Journal•ISSN: 0004-0010
Archives of Surgery
American Medical Association
About: Archives of Surgery is an academic journal published by American Medical Association. The journal publishes majorly in the area(s): Transplantation & Population. It has an ISSN identifier of 0004-0010. Over the lifetime, 18241 publications have been published receiving 640607 citations.
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TL;DR: Patients with early stage melanoma who have nodal metastases and are likely to benefit from radical lymphadenectomy are identified, with a high degree of accuracy, by a new procedure developed using vital dyes.
Abstract: • The initial route of metastases in most patients with melanoma is via the lymphatics to the regional nodes. However, routine lymphadenectomy for patients with clinical stage I melanoma remains controversial because most of these patients do not have nodal metastases, are unlikely to benefit from the operation, and may suffer troublesome postoperative edema of the limbs. A new procedure was developed using vital dyes that permits intraoperative identification of the sentinel lymph node, the lymph node nearest the site of the primary melanoma, on the direct drainage pathway. The most likely site of early metastases, the sentinel node can be removed for immediate intraoperative study to identify clinically occult melanoma cells. We successfully identified the sentinel node(s) in 194 of 237 lymphatic basins and detected metastases in 40 specimens (21%) on examination of routine hematoxylin-eosin—stained slides (12%) or exclusively in immunohistochemically stained preparations (9%). Metastases were present in 47 (18%) of 259 sentinel nodes, while nonsentinel nodes were the sole site of metastasis in only two of 3079 nodes from 194 lymphadenectomy specimens that had an identifiable sentinel node, a false-negative rate of less than 1%. Thus, this technique identifies, with a high degree of accuracy, patients with early stage melanoma who have nodal metastases and are likely to benefit from radical lymphadenectomy. (Arch Surg.1992;127:392-399)
4,169 citations
TL;DR: In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management as discussed by the authors, which is why a group of 40 international authorities from six medical disciplines and 15 countries participated in a three-day meeting and open discussion.
Abstract: • Acute pancreatitis is a protean disease capable of wide clinical variation, ranging from mild discomfort to apocalyptic prostration. Moreover, the inflammatory process may remain localized in the pancreas, spread to regional tissues, or even involve remote organ systems. This variability in presentation and clinical course has plagued the study and management of acute pancreatitis since its original clinical description. In the absence of accepted definitions for acute pancreatitis and its complications, it has not been possible to devise a clinical classification system useful for case management. Following 3 days of group meetings and open discussions, unanimous consensus on a series of definitions and a clinically based classification system for acute pancreatitis was achieved by a diverse group of 40 international authorities from six medical disciplines and 15 countries. The proposed classification system will be of value to practicing clinicians in the care of individual patients and to academicians seeking to compare interinstitutional data. (Arch Surg.1993;128:586-590)
2,521 citations
TL;DR: The concept of intestinal mucosal necrobiosis is reappraised and an explanation is presented for certain paradoxes observed in the bioenergetic studies as well as for the high susceptibility of the intestinal mucosa to damage in the low-flow states.
Abstract: Sequential studies of the intestinal mucosal lesion in low-flow states revealed that the extent of the damage is dependent upon flow. Microscopic evidence of epithelial disruption at the subnuclear portion and subsequent lifting off of the epithelial layer is presented and correlated with the postulated metabolic transport barrier at the epithelial-capillary interface. The formation of such a barrier may be related to the peculiar anatomico-physiological arrangements of the intestinal villi and may deprive the epithelial cells of important substrates during and after a period of hypoperfusion. The concept of intestinal mucosal necrobiosis is reappraised in the light of such findings, and an explanation is presented for certain paradoxes observed in the bioenergetic studies as well as for the high susceptibility of the intestinal mucosa to damage in the low-flow states.
1,570 citations
TL;DR: Evidence is presented that significant improvement often occurs in the clinical condition of patients with far advanced cancer of the prostate after they have been subjected to castration and this work provides a new concept of prostatic carcinoma.
Abstract: The thesis of this work may be briefly summarized In many instances a malignant prostatic tumor is an overgrowth of adult epithelial cells All known types of adult prostatic epithelium undergo atrophy when androgenic hormones are greatly reduced in amount or inactivated In this paper evidence is presented that significant improvement often occurs in the clinical condition of patients with far advanced cancer of the prostate after they have been subjected to castration Conversely, the symptoms are aggravated when androgens are injected We believe that this work provides a new concept of prostatic carcinoma The evidence that prostatic carcinoma is often composed of an adult type of epithelium derives from a study of such tissue with respect to the phosphatase which manifests optimum activity atpH5 An important advance in the technic of investigation of the prostate gland was made by Kutscher and Wolbergs,1who found that
1,413 citations
TL;DR: The efficacy of combined radiation and fluorouracil as adjuvant therapy for pancreatic cancer is suggested by a prospective randomized study conducted by the Gastrointestinal Tumor Study Group, which was terminated prematurely because of an unacceptably low rate of accrual.
Abstract: • The efficacy of combined radiation and fluorouracil as adjuvant therapy for pancreatic cancer is suggested by a prospective randomized study conducted by the Gastrointestinal Tumor Study Group (GITSG). Twenty-two patients randomized to no adjuvant treatment and 21 to combined therapy were analyzed. Neither life-threatening toxic reaction nor death due to toxic effect was encountered. The study was terminated prematurely because of an unacceptably low rate of accrual combined with the observation of increasingly large survival differences between the study arms. Median survival for the treatment group (20 months) was significantly longer than that observed for the control group (11 months). Four patients, three in the treated and one in the control group, have survived five years or longer following surgery. The extent of the tumor and initial performance status were significantly and independently related to survival. ( Arch Surg 1985;120:899-903)
1,380 citations