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Biomedical subjects

E D Staren

Publications and source records attributed to E D Staren.

At least 19 recordsLinked to original sources
PubMed1999

Ultrasound-guided needle biopsy of the breast.

BACKGROUND: To determine the role of office-based ultrasound in the early clinical evaluation of breast masses, a consecutive series of diagnostic and interventional breast ultrasounds performed in the surgeon's office were prospectively studied. METHODS: A series of 1028 diagnostic ultrasounds were performed in 662 patients over 2 years. The clinical-pathologic data from those patients undergoing ultrasound-guided fine-needle aspiration biopsy (FNAB; n = 267 patients) and/or core needle biopsy (CNB; n = 210 patients) were reviewed. RESULTS: Of the 267 patients undergoing initial FNAB, 179 cysts were identified; 25 patients underwent no additional intervention, and 63 patients with apparently solid lesions underwent subsequent CNB. Core needle biopsy was the initial interventional approach in 147 cases. Of the 210 total patients in whom a CNB was performed, needle biopsy pathologic findings included:fibroadenoma, 57 patients; fibrocystic breast change, 82 patients; carcinoma, 53 patients; abscess/cyst, 12 patients; and other, 6 patients. Operative excision was performed in 106 of these 210 patients. There was a significantly higher false-negative rate among those patients who underwent an initial FNAB (20%; 2/10 patients) as compared with those patients undergoing CNB (3.6%; 2/55 patients; P < . 05). No cancers have been identified in those patients undergoing a benign CNB and followed for 6 to 30 months (median, 18 months). CONCLUSION: Office-based diagnostic ultrasound and interventional ultrasound that uses core needle biopsy is an effective adjunct to the early clinical evaluation of breast masses.

Adipose Tissue↗
PubMed1998

Functional analysis of tumor-infiltrating leukocytes in breast cancer patients.

BACKGROUND: The immune system is capable of responding to cancer as evidenced by systemic, regional, and intratumoral leukocyte activation. For individual patients there is no predictable relationship between leukocyte composition, or function, and the prognosis of the disease. MATERIALS AND METHODS: Leukocytes from tumor tissues (TIL, n = 17), axillary lymph nodes (LNL, n = 26), and peripheral blood (PBL, n = 25) of human breast cancer patients were evaluated for the ability to synthesize type 1 cytokines (TNF alpha, IFN gamma, and IL-2) and type 2 cytokines (IL-4, IL-6, and IL-10) by flow cytometry. The capacity of these cells to mediate in vitro cytotoxicity against the ZR 75-1 breast cancer cell line was simultaneously evaluated. RESULTS: To cells (CD3+) were the major leukocyte population detected in each tissue with CD4+ cells being predominant in TIL, LNL, and PBL. Type 1 cytokines were the predominant type produced by stimulated T cells for each population with a statistically greater proportion of IFN gamma + T cells in TIL as compared with LNL and PBL (P = 0.013 and 0.04, respectively). However, LNL and PBL had a significantly greater proportion of IL2+ T cells as compared with TIL from the same patient (P = 0.02 and 0.01, respectively). The tumoricidal function could be stimulated with recombinant human IL-2 in each leukocyte population with substantially higher levels of activity being produced in TIL from node-positive as compared with node-negative patients. CONCLUSIONS: This study demonstrates that there are differences in the capacity of leukocytes from different anatomical sites of breast cancer patients to synthesize immunostimulatory cytokines and mediate tumor cell cytotoxicity. Such differences may reflect prognostically distinct subgroups of patients and might also provide a rationale for the development of biological approaches to therapy in selected patients.

B-Lymphocytes↗
PubMed1998

Myoepithelial hamartoma of the duodenal wall.

A rare case of myoepithelial hamartoma of the duodenal wall is presented, and previous case reports found in the literature are reviewed. Myoepithelial hamartomas are thought to arise from displaced pancreatic anlage present along the gastrointestinal tract during embryogenesis, which can differentiate into various pancreatic elements; the most highly differentiated form is heterotopic pancreas. An alternative theory is pancreatic metaplasia of endodermal tissues. We describe a 41-year-old man who presented with abdominal pain and vomiting. CT scanning revealed a mass at the head of the pancreas. A pancreaticoduodenectomy was performed for presumed cystadenoma. Histology of the mass revealed a disorderly arrangement of smooth muscle, dilated and nondilated ducts, pancreatic acinar tissue and mucus glands. The relationship of myoepithelial hamartomas involving the small bowel to similar lesions in the stomach, bile ducts and gallbladder is discussed.

Adult↗
PubMed1998

Breast ultrasound.

Ultrasound of the breast has been demonstrated to be an extremely effective tool in the evaluation of mammographically detected breast lesions. The technique is relatively straightforward and may be learned in a relatively short time by experienced breast clinicians. It is likely that the future care of patients with diseases of the breast will continue to be increasingly dependent on image-guided breast biopsy techniques. Therefore, surgeons would do well to familiarize themselves with this modality. This is likely to streamline patient care, improve cost efficiency, and facilitate therapeutic planning. Finally, the current health care climate is likely to encourage the use of ultrasound of the breast by surgeons.

Biopsy, Needle↗
PubMed1998

Breast carcinoma metastases.

With careful selection of patients, complete resection of pulmonary metastases from breast carcinoma may be a useful therapeutic option. Such a treatment appears to offer a significant survival benefit when compared with medical treatment alone, or with incomplete resection.

Antineoplastic Agents↗
PubMed1998

Thyroid reoperations: indications and risks.

Thyroid reoperations can be technically difficult and associated with an increased risk of complications. To determine the indications for reoperations and the risk of postoperative complications with these procedures, records of 362 patients undergoing thyroidectomy by a single surgeon (R.A.P.) were reviewed. Thirty-two patients had a reoperation. The group consists of 21 women and 11 men with an average age of 55 years (range, 31-79). Twenty-four patients had 1 prior operation, and 8 patients had 2 or more. We performed 4 of the initial operations, and 28 were done by surgeons at other centers. Fourteen reoperations were done for symptomatic multinodular goiter (MNG), and 5 because of a change in the histologic diagnosis from benign to cancerous. The remainder were for further treatment of malignancy. The most common operation was completion thyroidectomy (31). In 3 patients, either unilateral or bilateral modified radical neck exploration was performed. One patient required median sternotomy. One subtotal thyroidectomy was also performed. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another, who had 3 operations for MNG. One of the 2 patients with preoperative unilateral vocal cord paralysis had return of function after removal of a substernal goiter. The other had a permanent nerve injury from the original surgery. Three patients had postoperative hypocalcemia (calcium <8.0 mg/dL). This resolved in all patients within 1 to 6 months. One patient who had a third operation for MNG had postoperative hemorrhage necessitating tracheostomy for airway control. Another patient developed a seroma that resolved within 2 months. We conclude that reoperations are indicated for both benign and malignant thyroid disease. Because they carry a higher risk of complications, every effort should be made to avoid them by performing definitive initial treatment.

Female↗
PubMed1998

Use of ultrasound-guided fine needle aspiration biopsy in the management of thyroid disease.

Fine-needle aspiration biopsy (FNAB) of thyroid nodules has resulted in fewer patients needing thyroidectomy. Nondiagnostic FNAB specimens may require surgery for diagnosis. Ultrasound can help decrease nondiagnostic biopsies by visualizing lesions and guiding biopsy needles. Between 1996 and 1997, 76 patients had ultrasound-guided needle biopsies of thyroid nodules. Sixteen patients had clearly palpable nodules, whereas 19 were described as difficult to palpate. There were 32 patients who presented with either prominent thyroids or enlarged lobes. Six patients presented only with nonspecific symptoms, and 3 had nodules discovered incidentally on imaging studies. Biopsies were diagnostic in 73 of 76 (96%) patients. This varied with the size of the nodule, with the rate of nondiagnostic biopsies being 13 per cent in lesions <1.0 cm and 3 per cent in lesions >2.0 cm. Fifteen patients had surgery based on the FNAB, with a surgical yield of malignancy of 47 per cent. Ultrasound-guided FNAB is extremely useful in evaluating thyroid lesions that are difficult to palpate or nonpalpable, as well as the remainder of the gland and surrounding structures. The use of ultrasound guidance in performing FNAB results in a low rate of nondiagnostic biopsies, which may decrease the number of unnecessary thyroidectomies performed to rule out malignancy.

Biopsy, Needle↗
PubMed1997

Cryosurgery of breast cancer.

OBJECTIVE: To determine the feasibility and efficacy of cryosurgery of breast cancer. DESIGN: In phase 1, carcinogen-induced mammary adenocarcinomas in 13 Sprague-Dawley rats were treated by cryosurgery and were then examined for histopathologic change. In phase 2, transplantable mammary adenocarcinomas in 50 DBA/IJ mice were treated by cryosurgery to determine the effect of varying tumor temperatures, and duration and number of freeze-thaw cycles on tumor viability. In phase 3, 2- to 3-cm ultrasound-monitored cryolesions were formed in the breasts of 4 dogs and 4 sheep. These animals were followed up for procedure-related complications; the histopathologic necrosis of the cryolesions were correlated with the ultrasound images. Based on the results of these experiments, ultrasound-guided cryosurgery of breast cancer was initiated in a human clinical trial. RESULTS: In phase 1, a single, short-term (< 7 minutes) freeze killed only tumors smaller than 1.5 cm in diameter, despite an apparent decrease to -40 degrees C at the periphery of each tumor. In phase 2, varying the peripheral tumor temperature to as low as -70 degrees C, using a single, short-term (< 7 minutes) freeze did not alter the results from phase 1. If the ice ball fully encompassed the tumor, however, maintaining it for at least 15 minutes achieved 100% tumor kill independent of tumor size. In phase 3, creation of a reproducible ultrasound-monitored cryolesion was facilitated when 2 freeze-thaw cycles were performed. No procedure-related complications were noted. In the human trial, 2 invasive lobular carcinomas from 1 patient were treated by cryosurgery and were negative for persistent tumor by core needle biopsy performed 4 and 12 weeks after a well-tolerated procedure. CONCLUSIONS: In situ breast cryosurgery has been proved to be feasible and efficacious in small and large animal studies and has been successfully performed in 1 patient with breast cancer. The results of this study suggest that ultrasound-guided cryosurgery of breast cancer warrants further investigation.

Adenocarcinoma↗
PubMed1997

User of fine-needle aspiration biopsy and frozen section in the management of the solitary thyroid nodule.

BACKGROUND: This study evaluates the indication for frozen section (FSx) in the management of the solitary thyroid nodule given the increasing use of fine-needle aspiration biopsy (FNAB). METHODS: The charts of 561 patients who underwent thyroidectomy for a solitary nodule were reviewed. Each patient underwent either FNAB, FSx, or both. Results were compared to the final diagnosis to evaluate their effectiveness in predicting malignancy. RESULTS: The sensitivity and specificity for FNAB alone (162 patients) were 86% and 91%, respectively, and for FSx (494 patients) 79% and 99%, respectively. The routine use of FSx with diagnostic FNABs did not improve the accuracy over either test alone. Sensitivity, specificity, and accuracy were essentially unchanged when the use of FSx was limited to just atypical FNAB but dropped significantly when FSx was not used. CONCLUSIONS: When results of FNAB and FSx are interpreted as benign or malignant, both are highly accurate predictors of malignancy. Routine use of FSx and FNAB does not improve the sensitivity or specificity in the detection of malignancy over that of either examination alone. FSx proved useful in determining the extent of operation only when results of the FNAB were atypical.

Biopsy, Needle↗
PubMed1997

Invasive therapy of metastatic colorectal cancer to the liver.

Resection, when possible, is still the best hope for cure of colorectal metastasis to the liver. Poor prognostic indicators for survival include heavy tumor burden, the presence of extrahepatic disease, synchronous metastasis, and the inability to perform resection with a 1-cm margin. Questionable poor prognostic indicators include multiple metastases (more than three), bilobar disease, and the need to transfuse patients during resection. Preoperatively, a patient must be evaluated for the extent of liver disease and the presence of extrahepatic disease with a CT of the abdomen and routine studies of the chest. Intraoperatively, a surgeon should be able to perform or obtain ultrasonography of the liver to detect occult metastases and delineate anatomy. The surgeon should be experienced in wedge, segmental, and lobar resection. Equipment for cryotherapy and arterial infusion devices should be available, and staff experienced in these modalities should be present. If all of these factors are present, the options for the invasive treatment of colorectal metastasis to the liver can be carried out in a manner that should provide the most benefit at a low morbidity to this population of patients.

Colorectal Neoplasms↗
PubMed1997

Intraoperative ultrasound in the management of liver neoplasms.

The purpose of this study was to determine the impact of intraoperative ultrasound (IOUS) on the management of patients with neoplasms of the liver. Fifty-nine patients with liver neoplasms (primary, 6; metastatic, 53) and without pre- or intraoperative evidence of extrahepatic disease underwent laparotomy for possible liver resection. Preoperative imaging studies included external ultrasound (n = 12), magnetic resonance imaging (n = 11), and/or computed tomography (n = 57). Intraoperative evaluation on all patients included inspection, bimanual palpation, and ultrasonography. External ultrasound, magnetic resonance imaging, and computed tomography identified all intraoperatively confirmed liver neoplasms in 33, 45, and 67 per cent of cases, respectively. Unsuspected neoplasms were identified in 12 patients (20%) by inspection/palpation and in 19 patients (32%) by IOUS. In eight patients (14%), the occult neoplasms were identified only IOUS, and in one patient the neoplasms were identified only by inspection/palpation. Occult neoplasms identified by IOUS were characterized by small size (less than 2 cm). Findings from the intraoperative evaluation, such as unsuspected neoplasms and vascular proximity or invasion, altered the preoperative plan in 20 (34%) patients. Inspection, and particularly palpation, identifies a number of preoperatively unsuspected liver neoplasms. Intraoperative ultrasound, however, is the most sensitive method for detection of liver neoplasms and influences the operative management in a substantial number of patients.

Colorectal Neoplasms↗
PubMed1997

Hepatic resection for metastatic colorectal cancer.

One-hundred thirty-one primary hepatic resection for colorectal secondary tumors were performed at Rush-Presbyterian-St. Luke's Medical Center between 1975 and 1993. Perioperative mortality occurred in five patients (3.8%). Twenty-three patients had minor morbidities (18%); major morbidity occurred only in the five patients who died. Curative resections were performed in 107 patients. Overall actuarial survival at 2, 3, and 5 years was 62, 42, and 25 per cent, respectively. Patients with extrahepatic disease (5-year survival, 0% vs 27%; P = 0.049) and positive resection margins (0% vs 30%; P < 0.001) had significantly poorer survival. Among the curative resections, patients who had metachronous hepatic resections did significantly better than those who underwent synchronous colon and hepatic resections (35% vs 13%; P = 0.002). This survival benefit persisted when comparison was restricted to patients with synchronous metastases. Age, sex, race, number of lesions, site of colon primary resection, blood transfusion, disease-free interval, and extent of resection had no effect on survival. All patients who are acceptable surgical risks with potentially resectable metastatic colorectal cancer confined to the liver should undergo exploration. Assessment of resectability should include intraoperative ultrasound in all patients to maximize the probability of tumor clearance.

Adult↗
PubMed1997

Effectiveness of the thyroid scan in evaluation of the solitary thyroid nodule.

Solitary, palpable thyroid nodules are common, but only a small percentage are malignant. It is important to evaluate these nodules in a cost-efficient manner that avoids missing a cancer. Historically, radioisotope imaging has played a major role in the workup of thyroid nodules; however, with the advent of fine needle aspiration biopsy (FNAB), this role has become less clear. From 1974 to 1994, 770 patients with a solitary nodule underwent thyroidectomy. Preoperatively, 471 had thyroid scans, and 149 had FNAB. The incidence of carcinoma in nodules excised on the basis of thyroid scan was 23 per cent, whereas the incidence of carcinoma was 37 per cent when FNAB was used (P = 0.003). Fine needle aspiration was a significantly better predictor of malignancy than thyroid scan and resulted in a smaller proportion of excisions for benign nodules. Thyroid scan provided little additional information in those patients who underwent FNAB. Because thyroid scans add little in determining which nodules require surgical excision, they should no longer be a routine part of the evaluation of a solitary thyroid nodule.

Adolescent↗
PubMed1996

The dilemma of delayed cellulitis after breast conservation therapy.

OBJECTIVE: To determine the clinicopathologic characteristics of patients with breast cancers in whom delayed breast cellulitis developed after conservation therapy (lumpectomy, axillary dissection, and radiation). BACKGROUND: Breast cellulitis developing after conservation therapy represents a difficult diagnostic and management dilemma because determination of its origin may be necessary before further treatment decisions can be made. METHODS: In this retrospective evaluation of 184 sequential patients with breast cancers who underwent conservation therapy, 10 study patients (5%) in whom breast cellulitis developed 3 or more months after surgery were compared with the 174 patients in whom cellulitis did not develop. RESULTS: There was no significant difference in clinicopathologic characteristics of the study patients compared with control patients. The cellulitis resolved in 5 patients (50%) and persisted from 4 months to more than 1 year in 5 patients (50%). The cellulitis recurred in 1 patient who responded to repeated therapy. The 5 patients with persistent cellulitis underwent biopsies, and recurrent cancer was found in 1 patient. Recurrent cancer did not develop in the patients whose cellulitis resolved within 4 months with a minimum follow-up of 24 months. CONCLUSIONS: Delayed-onset cellulitis occurs in a small percentage of patients with breast cancers treated by conservation therapy. The cellulitis may take several weeks to clear, and/or it may recur or persist. If the condition persists after 4 months of therapy, a biopsy should be performed to rule out recurrent cancer.

Adult↗
PubMed1996

Rapid resolution of necrolytic migratory erythema after glucagonoma resection.

A 55-year-old man presented with an 11-year history of necrolytic migratory erythema and glossitis. After the patient's serum glucagon was demonstrated to be elevated, computed tomography scan revealed a mass involving the head of the pancreas. The patient underwent a Whipple-type pancreatico-duodenectomy and his rash resolved completely 6 days after tumor resection. He received no adjuvant treatment. A discussion of the varying theories regarding the pathogenesis and treatment of glucagon-associated necrolytic migratory erythema is presented.

Erythema↗
PubMed1996

Ultrasound-guided biopsy of nonpalpable breast masses by surgeons.

BACKGROUND: Recently, ultrasound (US)-guided needle biopsy has been proposed as an acceptable alternative to open biopsy in women with nonpalpable breast masses. This study evaluated the accuracy of US-guided needle biopsy of nonpalpable breast masses performed by surgeons at the time of the initial clinical examination. METHODS: Ultrasound-guided aspiration and/or core biopsy (US-GAB) was performed on 103 patients presenting with a nonpalpable, new, or increasing-size mass detected on mammography. Study patients included those whose US was classified as: fibroadenoma (FA) (n = 26), complex cyst (n = 32), indeterminate (complex cyst versus solid; N = 24), or suspect (n = 21). RESULTS: Of the 32 patients with diagnostic US of complex cyst, US-GAB confirmed 27 to be cysts. Twelve additional cysts were aspirated among the 24 indeterminate lesions. Sixteen FA were diagnosed on US-GAB; 11 of these underwent open biopsy and each was demonstrated to be a FA. Fibrocystic/benign-breast change (FBC) was diagnosed on 26 US-GAB; 15 of these underwent open biopsy, which demonstrated three FA and 12 FBC. Nine atypical lesions were diagnosed on US-GAB; six FBC, one papilloma, one FA, and one cancer were demonstrated on open biopsy. Seven cancers were diagnosed on US-GAB and all were confirmed on open biopsy. There were six insufficient specimens from US-GAB; four of these underwent open biopsy, which demonstrated two FA and two FBC. CONCLUSION: Ultrasound-guided aspiration and/or core biopsy performed by surgeons in conjunction with the initial clinical examination can accurately diagnose nonpalpable, mammographically detected breast masses.

Biopsy, Needle↗
PubMed1996

Cryosurgical ablation of unresectable hepatic tumors.

Ultrasound-guided hepatic cryosurgery is a potential treatment option for select patients with unresectable tumors. Intraoperative placement of cryoprobes and monitoring of tumor freezing with ultrasonography produce complete remission in 22% to 29% of patients with unresectable metastatic colorectal tumors to the liver. Perioperative nurses should be knowledgeable about cryosurgical techniques and be prepared to participate in this innovative treatment modality to provide optimal care to surgical patients.

Colorectal Neoplasms↗