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Biomedical subjects

P A Kirschner

Publications and source records attributed to P A Kirschner.

At least 19 recordsLinked to original sources
PubMed2001

Reoperation on the thymus. A critique.

Reoperation on the thymus, including even multiple re-resection, is a useful modality in carefully selected patients for recurrent thymoma or for incompletely removed thymus. In the case of MG, reoperation is used for completion of an otherwise incomplete thymectomy, usually by the transcervical method, although it also has been used after primary sternotomy. Interestingly enough, no instances of reoperation after primary VATS thymectomy have been reported yet. Indeed, VATS has been used successfully for reoperation after previous transcervical and trans-sternal thymectomies. In the case of thymoma, there have been an increasing number of reports of reoperation, including multiple procedures, in many cases. It is important to interpret the results of reoperation in the context of the biologic behavior of the thymus tumor. Thus far, no formal guidelines have been established for the follow-up of these patients. It is believed that all cases of thymectomy with or without thymoma and with or without MG should be followed for the lifetime of the patient with periodic examinations and imaging.

Adult↗
PubMed2000

The history of surgery of the thymus gland.

The history of surgery of the thymus gland is presented through highlights and landmark publications ranging from prehistoric times to the present day. The evolution of surgical techniques includes transcervical and transthoracic thymectomy along with other techniques such as current thoracoscopic VATS procedures. The significance of myasthenia gravis, autoimmunity, thymic oncology, adjuvant developments, and speculation on the future is discussed.

History, 19th Century↗
PubMed1998

Porous diaphragm syndromes.

Porous diaphragm syndromes are a group of seemingly disparate clinical symptom complexes involving a wide variety of unrelated medical specialties. However, they are linked by a common anatomical feature, a defect in the diaphragm. They usually present with thoracic symptomatology--pleural effusions, pneumothorax, hemothorax, empyema--mediated by this defect. Management of these syndromes utilizes principles of thoracic surgical practice including thoracotomy and thoracoscopy.

Body Fluids↗
PubMed1996

Cervical mediastinoscopy.

The continuity of cervicomediastinal fascial planes provides the anatomic basis for cervical mediastinoscopy and its derivatives. There are two such planes, both accessible through a single small neck incision: the retrovascular paratracheal plane (for standard cervical mediastinoscopy) and the prevascular retrosternal plane (the zone of extended mediastinal exploration). This article describes the evolution, technique, indications, applications, and complications of cervical mediastinoscopy in the diagnosis and therapy of thoracic diseases.

Cervical Vertebrae↗
PubMed1996

Sarcoidosis presenting as heart disease.

It is unusual for sarcoidosis to present with isolated cardiac involvement. We report 3 patients in whom conduction disturbances preceded other clinical or radiographic evidence of sarcoidosis, in 2 cases by several years. The literature of sarcoidosis manifesting solely with cardiac disease is reviewed. Our report is intended to emphasize consideration of sarcoidosis in the diagnostic evaluation of cardiac disease without another obvious cause, particularly in young patients with conduction disturbances, arrhythmias, or cardiomyopathy. We suggest diagnostic strategies and a therapeutic approach.

Adult↗
PubMed1994

Consultation in thoracic surgery.

The thoracic surgical consultation is not limited to the technical details of the operation. It is a global evaluation of the problem, firmly rooted in a close relationship between the patient, the referring physician, and the consultant.

Humans↗
PubMed1991

Usefulness of the nude mouse model in mesothelioma based on a direct patient-xenograft comparison.

A patient with malignant mesothelioma experienced tumor recurrence 3 months after pleuropneumonectomy. Samples of the tumor were transplanted into nude mice to assess chemosensitivity. There was close concordance between the results in xenografts and the clinical outcome in this patient. Both mitomycin and to a lesser extent cisplatin were effective as single agents against the nude mouse xenografts, and the combination of these two drugs produced a complete response both in the patient and in the xenografts. The patient survived 18 months from onset of chemotherapy and 24 months from diagnosis. The duration of clinical complete response to chemotherapy was 14 months, despite the fact that mitomycin, the most effective agent against the xenografts, was discontinued after only two cycles because the patient developed pulmonary toxicity. This direct patient-xenograft correlation further validates the usefulness of the nude mouse model in the search for effective therapies for malignant mesothelioma, a tumor characterized by frequent refractoriness to most available agents.

Animals↗
PubMed1990

Reoperation for thymoma: report of 23 cases.

Twenty-three patients underwent reoperation for thymoma at intervals of 2 months to 17 years 10 months after the initial operation. There were no operative or hospital deaths. Myasthenia gravis occurred in 12 patients, but in only 2 was it a determinant for reoperation. The longest survival after reoperation is 12 years 9 months, and that patient is free from tumor. Four distinct surgical groups emerged, and their recognition provides an improved method of reporting and suggests a strategy for better overall management. Group 1 (n = 5) had completion of thymectomy (reoperation) after thymomectomy alone or after incomplete thymectomy. The interval was 2 months to 17 years 10 months. All 5 had myasthenia gravis. At reoperation, thymomas were found in 3 and a hyperplastic thymus in 2. Four are alive and tumor free 2 years to 8 years 2 months after reoperation. One died tumor free after 5 years. Group 2 (n = 8) had reoperation for recurrent thymoma after standard (presumably complete) resection. The interval was 2 years to 13 1/2 years. Four had myasthenia gravis. Four are alive 8 months to 5 years 8 months after reoperation, 3 without detectable tumor. Four died 3 years 3 months to 8 years 4 months after reoperation, 3 free from tumor. Group 3 (n = 8) underwent reoperation for initially unresectable thymoma after adjuvant treatment with chemotherapy, radiotherapy, or both. The interval was 3 months to 4 years 8 months. Three had myasthenia gravis. Six are alive 4 months to 4 years after reoperation, only 1 with tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗