Showing papers on "Surgical oncology published in 1974"
Book•
01 Jan 1974
TL;DR: A more detailed surgical technique was described 33 years later by Kocher, who explained lymph node dissection from the submandibular triangle in the context of access to the operative treatment of carcinomas of the tongue.
Abstract: This is a revised and updated guide to the principles of surgery, highlighting advances and techniques in transplantation, surgical oncology and trauma. It also examines minimally invasive techniques and the principles underlying pathophysiology and surgical intervention.
1,073 citations
TL;DR: The objective of this study was to determine the effect of diverting bile acid from the proximal half to the distal half of the small intestine on intestinal tumor formation in rats given azoxymethane subcutaneously.
Abstract: THERE IS a STRONG EPIDEMIOLOGIC evidence that a dietary factor plays an impor tant role in the etiology of cancer of the colon.1 One of the food elements that is suspected is animal fat. A currently popula r theory is that a high level of dietary fat results in increased quantities of bile salts in the gut. There is an associated change in the bacterial flora of the colon which acts on these biliary compounds, and possibly with other dements in the gut, to form carcinogenic agents that act on intestinal epithelium.2 I t has recently been shown that increased bile acid secretion by the liver enhances intestinal tumor format ion in rats on certain carcinogens.3 T h e objective of our study was to determine the effect of diverting bile f rom the proximal half to the distal half of the small intestine on intestinal tumor formation in rats given azoxymethane subcutaneously.
183 citations
TL;DR: The selective infusion of vasoconstrictors into the mesenteric vascular bed, during angiography, provides a means of obtaining a local vasoconStricting effect with smaller doses and infusion rates.
Abstract: The use of vasoconstricting drugs to control bleeding is not new. Wiggers, 23 as early as 1911, suggested parenteral injection of vasopressin for the treatment of hemoptysis, and Kehne et a l . , 16 in 1956, introduced the use of intravenous vasopressin for the treatment of patients with bleeding esophageal varices. With intravenous administration, large doses are usually needed, resulting in high systemic levels and undesirable sideeffects. The selective infusion of vasoconstrictors into the mesenteric vascular bed, during angiography, provides a means of obtaining a local vasoconstricting effect with smaller doses and infusion rates.
54 citations
TL;DR: Although numerous investigations show increased frequencies of colorectal adenomas in patients with carcinoma of the large intestine, there have been only a few reports of increased frequency of subsequent additional adenoma or carcinomas in Patients withAdenomas.
Abstract: A D E N O M A S O F T H E C O L O N a n d r e c t u m occur more frequently in patients with carcinoma of the large intestine than in patients without such tumors. 2-~, 7-9 It has also been shown that patients who have had colorectal carcinomas removed have an increased risk of developing subsequent (metachronous) colorectal carcinomas. The risk is higher if the patient has coexisting adenomas of the large intestine, s Such a sequence of events may be explained by a common cause of adenomas and carcinomas, or by development of carcinomas from adenomas. In either case, the cause may be a constitutional disposition, and/or carcinogenic substances present in the contents of the large intestine.iS Although numerous investigations show increased frequencies of colorectal adenomas in patients with carcinomas, there have been only a few reports 4, 10, la, 14, ~6 of increased frequencies of subsequent additional adenomas or carcinomas in patients with adenomas.
54 citations
TL;DR: Hyperalimentation was used preoperatively in 25 patients seriously ill with Crohn's disease to provide caloric replenishment, promote positive nitrogen balance, and sustain weight gain prior to surgery and to alleviate various complications during the postoperative period.
Abstract: TIlE DEVELOPNIENT Of a method to provide complete intravenous nutrition while placing the gastrointestinal tract at rest for prolonged periods offers a new and promising modality for the treatment of inflammatory bowel disease. During the past two years, 66 patients received intravenous hyperalimentation on the Colon and Rectal Surgery Service at Cleveland Clinic Hospital. The large majority (46) had Crohn's disease. These 46 patients all had histologically documented transmural colitis (Crohn's disease) and /o r transmural ileitis. In each case, intravenous hyperalimentation was an important part of the patient's in-hospital therapy. The present study reviews and analyzes our experience with these patients. Indications for hyperalimentation were: 1) severe wasting and chronic nutritional debility; 2) enterocutaneous or internal fistulas; 3) intestinal obstruction; 4) shortbowel syndrome; 5) sepsis. Often these complications were present in combination. Hyperalimentation was used preoperatively in 25 patients seriously ill with Crohn's disease to provide caloric replenishment, promote positive nitrogen balance, and sustain weight gain prior to surgery. Another group of 12 patients with Crohn's disease received hyperalimentation to alleviate various complications during the postoperative period. In nine patients, parenteral hyperalimentation was considered primary therapy. Three patients had coexistent diverticulitis and transmural colitis. Four additional patients, whose diagnosis was mucosal ulcerative colitis, were treated with hyperalimentation.
39 citations
TL;DR: It is difficult to predict the clinical course of a patient who has a smooth-muscle tumor of the rectum, because the clinical courses of patients with histologically benign and malignant types are essentially the same.
Abstract: SMOOTH-MUSCLE TUMORS O[ t h e rectum a re rare in Japan. Experience with three cases in our department prompted a complete review of tile Japanese medical literature. As to histologic determination of malignancy of smooth-muscle tumors, many problems still remain. Some investigators put weight on histologic pattern~; others diagnose according to both histologlc findings and biological behavior of the tumor, because the clinical courses of patients with histologically benign and malignant types are essentially the same. e, * Cases initially diagnosed as leiomyoma because of no typical finding of malignancy later have manifested recurrence and metastasis Therefore, it is difficult to predict the clinical course of a patient who has a smooth-muscle tumor of the rectum.
37 citations
34 citations
TL;DR: Benign rectal carcinoids should be treated with biopsy and thorough fulguration or local excision, however, invasive tumors should betreated by radical resection whenever possible, since the metastatic lesions are often very slowgrowing and the patient may remain relatively asymptomatic for long periods.
Abstract: Thirty-eight patients were found to have carcinoid tumors of the rectum in a retrospective study of a 23-year period at the Ochsner Medical Center. Thirty-three patients had clinically benign tumors and five had invasive carcinoids with metastasis to regional lymph nodes or the liver. All benign tumors were completely asymptomatic and were discovered on routine rectal and proctoscopic examinations. All patients with malignant tumors had symptoms. The distinction between carcinoids which are clinically benign and those which are malignant can be made only by determining the extent of invasion of the bowel wall or by evidence of metastasis. The gross size of the tumor is important, since most tumors less than 2 cm in diameter are localized, whereas those 2 cm in diameter or larger have invasion and metastasis. Benign rectal carcinoids should be treated with biopsy and thorough fulguration or local excision. However, invasive tumors should be treated by radical resection whenever possible, since the metastatic lesions are often very slowgrowing and the patient may remain relatively asymptomatic for long periods.
24 citations
TL;DR: The patient, a 76-year-old diabetic man, was first seen in the outpat ient department of the Albany Veterans Administration Hospital complaining of severe back pain of ten days' duration, and physical examination disclosed no abnormality, and x-rays revealed moderately severe changes of the lumbosacral region and spina bifida occulta.
Abstract: The patient, a 76-year-old diabetic man, was first seen in the outpat ient department of the Albany Veterans Administration Hospital complaining of severe back pain of ten days' duration. Physical examination disclosed no abnormality, and x-rays revealed moderately severe arthrit ic changes of the lumbosacral region and spina bifida occulta. The latter was thought to be the cause of the pain, but it was noted that the leukocyte count was elevated to 14,000. Oral analgesics were prescribed and the pat ient was instructed to rest in bed pending an early appointment to the orthopedic clinic. There were no gastrointestinal symptoms at that time. Five days later the pat ient returned to the hospital in the early hours of the morning because of severe and steadily increasing pain in the left hip, primarily localized over the area of the greater trochanter. Physical examination disclosed that the left thigh had a mottled blue color, and was firm,
19 citations
TL;DR: A toxic reaction to the frequently used hypertonic phosphate enema, in the form of increased neuromuscular excitability is reported.
Abstract: ENEMAS are commonly used and usually benign. Mechanical and chemical injuries (perforation, laceration, dehydration, intoxication, water loading, hypokalemia, allergy, tetany) may, however result.3, 5, 6 All drugs have the potential of producing toxic manifestations. Pharmaceutical manufacturers are usually careful and explicit about the potential toxic reactions of their products. This paper reports a toxic reaction to the frequently used hypertonic phosphate enema, in the form of increased neuromuscular excitability. A convenient way to remember the effects on neuromuscular excitability can be found in the following form2:
16 citations
TL;DR: T h e patient, a 77-year-old retired schoolteacher, had three children, each the product of a normal pregnancy and labor, and there was no related history of mucous discharge, constipation or diarrhea, abdominal pain, or weight loss.
Abstract: T h e patient , a 77-year-old retired schoolteacher, had three children, each the product of a normal pregnancy and labor. Relevant past history amounted to a Fothergill 's repair for a prolapsed uterus with rectocele and cystocele at the age of 49 years. A second repair of the cystoceIe had been per formed two years pr ior to the present admission. Four years before the present admission, a single episode of rectal bleeding had been followed by a radiologic diagnosis of diverticular disease. T h e pat ient was then well unt i l February 1973, when she had a fur ther episode of profuse rectal bleeding. There was no related history of mucous discharge, constipation or diarrhea, abdominal pain, or weight loss. A bar ium-enema study was repor ted as normal. However, sig-moidoscopy showed an ulcerated lesion at 12 cm, and a biopsy confirmed the diagnosis of carcinoma. T h e definitive operat ion was an anter ior resection of the rectum and sigmoid colon wi th end-to-end anastomosis. T h e uterus and both tubes and ovaries were clearly and separately identified at laparotomy. Plain x-ray examinat ion of the pen i s postoperatively, specifically, showed no bony defect in the sacrum. Pathology. T h e operative specimen consisted of the distal 18 cm of colon (with attached mesocolon) and the proximal 5 cm of rectum. Situated wi thin the posterior wall of the rectum was a muhi loculated cystic mass 5 cm in max imum diameter, the largest loculus being 1.5 cm across. T h e mass was enveloped laterally by the perirectal fat trot was
TL;DR: All polypoid lesions at the Ferguson Clinic for the past 22 years were checked by the pathology department and 174 were found to be juvenile polyps and were studied in detail.
Abstract: All polypoid lesions at the Ferguson Clinic for the past 22 years were checked by our pathology department. Of these, 174 were found to be juvenile polyps and were studied in detail.
TL;DR: This report concerns 27 patients treated by exteriorization of the colonic suture line, and the operative technique used and results obtained are described.
Abstract: PENETRATINO INJURIES Of the colon have always been a dilemma for the surgeon. Currently, we are investigating this problem with a prospective randomized study of patients with colonic injuries. From February 1972 to May 1973, 113 patients with injuries of the colon were treated in our institution. Twenty-three patients had injuries suitable for primary closure and 37 had low-lying injuries not suitable for randomization. The injuries of the remaining 53 patients have been managed by colostomy or primary closure with exteriorization of the suture line. This report concerns 27 patients treated by exteriorization of the colonic suture line. The operative technique used and results obtained are described.
TL;DR: A case of verrucous tuberculosis of the anal canal is reported and the pathogenesis, clinical features and management of the condition are discussed.
Abstract: A case of verrucous tuberculosis of the anal canal is reported. The pathogenesis, clinical features and management of the condition are discussed.
TL;DR: Two patients with colonic and rectal carcinoma developed metastases to the nose and two others to the vagina, which led to the development of hepatic metastases and died of disease.
Abstract: A report of two unusual metastatic sites in four patients with colonic and rectal carcinoma is presented. Two patients developed metastases to the nose and two others to the vagina. Eventually the two patients with metastases to the nose developed hepatic metastases and died of disease.
TL;DR: A further case of leiomysarcoma of the rectum managed by radical operation is reported and the patient is alive and apparently free of recurrence 61/2 years after operation.
Abstract: A further case of leiomysarcoma of the rectum managed by radical operation is reported. The patient is alive and apparently free of recurrence 61/2 years after operation.
TL;DR: The anatomic boundaries of the anal canal and true rectum are clarified, and the literature regarding true rectal melanomas is reviewed.
Abstract: A case of a true rectal melanoma in a Negro patient is presented. The anatomic boundaries of the anal canal and true rectum are clarified, and the literature regarding true rectal melanomas is reviewed. Known cases of anal melanoma in Negro patients are reviewed.
TL;DR: D diverticular disease of the colon is a condition of the adult, and a notable feature of those patients who bleed massively is that they are elderly, and thus a selected, fragile group of people, often with associated cardiovascular, ptflmonary and renal disease, who do not tolerate emergency operations of any appreciable magnitude.
Abstract: I Will be confining my remarks to the treatment of massive diverticular bleeding, and I assure Mr. Heald that the modality that I will be mentioning is available, even in England. .About 15 per cent of patients with diverticular disease of the colon will bleed from this source. In the great majority of instances, the bleeding is slight, or even occult, and associated with diverticulitis. While significant acute bleeding is unusual in this condition, nevertheless, diverticular disease of the colon is now recognized as the most common cause of massive bleeding from the large intestine. Fortunately, in most of these patients with massive bleeding, the bleeding will stop spontaneously with no more than bed rest and transfusions, if needed, but, in some patients, the bleeding will continue and, in these patients, operative intervention becomes a consideration. However, diverticular disease of the colon is a condition of the adult, and a notable feature of those patients who bleed massively is that they are elderly, and thus we have a selected, fragile group of people, often with associated cardiovascular, ptflmonary and renal disease, who do not tolerate emergency operations of any appreciable magnitude. When we consider the high operative mortality rates that have been reported, avera~ng about 20 to 25 per cent, then
TL;DR: Four cases of sigmoidocervical fistula are reviewed and an additional case is presented and Causal factors and methods of diagnosis and treatment are discussed.
Abstract: Four cases of sigmoidocervical fistula are reviewed and an additional case is presented. Causal factors and methods of diagnosis and treatment are discussed. One-stage resection is the best procedure for the goodrisk patient.
TL;DR: A threefold decrease in bowel transit time was observed in three patients with polyposis coli associated with Gardner's syndrome.
Abstract: A threefold decrease in bowel transit time was observed in three patients with polyposis coli associated with Gardner's syndrome.
TL;DR: A patient bled from the margins of his ileostomy stoma 19 years after proctocolectomy for total colitis and was found to have portal hypertension and cirrhosis, and α-fetoprotein was detected in the serum.
Abstract: A patient bled from the margins of his ileostomy stoma 19 years after proctocolectomy for total colitis. He was found to have portal hypertension and cirrhosis, and α-fetoprotein was detected in the serum. He died later from a hepatoma.
TL;DR: Low operative mortality rate and low incidence of recurrence of bleeding warrant this technique to be performed as an either emergency or prophylactic measure.
Abstract: Ninety-eight patients who have undergone transthoracic esophageal transection with paraesophagogastric devascularization are reviewed. Ages ranged from 9 months to 74 years. Over-all operative mortality was 5.1%. Postoperative hemorrhage occurred in 2 patients, a patient with hepatoma and another with incomplete devascularization of the esophagus at the diaphragm. Disappearance of the esophageal varices was seen in 91 (98%) of all 93 survivors.
TL;DR: A simple holder for the fiberoptic colonoscope at the University of Minnesota, where this instrument will probably come when it will be used more freely, if not routinely.
Abstract: * Received for publication May 25, 1973. Reprint requests should be addressed to: Santhat Nivatvongs, M.D., Box 459 Mayo Bldg., University of Minnesota Hospitals, Minneapolis, Minnesota 55455. ing its routine nse. The time will probably come when this instrument will be used more freely, if not routinely. When biopsy or polypectomy is performed via fiberoptic colonoscope, one or two assistants are needed to stabilize the scope at the anus with one hand and to hold the scope at its proximal end with another, so that the operator can use his two hands freely. In difficult cases, this can be very troublesome. Recently, we have developed a simple holder for the fiberoptic colonoscope at the University of Minnesota. This device is
TL;DR: Attention is drawn to the frequency of rheumatoid arthritis among previously described cases of steroid-associated ulceration of the large bowel, and it is suggested that it may itself be an etiologic factor.
Abstract: Chronic ulceration of the ascending colon in a 57-year-old woman treated with steriods for rheumatoid arthritis is described. Attention is drawn to the frequency of rheumatoid arthritis among previously described cases of steroid-associated ulceration of the large bowel, and it is suggested that it may itself be an etiologic factor.