Edward F. Parker

Surgical resection for complications of pulmonary tuberculosis

From 1975 through 1984, 24 patients at the Medical University of South Carolina underwent surgical resection for complications of pulmonary tuberculosis. The complications fell into three major categories: persistent or drug-resistant disease, bronchiectasis, and hemoptysis. The major indications for surgical intervention included hemoptysis (14 patients), drug resistance (5), possible neoplasm (3), and bronchiectasis (2). Impaired pulmonary function was common. Surgical therapy generally necessitated lobectomy, sometimes resulted in substantial blood loss, and had a total major and minor complication rate of 46%. Despite these problems, the long-term prognosis after successful resection is good.

Carcinoma of the Esophagus: Observations of 40 Years

The long-term results of treatment of primary carcinoma of the esophagus continue to be poor, and attempts to improve them remain as challenging as any that exist in the field of malignant neoplasia today. Even so, there has been improvement, and this report contrasts age, race, sex, levels of involvement, methods of treatment, and results in our first series of 170 cases, seen between 1940 and 1951, with those in our last series of 300 cases, seen between 1967 and 1975. In the latter group, among those treated by megavoltage radiation as the sole theoretically curative method, the five-year survival rate was 1.0%. Among operable patients, there were 15 who had resection without preliminary radiation, with a mortality rate of 40% (6/15), a two-year survival rate of 13% (2/15), and a five-year survival rate of 7.0% (1/15). Also among operable patients, there were 75 who had resection following radiation therapy with a mortality rate of 19% (14/75), a two-year survival rate of 20% (15/75), and a five-year survival rate of 10% (7/75). These rates contrast with a five-year survival rate of 0.5% in the 1940–1951 series. Improvements in methods of treatment and adjuncts, such as nutrition, radiation, and operation, are cited. Even so, results in our last group did not show improvement over those in the 1962–1967 series. Therefore, we have begun a new program involving the use of chemotherapy in conjunction with radiation therapy and resection in those cases in which it may be applicable.

Barrett's esophagus in children. Diagnosis and management.

ObjectiveTo determine the local prevalence and optimal therapy for children with Barretts esophagus (BE), the authors studied children with esophageal strictures or gastroesophageal reflux (GER), or both, to diagnose BE and to follow after therapy. Summary Background DataBarretts esophagus is seldom reported in children and therapeutic recommendations are unclear. Barretts esophagus usually develops during the mucosal reparative process after acidreflux injury to the esophageal mucosa. Risk factors for BE include conditions that are associated with GER such as mental retardation, esophageal stricture, esophageal atresia, and reversed gastric tube esophagoplasty. Barretts syndrome increases the risk of esophageal adenocarcinoma by 30 to 40 times.8,9 MethodsAll children with the risk factors had repeated esophagoscopy and multiple mucosal biopsies before and after therapy. ResultsEleven children have been documented with BE. The initial diagnoses were: GER, 5; esophageal atresia, 4; nasogastric intubation, 1; lye ingestion, 1. A gastric tube esophagoplasty had been performed in three patients with BE in the esophagus proximal to the anastomosis. Three children with mid-esophageal strictures and long segments of BE had total resection with colic interposition. An additional two patients with tight stricture were treated with colic-patch esophagoplasty without resection. The final three patients were treated with fundopllcation alone. ConclusionsBarretts esophagus can be caused by acid from gastric tubes but responds to H2 blockers and diet. Resection eliminates BE; esophagoplasty only controls the stricture and must be accompanied by fundoplication. Barretts esophagus persists in patients with fundoplication alone if reflux control is incomplete. The authors conclude that acid reflux must be controlled to treat BE successfully or the involved segment must be resected. Esophagogastrostomy apparently predisposes to BE.21

Chemoradiation therapy and resection for carcinoma of the esophagus: Short-term results

The purpose of this report is to record the results of a treatment protocol for patients with carcinoma of the esophagus. In May, 1980, we initiated a program of chemoradiation therapy preliminary to resection in patients in whom the protocol was applicable. The chemotherapy consisted of mitomycin-C, 10 mg as a bolus intravenous injection on day 1, and 5-fluorouracil, 1,000 mg per square meter of body surface area in 1,000 ml of 5% glucose solution in distilled water given intravenously on each of days 1 through 4. The radiation therapy consisted of 3,000 rads in three weeks using cobalt 60 or 6 MeV or greater, with ports to cover the tumor and mediastinum. This protocol was given to patients with primary carcinoma of the esophagus whose disease remained or became operable during or following the course of the chemoradiation. Among the patients treated according to the protocol, the operability rate was increased. The resectability rate remained about the same as in our previous experience. The operative mortality was lessened appreciably. The percentage of resected specimens of the esophagus showing residual tumor decreased. However, the absence of any residual tumor in the surgical specimen has not conferred any improved chance of long-term survival to date. There has been a two-year survival of 33% (7/21) among the small group having chemoradiation therapy prior to resection, and this figure is roughly the same as that in our previously reported series of patients treated by preoperative irradiation (4,500 rads in three weeks) and resection without the chemotherapeutic adjunct.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of the Lung: A Clinical Review

Records of 702 patients with carcinoma of the lung seen from 1960 through 1970 were reviewed. The efficacy of various diagnostic and therapeutic procedures was assessed. Salient findings were as follows: Biopsy of nonpalpable ipsilateral supraclavicular lymph nodes was positive for carcinoma in 63 of 286 patients (22%). Even more surprising, biopsy of nonpalpable contralateral supraclavicular lymph nodes was positive for carcinoma in 9 of 38 patients (24%). Accordingly, the importance of biopsy of nonpalpable supraclavicular nodes is to be stressed. Squamous cell carcinoma was the most common type, but adenocarcinoma was more common in women and nonsmokers. Among the 702 patients, 48 (6.8%) were nonsmokers. The 5-year survival for 92 patients treated by lobectomy was 21%; the 5-year survival for 77 patients treated by pneumonectomy was 19%; the 5-year survival among 18 patients have resection of the chest wall in addition to resection of the primary lesion was 22%. Of 12 patients with small cell carcinoma of the lung treated by resection, there was 1 5-year survivor. The overall 5-year survival in the 702 patients was 6.6%.

Dirofilaria immitis (Dog Heartworm) as a Pulmonary Lesion in Humans

Dirofilaria immitis, the dog heartworm, has been identified in the pulmonary granulomas of 5 patients from the greater Charleston area; this is the largest series of such cases from one medical center. The patients had no pulmonary symptoms. On roentgenogram the lesions were all about 2 cm in size, of uniform light opacity, and located near the pleural surface. Thoractomy was performed in each instance because of the possiblity of carcinoma. The association of granuloma formation, pulmonary infarct, and eosinophilic infiltration led to the suspicion of dirofilaria, which was confirmed in each case.

The Cardiac Lymphatics

Abstract The cardiac lymphatic system is well developed. Investigations related to the lymphatics of the heart are recorded as early as the seventeenth century, and with improved techniques, many studies have produced new knowledge of the system during this century. Controversy remains, however, regarding the presence of lymphatics in certain areas of the heart such as the atrioventricular valves. Many investigators believe that malfunction of the cardiac lymphatics might be a factor in disease states for which the pathogenesis is still unknown. This review outlines the history, anatomy, and physiology of the cardiac lymphatics and their possible relationship to cardiac disease.

Carcinoma of the Esophagus

Life tables were computed from the Tumor Registry at the Medical University of South Carolina on 486 patients with histologically proven squamous cell carcinoma of the esophagus. The 5-yr follow-up was available in only 394 patients, or 81% of the total sample. For purposes of comparison with published literature, the traditional crude 5-yr survival percentages in the life-table analyses figures are presented. The life-table calculation utilizes all follow-up information available, in that patients observed for less than 5 yr still may contribute to the estimate of the true 5-yr survival rate in contrast to the past when all patients lost to follow-up were presumed to have died. In this method, patients not observed for the full time of the study are assumed to have had the same risk of dying as patients followed to the end of the fifth year experienced in their fifth-year analyses. The group with the most favorable prognosis in this series was that receiving preoperative irradiation. This operation. They were given 4,500 rads of supervoltage X ray over a period of 3 weeks prior to operation. The differences in surgical or radiation techniques employed by various reporters make comparative data difficult, if not impossible, to evaluate. Supervoltage irradiation has proved itself in some hands equal to surgery. A randomized prospective study would seem appropriate to conclude the best means of managing epidermoid carcinoma of the esophagus.