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Biomedical subjects

D G Coit

Publications and source records attributed to D G Coit.

66 records · Page 4Linked to original sources
PubMed1989

Major amputation for advanced malignant melanoma.

The Memorial Sloan-Kettering Cancer Center experience with major amputation for advanced malignant melanoma from 1965 to 1984 is reported. This is a retrospective review of 58 patients who underwent hemipelvectomy, disarticulation of the hip and above knee or forequarter amputation for advanced or recurrent malignant melanoma. Major amputation with curative intent was performed upon 43 patients. There were three deaths that occurred 30 days postoperatively (7 per cent). Intransit metastasis was one of the indications for amputation in 33 patients, and local control of disease was achieved in 30 of 43 patients. The median time to recurrence in those patients who did have a recurrence was 12 months (a range of 18 days to 16 years). Fifteen of 40 patients who survived the operation had no evidence of disease five years after undergoing a major amputation. Age, sex, primary site, stage of disease at diagnosis and amputation, disease-free interval and positive node status at any time during the course of the disease were not predictive of the outcome. Neurovascular involvement with melanoma and positive margins of resection predicted early failure. A palliative amputation for impending major vascular disruption or extensive, fungating disease was performed upon 15 patients. There was one death 30 days after the operation, and generally, hospitalization did not exceed 30 days. Median survival time was five months. All of the patients died of local or distant disease within 33 months of treatment. Local recurrence preceded death in nine of 15 patients.

Adolescent↗
PubMed1989

A simple modification of closed suction drainage systems.

A simple modification (patent pending) of existing systems of closed suction drainage is described herein. This system maintains patency in a closed sterile manner and facilitates sampling of drainage for laboratory analysis.

Drainage↗
PubMed1984

Alpha-factor-directed synthesis and secretion of mature foreign proteins in Saccharomyces cerevisiae.

Saccharomyces cerevisiae cells were transformed with plasmids containing hybrid genes in which the sequence encoding mature human epidermal growth factor was joined to sequences encoding the leader region (preprosegment) of the precursor of the yeast mating pheromone alpha-factor. These cells accurately process the hybrid protein and efficiently secrete authentic biologically active human epidermal growth factor into the medium.

Amino Acid Sequence↗
PubMedDate not supplied

Desmoplastic small round cell tumors: prognostic indicators and results of surgical management.

BACKGROUND: Desmoplastic small round cell tumors (DSRCT or DSCT) are rare aggressive cancers of adolescence and early adulthood. There are few reported series to guide clinical therapy. This study correlates survival with treatment variables, including aggressive surgical debulking. METHODS: Thirty-two patients with documented DSRCT received treatment at our institution. Demographic, clinical, and treatment variables were correlated with progression-free survival using log-rank statistics. RESULTS: Thirty patients were male (96%), and two were female (4%), with a median age at diagnosis of 22 years. The primary site of disease in 97% of cases was the abdomen or pelvis. Twenty-nine patients (91%) had extensive disease involving peritoneal surfaces, lymph nodes, or discontinuous organs. All 32 patients received systemic chemotherapy. Fifteen (47%) underwent tumor debulking greater than 90% at diagnosis or during therapy. A complete or very good response to therapy occurred in 13 patients, and depended on surgical removal of bulk disease in all. Thirteen patients remained progression-free, but three of these patients died from treatment toxicity. Improved survival was correlated with a complete or very good partial response to multimodality therapy, surgical debulking of more than 90% either before or after chemotherapy, and use of the P6 protocol. CONCLUSIONS: DSRCT is an aggressive cancer that occurs predominantly in young males. Improved survival is correlated with intense chemotherapy and aggressive resection.

Abdominal Neoplasms↗
PubMedDate not supplied

Computed tomography in evaluation of patients with stage III melanoma.

BACKGROUND: Metastatic disease is detected infrequently by computed tomography (CT) in early stage melanoma. The diagnostic yield of routine CT for stage III melanoma is less established, despite extensive use in clinical practice. METHODS: Charts from 347 asymptomatic patients with stage III melanoma were reviewed. Findings suggestive of metastatic melanoma identified by head or body CT, chest radiography, bone scan, or liver function studies were confirmed histologically or by progression of disease. RESULTS: Individual CT scans identified 33/788 (4.2%) instances of metastatic melanoma, with 66/788 (8.4%) false positive studies. No metastases were identified among 104 head CT scans. Chest CT had the highest yield in patients with cervical adenopathy (7/35, 20%), and the lowest yield with groin adenopathy (1/50, 2%). Pelvic CT diagnosed metastases in 7/94 (7.4%) patients with groin adenopathy, but no patients with palpable axillary (n = 76) or cervical (n = 21) nodes. Metastatic melanoma was diagnosed in 11/136 (8.1%) patients having complete body CT imaging (chest, abdomen, and pelvis), including six patients (4.4%) identified by CT alone. CONCLUSIONS: Routine CT in patients with clinical stage III melanoma infrequently identifies metastatic disease. Head CT in the asymptomatic patient, chest CT in patients with groin adenopathy, and pelvic CT in the presence of axillary or cervical adenopathy are not indicated. Selective use of chest CT in patients with cervical adenopathy or pelvic CT in the presence of groin disease may be useful.

Adolescent↗
PubMedDate not supplied

Detection of tyrosinase mRNA by reverse transcription-polymerase chain reaction in melanoma sentinel nodes.

BACKGROUND: Sentinel lymph node (SLN) biopsy is an alternative to elective dissection or observation for management of lymph node basins in patients with cutaneous melanomas. The detection of tyrosinase mRNA in melanoma SLN specimens by reverse transcription-polymerase chain reaction (RT-PCR) has been reported to be a more sensitive method to detect subclinical metastases, compared with histological analysis. The aims of this study were to (1) define the yield of RT-PCR in assessing SLNs, compared with histological analysis, (2) identify the incidence of false-positive results in SLNs, and (3) report the rate of actin PCR negativity (i.e., samples with degraded RNA) in SLNs. METHODS: Twenty-eight patients with 1.2-9.6-mm cutaneous melanomas underwent SLN biopsy (between October 1996 and March 1997). One half of each SLN was analyzed by nested RT-PCR for tyrosinase mRNA. The other half of the SLN was examined by routine microscopy. Twenty-one lymph nodes from patients without melanoma were evaluated as controls. RESULTS: Two of the 28 patients with melanoma were excluded because of RNA degradation, as indicated by actin negativity. Six of the remaining 26 patients exhibited melanoma metastases in routine histological examinations. All histologically positive lymph nodes were RT-PCR-positive. Thirteen of the 20 (65%) histologically negative cases were RT-PCR-positive. Of 21 control lymph nodes, 3 were actin-negative and were not assessable for tyrosinase mRNA. Two of the remaining 18 (11%) negative-control nodes were RT-PCR-positive. CONCLUSIONS: Among patients undergoing SLN biopsy, tyrosinase mRNA was detectable in 73% of SLNs from patients at risk for regional nodal metastases, including all of those with histologically positive SLNs. There is a definable false-positive rate for tyrosinase mRNA detection in the lymph nodes of patients who do not have melanoma. Actin verification of RNA integrity is necessary to ensure the accuracy of this test in detecting tyrosinase mRNA. Ongoing follow-up monitoring will define the prognostic value of this assay.

Adolescent↗
PubMedDate not supplied

Does the extent of operation influence the prognosis in patients with melanoma metastatic to inguinal nodes?

BACKGROUND: The role of pelvic lymphadenectomy in melanoma metastatic to the superficial inguinal region remains controversial. Some researchers advocate aggressive surgical management, whereas others feel that outcome depends more on extent of disease rather than extent of treatment. We reviewed our recent experience to investigate possible therapeutic effects of extended surgery. METHODS: We performed a retrospective clinical and pathological review of 227 consecutive patients having superficial (SLND) or combined inguinal lymphadenectomy (CLND) for cutaneous melanoma. RESULTS: A total of 174 SLNDs and 53 CLNDs were performed. Overall 5-year survival for node-positive patients was 39%. Survival for patients with positive superficial nodes was 40%; for those with positive deep nodes it was 35% (P = ns). In node-positive patients, number and size of involved lymph nodes and the presence of extranodal spread, failure to receive adjuvant therapy, and tumor ulceration were associated with poorer prognosis. Extent of surgery was not associated with differential survival, although CLND patients had worse pathological features. Subgroup analysis showed no significant survival difference between SLND and CLND. CONCLUSIONS: Some patients with deep nodal involvement apparently are cured by CLND. However, it is the biology of the disease and not the extent of surgery that primarily governs outcome. Patients with clinical or radiological evidence of pelvic nodal disease without evidence of systemic disease should have a CLND, but we find no evidence to support CLND if the pelvic nodes are clinically and radiologically negative.

Adolescent↗
PubMedDate not supplied

Is intra-abdominal drainage necessary after pancreaticoduodenectomy?

Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.

Abdomen↗
PubMedDate not supplied

Lymphatic mapping in the management of melanoma in children.

Lymphatic mapping allows the surgeon to identify and remove the first draining (sentinel) lymph node from a primary melanoma with minimal morbidity. The procedure facilitates accurate staging and identification of patients in need of additional therapy. We used lymphatic mapping and sentinel lymph node biopsy in two children with melanoma. Both patients had evidence of metastatic melanoma in their sentinel lymph nodes and underwent regional lymphadenectomy. Malignant melanoma and atypical pigmented lesions in children remain diagnostically challenging for the pathologist and clinician. Misdiagnoses occur, and the correct interpretation of a melanocytic tumor is too often made only after recurrence or metastasis has occurred. The use of lymphatic mapping facilitates accurate staging and identifies children in whom additional therapy may be indicated. In addition, it can assist in the assessment of the biologic potential of a difficult lesion.

Adolescent↗
PubMedDate not supplied

Role of surgery for metastatic malignant melanoma: a review.

The role of surgery in the management of metastatic melanoma is reviewed. Favorable prognostic factors include a longer disease free interval, single site of disease, complete resection, and nonvisceral metastases. Patients undergoing complete resection of remote nonvisceral metastases have a median survival of 17-50 months, and a 5-year survival (5YS) of 9-35%. Patients with pulmonary metastases are usually asymptomatic; complete resection results in a median survival of 8-20 months, and a 5YS of 10-25%. In contrast, patients with metastases to brain or gastrointestinal tract are usually symptomatic; resection offers good palliation, but their median survival is only 7-10 months with few long-term survivors. The key to effective surgical management of patients with metastatic melanoma is careful patient selection.

Humans↗