Showing papers on "Surgical oncology published in 1986"

The surgical management of anorectal diseases in AIDS and pre-AIDS patients.

Abstract: The charts of 340 patients with Acquired Immunodeficiency Syndrome (AIDS), AIDS-related complex (ARC), or AIDS-prodrome (AIDS-P), treated between January 1982 and April 1986 at the Roosevelt Division of the St. Luke's-Roosevelt Hospital Center, were reviewed. The incidence of anorectal disease was 34 percent. Fifty-two patients (15 percent) presentes with anorectal complaints prior to the diagnosis of AIDS, ARC, or AIDS-P. Over 50 percent of these patients were dead within 7.4 months. Fifty-one patients (15 percent) underwent 73 anorectal surgical procedures. Twenty-two of these patients (43 percent) were dead within six months, and only six patients had satisfactory wound healing 30 days after surgery. In addition to an 88 percent rate of poor healing, there was a 16 percent rate of major complications. Identification of these high-risk groups prior to any anorectal surgery is imperative to avoid unacceptable surgical complications. Aggressive surgical intervention should be reserved only for patients who did not fall into the high-risk groups presented.

The changing role of surgery in the treatment of primary liver cancer.

Abstract: For decades, the role of surgery in the treatment of primary liver cancer (PLC) was important but limited. However, a comparison of pathologically proven PLC during the three periods 1958-1966, 1967-1975, and 1976-1984 revealed that as a result of alpha fetoprotein (AFP) serosurvey, changing concepts in surgical oncology, and introduction of new surgical modalities, the role of surgery has become greater. The increasing proportion of subclinical PLC (0, 7.2, and 21.2%) has favored the increasing series resection rate (16.1, 34.7, and 39.6%) and palliative surgery (13.7, 17.0, and 29.8%). The results indicated that early resection, reoperation for subclinical recurrence, resection of huge PLC in stages, and combination of palliative surgery other than resection might be responsible for the increasing 5-year survival rate (1.7, 7.1, and 19.5%) in the entire series.

Secretory carcinoma of the breast in a Japanese woman.

Abstract: We report a case of secretory carcinoma of the breast in a 33 year old woman. Secretory carcinoma is a rare tumor and has distinctive pathological characteristics. This tumor usually occurs in children or adolescents. Modified radical mastectomy was carried out and the patient is doing well with no evidence of recurrence at 25 months later. Negative findings were obtained in the assay of estrogen and progesterone receptor.

Second primary cancer following adjuvant chemotherapy, radiotherapy and endocrine therapy for breast cancer: a nationwide survey on 47,005 Japanese patients who underwent mastectomy from 1963-1982.

Abstract: Out of a total of 47,005 cases of primary breast cancer with curative surgery recorded in Japan in the 20 year period from 1963 to 1982, 764, or 1.6 per cent had a second primary cancer occurring during the same period. The distribution of the second site was gastric cancer in 200 (26.2 per cent), breast cancer in 200 (26.2 per cent), colorectal cancer in 59 (7.7 per cent), cancer of the cervix uteri in 54 (7.1 per cent) and thyroid cancer in 37 (4.8 per cent). The gastric cancer was the Borrmann type 4, and the poorly differentiated scirrhous type. Incidence of the second cancer was enhanced, in the first period before 1971 and by contrast, in the second period after 1971 it was diminished. In the chemotherapy (+) group, the occurrence of the second cancer seemed to be strongly influenced by mitomycin C. In the radiotherapy prescribed group, leukemia was as frequent as esophageal cancer, and in those given endocrine therapy, breast cancer strongly inhibited the current one.

Perforated Diverticulitis of the Transverse Colon

Abstract: A case of localized, perforated diverticulitis of the transverse colon in a 45-year-old woman is presented. Preoperatively, this rare disease is indistinguishable from other acute surgical conditions, and often is mistaken for carcinoma at laparotomy. This report increases awareness of this unusual condition, and emphasizes the clinical, diagnostic, and therapeutic implications. Case reports described in the literature are reviewed.

Enhanced chemosensitivity of cells from malignant effusions under condition of exposure to high temperature.

Abstract: Utilizing a clonogenic assay, the effects of hyperthermia and selected chemotherapeutic drugs on growth of cells from malignant effusions were studied. Fourteen of 25 samples obtained from 25 patients with various carcinomas formed at least 30 colonies per plate. Exposure of the cells to heat at 42°C for 1 hr before the plating slightly inhibited the colony growth. The drugs, adriamycin (AM) and mitomycin C (MMC), were tested at 3 different concentrations. When the cells were treated with these two drugs for 1 hr at 42°C, the percent of surviving colonies was significantly decreased, as compared to findings at 37°C, in both groups, at 3 different concentrations. The combination of drugs and hyperthermia appeared to function synergistically in one-third of such cases. These results suggest that cells from malignant effusions in patients with various carcinomas were more sensitive to AM or MMC, under condition of a higher temperature (42°C).

Early mucosal changes in dimethylhydrazine-induced colonic carcinogenesis in rats.

Abstract: Early mucosal changes in dimethylhydrazine (DMH)-induced colonic carcinogenesis were investigated in 12 rats. These rats received subcutaneous injections of DMH in a dose of 15 mg/kg/week. Two rats each were killed at 6, 8, 10, 14, 18 and 22 weeks after initiation of the DMH-treatment. Overt carcinomas developed in 3 out of 4 rats killed after the 18th week of DMH-treatment. Histopathologically, epithelial dysplasia was present in the flat colonic mucosa of all 6 rats killed after the 14th week of DMH-treatment. Neither grossly visible tumors nor histopathological dysplasia was present in the colon of the 6 rats killed before the 14th week of DMH-treatment. However, cytophotometric DNA analysis disclosed that significant increases in proliferative activity of mucosa had occurred 4 weeks before the appearance of histopathological dysplasia, and 8 weeks prior to development of grossly visible tumors. Therefore, changes in the flat mucosa of a tumor-bearing colon represents a primary precancerous condition.

A plastic rod to facilitate longitudinal incision of the bowel: an inexpensive and practical device

Abstract: A plastic rod to facilitate long antimesenteric incisions of the bowel is described.

Surgical oncology in university departments of surgery in the United States.

Abstract: • Data on surgical oncology and multidisciplinary cancer program activity were obtained from 124 of 126 university surgery departments in the United States. Most of these institutions have American College of Surgeons—approved cancer programs (84%) as well as divisions of medical (95%), radiation (94%), pediatric (76%), and gynecologic (79%) oncology. Only 47 departments (38%) have formal divisions of surgical oncology. There are no major staffing or activity differences in surgical departments with or without such divisions, but multidisciplinary cancer program activity is greater in those institutions with a surgical oncology focus. Peer-reviewed cancer research grants are more frequent in departments of surgery with a surgical oncology division (68% vs 47%). The activities of the existing 47 divisions of surgical oncology are mainly operative, with breast cancer, melanoma, and soft-tissue sarcomas being the major clinical responsibilities. Chemotherapy is also frequent (81%). Cancer education for undergraduate and postgraduate surgical trainees is a major responsibility of most divisions, but only a small proportion (28%) have postresidency surgical oncology training programs. In contrast to the growth of some oncologic specialties, the establishment of surgical oncology within university departments has been slow, and the manpower needs appear modest. ( Arch Surg 1986;121:1088-1093)

Surgical Oncology in Children

Abstract: The only chance of curing a malignant solid tumour before the advent of radio- and chemotherapy was by radical surgical excision. Cure was usually only possible in early localized disease, and with most of the childhood cancers survival was less than 20% [1]. Radiotherapy was the first effective nonsurgical treatment used mainly for surgically inaccessible sites or palliatively in advanced disease.

Graduate education and training in surgical oncology.

Abstract: Training programs in surgical oncology have been developed at a number of institutions in the United States, employing guidelines developed by the Society of Surgical Oncology. Eight training programs have been approved by the Society. The program at the UMDNJ‐New Jersey Medical School is described in detail with comments on its evolution and current methods of training. The extensive advanced training in cancer surgery is complemented by rotations in medical oncology, radiation oncology, surgical pathology, and by both laboratory and clinical research experience. In addition, a course in the basic science of oncology is given. Increasing numbers of surgeons‐in‐training are applying to such programs. A list of selected publications in surgical oncology is provided.

Enhanced tumor metastases upon drug delivery in cross-linked albumin beads.

Abstract: Growth of the murine hepatoma H6 was significantly suppressed by amiloride, a sodium influx inhibitor. Primary tumor growth inhibition was augmented by loading the drug into cross-linked albumin carriers, but lung metastases were enhanced. These results emphasize the importance of using metastatic tumor models when testing new drugs and/or alternative modes of drug delivery.

Progress in Pediatric Solid Tumors

Abstract: Since 1980, impressive progress in the treatment of solid tumors has altered the practice of pediatric surgical oncology. Because these advances have been balanced by both liberal and conservative viewpoints, an accurate reassessment of traditional approaches has been possible. Noteworthy alterations in chemotherapy, radiation therapy, and surgical attitudes have improved survival rates and lessened the morbidity associated with malignant disease. Close cooperation among surgeons, pediatricians, and oncologists remains the common denominator in the successful treatment of pediatric solid tumors. This article presents examples of progress in the treatment of Hodgkin's disease, metastatic pulmonary disease, Wilms' tumor, and rhabdomyosarcoma and discusses the role of surgical intervention in conjunction with chemotherapy and radiation therapy.

Secondary penile malignancies.

Abstract: To the Editor:--We were interested to read the paper, \"Ileal Pouch-Anal Anastomosis without Temporary, Diverting I leostomy,\" by Metcalf et al. (Dis Colon Rectum 1986;29:33-5), and would like to comment on their findings. Of the nine patients reported, three (33 percent) developed anastomotic stenosis requiring dilatation. This is considerably higher than the 12 percent incidence of this complication reported by the same authors 1 in a larger group of patients who had a diverting ileostomy constructed. The incidence of proven sepsis and the number of pouches requiring excision is similar in the two series. However, the higher incidence of stenosis (33 percent) is presumably a reflection of an increased incidence of subclinical leakage, and indicates that construction of an ileoanal pouch requires a covering, temporary, diverting ileostomy.

Intraperitoneal administration of antibiotics.

Abstract: To the Editor:roWe agree with Silverman et al. (Dis Colon Rectum 1986;29:165-9) 1 and support the use of local antibiotics in potentially contaminated or contaminated abdominal operations. In the past, many studies have been published advocating peritoneal washing with a variety of antimicrobial drugsA -3 This useful maneuver, however, has not gained wide acceptance, possibly because in most studies, a variety of confounding factors in the development of infectious complications have not been taken into account.t-3 In a similar prospective study 4 we recently completed, four important confounding factors were specifically controlled: 1) the use of systemic antibiotics and the timing of their administration, 2) the use of intraperitoneal drainage, 3) the type of surgical incision, and 4) the type of wound closure used. One hundred one consecutive patients with peritonitis from diverse causes were randomized into two comparable groups. Their only difference was the local administration of 2 gm of chloramphenicol, diluted in 50 ml normal saline in the study group (50 patients). The same antibiotic was administered parenterally for three days perioperatively in both groups. Chloramphenicol was selected because it has been shown to increase chemotaxis and phagocytic activity of polymorphonuclear leukocytes and macrophages, s in addition to being an excellent bacteriostatic agent for aerobic and anaerobic bacteria, and it possibly is bacteriocidal in high doses. 6 Multiple linear regression and discriminant analyses were applied, to control for the confounding effects of age, sex, cause of peritonitis, and estimated time between onset of peritonitis and operation. The results were significantly better in patients receiving chloramphenicol locally as far as duration of postoperative ileus, hospital stay, infectious complications and deaths. Our study supports the notion that: 1) the combination of washing and local antibiotics is superior to washing alone, and 2) chloramphenicol may be the drug of choice for local use in generalized peritonitis. References

Principles of Surgical Oncology

Abstract: As a general rule, surgery and radiation therapy are utilized for local and regional control of cancers, while chemotherapy, hormonal therapy, and immunotherapy are used for systemic control.

The plight of medicine

Abstract: IT IS A GREAT HONOR for me to be the 23rd member of the Society chosen to deliver the Joseph M. Mathews Oration. I thank the executive committee and everyone who had a part in such an honor. I have chosen a timely subject, given the present atmosphere in which medicine, as a whole, is undergoing a serious threat to its integrity and to its function, evidenced by the innumerable media and journalistic reports that have flooded our airways and periodicals in the last few years. Medicine began as the \"Good Samari tan\" many centuries ago. Individuals who thought they were capable of curing h u m a n ailments and suffering or believed that they had a divine gift for healing assumed the role of physicians or \"medicine men.\" It was a beginning steeped in mystery because of ignorance, but one that presupposed trust, and out of which developed an increasing understanding of the ways of the physical world. We have come a long way since that beginning, and we can thank education, research, and modern technology for the great achievements medicine has made progressively to this day.