Biomedical subjects
Publications and source records attributed to R T Temes.
Adenomatous polyps of the esophagus are rare in comparison with those of the lower gastrointestinal tract. Like adenomatous colon polyps, they have been associated with malignancy. We describe a case of early adenocarcinoma and multiple polyposis of the esophagus arising in a Barrett's epithelium, treated with surgical resection.
STUDY OBJECTIVE: To determine the success and complication rates of fibrinolytic therapy (FL) in the treatment of thoracic empyema. DESIGN AND PATIENTS: Between December 1992 and November 1994, all patients referred with empyema thoracis (ET) were offered FL. FL consisted of streptokinase (275,000 +/- 170,000 IU) or urokinase (121,000 +/- 57,000 IU) daily for a mean of 6.2 +/- 2.1 days. SETTING: The University of New Mexico Health Sciences Center and the Albuquerque Veterans Affairs Medical Center. RESULTS: Twenty-six patients were treated. Sixty-two percent (16/26) had complete resolution (CR) of symptoms, near or complete normalization of chest radiographic findings, and required no surgery or empyema tubes. Eight percent (2/26) had relief of symptoms and partial resolution (PR) of radiographic abnormalities and were discharged from the hospital with empyema tubes in place. All patients with PR had empyema tubes removed within 30 days of hospital discharge. Thirty-one percent (8/26) of patients failed to completely improve clinically or radiographically (nonresponse) and were treated with decortication or empyema tubes for greater than 30 days. Bleeding occurred in a single patient (4%). There was no mortality associated with FL use. CONCLUSIONS: The use of FL is associated with resolution of ET in 69% (18/26) of patients. This modality is safe, effective, and spares most patients with empyema the morbidity and mortality of thoracotomy.
The development of aortoesophageal fistula after aortic repair is rare. We describe a patient who presented with hematemesis 4 months after emergent repair of a descending thoracic aortic dissection using a prosthetic graft. Diagnosis was supported by computed tomographic, angiographic, and endoscopic findings. Resection of the involved graft was performed through a left thoracotomy after placement of an ascending aorta-to-abdominal aorta conduit through an anterior approach. The patient died of uncontrollable bleeding a few hours after the procedure. Surgical intervention offers the potential for cure in this otherwise uniformly fatal condition. But like medical therapy, operative management has thus far been associated with 100% mortality.
Early identification and subsequent intervention are needed to decrease the high mortality rate associated with lung cancer. The examination of bronchial epithelium for genetic changes could be a valuable approach to identify individuals at greatest risk. The purpose of this investigation was to assay cells recovered from nonmalignant bronchial epithelium by fluorescence in situ hybridization for trisomy of chromosome 7, an alteration common in non-small cell lung cancer. Bronchial epithelium was collected during bronchoscopy from 16 cigarette smokers undergoing clinical evaluation for possible lung cancer and from seven individuals with a prior history of underground uranium mining. Normal bronchial epithelium was obtained from individuals without a prior history of smoking (never smokers). Bronchial cells were collected from a segmental bronchus in up to four different lung lobes for cytology and tissue culture. Twelve of 16 smokers were diagnosed with lung cancer. Cytological changes found in bronchial epithelium included squamous metaplasia, hyperplasia, and atypical glandular cells. These changes were present in 33, 12, and 47% of sites from lung cancer patients, smokers, and former uranium miners, respectively. Less than 10% of cells recovered from the diagnostic brush had cytological changes, and in several cases, these changes were present within different lobes from the same patient. Background frequencies for trisomy 7 were 1.4 +/- 0.3% in bronchial epithelial cells from never smokers. Eighteen of 42 bronchial sites from lung cancer patients showed significantly elevated frequencies of trisomy 7 compared to never smoker controls. Six of the sites positive for trisomy 7 also contained cytological abnormalities. Trisomy 7 was found in six of seven patients diagnosed with squamous cell carcinoma, one of one patient with adenosquamous cell carcinoma, but in only one of four patients with adenocarcinoma. A significant increase in trisomy 7 frequency was detected in cytologically normal bronchial epithelium collected from four sites in one cancer-free smoker, whereas epithelium from the other smokers did not contain this chromosome abnormality. Finally, trisomy 7 was observed in almost half of the former uranium miners; three of seven sites positive for trisomy 7 also exhibited hyperplasia. Two of the former uranium miners who were positive for trisomy 7 developed squamous cell carcinoma 2 years after collection of bronchial cells. To determine whether the increased frequency of trisomy 7 reflects generalized aneuploidy or specific chromosomal duplication, a subgroup of samples was evaluated for trisomy of chromosome 2; the frequency was not elevated in any of the cases as compared with controls. The studies described in this report are the first to detect and quantify the presence of trisomy 7 in subjects at risk for lung cancer. These results also demonstrate the ability to detect genetic changes in cytologically normal cells, suggesting that molecular analyses may enhance the power for detecting premalignant changes in bronchial epithelium in high-risk individuals.
Transthoracic percutaneous needle biopsy has become popular for evaluation of pulmonary nodules. However, it is a procedure with morbidity and mortality that is not negligible. In this article, we report massive air embolus complicating needle biopsy in a patient with amyloidosis. A negative biopsy does not exclude malignancy, and if surgical excision will be performed regardless of the result, preoperative assessment using this technique may not be necessary.
A technique for internal fixation of a silicone elastomer tracheal stent is described. This technique allows the use of a short stent in situations where complex stent placement otherwise would be necessary. The procedure was used successfully to manage a postresection stricture in the subglottic trachea.
Fistula formation between the esophagus and airway in acquired immunodeficiency syndrome is extremely unusual. We report 2 cases, the first in a patient who did not undergo definitive surgical management and died shortly after diagnosis. The second patient was managed successfully for 5 months by insertion of a Celestin endoesophageal prosthesis. This procedure can be performed with low morbidity and mortality, and may become the treatment of choice for this complex problem.
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Clinically apparent intrapulmonary lymph nodes are rare but may be incorrectly diagnosed as pulmonary metastatic disease. We report on a 65-year-old man who presented with a left renal mass and left lower lobe pulmonary nodules that were interpreted radiographically to be consistent with metastatic disease. Surgical pathologic examination confirmed intrapulmonary lymph nodes and a Stage II renal cell carcinoma. Failure to diagnose intrapulmonary lymph nodes may result in erroneous diagnosis of metastatic disease and preclude potentially curative treatment.
Despite the long-standing effort to identify a noninvasive method of diagnosing intestinal ischemia, no reliable biochemical or radiographic technique has evolved. We explored the use of phosphorus nuclear magnetic resonance (PNMR) as a method of detecting surgically induced intestinal ischemia. Using Lewis strain rats (250 to 300 g), small intestine ischemia was produced by ligation in succession from the ligament of Treitz to the ileocecal valve 1 of 2 (group I), 2 of 3 (group II), 3 of 4 (group III), and 4 of 5 (group IV) mesenteric terminal vessels. A sham-operated group was used as a control. Following the surgical procedure, the abdomen was closed and the rat positioned under the PNMR apparatus. Using phosphorus spectroscopy, data were analyzed using a computer program and plotted on a graph indicating relative peaks for the phosphate-based compounds. As a means of comparing groups, we devised an inorganic phosphate to phosphocreatine ratio ("ischemia index"), a qualitative measurement indicating trends used to evaluate ischemia. At the completion of the PNMR study, the abdomen was reopened and proximal, mid, and distal small intestine segments were harvested for histological evaluation using a previously established grading system for intestinal ischemia. Preoperatively, immediately postoperatively, and approximately 2 hours postoperatively, blood samples were obtained for hexosaminidase levels. With increasing vascular ligation, there was an upward trend in both the histological appearance of ischemia and the PNMR ischemia index indicative of increasing tissue ischemia. A similar trend was identified when the histological ischemia grade was directly correlated with the PNMR ischemia index. Hexosaminidase levels did not correlate with ischemia in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Identification of individuals at greatest risk of developing lung cancer could enhance the efficacy of intervention modalities, thereby greatly reducing mortality from this disease. One strategy for identifying these people is to establish molecular markers which reflect the severity of their cancerization field. Thus, investigations were initiated to determine of cells with chromosome aberrations frequently exhibited by lung tumor cells, i.e., trisomy 7, trisomy 20, and deletion of 9p23, are prevalent within the uninvolved airways of cancer patients. As a result, cells containing these aberrations were consistently found at significantly elevated levels by using fluorescence in situ hybridization (FISH). In contrast, cells collected from non-smokers who had never smoked were normal by this assay. The next objective was to determine of cells exhibiting these alterations are also present in upper airways of exposed, but cancer-free smokers and ex-uranium miners. The results showed that, although only a subset of these people will develop lung cancer in their lifetimes, they universally harbor increased numbers of abnormal cells within their airway epithelium. However, the number of sites with multiple verities of abnormal cells tended to be fewer compared with the cancer patients. Thus, quantifying cells with molecular alterations within the cancerization field of a smoker may delineate those with a lesser grade of damage, and these individuals may be at a lesser risk of developing disease. However, differences in the extent of genetic damage afforded by these assays may not clearly define individuals with pending disease, and additional molecular assays must be devised.