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Biomedical subjects

V F Trastek

Publications and source records attributed to V F Trastek.

108 records · Page 6Linked to original sources
PubMed1987

Treatment of bronchogenic carcinoma with chest wall invasion.

En bloc resection of chest wall and lung for primary non-small cell bronchogenic carcinoma with chest wall invasion, although often associated with a significant operative mortality, can be performed with a reasonable expectation of long-term survival if lymph nodes are not metastatically involved. Older age appears to decrease long-term survival, but age alone should not abrogate surgical resection. Non-small cell carcinoma cell type, tumor size, depth of chest wall invasion, and extent of chest wall or lung resection do not significantly influence survival.

Adult↗
PubMed1987

Cardiac dysrhythmia following pneumonectomy. Clinical correlates and prognostic significance.

Cardiac tachydysrhythmias occurred in 53 (22 percent) of 236 consecutive patients undergoing pneumonectomy. All patients had preoperative electrocardiograms which showed normal sinus rhythm. Patients did not receive digitalis before surgery. Atrial fibrillation was the most common dysrhythmia (64 percent; 34/53), followed by supraventricular tachycardia (23 percent; 12/53) and atrial flutter (13 percent; 7/53). No episodes of ventricular tachycardia were documented. Elevated concentrations of cardiac enzymes were associated with 12 (28 percent) of 43 tachydysrhythmias. Recurrent or persistent dysrhythmias were documented in 29 (55 percent) of 53 patients despite medical management or electrocardioversion (or both). Thirty-one percent (9/29) of these patients subsequently died during their hospitalization. There was no correlation between standard preoperative pulmonary function tests and the incidence of postoperative dysrhythmia. In addition, there was no correlation of dysrhythmia with postoperative diagnoses, surgical staging for lung cancer, postoperative arterial blood gas levels, or the fact that a completion pneumonectomy or chest wall resection was undertaken. An increased incidence of tachydysrhythmia was noted in patients undergoing intrapericardial dissections and those who developed postoperative interstitial or perihilar pulmonary edema. Twenty-five percent (13) of the patients experiencing tachydysrhythmias died within 30 days following their pneumonectomy. We conclude that tachydysrhythmias after pneumonectomy are associated with significant mortality, have poor correlation to preoperative pulmonary function, and occur more frequently following intrapericardial dissection and in patients who develop postoperative interstitial pulmonary edema or perihilar pulmonary edema.

Arrhythmias, Cardiac↗
PubMed1987

Esophagogastric anastomoses: the value of fibrin glue in preventing leakage.

Disruption of an esophagogastric anastomosis can result in a high mortality despite aggressive treatment. The efficacy of fibrin "glue" to seal esophagogastric anastomoses was evaluated as a means of preventing this complication. A left thoracotomy was performed in 25 adult mongrel dogs. After esophagogastric resection, a standardized esophagogastrostomy was performed and eight interrupted sutures were used to completely close the posterior wall. The anterior wall was approximated with only three sutures, leaving four large holes between sutures. The dogs were then randomized into the control group (n = 14; no attempt to seal the leaks) or into the fibrin glue-treated group (n = 11). An average of 3.3 ml of glue was applied to the anterior wall of the anastomosis in the treated group. In the control group, 13 of 14 dogs (92.9%) died of anastomotic leak a median of 3 days after operation. In the fibrin glue-treated group, only four of 11 dogs (36.4%) died of anastomotic leaks (p less than 0.01). Dogs that survived were put to death at 14 days. Postmortem examination in all dogs revealed no deleterious effects or complications related to the glue. Postmortem examination of the one surviving control dog and the seven fibrin glue-treated dogs that did not die of sepsis revealed a healed anastomosis without abscess formation. We conclude that fibrin glue is effective in lessening the incidence of esophagogastric anastomotic leaks as employed in this experimental model.

Animals↗
PubMed1986

Primary chest wall tumors: factors affecting survival.

Between 1955 and 1975, chest wall resection was done in 90 patients for primary chest wall tumors. Ages ranged from 8 to 96 years (mean, 44.3 years). A painful mass was the most common sign and symptom. Eighty-two tumors (91.1%) were located in the lateral chest wall and eight, in the anterior thorax. The tumor was malignant in 71 patients (78.9%) and benign in 19. All patients with benign tumors had complete excision and are currently free from disease. Malignant fibrous histiocytoma, chondrosarcoma, and rhabdomyosarcoma constituted 62% of the malignant neoplasms. Most malignancies were treated by wide resection. There were no thirty-day operative deaths. Overall 1-, 5-, and 10-year survival was 89%, 57%, and 49%, respectively. Recurrent tumor developed in 37 patients (52%); 5-year survival, however, was only 17% after recurrence. Cell type and extent of invasion significantly influenced survival. Both chondrosarcoma and rhabdomyosarcoma had a better prognosis than malignant fibrous histiocytoma (p less than 0.05). We conclude that early resection is the treatment of choice for primary malignant chest wall tumors and that development of recurrent disease is an ominous event.

Adolescent↗
PubMed1986

Current techniques for the surgical management of malignant lesions of the thoracic esophagus and cardia.

Cancers of the esophagus and cardia remain serious conditions that cause many thousands of deaths every year throughout the world. In North America, cancer of the esophagus and gastric cardia is an endemic disease of low order and stable incidence. Nevertheless, it is responsible for many deaths and considerable suffering. With current methods of treatment, substantial palliation and amelioration of patient disability are possible, and some patients gain long-term survival with comfort and even cure. A combination of surgical resection and reconstruction is the chief modern method of management of such cancers. Herein we discuss a variety of standard surgical procedures that are currently available and present detailed illustrations of these procedures. The selection of a specific operation depends largely on the site of the neoplasm. With all these procedures, function is restored and the local and regional neoplastic tissue is removed without compromising the potential for cure. Associated operative mortality is approximately 7%. The late results of the operations illustrated depend primarily on the cell type, grade, and stage of the neoplasm encountered at the time of surgical treatment. For patients who have undergone resection, 5-year survival rates have ranged from 15 to 54%, the results depending on the stage of the cancer. Of equal importance is the fact that oral diet can be maintained in 93% of patients despite recurrence of the neoplasm.

Cardia↗
PubMed1986

Mediastinoscopy.

Explore the source record for details and available documents.

Biopsy↗
PubMed1986

Pulmonary aspergilloma. Results of surgical treatment.

Between 1953 and 1984, 53 patients (40 male and 13 female) underwent thoracotomy for treatment of pulmonary aspergilloma. The median age was 58 years (range 4 to 86 years). Either underlying lung disease or immunologic risk factors were present in 49 patients (92%). Twenty-one patients (31%) had simple aspergilloma and 32 (47%) had complex aspergilloma. The most common indication for operation was an indeterminate mass, hemoptysis, or severe cough. Lobectomy, wedge excision, and pneumonectomy were the most frequent operations. Complications occurred in 78% of patients with complex aspergilloma and in 33% of patients with simple aspergilloma (p = 0.002). Operative mortality was 5% (one death) in patients with simple aspergilloma and 34% (11 deaths) in patients with complex aspergilloma (p = 0.01). Cause of death was respiratory failure in four patients, underlying pulmonary disease in three, aspergillosis in two, and other conditions in three. At follow-up, 84% of operative survivors with simple aspergilloma were alive and well compared with 43% of those with complex aspergilloma. Although operative mortality in patients with complex aspergilloma was high, 67% of the survivors had a good long-term result in terms of absence of symptoms, but they frequently died of underlying disease. In contrast, operation in patients with simple aspergilloma was done with low risk, and approximately 90% of survivors had a good late result. Late appearance of contralateral disease did occur and argues for rigorous postoperative surveillance.

Adolescent↗
PubMed1985

Concomitant cardiac and pulmonary operations.

From 1965 through 1983, 43 patients underwent concomitant cardiac and pulmonary procedures at our institution. Most patients presented with cardiac symptoms and were incidentally found to have a roentgenographically indeterminate lung nodule. The pulmonary diagnosis of 38 patients was unknown preoperatively, and nine of these had a malignant lesion. All 43 cardiac procedures necessitated extracorporeal circulation. Thirty-one patients had benign pulmonary disease, 10 had bronchogenic carcinoma, and two had metastatic carcinoma. Concomitant pulmonary procedures were performed via median sternotomy and included single wedge resections in 32 patients, lobectomy in seven, multiple wedge resections in three, and pneumonectomy in one. Most resections were performed either before or after institution of bypass, without systemic anticoagulation. Of the two operative deaths (4.6%), one was related to intraparenchymal pulmonary hemorrhage after multiple wedge resections during anticoagulation. Thus, pulmonary resections performed during anticoagulation may be associated with increased risk and probably should be avoided. The second death was cardiac in origin and not related to pulmonary resection. The remaining patients recovered uneventfully. Definitive correction of both cardiac and pulmonary disease can be performed at one operation via a single incision with safety and benefit to the carefully selected patient.

Adolescent↗
PubMed1985

Surgical management of broncholithiasis.

Fifty-two patients (31 men and 21 women) were treated for complications of broncholithiasis between 1969 and 1984. Mean age was 50.8 years (range 26 to 74 years). Indications for operation included symptoms in 49 patients and an abnormal chest x-ray film in three. Broncholithectomy was initially attempted by thoracotomy in 40 patients and by bronchoscopy in 12. In the thoracotomy group broncholithectomy was successful in all patients, 32 of whom underwent pulmonary resection. Significant postoperative complications occurred in five patients (12.8%). There was one postoperative death (2.5%). In the bronchoscopy group broncholithectomy was successful in eight patients (67%); significant complications occurred in two and there were no early deaths. Subsequent thoracotomy was done in three of the four patients in whom bronchoscopic removal was unsuccessful. Follow-up averaged 76.5 months (range 6 to 183 months). The 15 year survival rate (Kaplan-Meier) for all patients was 75.1% and did not differ from a control group of patients. No patient in the thoracotomy group had recurrent complications of broncholithiasis. In contrast, complications recurred in three of the eight patients (37.5%) successfully treated by bronchoscopy. We conclude that broncholithectomy via thoracotomy is the preferred treatment, as the risks are low and the long-term results are excellent.

Adult↗
PubMed1984

The effect of preclotting on surface thrombogenicity and thromboembolic complications of Dacron grafts in the canine thoracic aorta.

Previous reports have advocated preclotting and autoclaving of Dacron grafts to prevent graft hemorrhage, yet no data delineate possible changes in surface thrombogenicity or thromboembolic risks. To assess these factors, preclotted and preclotted-autoclaved woven Dacron prostheses were implanted in the thoracic aorta of 31 dogs. Grafts were harvested 1 week to 1 month following implantation, and the thrombus-free surface of each graft was calculated by computerized morphometry. Values for thrombus-free surface were lowest in autoclaved grafts preclotted in nonheparinized blood (72%) or in heparinized blood (78%). Grafts preclotted in platelet-rich plasma and autoclaved had a thrombus-free surface value of 85%. Regular preclotted grafts or grafts without preclotting had the greatest thrombus-free surface value (97% and 99%). Distal embolization to the kidneys was detected in seven of 31 animals (23%). No emboli were found in animals with grafts that were not preclotted or if grafts were preclotted with platelet-rich plasma and autoclaved. Thrombus-free surface values were lower (p less than 0.01) in grafts with embolic complications (71% versus 91%). These data suggest that, if the risk of severe bleeding in fully heparinized patients precludes the use of a woven Dacron graft without preclotting, autoclaving a graft preclotted with platelet-rich plasma appears to be the method of choice.

Animals↗
PubMed1984

Quantitative evaluation of ibuprofen treatment on thrombogenicity of expanded polytetrafluoroethylene vascular grafts.

To evaluate the effect of ibuprofen on graft thrombogenicity and early patency, expanded polytetrafluoroethylene (ePTFE) (Gore-tex) grafts with an inside diameter of 4 mm and length of 5 cm were implanted into the femoral artery in 43 dogs. Autogenous vein bypass was performed on the contralateral side. 111In-labeled platelets were injected into 16 dogs 24 hours prior to operation, and eight of these received 12.5 mg ibuprofen/kg intravenously 15 minutes prior to cross-clamping. The grafts were removed after 3 hours and radioactivity in five segments of the grafts, including both anastomoses, was determined with a gamma-well counter. Of 27 additional dogs, 13 received oral ibuprofen (150 mg three times daily till the time of sacrifice) and 14 served as controls. The grafts were harvested at 5 days and at 30 days and patency was evaluated. At 30 days, thrombus thickness and extent of intimal hyperplasia on the specimens were measured by light microscopy. At 3 hours, radioactivity per unit of weight (counts per minute per gram) of ePTFE graft to vein graft decreased from 8.46 to 1.34 (P less than 0.001) with ibuprofen treatment. The median radioactivity ratio of ePTFE to blood decreased from 11.62 to 0.89 (P less than 0.01). Platelet deposition was reduced in all segments of treated grafts. The median platelet count was 9.43 X 10(6)/mm2 in control and 0.27 X 10(6)/mm2 in treated grafts (P less than 0.01). The patency of vein grafts did not change significantly, whereas the patency of the ePTFE grafts significantly improved in the treated group at 5 days (P = 0.01) and at 30 days (P less than 0.01). These data demonstrate that ibuprofen effectively reduces early platelet deposition and improves patency of ePTFE grafts.

Animals↗
PubMed1984

En bloc (non-chest wall) resection for bronchogenic carcinoma with parietal fixation. Factors affecting survival.

Seventy-three patients (57 men and 16 women) underwent en bloc resection of lung and attached parietes between 1970 and 1982. All patients had documented malignant pleural invasion. Chest wall parietal pleura was invaded in 33 patients, pericardium in 14, phrenic or vagus nerve in nine, left atrium in five, superior vena cava in four, esophagus in two, diaphragm in one, and multiple structures in five. No patient underwent chest wall resection. Parietal pleurectomy was performed in all patients with involvement of the chest wall parietal pleura; 37 lobectomies and 36 pneumonectomies were performed. Operative mortality was 12.3%. The actuarial overall 5 year survival rate (Kaplan-Meier method) was 39.7%. We conclude that en bloc resection for primary bronchogenic carcinoma with invasion of adjacent intrathoracic structures, although associated with a significant mortality, can be performed with a reasonable likelihood of long-term survival.

Adult↗
PubMed1984

Experimental replacement of the inferior vena cava: factors affecting patency.

To evaluate factors influencing graft patency in the venous system, we replaced the inferior vena cava (IVC) in 50 dogs. Expanded polytetrafluoroethylene ( ePTFE ) grafts with external support were implanted into 32 animals while autogenous, spiral jugular vein grafts were used to replace the IVC in 18 dogs. 111In-labeled autologous platelets and 125I-labeled canine fibrinogen were utilized to evaluate early thrombus formation. A distal arteriovenous (AV) fistula significantly (P less than 0.05) decreased both platelet and fibrin deposition on ePTFE grafts 3 hours following implantation. Patency rate of 12 ePTFE grafts with a temporary AV fistula was higher (75%) than that of grafts without fistula (25%) at 3 months (P less than 0.05). Spiral vein grafts with fistula showed 91% patency at 3 months; without fistula patency was only 67%. Venograms confirmed patency in five grafts followed up to 6 months. Antiplatelet therapy resulted in 100% patency in ePTFE and vein grafts during its administration, and vein grafts maintained patency after discontinuation of antiplatelet treatment. Spiral vein grafts showed no decrease in cross-sectional area at 3 months, while the cross-sectional area of ePTFE grafts decreased significantly (59%). Distal AV fistula decreases platelet and fibrin deposition leading to early occlusion in ePTFE grafts and produces excellent patency in spiral vein grafts. Antiplatelet therapy appears to further improve patency.

Animals↗
PubMed1983

Cavernous hemangiomas of the liver: resect or observe?

Surgical decisions regarding cavernous hemangioma of the liver require consideration of the natural history of the lesion. To provide background, we retrospectively evaluated 49 cases of such hemangiomas exceeding 4 cm in diameter. There were 36 female patients (including 4 infants) and 13 males. Their ages ranged from 1 month to 68 years and averaged 44 years. Surgical procedures that ranged from simple excision to hepatic lobectomy were performed on 13 patients. Four had postoperative complications. There were no surgical deaths or any late deaths attributable to hemangioma. The other 36 patients have been observed for up to 15 years (mean 5.5 years) without the need for surgery. None of the patients in this group died, and none has experienced intraperitoneal hemorrhage or intensification of symptoms, although the size of four lesions increased. The benign course should be considered when deciding on management of lesions that are asymptomatic or so large as to pose significant operative risk.

Adult↗
PubMed1983

Noninvasive radioisotopic technique for detection of platelet deposition on bovine pericardial mitral-valve prosthesis and in vitro quantification of visceral microembolism in dogs.

Platelet deposition on bovine pericardial-tissue mitral-valve prostheses in dogs was observed noninvasively by use of 111In-labeled platelets and quantified after sacrifice at one, 14 and 30 days postimplantation (300-400 microCi of labeled platelets having been injected 24 hrs previously). Thrombosis on the sewing ring and pericardial leaflets at one and 14 days and on the leaflets at 30 days was delineated in scintiphotos. In vitro quantification (% injected dose) indicated that the sewing ring and perivalvular tissue retained 0.75% of labeled platelets at one day postimplantation, 0.084% at 14 days, and 0.0042% at 30 days. Platelet survival was reduced to 38 hrs at 21 days postimplantation but returned toward the normal (50 hrs) with endothelial covering of the sewing ring. Microemboli in lung and kidney, as measured by tissue/blood radioactivity ratio, decreased significantly at 30 days. 111In-labeled platelets thus provide a sensitive marker for noninvasive imaging and in vitro quantification of platelet deposition on valvular prostheses and microemboli trapped in viscera.

Animals↗
PubMed1982

Splenic artery aneurysms.

The records of 100 patients with documented splenic artery aneurysms seen between January 1960 and January 1980 were reviewed. Eighty-seven were women and 13 men. Ages ranged from 16 to 81 years (mean 58.2 years). Eighty women (92%) had been pregnant. The number of pregnancies ranged from 1 to 16 (mean 4.5); 21 women (24.1%) had been pregnant six or more times. Aneurysm diameter ranged from 0.6 to 30 cm (mean 2.1 cm). The aneurysm was calcified in 72 patients. Most aneurysms (78%) were located in the distal third of the splenic artery and were saccular. Multiple aneurysm occurred in 29 patients. Seventeen patients were symptomatic at the time of diagnosis; all presented with abdominal pain. Rupture occurred in three patients, one of whom was pregnant; two survived. Atherosclerotic occlusive disease occurred in 21 patients. Other arterial aneurysms occurred in 12 patients. Eighty-one patients had surgical treatment. Aneurysmectomy with splenectomy was the most common procedure. The elective operative mortality rate was 1.3%. The 19 patients not undergoing surgery were followed from 1.0 to 19 years (mean 7.4 years). No ruptures or other complications of the aneurysm occurred in these patients. This study supports the view that patients who are pregnant or who present with a symptomatic splenic artery aneurysm should undergo surgical resection.

Adolescent↗
PubMedDate not supplied

Radioisotopic techniques for noninvasive detection of platelet deposition in bovine-tissue mitral-valve prostheses and in vitro quantification of visceral microembolism in dogs.

Platelet deposition on bovine pericardial-tissue mitral-valve prostheses in 11 dogs was observed noninvasively by use of 111In-labeled platelets and quantified after sacrifice at one (n = 3), 14 (n = 3), and 30 (n = 5) days postimplantation (300-400 microCi of labeled platelets having been injected 24 hours previously). Thrombosis on the sewing ring and pericardial leaflets at one and 14 days and on the leaflets at 30 days was delineated in scintiphotos. In vitro quantification (% injected dose) indicated that the leaflets, sewing ring, and perivalvular tissue retained 0.904% of labeled platelets at one day postimplantation, 0.198% at 14 days, and 0.040% at 30 days. Platelet half-life was reduced to 38 hours at 21 days postimplantation but returned toward the normal (50 hours) with fibrous ingrowth in the sewing ring. Microembolism in lung and kidney, as measured by tissue/blood radioactivity ratio, also was decreased significantly at 30 days. 111In-labeled platelets thus provide a sensitive marker for noninvasive imaging and in vitro quantification of platelet deposition on valvular prostheses and microemboli trapped in viscera, although histochemical confirmation will be necessary to correlate the increase in tissue/blood ratio with the presence of microembolism.

Animals↗