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Biomedical subjects

M K Ferguson

Publications and source records attributed to M K Ferguson.

115 records · Page 7Linked to original sources
PubMedDate not supplied

Mortality after esophagectomy: risk factor analysis.

Esophageal resection is associated with a high incidence of operative mortality, suggesting the need for predictors of operative risk. A retrospective analysis was performed for esophagectomy patients using univariate and multivariate analyses; relative risks (RR) were calculated. Of the 269 patients, 35 (13%) died. The optimal model for the preoperative prediction of risk of mortality was defined by age (p = 0.001; RR = 2.6) and performance status (p = 0.04; RR = 1.9). Delimiting the data pool using a calculated risk of 0.2 accurately identified outcomes in 79% of patients and predicted 41% of deaths. The optimal model for the overall prediction of risk of mortality was defined by age (p = 0.001; RR = 3.9), intraoperative blood loss (p < 0.001; RR = 1.7), pulmonary complications (p = 0.002; RR = 6.6), and the need for inotropic support (p = 0.003; RR = 10.2). The individual risk of mortality after esophagectomy can be predicted preoperatively with a model based on patient age and performance status. The findings underscore the importance of preoperative evaluation of cardiopulmonary function, meticulous operative technique, and aggressive respiratory care in the management of the esophagectomy patient.

Adolescent↗
PubMedDate not supplied

Outcome after failed initial therapy for rupture of the esophagus or intrathoracic stomach.

Survival after rupture of the esophagus or intrathoracic stomach is improving, but continued leakage after initial therapy remains a problem. We retrospectively reviewed patients with rupture of the esophagus or intrathoracic stomach to determine the prevalence of continued leakage after initial therapy and how this complication affects outcome. Our review included 58 patients, 38 (66%) of whom had preexisting esophageal disease. The etiology of perforation was spontaneous rupture in 17, penetrating trauma in four, and iatrogenic injury in 35; two patients had perforation from other causes. Initial therapy consisted of drainage in eight, primary repair in 24, resection in 18, bypass in two, and observation in six. The overall mortality rate was 12% (7 of 58 patients) and continuing leaks were identified in 21% (12 of 58 patients). These leaks were unrelated to patient age, existence of prior disease, or delay in therapy but were more common after initial treatment by primary repair with or without pleural flap coverage compared to other management strategies (6 of 9 vs. 6 of 49; P < 0.001). Salvage therapy with survival was possible in 10 (83%) of 12 patients by means of esophagectomy in four, exclusion in one, drainage in two, or observation in three. Continuing leaks can be avoided by providing soft tissue coverage other than pleura over a primary repair and by not leaving an intrathoracic esophageal stump. Aggressive management of continuing leaks results in survival in more than 80% of patients.

Adolescent↗
PubMedDate not supplied

Immediate free gastro-omental flap reconstruction of the mouth and throat.

A portion of the greater curve of the stomach with its attached omentum was transplanted to reconstruct the pharynx and oral cavity after ablation of upper aerodigestive tract cancer. The tissue characteristics of the transplanted material were similar to those of the removed oropharyngeal tissue. The gastro-omental free flap produced a moist mucosal surface that was self-cleaning and distensible. The free gastro-omental flap was successful in five of seven patients. Because of excessive flap secretions during the early postoperative period, all patients had tracheotomies to protect the lower airway from aspiration.

Carcinoma, Squamous Cell↗