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Biomedical subjects

A S Ketcham

Publications and source records attributed to A S Ketcham.

At least 37 records · Page 2Linked to original sources
PubMed1985

Hartmann's pouch carcinoma.

Since 1921, when Henry Hartmann first described his procedure for rectal carcinoma, multiple modifications of the original technique have been proposed. However, the basic principle of a rectal pouch has always been retained. Two cases of carcinoma developing in such a pouch are described; both occurred years after creation of the pouch. One was managed by local resection through a transsacral approach; the other required an abdominoperineal resection. Consideration must be given to careful examination and sigmoidoscopy of these pouches as they tend to be forgotten by the physicians due to their hidden location.

Adenocarcinoma↗
PubMed1985

Hyperthermia for cancer: a practical perspective.

A causal relationship between hyperpyrexia and tumor regression was first suggested in 1866, when Busch reported the cure of a histologically diagnosed sarcoma in a middle-aged woman, following a bout of erysipelas. Over the years, interest in the effect of heat on cancer has remained alive, but this interest has increased dramatically in recent years. The literature on this subject is broadly reviewed and the clinical results discussed. It is apparent from clinical studies thus far that it is a relatively simple undertaking to treat superficial neoplasms with hyperthermia. However, the major challenges in clinical thermotherapy pertain to patients with deeply situated tumors. The lack of safe and reliable methods of monitoring temperature in deep tissues is a major impediment to a thorough understanding of thermal dosimetry in clinical hyperthermia, and routine thermal dosimetry in clinical hyperthermia will have to await the development of reliable noninvasive thermometry. As responses have been reported with modest levels of hyperthermia, the need for thermometry is somewhat lessened, given that invasive monitoring is imperfect and somewhat risky when used in deeply seated tumours. The eventual place of thermotherapy in the treatment of malignant tumours in man is as yet unclear and must be rigourously and thoroughly assessed in well-designed, prospective, randomized patient trials.

Animals↗
PubMed1985

Primary squamous carcinoma of the rectum. Report of a case and review of the literature.

Squamous cell carcinoma of the colorectum is a rare pathologic curiosity. Since the first report by Schmidtman in 1919, only 69 cases have been reported in the English medical literature. The mean age at presentation is 52 years, and the disease presents itself equally in men and women. The rectum accounts for slightly less than one half of all cases. Survival appears to correlate with nodal status and findings of visceral metastases at presentation. Most tumors can be identified easily by physical examination and/or barium enema. Therapy is limited largely to surgical resection, although attempts at irradiation and chemotherapy have been made. At this time, the etiology of this disease process is unknown, but a likely explanation revolves around replacement of damaged epithelium by cells which undergo anaplasia due to repeated trauma. In addition to this review of the literature, the authors wish to add one additional report of a patient treated successfully by a multimodality approach.

Adult↗
PubMed1985

Tumors of the paranasal sinuses: a therapeutic challenge.

Cancer involving the ethmoid and sphenoid frontal sinus complex can be successfully eradicated by a combined transcranial and transfacial surgical dissection. Survival rates of 44 to 58 percent with a 3 percent hospital mortality rate in patients whose previous surgery or radiotherapy was largely unsuccessful suggest that this cosmetically acceptable surgical endeavor should be used more often by the head and neck surgeon in treating paranasal sinus cancer. Utilizing the principles of antibiotic prophylaxis, strict attention to principles of tumor removal and surgical technique, and the talents of the combined surgical and neurosurgical team, this aggressive surgical approach to the paranasal sinuses can be safely and successfully carried out. The approach described herein has the following advantages: it allows accurate evaluation of intracranial tumor extension while protecting the intracranial contents, it essentially avoids cerebrospinal fistulization, it provides adequate exposure for hemostasis, facilitates en bloc tumor resection, selectively conserves the orbital contents, and provides patient survival rates up to 58 percent for paranasal cancer that involves the ethmoid and sphenoid frontal sinus complex.

Combined Modality Therapy↗
PubMed1985

Preservation of the intercostobrachial nerve during axillary dissection for breast cancer.

Preservation of the intercostobrachial nerve during axillary dissection in 50 patients with stage I breast cancer resulted in a significant improvement in sensory function compared with the standard dissection in which the nerve is routinely sacrificed. No local recurrence was found during the 3 to 5 year follow-up period. This modification is worthwhile in patients with axillas that are clinically negative for cancer.

Afferent Pathways↗
PubMed1985

The Penrose drain: a safe, atraumatic colostomy bridge.

Because of the problems associated with the large, bulky bridges presently used for construction of loop ostomies, particularly complications of leaks and skin excoriation, we have studied the use of the Penrose drain as an alternative. This method has been time-tested on 45 patients and has been found to be safe, reliable, and inexpensive and has gained popularity among patients and ostomy nurses. The bulky colostomy bridge should no longer be accepted as a standard of care.

Colostomy↗
PubMed1985

A single layer open anastomosis for all intestinal structures.

Dissatisfaction with time-consuming double layer anastomoses in intestinal surgery and with occasionally questionable stapled anastomoses prompted a review of available techniques for hand sewn suture lines. Single layer anastomoses have been used extensively and their integrity and safety have often been questioned. In 1951, Gambee described a method of single layer anastomosis which, in practice, is a double layer technique. His results at 10 years were comparable to those obtained with other techniques. We have sought a modification to decrease anastomotic complications and improve ease of suture insertion. Along with a description of technique, a review of 170 anastomoses performed from July 1982 to June 1984 is presented without a single clinically apparent leak.

Humans↗
PubMed1985

The management of recurrent rectal carcinoma.

Rectal carcinoma remains an enigma to surgical and medical oncologists. The chemo- and radiotherapeutic approaches have been fraught with failure, and when this happens the patient is left to the challenge of the surgical oncologist who sometimes must perform extensive re-resection to include adjacent structures. Experienced surgical judgement is assisted by preoperative and intraoperative criteria, which are contraindications to resection: preoperatively, they include metastases, fixation of tumour to pelvic wall, sciatica, obstruction of both ureters and leg edema. Intraoperatively, metastases within aortic nodes or beyond the pelvis and extension of disease laterally or deep to pelvic wall or to multiple loops of bowel are all contraindications. These tumours are often slow to metastasize so that aggressive local surgical resection is warranted to minimize the morbidity prone complications associated with low-lying perineal or pelvic recurrence of rectal cancer.

Colonic Neoplasms↗
PubMed1984

Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease.

The treatment of a patient for multiple recurrent pilonidal disease failed all forms of conventional therapy. After re-excision, a gluteus maximus myocutaneous flap, measuring 15 X 15 cm and based on the superior gluteal artery, was swung to cover the defect. Complete relief from severe pain was obtained immediately. No recurrence is noted after two and one-half years of follow-up.

Adult↗
PubMed1984

The effects of syngeneic soluble tumor membrane extract on concomitant spleen cell immunity and spontaneous metastases.

The effects of a soluble tumor KCl extract, containing membrane antigen on spontaneous metastases and spleen cell immunity were studied in a syngeneic C57BL/6J murine sarcoma model. The extract was shown to be antigenically distinct from normal tissue by tumor immunization rejection experiments. Tumor soluble extract (SE) was administered daily during the growth of a murine sarcoma. The afferent and efferent arc of immunity were monitored by proliferative index (PI) and in vitro cytotoxicity of spleen cells, as well as the incidence of metastases. PI was significantly activated in the group receiving sarcoma SE as compared to the two control groups receiving muscle SE or saline P less than 0.05. However, in vitro cytotoxicity was significantly depressed on Days 7 and 14 (P less than 0.05) of tumor growth in the mice receiving sarcoma SE. The incidence of metastases was significantly increased to 70% in the sarcoma SE group as compared to the incidence in the control groups of 50% P less than 0.05. This data supports the hypothesis that release of soluble antigen membrane components by growing tumor facilitates the growth of metastases in this model.

Animals↗
PubMed1983

Extended myocutaneous flap to cover major pelvic and craniofacial defects.

Experience with the extended myocutaneous flap, including distal randomly vascularized tissue, is seldom reported. This report details the use of five extended flaps--sternocleidomastoid, posterior trapezius, total rectus abdominis, tensor fascia lata and inferior gluteal. An average delay of 2 weeks was used to ensure viability. These flaps facilitated the resection of otherwise inoperable craniofacial and pelvic tumours by providing a safe primary closure. Such flaps are unique in their size and their particular application.

Aged↗
PubMed1982

The total thigh and rectus abdominis myocutaneous flap for closure of extensive hemipelvectomy defects.

Hemipelvectomy is a lifesaving procedure when used appropriately and yields a 35%, five-year survival in the cancer patient. However, the standard posterior flap for closure is not always available. Two flaps, the thigh flap and the rectus abdominis myocutaneous flap, are described in which any soft tissue defect resulting from hemipelvectomy can be safely closed primarily when the posterior flap is not available. The total rectus abdominis flap is previously undescribed and unique in its application. These techniques significantly contribute to the surgeon's armamentarium for decreasing morbidity and mortality and resectability of unusual pelvic and thigh tumors.

Abdominal Muscles↗
PubMed1982

The closure of large pelvic defects by extended compound tensor fascia lata and inferior gluteal myocutaneous flaps.

This report describes the use of myocutaneous flaps in two unique situations with extensive pelvic and perineal defects. In the first patient, bilateral tensor fascia lata myocutaneous flaps 10 x 40 cm were rotated posteriorly to cover a perineal defect measuring 15 x 30 cm. In the second patient, bilateral inferior gluteus maximus myocutaneous flaps 10 x 32 cm were rotated to fill a pelvic defect 10 x 15 x 8 cm that remained after a pelvic exenteration and sacral resection. Both flaps were delayed 2 weeks prior to surgery to insure 100% viability.

Aged↗
PubMed1981

The APUD system and its apudomas.

As sensitive radioimmunoassays for the detection of polypeptide hormones are developed, the exciting discovery of a diffusely distributed system of interrelated endocrine cells has begun a new era of endocrinology. This system, although anatomically disassociated, is bound together by a number of common features such as its biosynthetic mechanism, histochemical and ultrastructural features, and embryologic origin (Table I). The most prominent feature, however, is their biosynthetic pathways for hormone production, from which the acronym APUD has been derived. These are the capacity for Amine Precursor Uptake such as DOPA and then subsequent Decarboxylation, resulting in the synthesis of bioactive amines or polypeptide hormones. Hyperplasias or neoplasms of these cells are defined as apudomas. In the last ten years a great deal of research has rapidly altered the original concepts of this system, especially in terms of its embryologic origin, physiologic interrelationships, classification, as well as the addition of many new APUD cell members. These will be reviewed, and the origin, diagnosis, and treatment of each recognized apudoma will be synthesized in light of its membership within the APUD system.

APUD Cells↗
PubMed1980

Intestinal fistula following pelvic exenterative surgery: predisposing causes and treatment.

An interest fistula is a life-threatening complication when associated with the treatment of pelvic cancer. Such fistulae arise in 10% of patients treated by the combination of aggressive surgery and radiation therapy. Nineteen such occurrences developing in 245 patients who had pelvic exenterations are used to demonstrate the need for directing immediate attention toward correcting the physiologic and metabolic abnormalities created by the fistulae. Local control of the fistulae is facilitated by techniques for identifying its cause and precise location.

Female↗