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Biomedical subjects

B J Flehinger

Publications and source records attributed to B J Flehinger.

At least 37 records · Page 2Linked to original sources
PubMed1984

Non-small-cell lung cancer: results of the New York screening program.

Radiographs of 168 patients with non-small-cell lung cancer were reviewed. Following a negative initial examination, 102 tumors were detected during routine annual screening, while 66 were diagnosed during the interval between screenings. The cancers detected on routine yearly examination were smaller; the rate of resectability was higher, a larger number were Stage I, and survival was better. Within the routinely screened group, 65% had evidence of cancer on reviewing earlier radiographs; these patients tended to have earlier stages of cancer and a better survival rate.

Adenocarcinoma↗
PubMed1984

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study.

This is a report of the initial (prevalence) screening for lung cancer in a population of 10.040 cigarette-smoking men 45 yr of age and older, recruited from metropolitan New York. All had posteroanterior and lateral chest roentgenograms, and approximately half the men, randomly chosen, also had sputum cytology (dual screen). Fifty-three confirmed lung cancers were found; 22 (40%) were AJCC Stage I, with 85% survival for 5 yr after resection, whereas only 2 of the remaining men with Stage II to III lung cancer lived longer than 3 yr. In the dual screen group, in which the 2 detection techniques could be compared, 6 Stage I lung cancers were detected by radiology alone, 7 by cytology alone, and only 1 by both techniques. All of the cases detected by cytology alone were squamous carcinomas, whereas two thirds of those detected by radiology alone were adenocarcinoma.

Adenocarcinoma↗
PubMed1984

Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York.

The Memorial Sloan-Kettering lung cancer screening program was begun in 1974 to evaluate sputum cytology as a supplement to the annual chest x-ray examination for early detection and diagnosis. The 10,040 adult, male cigarette smokers who enrolled were randomly assigned to receive annual chest x-ray examinations only or a dual screen with annual chest x-ray examination and four monthly sputum cytology evaluation. Over 40 percent of the 288 who developed lung cancer were diagnosed in stage I, and their survival was 76 percent at five years; overall survival was 35 percent. Nearly one third of the lung cancers detected on first examination on the dual screen, and 14 percent of those on subsequent examinations were found by cytologic examination. The same number of cancers developed in the x-ray screen only group, and were diagnosed at a later date. Despite the delay, survival and mortality were the same, suggesting that the squamous carcinomas detected by cytologic examination alone are very slow growing and tend to remain localized until detectable by x-ray examination.

Carcinoma↗
PubMed1983

Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases.

From 1974 to 1981, 1598 patients with non-oat cell carcinoma of the lung were seen and treated. All were staged according to the AJC staging system. Of these, 706 patients had evidence of mediastinal lymph node metastases (N2). There were 151 patients (21%) who had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The histologic type of tumor was adenocarcinoma in 94 patients, epidermoid carcinoma in 46 patients, and large-cell carcinoma in 11 patients. The extent of pulmonary resection consisted of a lobectomy in 119 patients, pneumonectomy in 26 patients, and wedge resection or segmentectomy in six patients. Almost all patients also received radiation therapy to the mediastinum. Clinical staging of the primary tumor and the mediastinum was based on the radiographic presentation of the chest and on bronchoscopy. Before treatment, 104 of 151 patients (69%) were believed to have had stage I (90 patients) or II (14 patients) disease, and 47 patients had stage III disease, of whom only 33 had evidence of mediastinal lymph node involvement. Excluding deaths from unrelated causes, the overall survival rate was 74% at 1 year, 43% at 3 years and 29% at 5 years. Survival in patients with clinical stage I or II disease treated by resection was favorable despite the presence of N2 nodes (50% at 3 years). Survival in obvious clinical N2 disease was poor (8% at 3 years). There was no difference in survival between patients with adenocarcinoma and those with epidermoid carcinoma. However, survival was poorer in patients with N2 nodes in the inferior mediastinum compared to those without lymph node involvement at that level.

Adenocarcinoma↗
PubMed1983

Prognostic significance of N1 disease in carcinoma of the lung.

From 1973 to 1981, 75 patients with T1 N1 M0 and T2 N1 M0 disease had a complete, potentially curative resection with mediastinal lymph node dissection. Thirty-eight had adenocarcinomas, 36 epidermoid cancer and one large cell carcinoma. Surgical treatment consisted of lobectomy in 54, sleeve lobectomy in three, and pneumonectomy in 18. Two patients died postoperatively. Of 17 patients with T1 N1 disease, 14 had no further treatment and three received postoperative radiation and/or chemotherapy; the 5 year cumulative survival rate of these patients was 56%. There were 58 patients with T2 N1 disease. Forty-five had no further treatment and 13 received postoperative radiation and/or chemotherapy; the 5 year cumulative survival rate of these patients was 48%. The overall incidence of local and regional recurrence was low, and the brain was the most frequent site of recurrence. Factors influencing recurrence were histology and proximity of the tumor to hilum. The specific nodes involved, the number of nodes affected, and the extent of involvement within the nodes had no observed effect on survival. There was no observed improvement in survival with the use of adjuvants. However, survival was significantly poorer in patients with visceral pleural involvement.

Adenocarcinoma↗
PubMed1982

Complications of surgery in the treatment of carcinoma of the lung.

Nine hundred sixty-one patients underwent operations for the treatment of carcinoma of the lung; 18 percent of these were 70 years of age or older. The effect of various factors, singly or in combination, on the incidence of postoperative complications was assessed. Variables included age, sex, cardiopulmonary status, cell type, stage of the disease, and type of procedure performed. The postoperative course was uneventful in 81 percent of the patients; 8 percent had minor complications, 9 percent major complications and 2 percent died. The majority of the complications were cardiorespiratory. High risk factors were identified to be old age, restricted cardiopulmonary reserve, and the need for pneumonectomy. The low incidence of mortality and major morbidity observed was attributed to careful preoperative evaluation, selection of the appropriate surgical procedure, and inclusion of routine preoperative physiotherapy in all patients.

Adult↗
PubMed1981

Detection of true pathologic stage I lung cancer in a screening program and the effect on survival.

One-hundred-sixty-nine lung cancers have occurred to date among 10,040 cigarette smoking men who participated in the New York Lung Cancer Detection Program. Almost 40% of the cases, 65, were still Stage I when their disease was diagnosed; 62 had thoracotomy and resection, and in 57, mediastinal node dissection confirmed that the mediastinum was free of metastases ("true pathologic" Stage I). Fifty-four of the 62 (87%) are still alive at this time, while only 15 of 104 (14%) of those with Stage II and III lung cancers are alive. Only two patients of the 62 in Stage I who were treated by resection died of lung cancer, both with T2 tumors. Two others are alive with metastases, one died postoperatively, and five died of other causes without evidence of lung cancer. The estimated probability of survival for true Stage I lung cancer is over 90% at five years, and close to 40% of all lung cancers can be detected in this favorable stage by present radiologic and cytologic screening techniques.

Adenocarcinoma↗
PubMed1980

Radiologic diagnosis of oat cell cancer in a high-risk screened population.

A screening program of 10,040 cigarette-smoking men over 45 years of age was undertaken in an attempt to achieve earlier diagnosis, thereby increasing the cure rate, of oat cell lung cancer. Of the 155 men who were found to have lung cancer, 27 (17%) had confirmed oat cell cancer. Only one case was diagnosed at the first examination. The other 26 cases (called incidence cancer) were diagnosed by subsequent examinations. In 24 of the 26 patients, the tumor was not found until it was advanced (Stage III), and of these patients, only one is alive at 21 months follow-up. Two tumors were diagnosed as oat cell carcinoma at an early stage (Stage I), and both patients are alive with no evidence of disease at seven and 24 months. The screening program used in this study did not succeed in detecting oat cell cancer at an early stage.

Aged↗
PubMed1980

Metaphase chromosome associations: Colcemid distorts the pattern.

The nonrandom pattern of the spatial arrangement of chromosomes in the human metaphase complement has been resolved into separate properties by statistical analysis of matrices of ranks of interchromosomal distances averaged over sets of 25 or 50 metaphases. Assessment of the effect of a mitotic-arresting agent, Colcemid, on each of the properties of the pattern shows that those properties for which a spindle fiber dependence may be postulated are disordered by Colcemid, while the tendency for the acrocentric chromosomes to associate, attributable to their mutual participation in nucleolar organization, is not impaired by Colcemid. Furthermore, this analysis has revealed that chromosomes 21 and 22 display an exceptional propensity to be generally associative, i.e., to be close to all chromosomes; that property is obliterated by Colcemid. Since a mitotic-arresting agent is routinely used in the preparation of cells for cytogenetic analysis, that property has hitherto not been recognized.

Adult↗
PubMed1978

Patterns of association in the human metaphase complement: ring analysis and estimation of associativity of specific chromosome regions.

The pattern of metaphase chromosome association in the human complement was studied by two methods of statistical analysis of interchromosomal distances. Those methods included ring analysis in which a characteristic position of the centromere of each chromosome relative to the center of a two dimensional representation of a metaphase complement was defined, and estimation of the capacity for associativity of each of three regions of each chromosome: the centromere (c) and the ends of each arm (p, q). The following information was obtained: 1. In general, the distance from the center is directly related to chromosome size. 2. The most notable deviation from that size-related progression is displayed by the X chromosomes. The markedly peripheral position of the X is characteristic of both X's of the female and the single X of the male. 3. The relative associativity of each chromosome of the complement is, in general, inversely related to size with an additional preferential capacity of associativity displayed by the acrocentric chromosomes. Analyses of the different inter-regional classes established that the supplementary associativity factor of the acrocentric chromosomes was inherent in their pericentromeric and p-arm regions and excluded the ends of the q arms from participation in that factor. 4. Those analyses demonstrated that the specific morphology or 'geometry' of the acrocentric chromosomes contributes little to their high relative associativity. In addition to the tendency for the c/p regions of the acrocentric chromosomes to associate with each other, presumably because of their common function in nucleolar organization, those regions also displayed a propensity to associate with the distal regions of the arms of other chromosomes. A molecular basis for that propensity other than that of ribosomal DNA is postulated to be that of other fractions of highly reiterated DNA sequences. 5. Analysis of the relative associativities of each of the three regions of the Y chromosome revealed that the Yq displays a much stronger capacity to associate with the c's of other chromosomes than does the Yc or Yp.

Adult↗
PubMed1978

Accuracy of chest film screening by technologists in the New York early lung cancer detection program.

A study of the feasibility of using specially trained radiologic technologists to screen chest radiographs was undertaken as part of an early lung cancer detection program. In their initial examination, 8,000 men had posteroanterior and lateral chest films which were prepared and evaluated by two specially trained technologists prior to interpretation by a radiologist. The technologists' accuracy in screening was subsequently assessed by comparison with the radiologist's interpretation and with clinical follow-up information. There were differences in the level of suspicion of the two technologists, but both were effective in selecting a subset of the screened population that contained the men with radiologically identifiable lung cancer.

Humans↗
PubMed1977

Radiologically occult in situ and incipient invasive epidermoid lung cancer: detection by sputum cytology in a survey of asymptomatic cigarette smokers.

Approximately 8000 cigarette-smoking men over the age of 45 have entered into a lung cancer detection program in New York City. Cytologic examinations of sputum were carried out on 4000 subjects and lung cancer was found by this technique in nine men with normal chest x-rays. Seven had in situ or incipient invasive epidermoid carcinoma confined to the bronchus. These seven cases were studied by detailed histologic examinations of the bronchial tree in the resected specimens through sixth generation subsegmental bronchi. It was concluded that: 1) invasive epidermoid carcinoma arises from carcinoma in situ of bronchial surface epithelium or an extension of that neoplastic epithelium in bronchial glands; 2) the site of origin is a segmental bronchus in most instances; and 3) each carcinoma should be considered as unifocal in origin even though there is a continuing risk of another primary lung cancer. It seems unlikely that squamous metaplasia or basal hyperplasia is an essential step in carcinogenesis; rather, we believe that carcinoma may arise in bronchial epithelium without regard to the presence or absence of basal hyperplasia or squamous metaplasia, which should be considered nonspecific reactions to injury that may or may not accompany carcinogenesis.

Bronchoscopy↗