O'Neill Mj

Carcinoma of the Lung: Evaluation of Histological Grade and Factors Influencing Prognosis

The results in 96 patients with lung cancer who underwent lobectomy or pneumonectomy were analyzed. In reviewing the case histories of these patients, it became apparent that those with poorly differentiated tumor (grade 3) have an increased likelihood of positive lymph node metastases compared with those with well-differentiated (grade 1) or moderately differentiated (grade 2) tumor. Poor differentiation of the tumor, vascular invasion, and lymph node metastases appear to represent poor prognostic indices in patients undergoing operation. Compared with patients with grade 1 and grade 2 tumors, patients with a grade 3 adenocarcinoma had more local recurrences, while those with grade 3 squamous cell carcinoma had more distant metastases. The findings suggest that histological grading is an important adjunct to the clinical evaluation of and planning of treatment for patients with lung cancer.

Evaluation of adjuvant postoperative radiotherapy for lung cancer

One hundred eighteen patients with lung cancer were retrospectively analyzed to determine whether postoperative radiotherapy (RT) improves survival. Patterns of treatment failure and three year NED (no evidence of disease) survival rates were assessed according to extent of tumor spread, histology, and treatment method. Patients with hilar or mediastinal node metastases were at higher risk of local failure compared to those with negative nodes. Postoperative RT reduced local recurrence and improved 3 year survival among patients with positive nodes. However, postoperative RT did not improve survival among those with negative nodes. Our data indicated that patients with positive hilar or mediastinal nodes may require postoperative RT to improve survival.

Hetastarch as a Prime for Cardiopulmonary Bypass

Hetastarch, a synthetic colloid osmotic plasma volume expander, was employed in a prime for cardiopulmonary bypass in 37 patients undergoing myocardial revascularization. Comparison of laboratory values to those of 42 patients undergoing myocardial revascularization using an albumin-containing prime showed lower postoperative platelet counts (p less than 0.02) with hetastarch. There were no differences in chest tube drainage, blood use, plasma hemoglobin, fibrinogen levels, of coagulation times. The hetastarch prime cost

Evaluation of adjuvant postoperative radiotherapy lung cancer

119.50 per patient, whereas the albumin-containing prime cost

Metastatic periosteal osteosarcoma causing cardiac and renal failure

321.35 per patient.

Safe Release of Impacted Pacemaker Electrodes

One hundred eighteen patients with lung cancer were retrospectively analyzed to determine whether postoperative radiotherapy (RT) improves survival. Patterns of treatment failure and three year NED (no evidence of disease) survival rates were assessed according to extent of tumor spread, histology, and treatment method. Patients with hilar or mediastinal node metastases were at higher risk of local failure compared to those with negative nodes. Postoperative RT reduced local recurrence and improved 3 year survival among patients with positive nodes. However, postoperative RT did not improve survival among those with negative nodes. Our data indicated that patients with positive hilar or mediastinal nodes may require postoperative RT to improve survival.

A rationale for the use of sequential coronary artery bypass grafts.

The case of a 25-year-old man who had periosteal osteogenic sarcoma with intravascular metastases in unusual locations is reported. The patient presented with acute renal failure, unilateral pulmonary edema, functional mitral stenosis, and low cardiac output. After successful surgical removal of a left atrial metastasis with subsequent improvement in cardiac output, renal function improved only transiently and urinary output varied markedly. At autopsy, metastatic osteogenic sarcoma was discovered within the lumen of the abdominal aorta obstructing both renal arteries. The case is the first report of a neoplasm metastatic to the aorta causing intermittent bilateral renal arterial obstruction; it illustrates the diagnostic difficulties presented by intravascular metastatic disease.

Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting

Abstract If the original electrode is damaged during pacemaker replacement for battery depletion, the operation becomes substantially more involved and hazardous. By drilling a hole in the back of the electrode connector housing and inserting an Allen wrench into the drill hole, an impacted electrode hub can be pushed free without placing stress on the electrode components. This technique is recommended whenever an electrode hub cannot be easily removed from a pacemaker during a replacement operation, as traction on the electrode not infrequently results in gross or occult damage to the Silastic sheath or conductive elements.