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Biomedical subjects

M K Ferguson

Publications and source records attributed to M K Ferguson.

At least 73 records · Page 4Linked to original sources
PubMed1992

Empyema following percutaneous catheter drainage of upper abdominal abscess.

Percutaneous catheter drainage is a standard therapy for management of selected intra-abdominal abscesses. We describe three patients in whom this technique caused complicated thoracic empyemas. All patients required thoracotomy for decortication despite initial thoracostomy tube drainage. In each case, the percutaneously placed drainage catheter was found traversing the costophrenic angle, leading to direct communication between the pleural space and the abscess cavity. Review of the anatomic relationships of the inferior pleural margin to the lower ribs may help prevent this technical error.

Abdomen↗
PubMed1991

Achalasia: current evaluation and therapy.

The current evaluation of and therapy for achalasia are reviewed. Esophageal manometry remains the best means for diagnosing achalasia. Initial therapy can include either pneumatic dilation or esophagomyotomy. Symptomatic improvement occurs in 71% of patients after pneumatic dilation, with a risk of perforation of 1.4%. Eight percent of these patients require subsequent esophagomyotomy. Surgical procedures for achalasia can be performed through either an abdominal or a thoracic incision. Nearly all authors favoring an abdominal approach add an antireflux operation to esophagomyotomy, whereas many authors advocating a transthoracic esophagomyotomy believe that an antireflux wrap is unnecessary. Overall results for the various surgical approaches used as initial therapy are excellent, with symptomatic improvement in 89% of patients, a mortality rate of less than 1%, and development of gastroesophageal acid reflux in less than 10%. Factors governing the choice of initial therapy are discussed.

Catheterization↗
PubMed1991

Attenuation of histamine-induced lymphatic smooth muscle contractility by arachidonic acid.

Recent investigations have identified a class of outwardly rectifying potassium channels activated directly by arachidonic acid (AA) and select other fatty acids (FA) that inhibit smooth muscle contractions. We hypothesized that lymphatic smooth muscle contains similar fatty acid activated channels. Fresh porcine tracheobronchial lymphatic vessel rings were mounted in organ baths and connected to force-velocity transducers. Contractile responses were measured following exposure to histamine alone, with AA, and following AA washout, demonstrating a 40-55% inhibition of histamine-induced contractility by AA. Despite addition of indomethacin and nordihydroguaiaretic acid to inhibit formation of active AA metabolites, AA still attenuated contractility by 24-31%. Myristic acid and linoelaidic acid, FA's that are not substrates for cyclooxygenase or 5-lipoxygenase, inhibited histamine-induced contractility by 19 and 15%, respectively. The effects of AA and the other FA's were eliminated by exposure to a high potassium solution. The data support the existence of AA-activated hyperpolarizing potassium channels in lymphatic smooth muscle. Arachidonic acid, in addition to its metabolites, may play a direct role in regulating lymphatic smooth muscle tone.

Animals↗
PubMed1991

The thoracic vent. Clinical experience with a new device for treating simple pneumothorax.

We report recent experience with a new device, the thoracic vent, in the management of simple pneumothorax. There were 16 patients aged 19 to 73 years who suffered pneumothorax due to spontaneous (4), traumatic (3), or iatrogenic (9) causes. Ease of insertion, patient tolerance, and the presence of a unique signal diaphragm all contributed to patient and physician acceptance of the device. Average time to pneumothorax resolution was 2.5 days, and time to thoracic vent removal averaged 3.2 days. There were no immediate recurrences or significant complications. We conclude that the thoracic vent is an effective device for initial and definitive therapy of simple pneumothorax.

Adult↗
PubMed1991

Disorders of esophageal motility.

Patients with esophageal motility disorders usually have dysphagia and many also have chest pain similar to angina. The diagnosis is suggested by the clinical presentation, and supporting evidence is often provided by contrast roentgenography. Esophageal manometry is usually necessary to confirm the diagnosis. Conservative therapy using pharmacologic agents is often useful as an initial trial, although many patients who continue to be symptomatic ultimately require surgical intervention.

Esophageal Motility Disorders↗
PubMed1990

5-Fluorouracil with oral leucovorin and hydroxyurea and concomitant radiotherapy for stage III non-small cell lung cancer.

Twenty-three patients with regionally advanced non-small cell lung cancer (NSCLC) (Stage III) were treated with continuous infusion 5-fluorouracil (5-FU) augmented by high-dose oral leucovorin and hydroxyurea and concomitant radiotherapy. This chemoradiotherapy regimen was administered during 5 days of every other week for six cycles (total radiation dose, 6000 cGy). Three patients (13%) had stable disease, 13 patients (57%) had a partial response (PR), and 1 patient (4%) had a complete response (CR). The overall response rate was 61% (95% confidence interval, 41% to 81%). At a median follow-up time of 19 months, the median survival time for all 23 patients was 12 months. The median time to disease progression was 6 months. Twelve patients have had disease progression outside of the chest, and only 3 patients have had intrathoracic disease progression as the site of first failure. The toxicities of this regimen consisted of mild to moderate myelosuppression and moderate degree dermatitis and mucositis. It was concluded that concomitant chemoradiotherapy with this regimen results in high local activity at acceptable toxicity. However, the systemic activity of this regimen was low, resulting in a high distant recurrence rate and a median survival time that was not different from that achieved with standard therapy. Therefore, its use, as defined in this study, cannot be recommended.

Administration, Oral↗
PubMed1990

Indications for esophagectomy in nonmalignant Barrett's esophagus: a 10-year experience.

Between 1978 and 1988, 88 patients were referred for the surgical treatment of nonmalignant Barrett's esophagus. Nineteen patients required esophageal resection. Male/female ratio was 13:6; age range was 13 to 84 years (mean age, 49.8 years; median age, 40 years). Preoperative studies demonstrated strictures in 11 patients and ulcers in 7. Penetrating Barrett's ulcer resistant to treatment was the indication for resection in 5 patients. Ulcers penetrated to the pericardium (1 patient), pulmonary vein (1), lung (1), and mediastinum (2). Other indications for resection included undilatable strictures (2), previous operations (4), high-grade dysplasia (3), parietal cells lining the esophagus (1), patient's refusal of long-term surveillance (2), and the inability to exclude adenocarcinoma preoperatively (2). Reconstruction was achieved by colon interposition (15) or esophagogastrostomy (4), with one postoperative death. Mean follow-up was 41 months and was 100% complete. Of the 18 patients, 3 have occasional regurgitation but none have any dysphagia or weight loss. Esophageal resection is indicated in a select group of patients with Barrett's esophagus. Absolute indications include a deep penetrating ulcer confirmed intraoperatively, high-grade dysplasia, strong suspicion of cancer, and multiple previous operations. Relative indications include strictures not responding to dilation and young patients refusing long-term surveillance.

Adolescent↗
PubMed1990

Pericardial window: mechanisms of efficacy.

Although the term implies a persistent communication through which fluid might drain, how a pericardial window works is not clear. We believe that the mechanism of success is not window but rather fusion of the epicardium to the pericardium with obliteration of the potential space. To evaluate this, we studied 28 patients, all of whom underwent a subxiphoid pericardial window procedure with tube drainage maintained until output was minimal. There were no operative deaths, and 26 patients (92.9%) obtained permanent relief. Postoperative echocardiograms demonstrated thickening of the pericardium/epicardium and obliteration of the pericardial space. Autopsy performed on 4 patients who died of their underlying malignancy confirmed this fusion, which begins as an inflammatory process. A subxiphoid pericardial window relieves effusions with a low operative mortality and good long-term success (92.9%, 26 of 28). This success is dependent on the inflammatory fusion of the epicardium to pericardium and not maintenance of a window. Tube decompression should be maintained until fluid output is minimal to allow apposition and fusion of the two surfaces.

Adult↗
PubMed1990

Perioperative blood transfusion adversely affects prognosis of patients with stage I non-small-cell lung cancer.

It has been speculated that blood transfusion might adversely affect prognosis in cancer patients by immunosuppression. To avoid the confounding affect of advanced disease, we tested this hypothesis in 117 patients with stage I non-small-cell lung cancer. Mean and median follow-up were 49.7 months and 47 months, respectively. Patients who died during the postoperative period were not included. Perioperative transfusion was defined as administration of whole blood or packed cells within 30 days of operation. The overall cumulative 5-year disease-free survival rate was 67%. In patients with transfusion, it was 53% and in patients without transfusion it was 81% (p = 0.0055). A multivariate analysis was performed that included patient age, race, sex, cell type, extent of operation (pneumonectomy versus lobectomy/segmentectomy), operative blood loss, admission hematocrit, discharge hematocrit, and the presence or absence of perioperative transfusion. The only variable that significantly correlated with 5-year disease-free survival was the presence or absence of perioperative transfusion (p = 0.0278), and this effect was not related to the number of transfusions. Retrospective analysis of long-term results of patients surviving curative operation for stage I lung cancer shows that any perioperative transfusion significantly worsens the patient's prognosis and suggests very strongly that this association is due to an adverse effect of the transfusion rather than the transfusion serving as a marker for another risk factor.

Carcinoma, Non-Small-Cell Lung↗
PubMed1990

Sex-associated differences in presentation and survival in patients with lung cancer.

A retrospective study of 478 men and 294 women with primary lung cancer was conducted to characterize sex-associated differences in their presentation and survival. At the time of diagnosis, women were younger than men (mean age, 57.4 +/- 10.4 v 60.2 +/- 9.9 years, respective; P = .0007). Men were more likely to be current or previous smokers (94% v 84%; P less than .005), and in patients with a positive smoking history, cigarette consumption was greater in men (52.2 v 40.2 pack years; P = .0001). The proportion of adenocarcinomas compared with squamous cancers was high in women (45% v 23%), while these cell types were equally represented in men. The majority of patients in both sex groups had regionally advanced or metastatic disease at diagnosis. Survival was related to age, stage at presentation and cell type. In addition, sex was found to be an independent prognostic factor for survival. Women with tumors of all cell types lived longer than their male counterparts (P less than .0001), and survival by stage in patients with nonsmall-cell cancers was greater for women than it was for men. These data demonstrate that important sex-associated differences exist in presentation and survival from lung cancer. Such differences should be considered when planning and analyzing clinical trials.

Adult↗
PubMed1990

A sound idea.

Explore the source record for details and available documents.

Endoscopy↗
PubMed1990

Predicting failure following shunting of pleural effusions.

We placed 43 shunts in 34 patients in five years. Twenty-four had malignant effusions and ten had benign effusions. Thirty-one patients had unilateral shunts, three had bilateral shunts and six required revisions for shunt failure. Two patients died after shunt placement from disease progression. Of the nine patients who experienced poor results, one was noncompliant in operating the shunt and eight had occluded shunts. In the 30 patients, who were compliant and had adequate length of follow-up, five had excellent results, 12 had good results, and five had fair results. Two of the patients with occluded shunts had good results after shunt revision; 24 patients had some symptomatic relief with shunting. Evaluation of factors including a history of prior abdominal surgery, performance status, and pleural fluid cell counts, differential, chemistries, and cytology revealed no significant differences between the patients who experienced shunt failure and those who had patent shunts. Shunting of pleural effusions is well tolerated and has good success rates in properly selected patients.

Adult↗
PubMed1990

Diagnosing and staging of non-small cell lung cancer.

Lung cancer remains the most common cause of death due to neoplasm in the United States. Despite recent efforts, early diagnosis provided through screening studies has not resulted in improved survival. Most lung cancer victims are symptomatic at presentation, and 50% have distant metastases. The diagnosis, often suspected on plain chest radiograph, can usually be confirmed with bronchoscopy or sputum cytology. The most useful routine staging evaluation, in addition to history and physical examination, is computed tomography. The routine use of other staging modalities is not recommended. A new staging system, currently in use throughout North America, western Europe, and Japan, permits accurate estimation of prognosis and assignment to therapeutic groups.

Carcinoma, Non-Small-Cell Lung↗
PubMed1989

Efficacy of computed tomography of the thorax and upper abdomen and whole-body gallium scintigraphy for staging of lung cancer.

To assess the efficacy of performing both computed tomography (CT) of the thorax and upper abdomen and whole-body gallium scintigraphy for staging lung cancer, the results of each test were compared with those obtained by chest radiography and clinical examination in 100 patients. Clinical efficacy was defined in terms of accuracy in staging the tumor based either on surgery, biopsy, or clinical and radiologic follow-up. The CT provided significantly superior accuracy in 27 patients and minor additional staging information in 17 patients compared with the gallium scan. Whole-body gallium scintigraphy provided important additional information in nine patients and minor additional information in a further eight. The diagnostic yield of CT and gallium scanning was considered equivalent in 39 cases. Of the nine cases in which gallium was significantly superior to CT, clinical findings which suggested the presence of metastases had been noted before the scan in four cases. The authors' results confirm the utility of CT for staging lung cancer and indicate that the additional yield from gallium scintigraphy is relatively low provided a thorough history and physical examination have been performed.

Adult↗
PubMed1989

Early evaluation and therapy for caustic esophageal injury.

Forty-one patients with caustic ingestion were reviewed. Eighty-three percent were children, all of whom suffered accidental injury. Liquid drain cleaner was the agent in 57 percent and was responsible for all esophageal burns. Symptoms and physical findings were unreliable in predicting the extent of injury. Endoscopy was performed in most patients within 36 hours of ingestion and accurately estimated the risk of subsequent esophageal stricture formation. Steroid administration had no influence on the development of strictures. Esophageal strictures developed in 22 percent of the patients. One-third were successfully managed by periodic dilation, whereas the remaining two-thirds required esophagectomy and reconstruction. Early endoscopic evaluation was the best means of assessing the degree of injury after caustic ingestion. Routine steroid administration had no apparent clinical benefit.

Adult↗