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Biomedical subjects

F H Bagley

Publications and source records attributed to F H Bagley.

10 recordsLinked to original sources
PubMed1981

Changes in clinical presentation and management of malignant melanoma.

Records of 147 patients with primary cutaneous malignant melanoma treated at the Lahey Clinic from 1955--1979 were reviewed. Complete clinical follow-up data were obtained, and all pathologic material was reviewed. Proposed new risk categories based on a modification of the Clark and Breslow categorizations are outlined. The incidence of low-risk melanoma has dramatically increased (from 23--53%) and that of high-risk melanoma has decreased (from 34--10%) over the period of this study. Dermal punch biopsy gives accurate staging information and carries no increased risk of local recurrence, nodal metastases, or death from disease. Resection of a margin of clinically uninvolved skin measuring twice the diameter of the primary melanoma minimizes local recurrence (2.5% or less), does not adversely affect survival, and reduces the need for skin grafting. Arbitrary wide margins are not justified. Regional lymphadenectomy offers no improvement in survival in patients with low-risk and moderate-risk melanoma and can play only a minor role at most in improving survival for patients with high-risk melanoma.

Biopsy↗
PubMed1981

Ductal drainage or resection for chronic pancreatitis.

We report a 10 year review comparing the results of pain relief after three procedures for chronic pancreatitis: Whipple pancreatoduodenectomy, modified Puestow side-to-side longitudinal pancreaticojejunostomy and distal pancreatic resection. Results of follow-up review at 6 months, 2 years and 5 years were tabulated. Five year follow-up data were available on more than 80 percent of patients. The proportion of good results for pain relief decreased with the passage of time regardless of the procedure performed. Although equally good results are obtained after either pancreatoduodenectomy or pancreaticojejunosotomy, we conclude that in the presence of a dilated duct, the procedure of choice is pancreaticojejunostomy. If the duct is not dilated, we then favor pancreatoduodenectomy, after which the pain relief is significantly better (p = 0.05) than after distal resection. Our data show that, for all factors evaluated, the poorest pain relief was obtained after distal resection. Therefore that procedure has limited value when used specifically for relief of pain in chronic pancreatitis, except in the uncommon circumstance when the disease is confined to the distal part of the gland. Our study also shows that patients who have more radical distal resection have no better pain relief than those who have 50 percent distal resection.

Adult↗
PubMed1981

Sphincterotomy or sphincteroplasty in the treatment of pathologically mild chronic pancreatitis.

We reviewed 67 patients with a mild to moderate degree of chronic pancreatitis, 33 of whom had sphincterotomy and 34 of whom had sphincteroplasty of the sphincter of Oddi and the sphincter of the pancreatic duct. The cause of the pancreatitis was idiopathic in 35 and probably alcoholic in 32. Initial relief of symptoms at 6 months was acceptable in both groups (mean, 64 percent), but thereafter decreased at 2 years and 5 years postoperatively to significant relief in only 48 and 44 percent of patients, respectively. The more complex sphincteroplasty appears to offer no advantage over the simpler sphincterotomy in the management of patients with pain of pancreatitis. In the patients who were alcoholics, avoidance of alcohol seems to be a much more important determinant of the outcome of the operation than the operation itself.

Adult↗
PubMed1979

An abdominal extraperitoneal approach for the difficult orchidopexy.

An abdominal extraperitoneal approach is described for use in patients who have a severe degree of incomplete descent of the testicle. In 86 such operations, the testicle was placed in the scrotum in 85. The approach allows certainty of diagnosis in cases of anorchia and it is helpful when orchidopexy has to be combined with a herniotomy in infancy.

Adolescent↗
PubMed1978

Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer.

A retrospective study was performed of 18 women in whom ipsilateral brachial plexus neuropathy developed after treatment for carcinoma of the breast. In the absence of metastatic tumor elsewhere, the only distinguishing feature between carcinomatous neuropathy and radiation-induced neuropathy was the symptom-free interval after mastectomy and radiation therapy. Women with an interval of less than a year have radiation-induced neuropathy. Brachial plexus exploration in difficult diagnostic situations will permit early treatment and avoid debilitating loss of function. Brachial plexus exploration for biopsy is safe and free of complications if performed carefully. Treatment of carcinomatous neuropathy is most likely to succeed if the tumor is hormonally sensitive, but radiotherapy may also be effective. Treatment of radiation-induced neuropathy remains largely ineffective.

Adenocarcinoma↗
PubMed1977

Diffuse xanthogranulomatous pyelonephritis in children: an unrecognized variant.

Xanthogranulomatous pyelonephritis in childhood has been thought to exist only in focal form. We encountered 2 cases of diffuse xanthogranulomatous pyelonephritis in children and have found 3 others reported in the literature, making it necessary to change this concept. The essential radiologic and pathologic differences between focal and diffuse xanthogranulomatous pyelonephritis are reviewed.

Child, Preschool↗