Search PubMed⌕ Search

Biomedical subjects

P Goldstraw

Publications and source records attributed to P Goldstraw.

At least 145 records · Page 8Linked to original sources
PubMed1990

Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus.

In the staging of operable carcinoma of the bronchus, accurate assessment of mediastinal nodal status is essential in order to determine the feasibility and desirability of resection. In the UK, frozen section analysis is often logistically difficult, and many surgeons rely upon naked-eye assessment. To evaluate the accuracy of this approach, we have reviewed 100 thoracotomies performed for cancer in this unit and compared the naked-eye assessment of nodal staging with the ultimate histological findings. A total of 287 lymph nodes were examined. There were 14 false positives and 10 false negatives. The overall accuracy of naked-eye assessment was 96.1%. On no occasion did an error in naked-eye assessment result in a patient receiving inappropriate treatment. All patients were thought to be pTNM N0 or N1 prior to surgery, yet N2 disease was established in 24 patients. The value of routine mediastinal node dissection at the time of thoracotomy has been established and an important subgroup of patients with microscopic N2 disease has been identified.

Bronchial Neoplasms↗
PubMed1990

Pleuroperitoneal shunt for recurrent malignant pleural effusions.

The therapeutic options available for the management of malignant pleural effusions associated with a restricting malignant cortex remain unsatisfactory. The efficacy of pleuroperitoneal shunts was evaluated in 16 patients with recurrent malignant effusions. There were no operative deaths; one patient died on the third postoperative day as a result of lymphangitis carcinomatosa. The median hospital stay was five (range 3-21) days. Palliation was obtained in all but one of the other 15 patients. There was no appreciable reaccumulation of pleural fluid as judged by radiography. Two patients developed occlusion of the shunt. In one case this was due to blood clots in the pleural catheter and necessitated insertion of a new shunt. The other shunt was removed because of obstructing infected fibrin debris, and a rib resection was performed. There were eight deaths related to the underlying malignancy after a mean interval of 7.3 (range 1.5-23) months. The other six patients are still alive, with a mean survival of 11.0 (range 5-20) months, and have achieved good symptomatic relief. The insertion of a pleuroperitoneal shunt can offer effective palliation for patients with recurrent malignant pleural effusions.

Adult↗
PubMed1990

Elective resection of tumours of the trachea and main carina after endoscopic laser therapy.

In our patients with tumour affecting the trachea or carina elective surgery was carried out after endoscopic laser treatment. Laser treatment was performed as an emergency procedure in three of the patients, who presented with impending asphyxia; the improvement provided time in which to assess the disease, withdraw corticosteroids, and treat infection. The fourth patient was treated with the laser for life threatening haemoptysis, but further bleeding made it necessary to tamponade the tumour with a cuffed endotracheal tube for 24 hours. Elective resections of the trachea (three cases) and carina (one case) were performed successfully four to eight weeks after laser treatment. Frozen sections of the resection margins were clear in all cases and paraffin sections subsequently confirmed the localised nature of the lesions. All patients are alive and well with no evidence of tumour recurrence after 18 months to 4 years. Laser therapy appears to be an ideal preoperative treatment for patients with impending asphyxia but it may be of limited value in controlling very brisk haemorrhage.

Aged↗
PubMed1989

Slide tracheoplasty for congenital funnel-shaped tracheal stenosis.

Congenital funnel-shaped trachea is a serious condition, and the survival rate in infants is poor. A slide tracheoplasty is described, with a brief review of other methods of repair. Two cases that demonstrate the operability of congenital funnel-shaped trachea in infancy are reported.

Female↗
PubMed1989

Survival following pulmonary metastasectomy.

One hundred and fifty-six thoracic operations have been performed over an 8-year period, from 1980 to 1987, for 118 patients with pulmonary metastases. In 27 instances, the disease has been bilateral requiring a midline approach or sequential lateral thoracotomies. Resection was achieved by wedge excision in 74%, lobectomy in 16%, pneumonectomy in 4%, lobectomy plus wedge excision in 2%, bilobectomy in 1%, segmentectomy in 2% and segmentectomy plus wedge excision in 1%. The operative mortality for the group as a whole was 1.6% per patient (70% confidence limits CL. 0.6%-4.2%) and 1.2% per operation (70% CL. 0.5-3.2%). Actuarial survival for the histological subgroups at 2 and 5 years were: carcinoma 50% (+/- 11% standard error) and 35% (+/- 12%), sarcoma 59% (+/- 10%) and 51% (+/- 12%), teratoma 89% (+/- 5%) and 84% (+/- 7%) respectively. No patient following resection for metastatic melanoma was alive at 2 years. The survival in the teratoma group was significantly higher than in the other groups (P less than 0.001 carcinoma; P less than 0.01 sarcoma; P less than 0.001 melanoma). Survival in all groups was significantly greater than for the melanoma group. Metastasectomy is well tolerated by the patient. Worthwhile longterm survival is obtained in those patients in whom the primary disease has been controlled and all secondary disease is encompassed by the proposed surgery.

Actuarial Analysis↗
PubMed1989

Endobronchial stenting for anastomotic stenosis after sleeve resection.

Bronchial anastomotic stenosis is a potentially serious complication of sleeve resection. A Silastic endobronchial stent that prevents progressive narrowing at the anastomotic site is described. Insertion of the stent offers a simple and effective treatment that allows improved pulmonary performance, clearing of infection, and good quality of life. The long-term prognosis, however, remains questionable.

Aged↗
PubMed1989

Diathermy resection and radioactive gold grains for palliation of obstruction due to recurrence of bronchial carcinoma after external irradiation.

During 1985-7 15 patients previously treated by external radiotherapy for inoperable carcinoma of the lower trachea and major bronchi underwent endobronchial insertion of radioactive gold grains as a palliative procedure for relief of symptoms. Four patients had undergone three or more endobronchial laser treatments before being referred. Under general anaesthesia diathermy was used to resect obstructing tumour before the insertion of the gold grains into the tumour and the compressed endobronchial wall. Four patients died within one month. The remaining 11 patients were symptomatically and objectively improved when assessed at one month. Both collapsed lungs and three out of six collapsed lobes had re-expanded. Fourteen of the 15 patients died within 13 months (median survival 2.5 months); one patient with recurrent symptoms after 10 months underwent a further implantation and is alive after two years.

Adenocarcinoma↗
PubMed1988

Computed tomography of the brain, chest, and abdomen in the preoperative assessment of non-small cell lung cancer.

The benefit to be gained from carrying out computed tomography of brain and abdomen in addition to the chest has been evaluated retrospectively in 114 consecutive patients with non-small cell lung cancer who, on the basis of history, clinical examination, chest radiography, and bronchoscopy had been considered potentially operable. Computed tomography of the chest showed potentially inoperable tumour in 37 patients, of whom 25 had tumour confined to the chest. Three patients were shown to have malignant disease within the mediastinum and abdomen; five within the mediastinum and brain; and four within the mediastinum, abdomen, and brain. Computed tomography of the abdomen disclosed deposits in nine patients, but in only two were the abnormalities restricted to the abdomen. Computed tomography of the brain showed metastases in 10 patients, of whom only one had metastatic disease confined to the brain. Thus three patients had isolated deposits in the abdomen and brain. In 12 patients the identification of metastases in the abdomen and brain removed the need for mediastinoscopy. Preoperative computed tomography of the abdomen and brain detected occult metastases in 15 patients (13%) in this study. In three patients the extrathoracic abnormality proved the only contraindication to surgery, but in the other 12 it provided valuable corroborative evidence of incurability and facilitated the assessment of the mediastinal abnormality.

Abdominal Neoplasms↗
PubMed1988

Intracavity drainage for bullous, emphysematous lung disease: experience with the Brompton technique.

Twenty two operations have been performed on 20 patients for the relief of symptoms due to bullous lung disease. Open intubation drainage of the bullae was used in all patients, the technique initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses having been modified. Three patients died after surgery. Mortality was associated with low preoperative FEV1 (median 350 ml) and higher preoperative arterial carbon dioxide tension (PaCO2) (median 7.8 kPa). Symptomatic improvement was reported by 16 of the remaining 17 patients and was maintained over a median follow up period of 1.6 years. This was accompanied by objective improvement in lung function with a 22% median improvement in FEV1, an 11% median reduction in total lung capacity, and a 26% median reduction in residual volume. In one patient symptoms were unchanged after surgery. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It also allows for the treatment of further bullae at a later date by closed intubation under local anaesthetic. It has proved a suitable approach for all but those with the poorest lung function and is now our treatment of choice.

Adult↗
PubMed1988

Open lung biopsy.

Open lung biopsy (OLB) provides a safe, reliable method of obtaining a histological diagnosis in patients with chronic, stable lung disease. In these patients OLB is indicated where other closed methods have failed or as the primary diagnostic tool when interstitial lung disease is suspected on conventional chest X-ray or from pulmonary function data. In the critically ill patient in whom the establishment of a treatable diagnosis is imperative OLB provides the highest likelihood of obtaining a diagnosis. This must be weighed against the increased risks following OLB in this group of patients by the clinician in each case.

Biopsy↗
PubMed1987

A multidisciplinary approach to primary nonseminomatous germ cell tumors of the mediastinum.

The introduction of cis-platinum-based chemotherapy has dramatically improved the prognosis for patients with primary nonseminomatous germ cell tumors of the mediastinum. Since 1978, 12 male patients (mean age, 29 years) have been seen with a large mediastinal mass, normal testes, and abnormal testicular tumor markers. Eleven patients had raised alpha-fetoprotein levels (median, 1,300 micrograms/L; normal, less than 10 micrograms/L), and 3 had elevated levels of the beta fraction of human chorionic gonadotropin (median, 8,000 IU/L; normal, less than 5 IU/L). Two patients were treated by primary surgical intervention followed by chemotherapy. Ten patients were treated with primary chemotherapy (cis-platinum, vinblastine sulfate or etoposide, and bleomycin sulfate), and this was followed by timed surgical excision of the tumor mass in 7. Six (60%) patients responded to primary chemotherapy with normalization of tumor markers. In this group there was 1 postoperative death and 1 recurrence. The 4 remaining patients are alive and free from disease at a mean of five years. Of the 4 patients with persistently elevated tumor markers, 2 died within six months, 1 is alive with recurrence, and 1 is lost to follow-up at three months. Patients whose tumor markers return to normal after cis-platinum-based chemotherapy have a good long-term prognosis following radical surgery. If the tumor markers remain elevated, the prognosis is poor.

Adult↗