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Biomedical subjects

E H Laughlin

Publications and source records attributed to E H Laughlin.

14 recordsLinked to original sources
PubMed1995

Minimal-access surgery for staging of malignant melanoma.

OBJECTIVE: To develop a simple, minimally invasive technique of determining whether regional node metastasis has occurred in patients with melanoma. SETTING: Teaching hospital tertiary care and private practice settings. PATIENTS: Between February 1993 and October 1994, 121 patients with invasive malignant melanoma and clinically negative lymph nodes were enrolled in this clinical trial. DESIGN: Consecutive sample clinical trial. Within 24 hours prior to lymph node resection, a radioactive tracer was injected into the dermis around the site of the primary melanoma. Forty-four patients also had blue dye injected immediately prior to surgical resection. Measurement of radioactivity in the lymph nodes and surgical localization were made using a handheld gamma detector. Radiolabeled nodes were selectively removed with the least dissection possible. In patients with pathologically positive radiolabeled nodes, regional lymphadenectomy was performed. OUTCOME MEASURES: Successful identification of radiolabeled sentinel lymph nodes, correlation of radiolabeling with injection of blue dye, and regional node recurrence rate. RESULTS: Surgeons successfully resected the radiolabeled sentinel lymph nodes in 118 (98%) of 121 patients. One hundred percent of blue-stained lymph nodes were successfully radiolabeled. Fifteen patients had pathologically positive sentinel lymph nodes. In 10 patients, the sentinel node was the only node with metastasis. Two systemic and one regional node recurrences occurred during a mean follow-up of 220 days. CONCLUSIONS: Selective gamma probe-guided resection of the radiolabeled sentinel lymph node is possible in over 95% of patients with melanoma. This technique offers a simple and reliable method of staging of regional lymph nodes in these patients without performing a regional lymphadenectomy.

Adolescent↗
PubMed1991

Have changing treatment patterns affected outcome for operable breast cancer? Ten-year follow-up in 1288 patients, 1965 to 1978.

From 1965 to 1978, 1288 patients with primary operable breast cancer were treated by the senior author, using extended radical (ERM), radical (RM), and modified radical (MRM) mastectomy operations exclusively. Results were analyzed for trends in overall and disease-free survival, and patterns of local and distant relapse, the years 1965 to 1970 versus 1971 to 1974 versus 1975 to 1978. Significant changes (p less than 0.00001) from 1965 to 1978 included progressively earlier stage of disease, less frequent use of RM and ERM, a decline in the use of postoperative radiotherapy, and the introduction in 1975 of multidrug adjuvant chemotherapy. Ten-year disease-free survival rates improved significantly for all patients (by 11%, p = 0.00004) and for node-negative (by 12%, p = 0.0024), node-positive (by 8%, p = 0.012), clinical stage II (by 15%, p = 0.0022), and pathologic stage II (by 12%, p = 0.016) disease. Ten-year local recurrence for all patients was 3% (local only) and 2% (local with distant metastasis), and survival from date of recurrence for all patients failing treatment increased two times (p less than 0.0001) for patients treated most recently. As the primary surgical treatment of breast cancer continues to become more moderate, the promise of systemic adjuvant therapies can be realized only with continued emphasis on earlier diagnosis and maximal local control of disease.

Adult↗
PubMed1991

Benign and malignant neoplasms in a family with Peutz-Jeghers syndrome: study of three generations.

Three members of a family with Peutz-Jeghers syndrome had intussusception due to intestinal hamartomas. In addition, the grandfather had carcinoma of the jejunum, and the granddaughter had benign ovarian sex cord/stromal tumor causing sexual precocity. Benign and malignant tumors, not often associated with Peutz-Jeghers syndrome, pose a further threat in addition to the gastrointestinal bleeding and obstruction that often complicate this inherited syndrome.

Adenocarcinoma↗
PubMed1989

Metastasizing ameloblastoma.

A case of malignant ameloblastoma with widespread, indolent metastases is reported and 42 previously published cases of metastasizing ameloblastoma are reviewed. The disease-free interval (DFI) between diagnosis of tumor and appearance of metastasis in 43 patients is 9 years. The median survival time after metastasis is 2 years. Most metastases were in the lung. Although the biologic behavior of ameloblastomas cannot be predicted on the basis of morphology, metastasis appears to follow multiple recurrences. Early adequate resection of the primary to avoid repeated surgical procedures is advocated to prevent tumor spread. Surgical removal is preferred for treating metastasis. Although the response to radiation cannot be predicted, radiation should be used to treat lesions not amenable to surgical removal. Disseminated ameloblastoma does not appear to respond to chemotherapy.

Aged↗
PubMed1989

Palliating late-stage esophageal cancer.

Palliation for those with advanced cancer of the esophagus ideally should relieve dysphagia, stop aspiration, and sustain nutrition and hydration. Esophageal intubation with a Celestin prosthesis combined with Janeway gastrotomy is an excellent method for relieving the symptoms of advanced malignancy of the middle and lower thirds of the esophagus. Because intubation and gastrostomy do not require elaborate surgical facilities they can be performed in the community hospital. Although we have carried out the procedure in a small number of patients, palliation achieved has been such that we advocate intubation and gastrostomy as a quick and uncomplicated way to alleviate the symptoms of esophageal cancer patients with late-stage disease.

Esophageal Neoplasms↗
PubMed1986

Common duct stricture associated with hepatic artery infusion of FUDR.

A case report is presented giving the first detailed description of a benign common duct stricture occurring in a patient receiving hepatic artery infusion of FUDR for metastatic colon cancer. It is postulated that the stricture results from a combination of drug toxicity, and hypoxemia of the duct, with the lesion occurring more often than is recognized. A guide is given for the evaluation of the FUDR-infused patient with suspected nonmalignant duct stricture, and for the methods of alleviating extrahepatic blockage in these individuals.

Adenocarcinoma↗
PubMed1983

Heterotopic pancreas obstructing the ampulla of Vater.

Heterotopic pancreas, a developmental anomaly uncommonly noted both during operations and autopsies, is usually described in each instance as an incidental finding. Rarely, ectopic pancreas can cause intra-abdominal hemorrhage or obstruction. We studied a case in which aberrant pancreas located at the ampulla of Vater was found to be the cause of partial obstruction of the common bile duct. Resection of the duodenal papilla and anastomosis of the distal common duct to the duodenum resulted in complete cure. Treatment of the symptomatic patient with heterotopic pancreas demonstrated during gastrointestinal diagnostic examination, and the asymptomatic patient with ectopic pancreas discovered at laparotomy, are discussed.

Ampulla of Vater↗
PubMed1980

Fragmentation of Celestin tube: a cause of fatal intestinal perforation.

A singular case is described in which a pateint with a Celestin endoesophageal tube in place for 10 months died of complications from small bowel perforation resulting from disruption of the tube. The lower part of the tube lying within the stomach had deteriorated and become detached except for a single strand of nylon monofilament. This fragment passed into the small intestine, where it remained tethered at the level of the distal jejunum, acting first as an obscure cause of intermittent small bowel obstruction and later as the cause of jejunal perforation. In the patient who is a candidate for esophageal intubation and who has a life expectancy beyond 6 or 8 months, consideration should be given to using a device other than the Celestin tube. Whenever a Celestin appliance is used to palliate dysphagia, the intragastric part of the tube should be anchored to the stomach with multiple sutures.

Esophageal Stenosis↗
PubMed1977

Total parenteral nutrition: a guide to therapy in the adult.

Total parenteral nutrition (TPN), often referred to as intravenous hyperalimentation, is a complex technique for parenteral feeding that can be lifesaving. A basic knowledge of the theory behind, indications for, and hazards of TPN can help the practitioner determine which of his patients will benefit from this procedure. In the community hospital, where a skilled hyperalimentation team is not available, TPN can be managed safely by a physician, pharmacist and floor nurse if there is rigid adherence to a strict protocol. This paper presents the basic theory, indications, and contraindications associated with TPN, and details a protocol for administering total parenteral nutrition to the adult, hospitalized patient (Appendices 1, 2).

Adult↗