Current management of colorectal metastases to lung.

Colorectal carcinoma is the second most common visceral cancer in the United States, in both incidence and fatality rate. Of patients with colorectal carcinoma, 45% undergo resection and are cured. In cases of recurrence, 2% are restricted to lung only.

Evolution of the surgical management of pulmonary metastases.

Surgical treatment of pulmonary metastases dates back to the late 19th century. However, for the ensuing 50 years, the number of cases operated upon were few. Since the 1960s, the eligibility of patients for resection of pulmonary metastases has broadened.

Undernutrition in the elderly population living at home in the community: a review of the literature.

Undernourishment in elderly people has been found to have a variety of detrimental effects ranging from the development of pressure sores to the incidence of fractured femurs. Surveys within hospital settings have revealed that elderly patients are often admitted from their homes in a state of malnutrition, which would indicate nutritional deficits in at least some of the population. Reliable nutritional assessment in the community, however, is difficult and time consuming, with findings subject to distortions from other influences.

Audit of an anticoagulant clinic: doctor and patient knowledge.

Oral anti-coagulation with warfarin is increasingly required in the prophylaxis and treatment of vascular thrombosis and embolism. Unless the degree of anti-coagulation is maintained in the narrow therapeutic range either serious bleeding or failure to prevent thromboembolism may occur. Complications may occur in up to 31% of patients.

Magnetic resonance imaging of the postpneumonectomy chest: normal and abnormal findings.

To determine the normal findings at magnetic resonance imaging (MRI) of the postpneumonectomy space (PPS), and to evaluate the utility of MRI in detection of recurrent tumor in the postpneumonectomy chest, 32 MRI scans were performed in 31 patients at varying time intervals after pneumonectomy. Eleven patients also had 12 computed tomography (CT) scans performed at the same time to evaluate possible tumor recurrence. Of the 32 scans, 5 demonstrated complete obliteration of the fluid containing PPS, and 4 showed gas in the PPS; the remainder (n = 23) demonstrated persistence of fluid-filled spaces of varying size.

The impact of hospitalisation on prescribing costs for medical patients returning to the community.

As prescribed drugs represent an increasing expense in the health service, and prescribers assume more responsibility for costs, practitioners both in hospitals and the community are trying to define and limit this cost. We calculated drug costs in 107 consecutive medical admissions through the Accident and Emergency Department of admission and on discharge from hospital. The estimated (mean +/- SD) patient daily cost of drugs rose on admission from Pounds 0.

Knowledge and attitudes to prescribed drugs in young and elderly patients.

Increasing patient knowledge of drug therapy is said to improve compliance and may reduce adverse drug reactions. We assessed patient knowledge of prescribed drugs in fifty patients attending a hypertension clinic [outpatients] and in elderly patients on admission to (n = 129) and on discharge from (n = 100) an acute geriatric assessment unit. We found that 88% of outpatients, 40% of elderly admissions, and 41% of elderly discharges knew the indications for their therapy; only 40% of outpatients, 8% of elderly admissions and 12% of elderly discharges could name their medications.

Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases.

Objectives: The International Registry of Lung Metastases was established in 1991 to assess the long-term results of pulmonary metastasectomy.

Methods: The Registry has accrued 5206 cases of lung metastasectomy, from 18 departments of thoracic surgery in Europe (n = 13), the United States (n = 4) and Canada (n = 1). Of these patients, 4572 (88%) underwent complete surgical resection.

Increase in rT3 serum levels observed during extended Alaskan field operations of Naval personnel.

Members of a US Navy Special Warfare platoon had blood samples drawn by venipuncture and other baseline measurements carried out prior to departure for a three-month period of field operations in Alaska. Assays of serum reverse triiodothyronine (rT3), free thyroxine (fT3), free T4 (fT4), and thyroid stimulating hormone (TSH) were subsequently done at the Naval Medical Research Institute (NMRI), Bethesda, Maryland. In the field and at baseline, hematocrits and urine specific gravities were also measured to track hydration status, and body weights and fat were recorded to track nutritional status.

Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial.

Background: A retrospective review revealed a 42% error rate between computed tomographic scan reports and thoracotomy findings; therefore, a prospective study was designed to compare the value of computed tomographic scans, video-assisted thoracoscopic exploration, and open thoracotomy in the management of pulmonary metastases.

Methods: Eligibility included any patient with only one or two ipsilateral pulmonary metastases identified on computed tomographic scan who was being considered for surgical resection. Initially video-assisted thoracic surgery was performed and all lesions identified were resected.

Dissemination of malignant tumors after video-assisted thoracic surgery: a report of twenty-one cases. The Video-Assisted Thoracic Surgery Study Group.

Video-assisted thoracic surgical techniques are widely used for biopsy and resection of thoracic tumors, but studies of long-term outcomes have not been reported. Dissemination of tumor by these techniques is a potential hazard. Therefore we surveyed the surgical members of the Video-Assisted Thoracic Surgery Study Group to determine whether tumor implants thought to be directly related to video-assisted techniques had occurred.

Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomized clinical trial.

Unlabelled: Delayed gastric emptying after esophagogastrectomy can pose a significant early postoperative problem. Because erythromycin, which stimulates the gastric antral and duodenal motilin receptor, has been shown to significantly increase gastric emptying in patients with diabetic gastroparesis, we decided to evaluate its effect on gastric emptying after esophagogastrectomy.

Methods: Twenty-four patients (18 men and six women, age range 41 to 79 years, median 66 years) were randomized to receive either erythromycin lactobionate (200 mg in 50 ml normal saline solution intravenously) (n = 13) or placebo (50 ml normal saline solution intravenously (n = 11) 11 days after esophagogastrectomy (with pyloric drainage procedure).

Vocal cord medialization for unilateral paralysis associated with intrathoracic malignancies.

Patients with unilateral vocal cord paralysis from intrathoracic malignancies may have significant dysfunctions of speech, swallowing, ventilation, and effective coughing as a result of inadequate compensation of the nonparalyzed cord. In patients with already compromised pulmonary function, aspiration can be a life-threatening event. Sixty-three patients with intrathoracic malignancies required surgical correction of vocal cord paralysis.

Predictors of survival in malignant tumors of the sternum.

From 1930 to 1994, 54 patients with primary malignant tumors of the sternum were seen. Fifty patients were first seen with a mass, and one half of them also had pain in the sternal region. Two patients had no symptoms at presentation.

Thymoma: a multivariate analysis of factors predicting survival.

Background: Despite complete surgical excision, malignant thymomas often recur with resultant death. We reviewed our series to determine which factors independently predict survival after surgical resection.

Methods: A retrospective analysis of patients operated on for thymoma between 1949 and 1993 at Memorial Sloan-Kettering Cancer Center was performed.

The spontaneous reporting of adverse drug reactions by nurses.

In an attempt to improve the low reporting rate of adverse drug reactions (ADR) we examined the potential for hospital nurses to report ADRs through a spontaneous 'yellow card' system. Over 14 months 100 cards were received (compared with 28 cards from doctors). Although reports from doctors for the same period were of a more substantial nature, nurses nevertheless reported many life threatening (17%) or moderately severe (76%) reactions.

Incidence of local recurrence and second primary tumors in resected stage I lung cancer.

From 1973 to 1985, 598 patients underwent resection for stage I non-small-cell lung cancer. There were 291 T1 lesions and 307 T2 lesions. The male/female ratio was 1.

Management of non-small cell lung cancer with direct mediastinal involvement.

The results of surgical treatment were analyzed for 102 patients with non-small cell lung cancer invading the mediastinum by direct extension (T3 and T4), but those who had N2 disease were excluded to eliminate the adverse prognostic effect of this nodal subset. The histologic type was squamous cell carcinoma in 55 patients, adenocarcinoma in 40, and large cell carcinoma in 7. There were 58 T3 tumors invading the mediastinal pleura or fat, phrenic nerve, vagus nerve, pericardium, or pulmonary vessels and 44 T4 lesions invading the aorta, vena cava, esophagus, trachea, spine, or atrium.

Randomized trial comparing postoperative chemotherapy with vindesine and cisplatin plus thoracic irradiation with irradiation alone in stage III (N2) non-small cell lung cancer.

This prospective randomized trial was performed to determine whether postoperative chemotherapy with vindesine and cisplatin could lengthen time to progression and overall survival in stage III (T1-3N2M0) non-small cell lung cancer (NSCLC) patients. Seventy-two patients were entered; 36 were randomized to receive chemotherapy. Patients were stratified by extent of resection (complete vs.

The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor.

Median sternotomy has been the accepted approach for dealing with mediastinal tumors or bilateral pulmonary disease, but exposure to the lower lobes and to mediastinal tumors extensively involving a hemithorax is often limited. Based on the reported experience from double-lung transplantation, we explored the use of clamshell incisions for these difficult problems. From March 1991 to December 1993, we prospectively studied the utility of clamshell incisions in 90 patients for the following indications: bilateral pulmonary metastases (62 patients), primary lung carcinoma with mediastinal involvement (13 patients), primary tumors of the mediastinum (14 patients), and mesothelioma (1 patient).

A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma.

Purpose: This study investigated the feasibility of a novel approach to the treatment of malignant pleural mesothelioma by combining surgical resection with immediate postoperative intrapleural chemotherapy and subsequent systemic chemotherapy.

Patients And Methods: Patients with biopsy-proven, resectable malignant pleural mesothelioma underwent pleurectomy/decortication immediately followed by intrapleural chemotherapy with cisplatin 100 mg/m2 and mitomycin 8 mg/m2. Systemic chemotherapy was started 3 to 5 weeks postoperatively and included cisplatin 50 mg/m2 on days 1, 8, 15, 22, 36, 43, 50, and 57, and mitomycin 8 mg/m2 on days 1 and 36.