Biomedical subjects

Peter Goldstraw

Publications and source records attributed to Peter Goldstraw.

42 records · Page 3Linked to original sources

PubMed2002

Airway obstruction and ventilator dependency in young children with congenital cardiac defects: a role for self-expanding metal stents.

OBJECTIVE: Young children with congenital cardiac defect and airway obstruction leading to ventilator dependency present a significant clinical challenge with uncertain outcome. DESIGN: Retrospective review of our experience with self-expanding metal stents in these young children between 1996-2000. RESULTS: Airway stenting has been undertaken in five such children (four boys, one girl) at our institution. Their mean age was 7.4 months (range 2-14 months), and four of the five had undergone congenital cardiac surgery and could not be weaned from the ventilator following surgery. These five children were ventilator dependent for a mean of 112 days (range 40-210 days, median 71). A total of ten self-expanding metal stents were inserted (4-11 mm in diameter and 15-33 mm in length). The sites stented included the trachea (two stents), the left main bronchus (three stents) and the bronchus intermedius (five stents). Four of these five children were successfully weaned from the ventilator and extubated after a mean time interval of 6 days (range 2-11 days, median 5.5) after stenting. One child failed to wean from the ventilator, required tracheostomy and is ventilator dependent after 8 months. There was one death 2 months after extubation but unrelated to the airway. Three children remain well and asymptomatic 24, 36 and 54 months after stenting. CONCLUSIONS: Airway stenting in such young children is an infrequent procedure often undertaken in dire circumstances. We have found it valuable in enabling ventilator-dependent children to be extubated with encouraging early results. Their long-term outlook remains uncertain and is dependent on the underlying cardiac status.

Airway Obstruction↗

PubMed2002

Inter-observer variability in systematic nodal dissection: comparison of European and Japanese nodal designation.

BACKGROUND: Systematic nodal dissection is accepted as an important component of the intrathoracic staging of patients undergoing thoracotomy for lung cancer. Several lymph node maps have been proposed in an attempt to ensure uniformity in designating lymph node stations. The Japan Lung Cancer Society has published detailed definitions for each nodal station adopting the Naruke map. However, since these definitions had not been interpreted into other languages, they have not been universally accepted. The objective of this study was to assess the inter-observer variability in the interpretation of lymph node stations. METHODS: A total of 424 lymph node stations were removed from 41 patients undergoing thoracotomy for non-small cell lung cancer. All nodal stations were labeled using the Naruke map. As each station was excised, it was designated in a blind fashion by one of two surgeons trained in the UK and one surgeon trained in Japan. The designation accorded to each nodal station was analyzed. RESULTS: The total concordance was 68.5% (right side 67.0%, left side 69.9%). The concordance rate for individual nodal stations varied from 0% to 100%. Considerable discordance existed between the Japanese and European surgeons in the designation of nodal stations 2, 4, 8 and N1 station 12. In 14 (34.1%) patients, discordance in the labeling of lymph nodes led to disease being categorized as N1 by one observer, whereas the other considered the same nodes to be N2. CONCLUSIONS: Considerable discordance in the designation of nodal station has been demonstrated. We would expect similar inter-observer variability elsewhere between surgeons, institutions, or countries. More detailed nodal charts and precise, easily understood definitions of nodal stations are needed for intrathoracic staging. The first English version of the Japan Lung Cancer Society staging manual goes some way to address this.

Carcinoma, Non-Small-Cell Lung↗

PubMed2002

Cystic lung lesions in the pediatric and adult population: surgical experience at the Brompton Hospital.

BACKGROUND: Cystic lung lesions are found in the adult and pediatric populations. We present our 19-year experience with such lesions from a single institution. METHODS: We retrospectively reviewed our experience with such lung pathology, comparing the pediatric and adult populations with regard to their spectrum of pathology, presentation, surgical procedures, and postoperative morbidity and mortality. RESULTS: Forty-six operations were performed on 44 patients (24 children and 20 adults). Cystic adenomatoid malformation was the most common pathology in the pediatric group (53.9%), followed equally by simple cysts and sequestrations (15.4%). In three of the pediatric patients malignant features were identified after resection; bronchoalveolar carcinoma in 2 patients with cystic adenomatoid malformation and pleuropulmonary blastoma in 1 patient with bilateral cystic disease. In the adult population the most common pathology was simple cysts in 8 (40%), followed by cystic adenomatoid malformation in 5 (25%) and sequestrations in 2 patients (10%). The majority of the children, 16 (61.5%), required operation because of expanding or infected cysts, recurrent cysts, or chest infections; 4 were operated on as an urgent basis. In contrast, the majority of adults 11 (55%) were asymptomatic or had no specific symptoms, and all operations were elective. A larger number of major resections (65.4% versus 55%) were necessary in the pediatric group, possibly due to differences in the pathology. However, morbidity was comparable in the two groups with no mortality. CONCLUSIONS: Operation for cystic lung disease is safe. Asymptomatic cysts in children should be resected to avoid later complications of the cysts, which could make operation more difficult. Patients should be evaluated for associated congenital anomalies. Conservative anatomic resections should be attempted to salvage functional lung tissue. Careful histologic examination of the resection specimen is mandatory to identify occult malignancy.

Adolescent↗

PubMed2002

Cervical mediastinoscopy after total laryngectomy and radiotherapy: its feasibility.

OBJECTIVE: The feasibility of cervical mediastinoscopy after total laryngectomy and radiotherapy has not been documented. METHODS: We describe our experience with cervical mediastinoscopy in two patients with total laryngectomy and radiotherapy for squamous cell carcinoma and had a Blom-Singer speaking tracheostomy valve in situ. Both patients presented with mediastinal lymphadenopathy and radiographic features suggesting a new pulmonary malignancy. RESULTS: Rigid bronchoscopy and cervical mediastinoscopy were undertaken and paratracheal and subcarinal lymph nodes were biopsied. Both patients made uneventful post operative recovery. Mediastinal lymph node biopsy was definitive in deciding their further care. CONCLUSION: Cervical mediastinoscopy is feasible in patients with total laryngectomy, tracheostomy and radiotherapy.

Aged↗

PubMed2002

Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases.

OBJECTIVE: Metastatic breast cancer is still defined as an incurable disease. Although the prognosis after resection of isolated metastases to the lung is much better than after chemotherapy most oncologists and gynecologists disapprove of lung metastasectomy. METHODS: In order to summarize the experience of pulmonary metastatic surgery and to achieve more relevant data by an increased number of cases, we evaluate the data of the International Registry of Lung Metastases of 467 patients having lung metastases from breast cancer with regard to long-term survival and prognostic factors. RESULTS: In 84% a complete metastatic resection was possible. The survival rates are 38% after 5 years, 22% after 10 years, and 20% after 15 years. Prognostic factors are a disease-free interval of > or = 36 months with 5-year survival of 45%, a 10-year survival of 26% and a 15-year survival of 21% (P=0.0001), solitary lung metastasis is associated with a survival rate of 44% after 5 years and of 23% after 10 and 15 years, but this is not statistically significant compared to multiple metastases. When establishing prognostic groups as suggested by Pastorino and the International Registry of Lung Metastases based on the risk factors disease-free interval, number of metastases and complete resection the group with the best prognosis showed 5-year survival of 50%, 10- and 15-year survival of 26% with a median survival of 59 months. CONCLUSION: Considering the low morbidity and mortality rate, we think that lung metastasectomy today is the best treatment option in selected cases of lung metastases from breast cancer.

Breast Neoplasms↗

PubMed2002

Asymmetric ARDS following pulmonary resection: CT findings initial observations.

PURPOSE: To investigate whether asymmetric distribution of acute respiratory distress syndrome (ARDS) following lobectomy is due to compensatory hyperexpansion of the residual lung within the hemithorax operated on and to discern if this distribution reflects true asymmetry of the disease process. MATERIALS AND METHODS: Retrospective review of the intensive care unit database was performed over a period of 6 years to identify all cases of lung injury following lung surgery that satisfied the American-European consensus criteria for ARDS. Time to onset following surgery, time of subsequent computed tomographic (CT) examination, patient age and sex, and nature of surgery were recorded, as well as eventual patient status (ie, death or discharge). Availability of both preoperative and postoperative CT scans was required for inclusion for further analysis. These images were analyzed on a commercial CT workstation for the volume of lung resected and the pre- and postoperative volume and density of each lung. Expected postoperative densities (preoperative density adjusted for volume) were compared with observed postoperative densities. RESULTS: Review disclosed 583 patients who underwent lobectomy or segmentectomy. Seventeen patients (2.9%) developed postoperative ARDS. Nine of these patients had pre- and postoperative CT scans available for analysis. In eight of nine cases, density increased more in the nonoperated lung than in the operated lung (P =.01). The degree of density increase in the nonoperated lung was significantly greater (305 mg/mL; range, 48-449 mg/mL) than that in the operated lung (13 mg/mL; range, -198 to 231 mg/mL; P <.001). CONCLUSION: Following lobectomy, there appears to be a truly asymmetric form of ARDS rather than compensatory hyperexpansion of the residual lung on the operated side.

Adult↗