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Sulibhavi A, Asokan S, Miller MI, Moreira P, Daly BD, Fernando HC, Litle VR, Suzuki K. Peripheral Blood Lymphocytes and Platelets Are Prognostic in Surgical pT1 Non-Small Cell Lung Cancer. Ann Thorac Surg 2019; 109:337-342. [PMID: 31593659 DOI: 10.1016/j.athoracsur.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a paucity of prognostic factors for patients with stage I non-small cell lung cancer (NSCLC) undergoing operations. We investigated the prognostic role of preoperative complete blood count values in patients with stage I NSCLC patients undergoing operations. METHODS A retrospective medical record review was performed of patients who underwent operations for stage I NSCLC between 2000 and 2015. Patients who died within 30 days of the operations were excluded. The primary end point was recurrence. Preoperative complete blood count values were analyzed, and a median value was used as the cutoff. Statistical analysis used χ2 and t tests along with univariate and multivariate analyses by Cox regression modeling. RESULTS The study included 103 patients. A high lymphocyte count was significantly associated with recurrence (5-year recurrence-free survival [RFS] of 69.8% for high vs 95.7% for low, P = .003), as well as high platelet (5-year RFS of 72.0% for high vs 91.8% for low, P = .02). Independent prognostic factors on multivariate analysis were high lymphocyte (hazard ratio [HR], 7.27; P = .005) and platelet counts (HR, 7.49; P = .003) as well as tumor (HR, 5.40; P = .008) and treatment characteristics (HR, 4.59; P = .01). Among patients with pT1 lesions, high lymphocyte (HR, 8.41; P = .03) and high platelet counts (HR, 19.78; P = .004) remained independent prognostic factors. Neither NLR nor PLR were significantly associated with recurrence. CONCLUSIONS In patients with pathologic stage I NSCLC undergoing surgical resection, the preoperative blood count from peripheral blood may provide prognostic value. Of significance, in patients with pT1 N0 NSCLC, high lymphocyte count and high platelet count were associated with higher recurrence.
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Affiliation(s)
| | - Sainath Asokan
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Paulo Moreira
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Benedict D Daly
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Hiran C Fernando
- Thoracic Surgery, Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, Virginia
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
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Muñoz-Largacha JA, Rao SR, Brinckerhoff LH, Daly BD, Fernando HC, Litle VR, Suzuki K. Induction chemoradiation is associated with improved survival in chest wall invasion lung cancer. Tumori 2019; 105:331-337. [PMID: 30905273 DOI: 10.1177/0300891619839283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if induction chemotherapy with concurrent high-dose radiation followed by resection is associated with improved survival in patients with nonsuperior sulcus lung cancer with chest wall invasion. METHODS We performed a retrospective review of clinical T3 (chest wall invasion) N0/N1 patients with non-small cell lung cancer who underwent surgical resection between January 1, 1992, and January 31, 2017. Exclusion criteria included superior sulcus tumors and resection performed for palliation/recurrence. Patients undergoing induction chemoradiation followed by surgical resection were compared to those undergoing resection first or those receiving induction radiation followed by resection. Overall survival was calculated using the Kaplan-Meier method. RESULTS Thirty-four patients were included in the analysis, with 5-year overall survival (OS) of 30%. By clinical stage, 31 (91%) were IIB (T3N0) and 3 (9%) were IIIA (T3N1). Sixteen patients (47%) received induction chemoradiation before surgery. Of the remaining 18 patients, 5 (15%) received induction radiation followed by surgery, and 13 (38%) underwent surgery as the first treatment. Three patients belonging to the group not receiving induction chemoradiation died within 30 days after surgery and were excluded from survival analysis. In the remaining 31 patients, induction chemoradiation was associated with improved 5-year OS (53% for induction chemoradiation vs 7% for others; P<0.01). Disease recurrence was evident in 9 cases, 2 (12.5%) in the induction chemoradiation group and 7 (46.6%) in the others (median disease-free time 103.0 months for induction chemoradiation group vs 8.0 months for others; P<0.01). CONCLUSION In patients with nonsuperior sulcus lung cancer with chest wall invasion, induction chemoradiation therapy followed by resection is associated with improved OS.
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Affiliation(s)
- Juan A Muñoz-Largacha
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Sowmya R Rao
- 2 Department of Surgery, Division of Biostatistics, Boston University School of Medicine, Boston, MA
| | - Laurence H Brinckerhoff
- 3 Department of Surgery, Division of Thoracic Surgery, Tufts University School of Medicine, Boston, MA
| | - Benedict D Daly
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Hiran C Fernando
- 4 Thoracic Surgery, Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, VA
| | - Virginia R Litle
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Kei Suzuki
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
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Ebright MI, Sridhar P, Litle VR, Narsule CK, Daly BD, Fernando HC. Endoscopic Fundoplication. Innovations 2017. [DOI: 10.1177/155698451701200303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael I. Ebright
- Section of Thoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Virginia R. Litle
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Chaitan K. Narsule
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Benedict D. Daly
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Hiran C. Fernando
- Section of Thoracic Surgery, Inova Fairfax Hospital, Fairfax, VA USA
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dos Santos RS, Bizekis C, Ebright M, DeSimone M, Daly BD, Fernando HC. Radiofrequency ablation for Barrett's esophagus and low-grade dysplasia in combination with an antireflux procedure: a new paradigm. J Thorac Cardiovasc Surg 2010; 139:713-6. [PMID: 20074750 DOI: 10.1016/j.jtcvs.2009.10.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 09/13/2009] [Accepted: 10/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Radiofrequency ablation for Barrett's esophagus in combination with an antireflux procedure has not been widely documented. We report our initial experience with radiofrequency ablation in association with antireflux procedure for Barrett's metaplasia and low-grade dysplasia. METHODS A total of 14 patients (10 male and 4 female patients) presented with Barrett's metaplasia (n=11) or low-grade dysplasia (n=3). Median age was 60 years (38-80 years). The severity of Barrett's esophagus was classified by length (in centimeters), appearance (circumferential/noncircumferential), and histology (1, normal; 2, Barrett's metaplasia; and 3, low-grade dysplasia). Radiofrequency ablation was performed with the HALO 360 degrees or 90 degrees systems (BARRX Medical, Sunnyvale, Calif). RESULTS Median follow-up was 17 months. The mean number of ablative procedures undertaken was 2.6 (range, 1-6). There was no mortality, but there were 2 perioperative complications after the antireflux procedure (pneumonia, 1; atrial fibrillation, 1). One patient had mild dysphagia requiring a single dilation 2 months after ablation. The mean length of Barrett's esophagus decreased from 6.2 to 1.2 cm after treatment (P=.001). Barrett's grade decreased significantly (P=.003). Before therapy, circumferential Barrett's esophagus was present in 13 patients. At last endoscopy, only 1 patient had circumferential Barrett's esophagus present. The number of radiofrequency ablation treatments was significantly (P < .05) associated with success. All patients receiving 3 or more treatments had complete resolution of Barrett's metaplasia. CONCLUSIONS Radiofrequency ablation performed either before or after an antireflux procedure is safe. This approach is effective for reducing or eliminating metaplasia and dysplasia. Long-term studies will be necessary to determine whether this approach can provide durable control of both reflux and Barrett's esophagus.
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Affiliation(s)
- Ricardo S dos Santos
- Department of Cardiothoracic Surgery, Boston University School of Medicine, Boston, MA, USA
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Jatoi A, Daly BD, Hughes VA, Dallal GE, Kehayias J, Roubenoff R. Do patients with nonmetastatic non-small cell lung cancer demonstrate altered resting energy expenditure? Ann Thorac Surg 2001; 72:348-51. [PMID: 11515864 DOI: 10.1016/s0003-4975(01)02847-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The cancer cachexia syndrome occurs in patients with non-small cell lung cancer (NSCLC) and includes elevated resting energy expenditure (REE). This increase in REE leads to weight loss, which in turn confers a poor prognosis. This study was undertaken to determine whether the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC. METHODS In this case-control study, 18 patients with nonmetastatic NSCLC (stages IA to IIIB) were matched to healthy controls on age (+/- 5 years), gender, and body mass index (+/- 3 kg/m2). Only 4 cancer patients had experienced > 5% weight loss. Cancer patients and controls were compared on the basis of: (1) unadjusted REE, as measured by indirect calorimetry; (2) REE adjusted for lean body mass, as measured by dual x-ray absorptiometry; (3) REE adjusted for body cell mass, as measured by potassium-40 measurement; and (4) REE adjusted for total body water, as measured by tritiated water dilution. RESULTS We observed no significant difference in unadjusted REE or in REE adjusted for total body water. However, with separate adjustments for lean body mass and body cell mass, cancer patients manifested an increase in REE: mean difference +/- standard error of the mean: 140+/-35 kcal/day (p = 0.001) and 173+/-65 kcal/day (p = 0.032), respectively. Further adjustment for weight loss yielded similarly significant results. CONCLUSIONS These results suggest that the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC and raise the question of whether clinical trials that target cancer cachexia should be initiated before weight loss.
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Affiliation(s)
- A Jatoi
- Department of Medicine, The New England Medical Center, Tufts University, Boston, Massachusetts, USA.
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Abstract
BACKGROUND AND OBJECTIVES This case control study explored the purported inverse relationship between folate status and lung cancer development. METHODS Folate status of 46 postoperative non-small cell lung cancer (NSCLC) patients was compared to that of 44 non-cancer patients. Cancer patients had completed treatment > 3 months prior and had no evidence of cancer. Ineligibility criteria for all patients included (1) > 2 alcoholic drinks/day (2) ongoing tobacco use, or (3) folate supplementation > 400 microg/day. RESULTS No differences were found between groups in serum and RBC folate after adjustment for age and use of folate-interfering medications: geometric means (GM) x /geometric standard error (GSE): 7.9 ng/ml x /1.1 vs. 7.8 ng/ml x /1.1, respectively (P = 0.91) for serum folate; 264 ng/ml x /1.1 vs. 263 ng/ml x /1.1, respectively (P = 0.97) for RBC folate. Age- and creatinine-adjusted homocysteine was no different between groups: GM x /GSE: 9.4 micromol/L x /1.0 vs. 8.6 micromol/L x /1.0, respectively (P = 0.17). No difference were seen in folate intake. Frequencies of the homozygous genotype for the MTHFR polymorphism, an enzyme important in folate metabolism and associated with a reduced risk of other cancers, were no different. CONCLUSIONS This case control study does not support the hypothesis that low folate is an independent risk factor for NSCLC.
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Affiliation(s)
- A Jatoi
- Division of Hematology/Oncology, Department of Medicine, New England Medical Center, Tufts University, Boston, MA, USA.
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Vora SA, Daly BD, Blaszkowsky L, McGrath JJ, Bankoff M, Supran S, Dipetrillo TA. High dose radiation therapy and chemotherapy as induction treatment for stage III nonsmall cell lung carcinoma. Cancer 2000; 89:1946-52. [PMID: 11064351 DOI: 10.1002/1097-0142(20001101)89:9<1946::aid-cncr10>3.0.co;2-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The current study was conducted to review the authors' experience in treating consecutive patients with American Joint Committee on Cancer (1997 revision) Stage III nonsmall cell lung carcinoma with aggressive preoperative chemoradiation followed by surgical resection. METHODS The records of all patients who received preoperative chemoradiation were evaluated. Patients received 2 cycles of concurrent cisplatin and etoposide with 5940 centigrays of radiation therapy. They then were reevaluated to determine whether they were surgical candidates. If so, resection of the primary tumor with mediastinal lymph node dissection was performed 4-6 weeks after the completion of preoperative treatment. After adequate healing, an additional four cycles of cisplatin/etoposide or carboplatin/paclitaxel was given. RESULTS Forty-two patients received preoperative chemoradiation, 33 of whom underwent surgical resection (79%), including 9 patients who underwent pneumonectomies. Complete pathologic responses were observed in 27% of these patients. Postoperative complications were noted in 21% of the patients and included persistent air leak, supraventricular arrhythmia, and empyema. There were no reported treatment-related deaths. The median follow-up was 26 months. The overall 5-year survival rate for all patients was 36.5% and was 45. 3% for patients who underwent resection. A trend toward increased 5-year survival was observed in patients who had a complete pathologic response (57.1%). Univariate analysis revealed the N stage classification to be significant for predicting a complete response. Patterns of failure revealed the brain to be the most common site of first recurrence (50%) and the only site of recurrence in 36% of patients. There was only one case of local failure. CONCLUSIONS Preoperative chemoradiation using high radiation doses is feasible with acceptable toxicity. The results of the current study suggest an increased complete pathologic response rate and increased overall survival rate compared with reports in the published literature.
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Affiliation(s)
- S A Vora
- Department of Radiation Oncology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
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8
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Daly BD. Late results. Chest Surg Clin N Am 1999; 9:675-93, x. [PMID: 10459435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Pneumonectomy is performed for a number of benign and malignant conditions. It is most commonly performed for lung cancer. Adjuvant and neoadjuvant protocols have increased the number of these operations being performed and the long-term results are improving. Pneumonectomy may also be performed for metastases to lung and for mesothelioma with encouraging results. Some bronchial adenomas require pneumonectomy. Treatment of resistant mycobacteria or the complications of tuberculosis frequently require pneumonectomy. Late bronchopleural fistulae, esophagopleural fistulae, and empyema may occur.
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Affiliation(s)
- B D Daly
- Department of Cardiothoracic Surgery, New England Medical Center Hospital, Boston, Massachusetts, USA.
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9
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Abstract
OBJECTIVE Increased resting energy expenditure (REE) is thought to confer a poor prognosis in patients with non-small cell lung cancer (NSCLC). However, no study has validated this hypothesis to date. This study's objective was to examine the prognostic significance of REE in NSCLC. METHODS Seventeen patients with NSCLC (stages IA-IIIB) underwent measurement of REE with indirect calorimetry before the initiation of cancer treatment. Similar measurements were performed in 17 control subjects, each of whom was matched to a cancer patient by age ( +/-5 years), sex and body mass index ( +/-3 kg/m2). Patients were classified as hypermetabolic or hypometabolic based on a direct comparison of measured REE between cancer patients and their matched controls. After cancer treatment, these 17 patients were followed for evidence of metastatic disease for up to 32 months. RESULTS Six patients developed metastatic disease. The eight hypometabolic cancer patients had a significantly shorter mean disease-free survival compared to the nine hypermetabolic cancer patients: 19 months (95% confidence interval (CI) 12, 26) versus 29 months (95% CI 24, 34), respectively (P < 0.05 by log-rank test). In contrast, Cox regression showed no relationship between disease-free survival and differences in REE between cancer patients and their matched controls (P = 0.20). CONCLUSIONS These results suggest that hypermetabolism may predict a longer disease-free survival in NSCLC patients. This finding differs from the prevailing hypothesis that hypometabolic patients with NSCLC survive longer, and deserves further investigation.
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Affiliation(s)
- A Jatoi
- Department of Medicine, The New England Medical Center, Tufts University, Boston, MA, USA.
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Pantongrag-Brown L, Krebs TL, Daly BD, Wong-You-Cheong JJ, Beiser C, Krause B, Brown AE. Frequency of abdominal CT findings in AIDS patients with M. avium complex bacteraemia. Clin Radiol 1998; 53:816-9. [PMID: 9833784 DOI: 10.1016/s0009-9260(98)80192-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Use of blood culture studies for early diagnosis of Mycobacterium avium complex (MAC) infection has become important due to the recent development of effective antibiotic therapy for this condition. This study assessed the abdominal computed tomography (CT) findings in patients with AIDS who presented with bacteraemic MAC infection. METHODS A retrospective analysis of abdominal CT scans was performed in 24 patients who presented with MAC-positive blood culture. CT images were reviewed specifically to evaluate for lymph node enlargement and attenuation, hepatomegaly, splenomegaly, bowel wall abnormality and for any other pathological changes. Comparison was made to prior reports of the CT findings in this disease process. RESULT Enlarged intra-abdominal mesenteric and/or retroperitoneal lymph nodes were found in 10 patients (42%). These nodes were characterized by homogeneous, soft-tissue attenuation in eight of the 10 patients. Hepatomegaly, splenomegaly and small bowel wall thickening were noted in 12 (50%), 11 (46%) and four (14%) patients, respectively. CT findings were evaluated as normal in six (25%) patients. CONCLUSIONS Enlarged mesenteric and/or retroperitoneal lymph nodes in AIDS patients with bacteraemic MAC were observed much less frequently on CT than previously reported in AIDS patient populations. Normal abdominal CT findings do not exclude this diagnosis and may reflect a trend towards earlier detection of MAC disease.
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Affiliation(s)
- L Pantongrag-Brown
- Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore 21201-1595, USA
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Abstract
BACKGROUND AND OBJECTIVES This cross-sectional study of postoperative non-small cell lung cancer (NSCLC) patients examined possible effects of vitamin intake and folate status on disease-free survival. METHODS Supplemental vitamin usage, dietary vitamin intake (Willett Food Frequency Questionnaire), red blood cell (RBC) folate, and serum folate concentrations were assessed in patients with a history of NSCLC. Exclusion criteria included factors that alter folate status or that are associated with altered nutritional habits: (1) evidence of cancer on history, physical, or chest radiograph; (2) tobacco, alcohol ingestion (>2 drinks/ day), or cancer treatment within 3 months; (3) use of folate antagonists; and (4) age <60 years. RESULTS 36 subjects were evaluated. The median disease-free censored survival was 24 months (range 4-41). Nineteen of 36 patients (53%) reported vitamin supplementation. Vitamin users had a longer median censored survival compared with nonusers (41 months versus 11 months; P = 0.002). With adjustment for cancer stage, the association between RBC folate and censored survival (r = 0.35; P = 0.055) and between serum folate and censored survival (r = 0.32; P = 0.083) approached statistical significance. CONCLUSIONS NSCLC patients who took vitamin supplements were more likely to be long-term survivors in the patients studied; a similar trend toward long-term survival was seen among patients with higher circulating folate concentrations.
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Affiliation(s)
- A Jatoi
- Department of Medicine, Tufts University and New England Medical Center, Boston, Massachusetts 02111, USA.
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12
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Affiliation(s)
- T L Krebs
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, USA
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Abstract
Comprising 1.6% of primary bone malignancies, parosteal osteosarcomas are rare. Rib parosteal osteosarcomas are even rarer, with only 2 cases in the literature. We report a third such case, with a 32-month disease-free survival. Issues relevant to the management of rib parosteal osteosarcomas are discussed.
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Affiliation(s)
- A Jatoi
- The Lung Tumor Evaluation Center, New England Medical Center, Tufts University, Boston, Massachusetts, USA
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Johnson LB, Krebs TL, Van Echo D, Plotkin JS, Njoku M, Wong JJ, Daly BD, Kuo PC. Cytoablative therapy with combined resection and cryosurgery for limited bilobar hepatic colorectal metastases. Am J Surg 1997; 174:610-3. [PMID: 9409583 DOI: 10.1016/s0002-9610(97)00176-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size and the number of metastases are limited. However, local recurrence can result from incomplete ablation. We proposed a trial of complete cytoablation with a combined approach of cryosurgery and hepatic resection for patients with bilobar hepatic metastases. METHODS Seven patients underwent cryosurgery alone (CRYO). Seven additional patients underwent combined resection and cryosurgery (CRYO+RES) for bilobar metastases. RESULTS In the CRYO group, 5 of 7 patients had at least one centrally located tumor. All 5 of these patients had early recurrence at the site of ablation. In the CRYO+RES group complete ablation was achieved in 7 of 7. Two (28.6%) of these patients developed local recurrence. CONCLUSION Cytoablation of hepatic metastases can be safely achieved with combined hepatic resection and cryosurgery in selected patients. Long-term survival data are necessary before advocating widespread application of this approach.
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Affiliation(s)
- L B Johnson
- Department of Surgery, University of Maryland School of Medicine, Baltimore 21201, USA
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Abstract
INTRODUCTION Failed renal allografts often are left in situ in patients who revert to chronic dialysis therapy or who undergo retransplantation. These patients may be investigated with computed tomography (CT) imaging for allograft-related or other abdominopelvic disease. This study describes the appearances of failed renal transplants on CT. METHODS A retrospective study was made of the clinical records and CT findings on 25 studies in 14 patients, 5-156 months (average, 44 months) following allograft failure. CT studies were reviewed for allograft position, size, shape, attenuation value, calcification, cyst formation, related abdominopelvic findings and the presence of other allografts. Correlation was made with clinical findings in all patients and with pathological findings in six. RESULTS Global shrinkage was noted in eight failed allografts, all of which were asymptomatic. Enlargement of two failed allografts was due to symptomatic acute infarction of the allograft in one patient and subacute haemorrhagic infarction simulating a tumour mass in another. CT attenuation values in individual allografts varied markedly due to fatty replacement, hydronephrosis, haemorrhage or dense calcification. Both a failed longstanding and a functioning more recently placed renal allograft were present in seven patients, four of whom had acute complications related to the more recently transplanted kidney. Two of six calcified allografts were mistaken for opacified bowel on CT. CONCLUSION A wide spectrum in size, shape and attenuation values may be detected in failed renal allografts by CT. These organs may be the site of acute disease despite their lack of physiological function or may be diagnostically confusing findings in patients with acute disease related to more recently transplanted organs.
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Affiliation(s)
- B D Daly
- Department of Radiology, University of Maryland School of Medicine, Baltimore 21201-1595, USA
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Bankoff MS, McEniff NJ, Bhadelia RA, Garcia-Moliner M, Daly BD. Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT. AJR Am J Roentgenol 1996; 167:629-30. [PMID: 8751667 DOI: 10.2214/ajr.167.3.8751667] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to assess the prevalence of pathologically proven intrapulmonary lymph nodes and to evaluate their appearance on CT. MATERIALS AND METHODS Over a 15-year period (1980-1994), 184 patients underwent minithoracotomies for evaluation of CT-detected peripheral pulmonary abnormalities. Of these 184 patients, 96 had well-circumscribed peripheral pulmonary nodules. The size, position, and radiographic features of all pathologically proven intrapulmonary lymph nodes were independently assessed by two experienced radiologists. RESULTS The nodules in 17 (18%) of the 96 patients with well-circumscribed peripheral pulmonary nodules were pathologically proven to be intrapulmonary lymph nodes. Two of the 17 patients had two nodules; the remaining patients had solitary nodules. The maximum diameter of the nodules varied from 7 to 12 mm. All the nodes were located within 20 mm of a visceral pleural surface. Twelve of the nodules were located in the lower lobes, and the remaining nodules were located in the right middle lobe. CONCLUSION Although intrapulmonary lymph nodes are not a well-known entity, our results indicate that they are discovered in a significant number of patients who undergo minithoracotomies for the evaluation of CT-detected pulmonary nodules. Although these lymph nodes do not possess any specific CT appearance, they should be considered in the differential diagnosis of single (or multiple) parenchymal nodules, particularly those found in the lower lobes.
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Affiliation(s)
- M S Bankoff
- Department of Radiology, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
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Abstract
OBJECTIVE We describe the CT appearance of pulmonary zygomycosis (mucormycosis), an opportunistic infection typically occurring in immunocompromised patients. MATERIALS AND METHODS Eight patients with pulmonary zygomycosis imaged with CT were reviewed, seven at initial diagnosis and one with a subsequent complication. The appearance, number, and location of pulmonary lesions and the presence of pleural effusions and extrapulmonary involvement were assessed. Rim enhancement, air bronchograms, the halo sign, air crescent sign, cavitation, and central low attenuation suggesting necrosis were recorded. RESULTS There were 14 nodules and 5 areas of mass-like or wedge-shaped consolidation. Pleural effusion was present in five patients, halo sign in three, central low attenuation in two, and cavitation in one. In the affected lobe 13 of 14 nodules and all consolidations were posterior. Of 19 lesions 16 (84%) were confined to the upper lobes, with 3 in the superior segment of a lower lobe. Endobronchial disease with lobar collapse was the only manifestation in one patient. Major complications were direct spinal invasion in one patient and multiple pulmonary artery pseudoaneurysms in another patient. CONCLUSION In the appropriate clinical circumstance, nodules or mass-like or wedge-shaped consolidation, especially posteriorly in the upper lobes of the lung, should suggest zygomycosis. Endobronchial zygomycosis is less common.
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Affiliation(s)
- D A Jamadar
- Department of Radiology, University of Michigan Hospital, Ann Arbor 48109-0326, USA
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18
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Abstract
The imaging findings in a group of 33 patients who developed thoracic metastases following prior therapy for nasopharyngeal carcinoma (NPC) were reviewed. Four (12.1%) patients had scintigraphic or radiographic evidence of hypertrophic pulmonary osteoarthropathy (HPOA) on presentation. In one case this developed prior to radiographic or CT evidence of pulmonary metastatic disease. Evidence of hilar or mediastinal metastatic involvement was seen in three of four patient, and a pulmonary metastasis alone in one. Similarity in appearance of the hilar or mediastinal deposits to primary bronchial carcinoma and the presence of HPOA necessitated biopsy confirmation of NPC metastasis in all four cases. The scintigraphic and CT appearances of this unusual radiological association are discussed.
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Affiliation(s)
- B D Daly
- Department of Radiology and Organ Imaging, Chinese University, Hong Kong
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Abstract
The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection. The groups were similar in reference to history of pulmonary disease, preoperative pulmonary function, and pulmonary risk index score. The no-exercise patients were more likely to have a history of cardiac disease (64 vs 28%; p < 0.01) and had a higher CRI score (2.0 +/- 0.2 vs 1.4 +/- 0.1; p < 0.05). Cardiopulmonary postoperative complications (POCs) and mortality were more likely among those in the no-exercise group vs those in the exercise group (POCs, 79 vs 35%, p < 0.01; mortality, 21 vs 2%, p < 0.05). Among the eight no-exercise patients with a CPRI of 4 or more, all eight suffered a POC (100%) and three died (38%). Using multiple logistic regression analysis, both the CPRI score and the inability to exercise were independently associated with increased risk for POCs. We conclude that patients unable to perform even minimal preoperative exercise are at substantially increased risk for morbidity and mortality after lung resection. This results both from greater identifiable preoperative cardiopulmonary risk factors (as assessed by the CPRI) and from an independent effect related to the inability to exercise.
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Affiliation(s)
- S K Epstein
- Department of Medicine, Boston Veterans Affairs Medical Center, MA
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20
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Chow CC, Daly BD, Burney TL, Krebs TL, Grumbach K, Filderman PS, Jacobs SC. Complications after laparoscopic pelvic lymphadenectomy: CT diagnosis. AJR Am J Roentgenol 1994; 163:353-6. [PMID: 8037029 DOI: 10.2214/ajr.163.2.8037029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Laparoscopic dissection of pelvic lymph nodes has become an accepted alternative to open lymphadenectomy for staging of genitourinary tumors. This study reviews the CT findings in patients with major complications detected after laparoscopic dissection. MATERIALS AND METHODS Of 85 patients who had laparoscopic dissection of pelvic lymph nodes at our institutions during a 3-year period, complications developed in 12 patients (14%), and eight of these had abdominopelvic CT studies done. CT findings and initial interpretations were correlated with follow-up surgical, clinical, or interventional radiologic findings in all cases. RESULTS Complications of laparoscopic dissection detected with CT included small-bowel obstruction due to herniation through the trocar site in the abdominal wall (n = 2), extensive hematoma of the abdominal wall or retroperitoneum (n = 2), urinary ascites or multiple urinomas due to ureteral laceration or transection (n = 2), and lymphocele compressing the bladder where the peritoneum was sealed after lymphadenectomy (n = 1). In one case, CT showed pneumoperitoneum but failed to show a perforation of the sigmoid colon. CONCLUSION Major complications occurred after laparoscopic dissection of pelvic lymph nodes and were diagnosed on the basis of CT findings in seven of eight patients. Recognition of the CT appearances of hernia or hematoma at the insertion sites of the trocars or the laparoscope is important, as is detection of injury to bladder, ureter, bowel, or blood vessels. Symptomatic lymphoceles were infrequently detected, probably because of the use of free drainage into the peritoneal cavity after laparoscopic dissection.
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Affiliation(s)
- C C Chow
- Department of Radiology, University of Maryland School of Medicine, Baltimore 21201
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21
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Brunsting LA, Lupinetti FM, Cascade PN, Becker FS, Daly BD, Martinez FJ, Lynch JP, Whyte RI, Bove EL, Bolling SF. Pulmonary function in single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1994; 107:1337-44; discussion 1344-5. [PMID: 8176978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The primary determinants of pulmonary function after heart-lung or double lung transplantation are the volume and compliance of the recipient's thoracic cage. This study evaluated the influence of recipient chest wall factors on static and dynamic lung volumes after single lung transplantation for chronic obstructive pulmonary disease. Fourteen patients with chronic obstructive pulmonary disease received 15 single lung transplants (one retransplant). Posttransplantation follow-up data at 3 and 6 months, in the absence of infection or rejection, were available in nine patients. Overall pulmonary function at 6 months improved from preoperative levels to 55% to 65% of predicted values (forced vital capacity 38% to 55%, forced expiratory volume at 1 second 18% to 55%, maximum voluntary ventilation 21% to 65%), and allograft-specific pulmonary function improved to nearly normal predicted single-lung values (forced vital capacity 89%, forced expiratory volume at 1 second 90%, maximum voluntary ventilation 105%). Postoperative pulmonary function in these patients correlated significantly with preoperative thoracic volume measured by planimetry of chest radiographs. No correlation between postoperative pulmonary function was demonstrated with either the estimated volume of donated lung tissue or relative donor-to-recipient size matching. These findings support the concept that recipient chest wall factors determine postoperative pulmonary function in patients undergoing single lung transplantation for chronic obstructive pulmonary disease. Furthermore, the allograft lung functions at a normal level for the recipient and does not appear to be constrained by hyperinflation of the contralateral lung.
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Affiliation(s)
- L A Brunsting
- Department of Surgery, University of Michigan Medical Center, Ann Arbor
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22
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Daly BD, Cascade PN, Hummel JD, Kalbfleisch S, Strickberger SA, Langberg J, Morady F. Transvenous and subcutaneous implantable cardioverter defibrillators: radiographic assessment. Radiology 1994; 191:273-8. [PMID: 8134587 DOI: 10.1148/radiology.191.1.8134587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess chest radiograph configurations in 102 patients following total or partial transvenous and subcutaneous insertion of a non-thoracotomy lead implantable cardioverter defibrillator (NTL-ICD) device. MATERIALS AND METHODS The four overlapping system types reviewed were the Endotak (49 patients), PCD (32 patients), Res-Q (10 patients), and hybrid combinations of NTL-ICD and surgically inserted pericardial and epicardial automatic implantable cardioverter defibrillator (AICD) devices (15 patients). RESULTS Abnormalities were detected on radiographs both at the time of implantation and at early follow-up. NTL-ICD electrodes partially replaced or augmented AICD systems in 11 patients (10.7%) because of sensing lead or defibrillation failure or infection. Defibrillation failure necessitated augmentation of NTL-ICD systems with AICD pericardial patches in four patients (3.9%). Catheter displacement, lead fracture, or pneumothorax was detected in eight patients (7.8%). CONCLUSION Complex radiographic appearances may be seen and important abnormalities may be detected after insertion of these devices.
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Affiliation(s)
- B D Daly
- Department of Radiology, University of Michigan Hospitals, Ann Arbor
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23
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Daly BD, Martinez FJ, Brunsting LA, Deeb GM, Cascade PN, Lynch JP. High-resolution CT detection of lacerations in the transplanted lung after transbronchial biopsy. J Thorac Imaging 1994; 9:160-5. [PMID: 8083931 DOI: 10.1097/00005382-199422000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Relatively large tissue samples may be obtained from the lung with the "Alligator" biopsy forceps. We report the radiographic and high-resolution computed tomography (HRCT) appearances of six pulmonary lacerations in the transplanted lungs of three asymptomatic patients after transbronchial biopsy with this large caliber biopsy forceps. All patients had undergone transbronchial biopsy from 4 to 10 days before HRCT that was performed as part of routine surveillance after transplantation. The site and histopathologic findings of lung biopsies and negative microbiologic studies on bronchoalveolar washings correlated accurately with each pulmonary lesion seen. Laceration size varied from 9 to 20 mm (mean 14 mm) on HRCT. A thickened wall or surrounding alveolar reaction related to bronchoalveolar lavage or biopsy-induced hemorrhage was seen in five lesions. These simulated the appearance of lung abscess or invasive fungal disease. Only nonspecific alveolar opacities were noted on chest radiographs. The Alligator biopsy forceps may cause pulmonary lacerations in transplanted lungs that are detectable on HRCT but not on chest radiographs. Differentiation from opportunistic infection by CT criteria alone is difficult in these immunocompromised patients. CT studies in this population should be performed prior to transbronchial biopsy whenever possible.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology, University of Michigan Hospitals, Ann Arbor
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24
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Daly BD, Chow CC, Cockram CS. Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features. Postgrad Med J 1994; 70:10-6. [PMID: 8140010 PMCID: PMC2397563 DOI: 10.1136/pgmj.70.819.10] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation. Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T
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25
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Esakof DD, Schneider AT, Pandian NG, Schwartz SL, Khurana J, Bojar RM, Daly BD. Delineation of pulmonary artery sarcoma with multiplane and panoramic transesophageal echocardiography. J Am Soc Echocardiogr 1993; 6:619-23. [PMID: 8311970 DOI: 10.1016/s0894-7317(14)80181-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 38-year-old woman came for treatment with massive hemoptysis. A hilar density was observed on a chest radiograph. Transthoracic echocardiography demonstrated an intravascular pulmonary arterial mass that was studied in further detail with multiplane and panoramic transesophageal echocardiography. Surgical resection proved the mass to be a sarcoma arising from the main pulmonary artery. This case report demonstrates the utility of multiplane and panoramic transesophageal echocardiography in the study of intravascular tumors of the thorax.
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Affiliation(s)
- D D Esakof
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts-New England Medical Center, Boston, MA 02111
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26
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Daly BD, Hummel JD, Langberg J, Strickberger SA, Kalbfleisch S, Morady F, Cascade PN. Nonthoracotomy lead implantable cardioverter defibrillators: normal radiographic appearance. AJR Am J Roentgenol 1993; 161:749-52. [PMID: 8372750 DOI: 10.2214/ajr.161.4.8372750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recently, cardioverter defibrillators with leads and patches that can be implanted via a combination of transvenous and subcutaneous routes rather than via thoracotomy have been developed. Early experience in patients subject to serious ventricular arrhythmias suggests that, as with surgically implanted defibrillators, these nonthoracotomy defibrillators can reduce the risk of sudden death due to cardiac arrest [1]. Moreover, high perioperative complication rates associated with thoracotomy-inserted cardioverter defibrillators are avoided [2]. Four models are currently undergoing clinical trials in the United States. We have used three of these models: PCD (Medtronic, Minneapolis, MN), ENDOTAK (Cardiac Pacemakers Inc., St. Paul, MN), and RES-Q (Intermedics, Freeport, TX). This essay illustrates the normal radiographic appearance of these devices.
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Affiliation(s)
- B D Daly
- Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109
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27
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Epstein SK, Faling LJ, Daly BD, Celli BR. Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index. Chest 1993; 104:694-700. [PMID: 8365278 DOI: 10.1378/chest.104.3.694] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] < 70 percent, and PaCO2 > 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p < 0.0001). We found that patients with a peak VO2 less than 500 ml/m2/min (body surface area) were 6 times more likely to experience a cardiopulmonary complication (p < 0.05). With multiple logistic regression analysis, peak VO2 was not an independent predictor of postoperative complications. Analysis also demonstrated that a CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.
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Affiliation(s)
- S K Epstein
- Department of Medicine, Boston VA Medical Center
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28
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Yang WT, Daly BD, Li EK, Hutchinson R. Cranial computed tomography in the assessment of neurological complications in critically ill patients with systemic lupus erythematosus. Anaesth Intensive Care 1993; 21:400-4. [PMID: 8214543 DOI: 10.1177/0310057x9302100404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease. Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23%), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.
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Affiliation(s)
- W T Yang
- Department of Radiology and Medicine, Prince of Wales Hospital, Hong Kong
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29
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Abstract
The computed tomographic and scintigraphic appearances of dermatofibrosarcoma protuberans involving the mental region are presented. The tumour was demonstrated as a moderately well-defined vascular mass extending from the skin to invade the subcutaneous tissue and strap muscles. Only one case of the imaging features of this rare tumour has been reported previously.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong
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30
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Abstract
A review of the ultrasound (US) findings with clinical and pathological correlation in 18 Chinese patients with gall-bladder carcinoma (GBCa) showed that the most frequent appearance was that of diffuse infiltration and thickening of the GB wall (8/18 patients, 44%). Polypoid protrusion into the GB lumen (5/18 patients, 28%) and massive replacement of the entire GB (5/18 patients, 28%) accounted for the remainder. The infiltrating type of tumour was poorly-detected by US (1/8) and was more frequently seen than has been reported in the Western population. Frequent associations with GB calculi (13/18) and synchronous presentation of biliary sepsis (6/18) also contributed to a modest overall US detection rate of 50% (9/18) in this series. Most tumours detected by US were hyperechoic in appearance (6/9). Biliary obstruction was detected by US in 5/6 patients, but only thought to be malignant in 3/6. It most often occurred due to spread of tumour to peripancreatic lymph nodes. Hepatic metastases were seen by US in 4/5 patients. Discontinuous GB wall calcification and non-dependent stones due to elevation by tumour (the 'elevated stone' sign) were infrequent but reliable signs of GBCa, seen in 5/18 and 3/18 respectively. This study suggests that GBCa is as difficult to detect sonographically in Chinese patients as in the Western population. GBCa must be included in the differential diagnosis of causes of both the acutely-presenting 'hot' gall-bladder and lymph node masses in the peripancreatic region if the US detection rate of this important biliary malignancy is to be improved.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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31
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Daly BD, Mueller JD, Faling LJ, Diehl JT, Bankoff MS, Karp DD, Rand WM. N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest. J Thorac Cardiovasc Surg 1993; 105:904-10; discussion 910-1. [PMID: 8487569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan-Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.
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Affiliation(s)
- B D Daly
- Department of Cardiothoracic Surgery, Tufts University School of Medicine, Boston, Mass
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Daly BD, Leung SF, Cheung H, Metreweli C. Thoracic metastases from carcinoma of the nasopharynx: high frequency of hilar and mediastinal lymphadenopathy. AJR Am J Roentgenol 1993; 160:241-4. [PMID: 8424324 DOI: 10.2214/ajr.160.2.8424324] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Nasopharyngeal carcinoma is a malignant tumor commonly encountered in Chinese patients living in or originating from Hong Kong or southern China. This article describes the previously unreported radiologic appearances of thoracic metastases from nasopharyngeal carcinoma. MATERIALS AND METHODS The radiographic (33 patients) and CT (eight patients) appearances of thoracic metastases from nasopharyngeal carcinoma were studied retrospectively. All 33 patients had biopsy-proved primary nasopharyngeal carcinoma, and seven patients had biopsy-proved thoracic metastases. Radiologic and clinical evidence of metastases was unequivocal in 26 others, 16 of whom had synchronous spread to cervical lymph nodes, bone, or liver. RESULTS Twenty-one patients (64%) had evidence of thoracic lymphadenopathy, most frequently hilar (n = 18, 55%), on chest radiographs or CT scans. Seventeen patients (52%) had evidence of multiple parenchymal pulmonary metastases. Enlargement of lymph nodes without multiple pulmonary deposits was seen in 12 patients (36%), seven of whom had radiologic signs of bronchial obstruction, hemoptysis, or a single pulmonary lesion simulating a synchronous bronchial neoplasm. Pleural effusions or deposits (n = 6), lymphangitis carcinomatosa (n = 5), and rib metastases (n = 4) also were seen. CONCLUSION Metastases from nasopharyngeal carcinoma may be detected in a wide range of thoracic sites. This disease appears to be as likely to disseminate to the mediastinal or hilar lymph nodes as to the pulmonary parenchyma, and it can simulate a primary bronchial tumor or lymphoma.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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33
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Daly BD, McPhillips M, Leung AW, Evans RM, Metreweli C. Ultrasound, computed tomography and magnetic resonance in the investigation of iliopsoas compartment disease. Australas Radiol 1992; 36:294-9. [PMID: 1299185 DOI: 10.1111/j.1440-1673.1992.tb03202.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors reviewed the results of imaging studies performed in 30 patients with diseases involving the iliopsoas compartment (IPC) to assess the role of Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) in the investigation of these deep seated and often clinically undetectable lesions. 16 (53%) patients had histologically proven benign or malignant IPC tumours with bacterial infection in 12 (40%) and haemorrhage into the IPC in 2 (7%). US correctly detected iliopsoas pathology in only 9 of 17 cases (53%) and was satisfactory only in limited situations, such as abscess formation in children and haemorrhage in haemophiliacs. CT was much more accurate (16/17, 94%) than US and correctly diagnosed 7 cases overlooked on US, while also offering greater information in 5 cases where both studies were abnormal. CT was particularly helpful for the detection of both abscess formation and calcification within mass lesion. MR was accurate in all 9 cases imaged, and was very helpful in the assessment of associated vertebral, disc or spinal canal involvement by tumour or infection. A review of the literature, and the results of this study, suggest that CT and MR often have complementary roles where IPC disease is known or suspected. The accuracy of US in IPC disease is limited, preferably being followed by CT or MR imaging.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Chinese University, Prince of Wales Hospital, Hong Kong
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Abstract
The imaging investigations in six patients with alveolar soft part sarcoma (ASPS) are reviewed. Five patients presented with a pelvic or lower limb mass and one with haemoptysis from pulmonary metastases. Magnetic resonance imaging (MRI), CT, Doppler US and angiography studies demonstrated the highly vascular nature of this rare tumour and the frequent occurrence of pulmonary and intracranial metastases. Previously unreported Doppler US and MR evidence of multiple enlarged vessels and high blood flow within primary and secondary ASPS tumours is emphasized. Imaging is of considerable importance both for pre-operative localization and long term surveillance of this slow growing but invariably disseminating tumour.
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Affiliation(s)
- B D Daly
- Department of Diagnostic Radiology and Organ Imaging, Chinese University, Prince of Wales Hospital, Hong Kong
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35
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Ciccolella DE, Daly BD, Celli BR. Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis. Am Rev Respir Dis 1992; 146:797-9. [PMID: 1519867 DOI: 10.1164/ajrccm/146.3.797] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We studied pulmonary function tests, maximal voluntary ventilation, arterial blood gases, and respiratory muscle strength and recruitment pattern in a 37-yr-old symptomatic man before and after surgical plication for a left unilateral diaphragmatic paralysis. After plication, FVC, FEV1, TLC and FRC increased, whereas residual volume remained unchanged. Arterial PO2 improved from 70 to 87 mm Hg. Diaphragmatic strength, as expressed by the maximal transdiaphragmatic pressure increased from 30 to 75 cm H2O, and maximal voluntary ventilation increased from 74 to 123 L/min. Ventilatory muscle recruitment also changed: there was a shift from a positive to a negative delta Pg/delta Ppl slope during tidal breathing. This indicates more effective diaphragmatic recruitment after the procedure. We conclude that surgical plication may be of benefit to patients with symptomatic unilateral diaphragmatic paralysis. The improvement is due to improved respiratory muscle function.
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Affiliation(s)
- D E Ciccolella
- Pulmonary Section, Department of Veterans Affairs Medical Center, Boston, MA 02130
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36
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Abstract
We present our experience with 5 patients, all of whom were noted to have radiological signs of pneumoperitoneum in the absence of clinical features of peritonitis. All 5 cases were eventually shown to be due to causes not requiring surgery. We review the numerous unusual causes of pneumoperitoneum which do not require urgent surgical intervention and emphasize their importance in cases where the absence of signs of peritonitis may cause diagnostic difficulty.
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Affiliation(s)
- B D Daly
- Department of Radiology, St James's University Hospital, Leeds, UK
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Davidson MJ, Daly BD, Russell JL. The use of computed tomography in the management of facial trauma by British oral and maxillofacial surgeons. Br J Oral Maxillofac Surg 1991; 29:80-1. [PMID: 2049360 DOI: 10.1016/0266-4356(91)90085-j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A survey of 184 British oral and maxillofacial surgeons on their use of computed tomography (CT) in the management of craniofacial trauma showed that the majority of the 116 surgeons who replied used this form of imaging for frontal, nasoethmoidal, and orbital fractures. Only 6% of respondents reported no advantage in CT imaging over plain radiography. The access to CT scanners and the value of the reports in the management of patients was rated as satisfactory by 75% of respondents, and a similar percentage reported that CT service was becoming increasingly available to their units.
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Affiliation(s)
- M J Davidson
- Department of Oral Surgery, Dental School, Leeds
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39
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Christian AS, Daly BD, Guthrie KA. Management training for senior registrars. Health Serv Manage 1991; 87:87-8. [PMID: 10110424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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40
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Abstract
Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients. Twenty-six patients had single nodules and 32 patients had multiple nodules. The preoperative diagnosis was inaccurate in 67% of the patients. In 61% of the patients in whom malignancy was suspected, no tumor was demonstrated. Conversely, of the 20 patients in whom a malignant nodule was excised, the preoperative diagnosis was correct in only 50%. Thirty-one patients required no further treatment apart from their biopsy and 27 required additional intervention. Small peripheral pulmonary nodules require biopsy for diagnosis. When percutaneous needle aspiration biopsy is unsuccessful, or technically difficult, a computed tomography-guided thoracotomy is an effective and minimally invasive surgical alternative.
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Affiliation(s)
- B D Daly
- Department of Surgery, New England Medical Center, Boston, MA
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41
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Kaplan E, Diehl JT, Peterson MB, Somerville KH, Daly BD, Connolly RJ, Cooper AG, Seiler SD, Cleveland RJ. Extended ex vivo preservation of the heart and lungs. Effects of acellular oxygen-carrying perfusates and indomethacin on the autoperfused working heart-lung preparation. J Thorac Cardiovasc Surg 1990; 100:687-97; discussion 697-8. [PMID: 2232831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The autoperfused working heart-lung preparation has been proposed as a method for long-term heart-lung preservation. We investigated the effects of acellular oxygen-carrying perfusates (study 1) and the effect of donor pretreatment with indomethacin (study 2) on the working ex vivo heart-lung block. In study 1 perfusion with stroma-fee hemoglobin resulted in significantly reduced survival (118 +/- 46 minutes) compared with autologous blood (561 +/- 125 minutes, p less than 0.05) or perfluorocarbon (438 +/- 114 minutes, p less than 0.05). Decrease in survival with stroma-free hemoglobin perfusate is associated with a marked decrease in left ventricular performance and a significant increase in pulmonary vascular resistance. Perfusion with autologous blood is associated with a significant increase in pulmonary vascular resistance after 240 minutes of explantation, which is significantly delayed by perfusion with perfluorocarbon. Perfusion for 6 hours with blood pretreated with indomethacin (study 2) resulted in a decrease in the concentration of prostacyclin and thromboxane A2 metabolites but an increase in the prostaglandin/thromboxane A2 metabolite ratio. This is associated with abrogation of the increase in pulmonary vascular resistance (12,787 +/- 1682 dynes/sec/cm-5, T = 0; 13,134 +/- 2654 dynes/sec/cm-5, T = 360 minutes) observed in preparations perfused with autologous blood (13,194 +/- 1942 dynes/sec/cm-5, T = 0; 24,768 +/- 3325 dynes/sec/cm-5, T = 360 minutes, p less than 0.05). We conclude that alteration of the cellular and humoral components of autologous blood may prove advantageous for increasing the utility of the autoperfused working heart-lung preparation as a preservation technique.
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Affiliation(s)
- E Kaplan
- Department of Surgery, Tufts University School of Medicine, Boston, Mass
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42
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Abstract
A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.
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Affiliation(s)
- J L Russell
- Department of Oral Surgery, Dental Hospital, Leeds
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43
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Abstract
We reviewed the computed tomography (CT) appearances, plain film radiographs and clinical findings of 17 patients who suffered fractures of the naso-ethmoidal complex. Six patients (35%) with diplopia were noted on CT to have lateral displacement of medial orbital wall fragments into the orbit (medial wall 'blow-in' fractures) leading to displacement of the globe or extra-ocular muscles. Medial displacement of ethmoid bone fragments (medial wall 'blow-out' fractures) with medial rectus entrapment was noted in a further two cases (11%) also. Multiple associated facial fractures were seen in all but one case with CT evidence of frontal bone fracture and intracranial injury in 12 (70%) patients. CT was judged to add valuable information to clinical findings and plain film radiography and was especially helpful where marked soft tissue swelling precluded detailed physical examination of the naso-orbital region. The CT features of naso-ethmoidal trauma are illustrated and discussed and the advantages of CT in the pre-operative evaluation of such injuries are emphasised.
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Affiliation(s)
- B D Daly
- Department of Radiology, General Infirmary, Leeds
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44
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Affiliation(s)
- B D Daly
- Department of Radiology, Mater Hospital, Dublin, Eire
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45
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Affiliation(s)
- B D Daly
- Department of Radiology, Meath Hospital, Dublin, Eire
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46
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Jaworek AM, Connolly RJ, Kaplan E, Barry KJ, Daly BD. A rabbit model for evaluation of an extracorporeal LDL removal system. ASAIO Trans 1989; 35:351-3. [PMID: 2597480 DOI: 10.1097/00002480-198907000-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Elevated levels of plasma low density lipoprotein cholesterol (LDL) are associated with an increased incidence of atherosclerosis and its sequelae. A decrease in LDL levels correlates with a reduction in atherosclerosis. Drug therapy and diet have been moderately successful in lowering cholesterol levels, but require significant periods of treatment. Furthermore, a patient with genetically high LDL levels, as in familial hypercholesterolemia, may need a more rapid and reliable method of decreasing serum LDL. The present study was designed to test a device which can rapidly remove LDL from the circulation. The device consists of a filter cartridge filled with semipermeable hollow fibers which have a proprietary acidic polymer (pap) immobilized on the blood/plasma contacting surfaces; this polymer has been reported to selectively bind LDL cholesterol. The device was evaluated in a hypercholesterolemic rabbit model. Reductions in LDL serum concentration, ranging from 1.4-25.3%, occurred in 6/6 studies. All animals survived the procedure. Autopsy results at 10 days showed normal histology. Binding of other proteins (HDL, albumin) were minimal and no hemolysis was observed. Results of this preliminary study demonstrate the feasibility of reducing serum LDL levels with a hollow fiber device.
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Affiliation(s)
- A M Jaworek
- Department of Surgery, New England Medical Center, Boston, Massachusetts
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47
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Hatton PD, Diehl JT, Daly BD, Rheinlander HF, Johnson H, Schrader JB, Bloom M, Cleveland RJ. Transsternal radical thymectomy for myasthenia gravis: a 15-year review. Ann Thorac Surg 1989; 47:838-40. [PMID: 2757437 DOI: 10.1016/0003-4975(89)90015-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thymectomy is an accepted therapeutic modality for patients with myasthenia gravis. The selection of patients for operation and the surgical approach are controversial. We reviewed 52 patients (aged 18 months to 82 years; mean age, 34 years) treated with transsternal radical thymectomy between 1972 and 1987. Patients were symptomatically staged according to the modified Osserman classification. There was one hospital death and postoperative follow-up was obtained on 51 patients. Improvement after thymectomy was observed in 3 of 11 patients (27%) in Osserman stage I, 16 of 25 patients (64%) in Osserman stage IIA, and 13 of 15 patients (86%) in combined Osserman stages IIB, III, and IV. Preoperative Osserman stage, patient sex, and thymic histology correlated with postoperative clinical response. Transsternal radical thymectomy is effective therapy for myasthenia gravis. Sustained improvement is obtained in patients with moderate and advanced disease. The majority of patients with ocular disease do not benefit from operation.
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Affiliation(s)
- P D Hatton
- Department of Cardiothoracic Surgery, New England Medical Center Hospitals, Boston, MA 02127
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48
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Abstract
Ten cases of angiofibroma treated by irradiation are reported. Relief of symptoms occurred by the end of treatment in eight patients. Objective regression was much slower, six having visible disease for greater than 6 months and four for at least 1 year. Only one was symptomatic. Radiological resolution lagged behind clinical improvement and was complete in only one of three asymptomatic patients evaluated by computed tomography (CT) at between 2 and 3 years after treatment. The significance of these residual masses seen on CT is unclear.
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Affiliation(s)
- A C Robinson
- University Department of Radiotherapy, Cookridge Hospital, Leeds
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49
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Abstract
The radiographic appearances of colonic staple ring anastomoses are presented. Staple ring disruption on plain abdominal radiographs in the early post-operative period suggests dehiscence of the bowel anastomosis and is an indication for urgent water-soluble contrast medium enema to confirm the diagnosis. Rectal stenosis can develop as a late complication of staple anastomosis and may be detected on barium enema.
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Affiliation(s)
- B D Daly
- Department of Radiology, St James's University Hospital, Leeds
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50
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Daly BD, Towers MJ, Hamilton S. Medial talo-calcaneal coalition. Case report. Eur J Radiol 1988; 8:253-4. [PMID: 3234404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Medial talo-calcaneal coalition is an uncommon developmental anomaly consisting of a bony projection arising from the postero-medial aspect of the sustentaculum tali, which may articulate with another bony projection from the medial aspect of the talus. Fibrous, cartilaginous or bony ankylosis may occur. It usually presents in adolescents, and causes pain following exercise. It may cause a lump, and can predispose to flat foot and early osteoarthrosis. This condition is easily overlooked on routine views of the ankle, and may require oblique views and tomography for its detection and clarification.
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Affiliation(s)
- B D Daly
- Dept. of Radiology, Meath Hospital, Dublin, Ireland
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