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T W Rice

Publications and source records attributed to T W Rice.

At least 73 records · Page 4Linked to original sources
PubMed1998

Erosion of implantable cardioverter defibrillator patch electrode into airways: an unusual cause of recurrent hemoptysis.

A 74-year-old man presented with a 9-month history of recurrent hemoptysis. He had implantable cardioverter defibrillator (ICD) patch electrodes placed 4 years before. A chest x-ray film showed crinkling of his posteriorly placed ICD patch which also appeared to have separated from his ventricle on a CT scan of the chest. Bronchoscopy localized the ICD patch electrode to the lower lobe of the left lung. He underwent a lobectomy and was treated with antibiotics at home. In patients with known ICD implantation, patch erosion into the airways should be considered in the differential diagnosis of recurrent hemoptysis.

Aged↗
PubMed1997

Use of concurrent chemotherapy, accelerated fractionation radiation, and surgery for patients with esophageal carcinoma.

BACKGROUND: The results of a Phase II study of concurrent chemotherapy and accelerated fractionation radiation therapy followed by surgical resection for patients with both adenocarcinoma and squamous cell carcinoma of the esophagus are presented. Pretreatment and postinduction staging were correlated with pathologic findings at surgery to assess the role of surgical resection and the predictive value of noninvasive staging techniques. METHODS: Patients received 2 induction courses with 4-day continuous intravenous infusions of cisplatin (20 mg/m2/day) and 5-fluorouracil (1000 mg/m2/day) beginning on Day 1 and Day 21, concurrent with a split course of accelerated fractionation radiation (1.5 grays [Gy] twice daily, to a total dose of 45 Gy). All patients were subsequently referred for surgical resection. A single, identical postoperative course of chemotherapy and 24 Gy accelerated fractionation radiation was planned for patients with residual tumor at surgery. RESULTS: Seventy-four patients were entered on this study; 72 patients were considered eligible and evaluable. Induction toxicity included nausea (85%), increased dysphagia (90%), neutropenia (<1000/mm3) (43%), thrombocytopenia (<20,000/mm3) (10%), and reversible nephrotoxicity (8%). Sixty-seven patients (93%) underwent surgery, and 65 (90%) were found to have resectable tumors. Twelve of these patients (18%) died perioperatively, and 18 (27%) had no residual pathologic evidence of disease. Resolution of symptoms and normalization of radiographic studies, endoscopy, or esophageal ultrasound did not identify pathologic complete responders accurately. No patient completing induction therapy and surgery experienced a locoregional recurrence. The Kaplan-Meier 4-year projected recurrence free and overall survival rates were 49% and 44%, respectively. CONCLUSIONS: Although this regimen is feasible, there was significant preoperative toxicity and perioperative mortality. Nonetheless, the recurrence free and overall survival rates were encouraging. However, no staging tool can predict a pathologic complete response after induction therapy accurately, suggesting a continued need for surgical resection.

Adenocarcinoma↗
PubMed1997

Bilateral thoracotomy and inferior sternotomy for bypass grafting after esophagostomy.

In the presence of a cervical esophagostomy, a median sternotomy may jeopardize the stoma, risk mediastinal or sternal infection, and potentially compromise future esophageal operations. Coronary artery bypass grafting was performed using a modified bilateral thoracotomy before esophageal reconstruction in a patient with cervical esophagostomy. The surgical technique is described with a review of the relevant literature.

Aged↗
PubMed1997

Achalasia is not associated with measles or known herpes and human papilloma viruses.

Achalasia is an esophageal motility disorder of unknown etiology. Several studies suggest possible herpes or measles virus etiology, but results are inconclusive. The aim of this study was to test whether herpesvirus (HV), measles (MV), or human papilloma virus (HPV) sequences could be detected in myotomy specimens from a wide spectrum of achalasia patients, using the polymerase chain reaction (PCR) technique. Myotomy specimens from 13 achalasia patients, esophagectomy specimens from nine esophageal cancer patients, and autopsy specimens from six fetuses were studied with the PCR technique. Paired oligonucleotide primers of HV (HSV-1 and 2, CMV, EBV, VZV, and HHV-6), MV and HPV sequences and exon 3 of the HPRT gene were used for the PCR DNA amplification. Amplified products were resolved on agarose gels and stained with ethidium bromide. All specimens yielded the appropriate-sized products for exon 3 of the HPRT and viral controls. No amplified products were seen in the achalasia specimens or controls corresponding to any of the virus sequences tested. The absence of HV, MV, and HPV sequences suggests that these viruses are not associated with achalasia but does not exclude the possibility of a previously unidentified virus as a causal agent. Further studies aimed at identifying an unknown viral agent as a cause for achalasia are warranted.

Adult↗
PubMed1997

Surveillance of patients with Barrett's esophagus for dysplasia and cancer with balloon cytology.

BACKGROUND & AIMS: A less costly cancer surveillance method for Barrett's esophagus is desirable. The aim of this study was to compare nonendoscopic balloon cytology with biopsy and brush cytology for detecting dysplasia and carcinoma in patients with Barrett's esophagus. METHODS: Patients in a surveillance program underwent balloon cytology before endoscopy with biopsy and brush cytology. Results of cytology were compared with those of histology. RESULTS: Adequate columnar epithelium was obtained in 52 of 63 (83%) patients with balloon cytology and 59 of 61 (97%) with brush cytology. Balloon cytology obtained abnormal cells in 6 of 8 patients with adenocarcinoma, 2 of 2 patients with high-grade dysplasia, and 2 of 8 patients with low-grade dysplasia. Sensitivity of balloon cytology for high-grade dysplasia or carcinoma was 80% but only 25% for low-grade dysplasia. No patients without dysplasia or carcinoma had abnormal cells. Brush cytology was abnormal in all 11 patients with high-grade dysplasia or carcinoma but only 2 of 9 patients with low-grade dysplasia (sensitivity, 22%). Two of 39 patients without dysplasia had abnormal cells (specificity, 95%). Balloon cytology cost was sixfold less than endoscopy with biopsy. CONCLUSIONS: Balloon cytology detected 80% of patients with high-grade dysplasia or carcinoma when sampling was adequate. Brush cytology data suggest that a more abrasive balloon may improve balloon cytology sensitivity. The potential cost savings of balloon cytology compared with endoscopic cancer surveillance in Barrett's esophagus support further studies of this technique.

Adenocarcinoma↗
PubMed1997

Preliminary experience with double-phase SPECT using Tc-99m sestamibi in patients with hyperparathyroidism.

BACKGROUND: There is a continual search for a better imaging modality for parathyroid pathology. In recent years, Tc-99m sestamibi has been proposed as an alternative to T1-201 for parathyroid scintigraphy. The purpose of this study is to assess the usefulness of a double-phase Tc-99m sestamibi SPECT technique for parathyroid imaging. METHODS: Sixty-one consecutive patients with hyperparathyroidism were studied. Sixteen had previously undergone unsuccessful surgery for hyperparathyroidism. SPECT imaging of the neck and chest was performed at 15 minutes and again at 2 hours after 20-25 mCi of Tc-99m sestamibi was given intravenously. A positive scan was defined as a region of increased focal uptake that persisted on the delayed images. RESULTS: When compared with surgical findings, double-phase sestamibi SPECT correctly identified 55% (26/ 47) of the parathyroid adenomas in the previously unoperated group, and 91% (10/11) of the parathyroid adenomas in the reoperative group. Double-phase sestamibi SPECT was negative in 92% (109/118) of the normal parathyroid glands in the previously unoperated group, and in 88% (15/17) in the reoperative group. CONCLUSIONS: These preliminary data suggest that double-phase Tc-99m sestamibi SPECT is a promising procedure for the preoperative detection and localization of hyperfunctioning parathyroid tissue, especially in patients with recurrent or persistent postoperative hyperparathyroidism.

Adenoma↗
PubMed1997

Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism.

OBJECTIVE: Our purpose was to compare double-phase 99mTc-sestamibi single-photon emission computed tomography (SPECT) and simultaneous 123I-99mTc-sestamibi subtraction SPECT for preoperative localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism. SUBJECTS AND METHODS: Fifteen patients with primary hyperparathyroidism underwent preoperative double-phase 99mTc-sestamibi SPECT and simultaneous 123I-99mTc-sestamibi subtraction SPECT imaging. At surgery, the location, weight, and histopathologic evaluation of all identified parathyroid glands were recorded. RESULTS: At surgery, 17 parathyroid adenomas and 37 normal parathyroid glands were identified. The sensitivity, specificity, and diagnostic accuracy for the detection of parathyroid adenomas were 88%, 97%, and 94%, respectively, for simultaneous 123I-99mTc-sestamibi subtraction SPECT and 53%, 86%, and 76%, respectively, for double-phase 99mTc-sestamibi SPECT. The differences in sensitivity and diagnostic accuracy were statistically significant (p = .031 and p = .016, respectively). CONCLUSION: Compared with double-phase 99mTc-sestamibi SPECT, simultaneous 123I-99mTc-sestamibi subtraction SPECT is a superior imaging study for the preoperative localization of hyperfunctioning parathyroid tissue.

Adenoma↗
PubMed1997

The lack of association between adenocarcinoma of the esophagus and gastric surgery: a retrospective study.

BACKGROUND: The cause of the rapid increase in the incidence of adenocarcinoma of the esophagus since the 1970s is unknown. OBJECTIVE: To test the hypothesis that duodenogastroesophageal reflux causes adenocarcinoma of the esophagus by comparing the frequency of gastric surgery (a human model of duodenogastroesophageal reflux) and other potential risk factors between patients with adenocarcinoma and patients with squamous cell carcinoma of the esophagus. METHODS: Medical records of all patients with adenocarcinoma or squamous cell carcinoma of the esophagus seen at the Cleveland Clinic Foundation between 1987 and 1994 were reviewed. The following data were retrieved: age, gender, race, tumor location, history of gastric surgery and gastroesophageal reflux symptoms, and use of tobacco, alcohol, histamine-2 receptor antagonists, and proton pump inhibitors. RESULTS: The data of 325 patients with adenocarcinoma (73.5%) and 117 patients with squamous cell carcinoma (26.5%) were analyzed. No differences were found between the groups in age, proportion with gastric surgery (patients with adenocarcinoma: 1.2%, 95% confidence interval 0.3-3.1%; patients with squamous cell carcinoma: 0.9%, 95% confidence interval 0.0-4.7%), smoking (76.7 vs 81.6%), or alcohol use (71.8 vs 79.1%). Significant risk factors associated with adenocarcinoma of the esophagus were male gender, white race, distal cancer location, and Barrett's esophagus. CONCLUSIONS: Previous gastric surgery is rarely found in patients with esophageal cancer and is performed with equal frequency in patients with adenocarcinoma and those with squamous cell carcinoma of the esophagus. This suggests that gastric surgery and its associated duodenogastroesophageal reflux do not play a role in the etiology and rising incidence of adenocarcinoma of the esophagus. White males in their mid-60s with Barrett's esophagus who smoke and drink alcohol are at highest risk for adenocarcinoma of the esophagus.

Adenocarcinoma↗
PubMed1997

Laparoscopic antireflux surgery.

Laparoscopic antireflux surgery is a safe and effective alternative surgical approach for the treatment of gastroesophageal reflux disease (GERD). However, the same rigorous evaluation required for open fundoplication is mandated for patients undergoing laparoscopic antireflux surgery. For successful laparoscopic antireflux surgery, both the mastery of laparoscopic techniques and the application of the principles of antireflux surgery are required. Operative mortality and morbidity compare favorably with those of open antireflux procedures, and there is a marked reduction of certain complications. Meticulous laparoscopic technique during the mobilization of the gastric cardia and esophagus will limit mortality and intraoperative and postoperative complications. Although laparoscopic antireflux surgery shortens postoperative recovery and speeds return to work, it may be the double-edged sword causing early failures. Short and intermediate term results compare similarly with open antireflux surgery. Laparoscopic antireflux surgery is an important and significant advancement in the evolution of GERD therapy, its definitive role in the surgeon's armamentarium is dependent on evaluation of long-term data.

Gastroesophageal Reflux↗
PubMed1997

Precise clinical staging allows treatment modification of patients with esophageal carcinoma.

Treatment of esophageal carcinoma requires the realization that this neoplasm is not a single entity with a uniformly poor prognosis. As with any other malignancy, disease stage has prognostic and therapeutic importance. Patients with stage T1-2,N0,M0 or lower tumors have acceptable surgical cure rates and should undergo immediate resection. Patients with more advanced tumors (T3 or N1) are still potentially curable but do poorly with surgery alone. These patients should be considered for multimodality therapy. Patients with hematogenous metastatic disease should be treated with palliative intent. Endoscopic ultrasound (EUS), an accurate, reproducible staging tool, allows for clinical staging of these patients and modification of treatment at the time of diagnosis. Our experience at The Cleveland Clinic Foundation using this algorithm of surgery alone in patients with EUS-defined early-stage carcinomas and multimodality therapy in patients with EUS-staged locally advanced disease is described.

Combined Modality Therapy↗
PubMed1997

Advances in the treatment of esophageal carcinoma.

Recent changes in the epidemiology of esophageal carcinoma now recognize adenocarcinoma as the predominant histologic cell type. Barrett's esophagus and dysplasia in this epithelium identify patients who are at risk of developing invasive adenocarcinoma. This neoplasm is not a single entity with a consistently poor prognosis, and disease stage is important for determining therapy. These findings offer the potential for further development of therapeutic regimens. Endoscopic esophageal ultrasound is an accurate and reproducible staging tool. It allows the physician to determine clinical stage and modify treatment. T2 N0 M0 or lesser stage tumors have acceptable surgical cure rates, and patients should undergo immediate resection. Patients with more advanced T3 or N1 tumors have a potential for cure but do poorly with surgery alone. These patients should be considered for multimodality therapy. Palliative therapy should be given to patients with hematogenous metastatic disease. Treatment stratification by stage proves that esophageal carcinoma is not a uniformly fatal disease without hope for cure.

Adenocarcinoma↗
PubMed1996

Granular cell tumors of the esophagus: a clinical and pathologic study of 13 cases.

BACKGROUND: Fewer than 200 cases of esophageal granular cell tumors (GCT) have been reported. However, determination of malignant potential and appropriate management are as yet unresolved issues. METHODS: We evaluated the clinical and pathologic features of 13 esophageal GCTs. RESULTS: This group included 11 women and 2 men. Six patients were black. Patient ages ranged from 27 to 69 years (median, 47 years). Tumors were found incidentally in 10 patients. Only 2 patients were symptomatic. Most tumors were in the distal esophagus and were less than 8 mm. In 5 patients, multiple GCTs were found, including 3 patients with multiple esophageal GCTs. In 11 cases, the tumor was diagnosed by endoscopic biopsy. Ten patients were treated with biopsy alone, without further attempt at tumor excision. No recurrent or metastatic disease developed within the follow-up period. In all but 1 case, tumors were characterized by nests of cells with pyknotic nuclei, abundant granular cytoplasm, an absence of mitotic figures, and strong S-100 protein positivity. One patient who presented with dysphagia had a 2.5-cm distal esophageal GCT that showed atypical histologic features, including cellular spindling, nuclear pleomorphism, and mitoses. Because of this patient's symptoms, the large tumor size, and atypical endoscopic ultrasonographic and histologic features, the lesion was surgically excised. CONCLUSIONS: Esophageal GCTs are usually asymptomatic, small, and found incidentally on upper endoscopy done for other reasons. Flexible esophagoscopy and biopsy are the mainstay in diagnosis, and endoscopic ultrasound can provide additional information on the layer of origin and tumor extension. Observation of these tumors is indicated unless the patient is symptomatic or the tumor is greater than 1 cm or has atypical endoscopic ultrasonographic or histologic features.

Adult↗
PubMed1996

Stage II esophageal carcinoma: the significance of T and N.

OBJECTIVE: Stage II esophageal carcinomas are a heterogeneous group of uncommon malignant tumors that include both node-negative (IIA; T2 N0 M0 and T3 N0 M0) and node-positive (IIB; T1 N1 M0 and T2 N1 M0) carcinomas. The purpose of this study was to evaluate this heterogeneity and to identify predictors of improved survival. RESULTS: Ninety-four of 345 patients undergoing esophageal resection at the Cleveland Clinic Foundation between 1985 and 1994 had stage 11 carcinomas; 70 stage IIA (24 T2 N0 M0 and 46 T3 N0 M0) and 24 stage IIB (9 T1 N1 M0 and 15 T2 N1 M0). Pathologic stage and T and N status were the only identifiable predictors of survival. Stage IIA survival was significantly better than stage IIB (p = 0.01). T2 N0 M0 survival was not different from T1 N0 M0 survival (p = 0.83). T3 N0 M0 survival was significantly worse than T1 N0 M0 (p = 0.03) and intermediate between T2 N0 M0 survival (p = 0.06) and T1 N1 M0 and T2 N1 M0 survivals (p = 0.07). T1 N1 M0 and T2 N1 M0 survival was not significantly different from T3 N1 M0 survival (p = 0.63). CONCLUSIONS: (1) N1 disease is the principal predictor of reduced survival and N1 is independent of T. Therefore the distinction between T1 N1 M0, T2 N1 M0, and T3 N1 M0 carcinomas is not warranted. (2) N0 disease is the principal predictor of improved survival but N0 is not independent of T. T1 N0 M0 and T2 N0 M0 survivals are similar and therefore distinction between these subgroups is not warranted. T3 N0 M0 survival is intermediate between T1 N0 M0 and T2 N0 M0 carcinomas and between T1 N1 M0, T2 N1 M0, and T3 N1 M0 carcinomas. Therefore stratification by T for N0 carcinomas is warranted.

Adenocarcinoma↗
PubMed1996

Histopathologic features in esophagomyotomy specimens from patients with achalasia.

BACKGROUND & AIMS: A previous study evaluating the morphological features of esophagi resected for endstage achalasia showed marked depletion of myenteric ganglion cells, widespread destruction of nerves, and variable chronic inflammation. The aim of this study was to evaluate the histological features in esophagomyotomy specimens from 11 patients with early achalasia, defined as minimal to moderate esophageal dilation without sigmoid deformity. METHODS: The histological features of esophagomyotomy specimens from 11 patients with achalasia were analyzed and compared with the findings of control specimens obtained from 8 patients who underwent esophagectomy for intramucosal adenocarcinoma. RESULTS: Control specimens had normal numbers of ganglion cells (0.70-0.91 ganglion cells per high-power field) and minimal inflammation. Three patients with vigorous achalasia had normal ganglion cell numbers (0.79-0.91 ganglion cells per high-power field) and at least mild myenteric inflammation without neural fibrosis. The remaining 8 patients had few or no ganglion cells (0-0.30 ganglion cells per high-power field) and at least mild myenteric inflammation and neural fibrosis. Ganglionitis was found in 2 cases. Ganglion cell number was inversely correlated with degree of myenteric neural fibrosis (P < 0.001). CONCLUSIONS: Vigorous achalasia has pathological features that are distinct from classic achalasia. The earliest pathological changes consist of myenteric inflammation with injury to and subsequent loss of ganglion cells and injury to and fibrosis of myenteric nerves.

Adenocarcinoma↗
PubMed1995

Continuous nitric oxide synthesis by inducible nitric oxide synthase in normal human airway epithelium in vivo.

Nitric oxide (NO) is an important mediator of inflammatory responses in the lung and a key regulator of bronchomotor tone. An airway NO synthase (NOS; EC 1.14.13.39) has been proposed as a source of endogenous NO in the lung but has not been clearly defined. Through molecular cloning, we conclusively demonstrate that NO synthesis in normal human airways is due to the continuous expression of the inducible NOS (iNOS) isoform in airway epithelial cells. Although iNOS mRNA expression is abundant in airway epithelial cells, expression is not detected in other pulmonary cell types, indicating that airway epithelial cells are unique in the continuous pattern of iNOS expression in the lung. In situ analysis reveals all airway epithelial cell types express iNOS. However, removal of epithelial cells from the in vivo airway environment leads to rapid loss of iNOS expression, which suggests expression is dependent upon conditions and/or factors present in the airway. Quantitation of NOS activity in epithelial cell lysates indicates nanomolar levels of NO synthesis occur in vivo. Remarkably, the high-level iNOS expression is constant in airway epithelium of normal individuals over time. However, expression is strikingly decreased by inhaled corticosteroids and beta-adrenergic agonists, medications commonly used in treatment of inflammatory airway diseases. Based upon these findings, we propose that respiratory epithelial cells are key inflammatory cells in the airway, functioning in host defense and potentially playing a role in airway inflammation.

Adult↗
PubMed1995

Expression of blood group antigen A by stage I non-small cell lung carcinomas.

To clarify the significance of blood group antigen A (BAA) expression by neoplastic cells, we studied patients who had curative resections of stage I non-small cell lung carcinomas. Immunohistochemical staining using monoclonal antibodies was used to detect BAA expression by paraffin-embedded carcinoma cells. One hundred three patients were studied; mean age was 62.6 years, and 70 (68%) were male. Histologic types were as follows: adenocarcinoma, 52 (50.5%); squamous cell, 25 (24.3%); large cell, 24 (23.3%); and adenosquamous, 2 (1.9%). Histologic grades were as follows: I, 13 (12.6%); II, 26 (25.3%); and III, 64 (62.1%). All patients had American Joint Committee on Cancer stage I tumors: 65 patients (63.1%) had T1 tumors, and 38 (36.9%) had T2 tumors. Recurrences developed in 25 (24.3%) and metachronous malignancies in 4 (3.9%). Survival was 75% +/- 4.8% at 3 years and 66.6% +/- 7.5% at 5 years. Eighty-nine patients (86.4%) were blood group A and 14 (13.6%) were AB. Ninety-five (92.2%) were secretors of BAA and 8 (7.8%) were not. The expression of BAA by neoplastic cells was not detectable in 34 (33%), trace (1% to 5% of neoplastic cells) in 10 (9.7%), 1+ (6% to 25%) in 8 (7.8%), 2+ (26% to 50%) in 12 (11.7%), 3+ (51% to 75%) in 12 (11.7%), and 4+ (76% to 100%) in 27 (26.2%). The pattern of neoplastic cell staining was homogeneous in 14 patients (20.3%) and heterogeneous in 55 (79.7%). Carcinoma recurrence, overall survival, and event-free survival were not related to secretor status, BAA expression, or pattern of staining.(ABSTRACT TRUNCATED AT 250 WORDS)

ABO Blood-Group System↗