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Biomedical subjects

D L Roseman

Publications and source records attributed to D L Roseman.

At least 19 recordsLinked to original sources
PubMed1996

Survival after repeat hepatic resection for recurrent colorectal hepatic metastases.

BACKGROUND: This is a retrospective clinical study done to examine survival of patients undergoing repeat hepatic resection for recurrent colorectal hepatic metastases. METHODS: The records of 131 patients undergoing hepatic resection for metastatic colorectal cancer were reviewed. Curative resection was performed in 107 of these patients. Thirty-one experienced recurrences confined to the liver. Thirteen (13 of 107, 12%) of them underwent resection and make up the study population. RESULTS: The eight men (62%) and five women (38%) had a median age of 60 years (range, 32 to 75 years). In 30% of patients recurrence developed near the original resection site. In 70% the recurrences were remote from the original site. The patients underwent a total of six wedge resections, two left lateral segmentectomies, three right lobectomies, and two trisegmentectomies. Average blood loss was 2995 cc; average hospital stay was 17.2 days. Morbidity was 23% (3 of 13); mortality was 8% (1 of 13). Four patients died of recurrent disease, with a mean disease-free survival of 9.7 months (median, 7.5 months; range, 3 to 21 months) and mean total survival of 39 months (median, 24 months; range, 8 to 99 months). One of these patients had a second recurrence resected at month 21 and lived an additional 78 months. Seven patients were alive with no evidence of disease, with a mean follow-up time of 34.9 months (median, 14 months; range, 1 to 186 months). Actual 5-year survival was 23% (3 of 13). Actual disease-free 5-year survival was 15% (2 of 13). CONCLUSIONS: In properly selected patients morbidity, mortality, and survival after repeat resection are similar to those after initial resection.

Adult↗
PubMed1993

Synchronous, metachronous, and multiple hepatic resections of liver tumors originating from primary gastric tumors.

BACKGROUND: The role of hepatic resection for noncolorectal gastrointestinal malignancies involving the liver is not well defined. To address this issue we studied our experience with resection of liver tumors arising from primary gastric malignancies. METHODS: A retrospective study of 195 patients who underwent a total of 207 liver resections identified 12 patients with primary gastric cancer who underwent 16 resections for liver involvement. There were 10 adenocarcinomas and two leiomyosarcomas. We examined the type of hepatic surgery, the status of residual disease, and the primary histologic findings. Morbidity, mortality, and actual survival rates were recorded. RESULTS: Thirty-day operative mortality was 8.3% (1 of 12). Hospital mortality was 25% (3 of 12). Operative morbidity occurred in three of nine survivors (33%). Synchronous en bloc resection (n = 3) of stomach and liver for adenocarcinoma produced two long-term survivors (no evidence of disease for 10 and 13 years). Mean survival after synchronous discontinuous resection (n = 4) was 8 months (range, 2 to 17 months). Metachronous resection for adenocarcinoma (n = 3) produced one long-term survivor (74 months), and one patient with recurrent leiomyosarcoma underwent a total of five liver resections and survived 64 months. CONCLUSIONS: For adenocarcinoma, en bloc resection of contiguous liver involvement produced long-term survivors. Synchronous resection of discontinuous metastases did not. Metachronous resection of isolated disease and multiple resections of recurrent isolated disease may have value in carefully selected patients.

Adenocarcinoma↗
PubMed1992

Adjuvant therapy with a doxorubicin regimen and long-term tamoxifen in premenopausal breast cancer patients: an Eastern Cooperative Oncology Group trial.

PURPOSE: A randomized trial was performed in premenopausal postoperative women with ipsilateral axillary node-positive (N+) breast carcinoma and known estrogen receptor (ER) status to assess the efficacy of an Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH)-based induction regimen and 5 or more years of tamoxifen (Tam). PATIENTS AND METHODS: Patients received 12 28-day cycles of cyclophosphamide 100 mg/m2 orally days 1 to 14, methotrexate 40 mg/m2 intravenously (IV) days 1 and 8, fluorouracil 600 mg/m2 IV days 1 and 8, prednisone 40 mg/m2 orally days 1 to 14, and Tam 10 mg orally twice daily (CMFPT), or the same regimen plus halotestin 10 mg orally twice daily (CMFPTH) alternating monthly with 22-day cycles of vinblastine 4.5 mg/m2 IV day 1, Adriamycin 45 mg/m2 IV day 1, thiotepa 12 mg/m2 IV day 1, halotestin, and Tam (ALTER). Prednisone in the ALTER regimen was stopped after the second CMFPTH cycle. After 12 cycles, patients were again randomized to stop or continue Tam. After 5 years, patients on Tam were again randomized to continue or stop Tam; the results from this randomization are still coded. Among 533 analyzed induction cases, 263 received CMFPT and 270 ALTER. Among 396 analyzed maintenance cases, 201 continued Tam and 195 were observed. Pretreatment characteristics were balanced among treatments. The median follow-up times are 5.1 years for induction and 4.1 years for maintenance. RESULTS: The time to relapse (TTR) was superior for the ALTER regimen (P = .04) and for the maintenance Tam (P = .05). Overall survival comparisons between the regimens are not statistically different. A longer TTR was associated with decreasing nodal involvement, ER+ status, and increasing age. The favorable effects of decreasing nodal involvement and ER+ status carried over to survival; a progesterone receptor-positive (PgR+) status and decreasing tumor size were also associated with longer survival. Development of amenorrhea was associated with improved TTR and survival. Toxicity was similar for the two induction regimens and for the two maintenance regimens. Overall relapse patterns were similar among the induction regimens, but continuing Tam led to fewer locoregional relapses. CONCLUSION: The results suggest significant overall TTR therapeutic benefits of an Adriamycin-containing alternating induction regimen and of continuing maintenance Tam therapy for at least 5 years.

Adult↗
PubMed1990

Overcoming deficiencies of the rule-based medical expert system.

One of the current deficiencies of the rule-based expert system is its static nature. As these systems are applied to medicine, this shortcoming becomes accentuated by: the rapid speed at which new knowledge is generated, the regional differences associated with the expression of many diseases, and the rate at which patient demographics and disease incidence change over time. This research presents a solution to the static nature of the rule-based expert system by proposing a hybrid system. This system consists of an expert system and a statistical analysis system linked to a patient database. The additional feature of a rule base manager which initiates automatic database analysis to refresh the statistical correlation of each rule ensures a dynamic, current, statistically accurate rule base. The philosophical differences between data and knowledge are also addressed as they apply to this type of hybrid system. The system is then used to generate four rule bases from different knowledge sources. These rule bases are then compared.

Artificial Intelligence↗
PubMed1990

A positive family history of breast cancer. Does it effect diminish with age?

To determine whether the influence of family history on the incidence of breast cancer diminishes with age, we studied data from 9000 women: 2712 with breast cancer, 2972 with benign breast disease, and 3316 control subjects. Patients were divided into eight cohorts by age; for each, odds ratios were computed to compare cancer patients with patients who have benign disease and with control subjects for positive family history of breast cancer. For both sets of comparisons, odds ratios are highest for subjects from 30 to 34 years old. After the age of 45 years, odds ratios decline, and after age 60 years the odds of breast cancer occurring in women with a positive family history are no greater than it is in women without such a history. These results suggest that a family history of breast cancer is a determinant of breast cancer only for women under age 60 years. The mechanism through which this is effected needs to be studied.

Adult↗
PubMed1988

Elevated creatine phosphokinase MB in a patient with neuroendocrine carcinoma of the colon--evidence for a tumor marker. Report of a case.

Elevated creatine phosphokinase (CPK) MB isoenzyme has become accepted as a highly specific criterion for the diagnosis of myocardial infarction (MI). A patient with metastatic neuroendocrine carcinoma of the colon who had marked and persistent elevation of CPK-MB isoenzyme, in the absence of clinical and cardiographic evidence for MI, is described. The CPK-MB level was 25 percent (normal, less than 3 percent) on admission, 39 percent postoperatively, and 57 percent on discharge. A prompt decline in serum CPK-MB activity (11 percent, less than 3 percent) paralleled chemotherapy-induced tumor regression. Resurgence of the isoenzyme heralded recurrent disease. These findings suggest that CPK-MB may be a valuable adjunct marker in the diagnosis and monitoring of neuroendocrine carcinomas.

Biomarkers, Tumor↗
PubMed1988

Intra-operative radiation therapy in the treatment of pelvic malignancies: a preliminary report.

Local control of advanced pelvic malignancies, particularly when complete surgical resection is not feasible, is often impeded by dosage limitations in radiation therapy and the intolerance to radiation of normal tissues. This is a preliminary report on the feasibility of improved local control in pelvic malignancies treated by intra-operative radiation therapy, as a radiation boost, in addition to conventional surgical resection and external beam radiation therapy. Fifteen gynaecological malignancies (five cervix, five uterus, four ovary, and one vulva) from Rush Medical College and the University of Navarre, as well as 36 other pelvic malignancies (32 colorectal, 4 genito-urinary) from Rush Medical College were reviewed. All tumours were advanced or recurrent, and all patients were felt to be at high risk of local failure. IORT was administered at a dose range of 10-26 Gy. Our data suggest that the probability of local control improves when IORT is used for primary and for microscopic disease, when the tumour is at least partially resectable, and when the total dose given in IORT and external beam radiation exceeds 70 Gy.

Brachytherapy↗
PubMed1988

Neuroendocrine carcinomas of the colon and rectum: a clinicopathologic evaluation.

Neuroendocrine carcinomas were diagnosed in 13 of 683 patients who had colon cancers removed from January 1980 to June 1987 for an incidence of 1.9%. The patients were 28 to 89 years of age (median, 72 years). There were seven male and six female patients. The treatment was as follows: right hemicolectomy, 5; transverse colectomy, 1; left hemicolectomy, 1; low anterior resection, 2; abdominal-perineal resection, 1; and in 3 patients with rectal tumors, biopsy examination only was performed. Microscopic stages were as follows: Dukes' stage B, 1; stage C, 6; stage D, 5; and stage indeterminate, 1. By light microscopy, the tumors showed solid clusters or ribbons of round to fusiform, small to intermediate-sized cells with variably abundant mitoses. Eight tumors had foci of glandular and/or squamous differentiation. By immunohistochemistry, all tumors showed one or more neuroendocrine markers, including neuron-specific enolase, chromogranin, synaptophysin, serotonin, and various neuropeptides. By electron microscopy, single membrane-bound neurosecretory granules were noted. The sites of metastases included regional nodes, 8; liver, 5; bone, 1. Four patients were treated with a combination of chemotherapy and radiation therapy. These tumors were, as a group, aggressive, with eight patients dead within 12 months of diagnosis. Median survival was 7 months, with three patients alive at 2, 38, and 68 months, respectively. Specifically, small- and intermediate-cell neuroendocrine carcinomas of the colon and rectum behaved very aggressively and displayed numerous structural and functional similarities with their bronchopulmonary counterparts.

Adult↗
PubMed1988

Intraoperative radiation therapy in biliary tract cancer.

From 1983 to 1986, nine patients with advanced cancers of the proximal biliary tract were treated with intraoperative electron beam radiation therapy (IORT) following surgical resection or intubation. Five patients also received external beam radiation and four received chemotherapy. Early complications were minimal. Late complications included cholangitis, gastroduodenal ulceration, gastric outlet obstruction and portal vein thrombosis. Symptomatic recurrent or residual disease developed in eight patients with a median disease-free survival of 6 months. Seven patients failed locally; four recurred outside of the intraoperatively radiated field. The longest survivor is free of disease at 40 months; one patient is alive with disease at 30 months. Mean and median survivals were 16.8 months and 13 months respectively with 56 per cent 1-year survival. This was not different from a mean survival of 11 months and 46 per cent 1-year survival observed in 13 concurrent patients treated by external beam +/- 192Ir. Survival of six patients not treated by radiation was only 4.6 months (P = 0.3). Two thirds of patients had good or fair palliation. IORT has theoretical advantages for the treatment of locally advanced biliary cancer; preliminary results suggest useful palliation and potential long-term survival. Complications require ongoing evaluation and superiority to conventional treatment modalities has not been demonstrated.

Adenocarcinoma↗
PubMed1987

Multiparameter flow cytometric analysis of colon polyps.

Sixty-eight colonic polyps of various histologic types were studied using retrospective flow cytometric (FCM) DNA analysis to determine the prevalence of aneuploid cell populations and whether they were associated with any particular histologic features. Overall, 13 of 68 polyps (19%) contained DNA-aneuploid cells, including 3 of 9 villous and 4 of 10 villoglandular polyps with histologic features of carcinoma in situ (CIS), 4 of 11 villous and 1 of 18 villoglandular polyps without CIS, and 1 of 12 adenomatous polyps. Eight hyperplastic polyps were diploid. These results show retrospective FCM analysis can detect DNA aneuploidy in polyps; DNA aneuploidy may occur before histologic evidence of invasive carcinoma; and this change is more frequent in types of polyps thought to have increased malignant potential (i.e., those with villous morphology and/or CIS).

Adenoma↗
PubMed1986

Origin of multiple "primary" colon carcinomas. A retrospective flow cytometric study.

Multiple, synchronous, apparently primary carcinomas of the colon are a relatively common occurrence. The DNA ploidy in 23 colon carcinomas from 10 patients was determined to see if this parameter supported common or independent origins for such synchronous lesions. Paraffin blocks of each tumor were prepared for flow cytometry, then analyzed for nuclear DNA content. In 3 of the 10 cases, the tumors within each colon differed with respect to DNA ploidy; in four cases all tumors were diploid; and in three cases both (all) tumors within each colon had identical aneuploid DNA indices. Tumors from the same colon with identical DNA histograms often had dissimilar histology. The replicate aneuploid DNA indices strongly suggest a common origin for the multiple tumors within these colons; tumors in the other groups are compatible with either single or multiple origins. These findings suggest that multiple "primary" colon carcinomas may, in some cases, arise as translumenal metastases from an initial single lesion.

Adenocarcinoma↗
PubMed1986

The role of C-reactive protein and polyarginine in tumor immunotherapy.

C-reactive protein (CRP) is an acute-phase reactant whose serum level rises rapidly in response to tissue injury. C-reactive protein binding to cells can activate the classical complement pathway, and enhance opsonophagocytosis. The polycation poly-L-arginine (PLA) can artificially fix CRP to target cells. The effects of CRP and PLA on tumor growth were evaluated, both independently and synergistically, using the V X 2 tumor line in the rabbit host. Ten normal animals and seven acute-phase animals were bilaterally inoculated with V X 2 cells (control side) and PLA-treated V X 2 cells (experimental side). Tumor growth was significantly retarded on the treatment side (P less than 0.005), in both animal groups. It is concluded that topical PLA is a potent inhibitor of V X 2 tumor growth. Comparison of normal and acute-phase animals revealed no persistent difference in tumor growth for either cell inoculum. Similarly, cell treatment with topical CRP did not inhibit tumor growth, whether PLA was present or not. Thus, circulating and topical CRP did not alter the rate of V X 2 tumor growth. PLA cytotoxicity remains to be evaluated when the agent is administered orthotopically, selectively, or systemically.

Animals↗
PubMed1986

A model for the treatment of accidental severe hypothermia.

Central to the controversy that surrounds the treatment of accidental severe hypothermia is the question of how the method of rewarming affects myocardial performance, and therefore survival. We induced severe hypothermia and cardiac arrest in 15 mongrel dogs. Each dog was rewarmed by one of three methods: partial cardiac bypass (Group I); peritoneal dialysis (Group II); or external rewarming with a fluid-circulated blanket (Group III). The cardiac arrest state was supported by partial cardiac bypass in Group I and by standard mechanical cardiopulmonary resuscitation (CPR) in Groups II and III. In all dogs, the hypothermically depressed myocardial performance returned to normal upon rewarming. Groups I and II had similar rewarming times and required similar volumes of crystalloid and bicarbonate solutions to maintain adequate cardiac filling pressures and arterial pH. However, Group III had a significantly slower rewarming time and required significantly greater volumes of crystalloid and bicarbonate solutions. The sole procedural death occurred in Group III. Our results show that partial cardiac bypass, peritoneal dialysis, and the fluid-circulated blanket are equally effective in rewarming severely hypothemic dogs with cardiac arrest, provided that the cardiac arrest is relieved by partial cardiac bypass or standard mechanical CPR and that physiologic levels of intravascular volume, oxygenation, and pH are maintained.

Accidents↗
PubMed1985

Should flow cytometric DNA analysis precede definitive surgery for colon carcinoma?

Conventional prognostic parameters for colon carcinoma are predominantly determined after resection and have limited predictive value. For an evaluation of the significance of flow cytometric (FCM) DNA analysis in colon carcinoma, 56 invasive colon carcinomas were prospectively studied to compare DNA ploidy with established prognostic parameters obtained from pathologic examination of resected specimens. Objective parameters, i.e., depth of invasion and node status, were strongly linked to DNA ploidy; diploid tumors tended to be Astler-Coller stage A or B and nondiploid tumors stage C or D. Diploid and nondiploid tumors did not differ according to subjective criteria such as histologic grade and microscopic invasion of vessels and nerves. These results suggest that FCM DNA analysis may be a valuable tool in managing patients with colon carcinoma, since analysis of biopsies could indicate the likelihood of tumor spread before surgery.

Adult↗
PubMed1984

The evaluation of various bioabsorbable materials on the titanium fiber metal tracheal prosthesis.

A new type of tracheal prosthesis was studied. It consists of a rigid, porous cylinder of titanium fiber metal coated with a polymer that provides an initial air seal and then is absorbed to permit subsequent fibrous tissue ingrowth and reepithelialization. Fifteen such cylinders measuring 50 mm by 26 mm were coated with one of the following polymers: polycaprolactone 700 (3 coated internally and 3 externally); a copolymer of 75% poly-L-lactic acid and 25% polyglycolic acid (3 coated internally and 3 externally); and polyglactin 910 (3 coated externally). Fifteen kennel-conditioned mongrel dogs, each randomly assigned to one of these five groups, underwent implantation of the prosthesis through a right thoracotomy into a 5-cm defect in the distal intrathoracic trachea. There were no immediate postoperative deaths, and no instances of major air leak from the prosthesis. One animal died after two weeks secondary to a lower respiratory tract infection. Bronchoscopic evaluation revealed varying degrees of tissue ingrowth into the prostheses, with no evidence of infection or distal accumulation of secretions. Histological evaluation showed superior tissue ingrowth and reepithelialization with internally coated prostheses; two out of three polymers gave good results.

Animals↗
PubMed1984

Congenital hepatic artery aneurysm simulating pancreatic carcinoma.

The authors report a case of a hepatic artery aneurysm that simulated a mass in the head of the pancreas. The correct diagnosis was made preoperatively based on several findings: curvilinear calcification within the mass on CT, a well-defined cystic collection on ultrasound, absence of biliary duct dilatation or jaundice, and presence of other aneurysms.

Aneurysm↗
PubMed1984

A ten year experience with hepatic resection.

The results of our experience have demonstrated that patients who undergo hepatic resection for primary or metastatic carcinomas have survival rates considerably higher than those reported in the literature for patients who do not undergo resection. Morbidity rates as well as survival rates among the patients we studied lie within the reported values of the major institutions. It is certainly clear that, within the past five years, metastatic disease to the liver from a primary carcinoma of the colon and rectum has become a treatable disease. We, therefore, advocate the aggressive approach to carcinoma of the liver and look forward to further advancement in the treatment of this disease.

Actuarial Analysis↗