Marcus L. Dillon

The Role of Thymectomy in Red Cell Aplasia

Red cell aplasia is an unusual cause of anemia. Fifty percent of all patients with red cell aplasia will have a thymoma. Twenty-five to 30% of those who undergo thymectomy will be cured. Data are presented that suggest that any patient with red cell aplasia should have thymectomy through a median sternotomy. One of 3 such patients who underwent the operation has had complete remission for two years.

Radiographic Manifestations of Mediastinal Hemorrhage from Blunt Chest Trauma

The diagnosis of rupture of the thoracic aorta or its major branches depends largely on the recognition of mediastinal hemorrhage from the initial chest radiograph and subsequent thoracic aortography. This review discusses the radiographic manifestations of mediastinal hemorrhage, including widening of the mediastinum; a ratio of mediastinal width to chest width greater than 0.25; abnormalities of aortic contour; opacification of the aortopulmonary window; depression of the left main bronchus; deviation of the trachea to the right; deviation of the nasogastric tube to the right; the apical cap sign; widening of the paraspinal lines; widening of the right paratracheal stripe; and left hemothorax. The relationship of these manifestations to major thoracic arterial injury is examined. Pitfalls in the radiographic evaluation of mediastinal abnormalities are considered, and indications for computed tomography of the thorax and thoracic aortography in the severely injured patient are reviewed.

Endobronchial brachytherapy in the treatment of recurrent bronchogenic carcinoma.

Abstract Local recurrence of lung cancer after high dose irradiation poses a difficult management problem. Three patients have been treated at the University of Kentucky Medical Center and Veterans Administration Hospital, Lexington, Kentucky with a combination of low dose external irradiation and endobronchial brachytherapy with satisfactory palliative results. Simple techniques for transbronchoscopic implantation or insertion of afterloading tubes are described.

Mediastinal epithelioid hemangioendothelioma.

An epithelioid hemangioendothelioma arising from the innominate vein in the anterior superior mediastinum of a 62-year-old man was treated by wide local excision followed by radiotherapy. This clinicopathologic entity is a rare cause of mediastinal mass and is characterized by an intermediate malignant potential. To our knowledge, very few cases have been reported in the mediastinum; those cases are listed in this report. Gross and microscopic distinguishing features of epithelioid hemangioendothelioma, as well as differential diagnosis, are reviewed from the literature. Finally, clinical behavior is discussed and treatment options are suggested.

Comparison of ice water with iced saline solution for gastric lavage in gastroduodenal hemorrhage

Abstract Ice water is simpler to use than iced saline solution for gastric cooling in patients with upper gastrointestinal bleeding. Gastric lavage in dogs with either saline solution or water results in a decrease in serum potassium and osmolality. The lack of differences in systemic effects suggests that ice water may be used as readily as iced saline solution when complemented with intravenous electrolyte solutions and the monitoring of serum potassium.

Lung uptake of Tc-99m HMPAO in cigarette smokers expressed by lung/liver activity ratio.

Tc-99m HMPAO, a lipophilic radiopharmaceutical used for brain imaging, has been reported to localize in smokers lungs. To quantitate this uptake in the lung, 55 patients, who were referred for brain imaging for dementias or strokes, also underwent lung imaging (anterior lung imaging includes a large part of the liver) after IV injection of the radiopharmaceutical. Regions of interest over the liver and the lung were calculated. Of the 55 patients (ages 13-79), 30 were smokers and 25 were nonsmokers. The smokers had been smoking from 6-59 years, and daily cigarette consumption ranged from 8-50 cigarettes. The mean lung/liver ratio for smoking patients were 0.792 +/- 0.042 (SE); the mean lung/liver ratio for nonsmoking patients was 0.408 +/- 0.019 (SE). Lung/liver ratio uptake was significantly higher in the smoking patients (P < 0.01) than in the nonsmokers. Thus, lung/liver uptake of Tc-99m HMPAO may be used as an indicator of cigarette smoking.

Application of I-123 HIPDM as a lung imaging agent

N,N,N′-Trimethyl-N′-(2-Hydroxyl-3-Methyl-5-123I Iodobenzyl)-1,3-Propanediamine · Hcl (123I-HIPDM) has been used for diagnosis of patients with strokes and dementias. Since this radiopharmaceutical is also accumulated in the lung, we routinely performed a lung image or images immediately prior to cerebral planar and SPECT images after a 3–5 mCi 123I-HIPDM injection. During the past 14 months, we obtained 78 (age from 41 to 92 years, average 66.7±8.9 years; 64 males, 14 females) suspected stroke or dementia patients lung images. All lung images were correlated to chest X-ray (CXR) or CT and other clinical data. Sixty five of 78 patients had normal lungs showing homogeneous distribution of activity throughout the lungs which correlated well to normal CXR and/or CT studies. Abnormal scintigraphic patterns of the 13 patients included lung defect (5 bronchogenic carcinoma with or without atelectasis) and decreased uptake in apices (8 chronic obstructive pulmonary disease). The findings of pulmonary intrathoracic pathologies on lung images with 123I-HIPDM suggests further evaluation of the agent for detection of localized pulmonary diseases and pulmonary physiological studies relating to amine metabolism.

The role of bougienage in the management of achalasia-the need for reappraisal

Passive dilatation, advocated in the past by a number of gastroenterologists as the initial therapy for achalasia, has fallen into disrepute in the last 15 years. Our recent experience with five achalasia patients, four of whom were judged too fragile for esophageal myotomy or forcible dilatation, indicates the need for reappraisal of bougienage therapy.

Open Rib Biopsy Guided by Radionuclide Technique

When abnormally increased radioactivity is seen in a rib or ribs by bone imaging in a patient with suspected or known malignancy, it frequently is difficult to differentiate fracture from metastatic disease. Histological examination of the lesion is crucial for diagnosis, staging, and planning of therapy. To assess the value of external localization of the site or sites of abnormal uptake in a rib as a guide for open rib biopsy, 10 patients (7 men, 3 women; age range, 34 to 68 years) with known or suspected malignancy were studied. With reference to the oscilloscope image, a cobalt 57 marker was placed on the skin overlying the focus of increased uptake, and the area of increased activity was marked on the skin as a guide to surgical resection. Of ten resected ribs, four showed metastatic disease and five had fractures. (One patient underwent two external marking procedures and two surgical procedures.) Rib biopsy was not performed in 1 patient because prior to the surgical procedure, a small subcutaneous nodule adjacent to the skin marker was excised and confirmed to be carcinoma. Appropriate courses of management (operation, irradiation, chemotherapy) were taken after the biopsies. The surgeon responsible for the biopsy should be present during the skin-marking procedure, and the area beneath the scapula and the region adjacent to the spine should be avoided. Our results indicate that the technique is a very useful aid for approaching open rib biopsies more precisely.

Air-filled, multilocular, bronchopulmonary foregut duplication cyst of the mediastinum unusual computed tomography appearance

Mediastinal bronchopulmonary foregut duplication cysts are usually identified on computed tomography (CT) as well-defined masses of water density that may contain rim calcification. Occasionally they are heterogenous in attenuation or are of intermediate or high attenuation due to contained calcium. Communication with the tracheobronchial tree or esophagus is rare. We report a bronchogenic cyst that communicated with the trachea and was identified by CT as a multilocolor, completely air-filled cyst adjacent to the trachea and esophagus. This appearance of a bronchogenic cyst has received little attention in the literature.