysematous changes with pneumonitis was observed in 3, nonspecific pneumonitis in 2. Anthracosis, connective tissue disorder, leukemic infiltrate with interstitial fibrosis and CMV pneumonitis were observed in one patient each. The clinical diagnosis correlated with pathological diagnosis and intraoperative findings. Thoracoscopy is a safe and effective method for diagnosis of interstitial lung disease.

Adult↗
PubMedDate not supplied

The role of thoracoscopic lymph node staging in esophageal cancer.

BACKGROUND: Unlike mediastinoscopy in lung cancer, there exists no standard minimally invasive test to stage esophageal cancer. If it were possible to obtain exact preoperative staging in esophageal cancer, patients could be separated prospectively to receive adjuvant therapy appropriately. METHODS: We studied the feasibility and efficacy of thoracoscopic lymph node staging (TSLN) and laparoscopic lymph node staging (LSLN) in esophageal cancer. RESULTS: TSLN was performed in 45 patients with biopsy proven carcinoma of the esophagus. LSLN was done in the last 19 patients. TSLN was aborted in 3 pts due to adhesions. Thoracic LN stage was N0 in 39 patients and N1 in 3; celiac LN were negative in 13 and positive in 6 patients. Esophageal resection was performed in 30 patients after TSLN; 17 of these underwent LSLN. TSLN staging showed N0 lymph node status in 28 patients and N1 in 2 patients. Two of the 28 N0 patients (7%) were found at resection to have paraesophageal lymph node involvement (N1) and were thus understaged by TSLN. Thus TSLN was accurate in detecting the presence of thoracic LN in 28/30 cases (93%). LSLN staging found negative celiac nodes in 12 patients and positive LN in 5 patients. After esophagectomy, final pathology of the 12 N0 patients was N0 in 11 and positive LN in one patient. Thus, LSLN was accurate in detecting lymph node metastases in 16/17 patients (94%).

Esophageal Neoplasms↗