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Biomedical subjects

Frederick L Greene

Publications and source records attributed to Frederick L Greene.

27 records · Page 2Linked to original sources
PubMed2003

Flexible endoscopy and enteral nutrition.

The use of intensive nutritional support to meet the metabolic nutrient requirements of critically ill patients has become standard medical treatment. It has been shown that enteral feeding provides significantly better metabolic support than long-term intravenous hyper-alimentation and therefore, endoscopic placement of enteral access has become common-place. As an extension of flexible endoscopy, the transoral or percutaneous placement of enteral access devices is appropriate for patients with gastrointestinal disease, post-trauma support, and oncologic processes. The main access route continues to be achieved through the use of nasoenteric feeding tubes that may be facilitated by endoscopic placement. Percutaneous endoscopic gastrostomy and jejunostomy have become reliable methods of achieving enteral access as videoendoscopy usage has increased. The placement of jejunal feeding tubes reduces the opportunity for reflux of gastric content and, in the long-term, has proven a reliable method for enteral support.

Endoscopy, Gastrointestinal↗
PubMed2002

Revision of the American Joint Committee on Cancer staging system for breast cancer.

PURPOSE: To revise the American Joint Committee on Cancer staging system for breast carcinoma. MATERIALS AND METHODS: A Breast Task Force submitted recommended changes and additions to the existing staging system that were (1) evidence-based and/or consistent with widespread clinical consensus about appropriate diagnostic and treatment standards and (2) useful for the uniform accrual of outcome information in national databases. RESULTS: Major changes included the following: size-based discrimination between micrometastases and isolated tumor cells; identifiers to indicate usage of innovative technical approaches; classification of lymph node status by number of involved axillary lymph nodes; and new classifications for metastasis to the infraclavicular, internal mammary, and supraclavicular lymph nodes. CONCLUSION: This revised staging system will be officially adopted for use in tumor registries in January 2003.

Breast Neoplasms↗
PubMed2002

TNM residual tumor classification revisited.

BACKGROUND: For cancer patients, prognosis is strongly influenced by the completeness of tumor removal at the time of cancer-directed surgery or disease remission after nonsurgical treatment with curative intent. These parameters define the relative success of definitive treatment and can be codified by an additional subclassification within the TNM system, the residual tumor (R) classification. Despite the importance of residual tumor status in designing clinical management after treatment, misinterpretation and inconsistent application of the R classification frequently occur that diminish or abrogate its clinical utility. METHODS: An analysis of the relevant literature regarding the use and prognostic importance of the R classification was undertaken. RESULTS: In the current study, the prognostic importance of the R classification for different kinds of tumors is discussed. Problems that arise in using the R classification are described. Special issues regarding the use of the R classification are addressed. CONCLUSIONS: The R classification is a strong indicator of prognosis and facilitates the comparison of treatment results if applied in a consistent manner. Uniform use and interpretation of this classification is essential for the standardization of posttreatment data collection.

Humans↗
PubMed2002

A new TNM staging strategy for node-positive (stage III) colon cancer: an analysis of 50,042 patients.

OBJECTIVE: To analyze a large cohort of patients with stage III colon cancer to determine whether subgroup stratification better defines outcome. SUMMARY BACKGROUND DATA: The Tumor (T), Node (N), Metastasis (M) system is based on depth of tumor invasion into the colonic wall, the number of regional lymph nodes involved, and distant metastasis. Traditionally, colon cancer has been designated as stage III based on nodal involvement regardless of the depth (T1-4) of tumor penetration. Treatment decisions have been based on nodal involvement with less emphasis on colonic wall penetration in stage III patients. METHODS: Patients (n = 50,042) with stage III colon cancer reported to the National Cancer Data Base from 1987 through 1993 were analyzed. Observed survival was calculated by actuarial life table methods for three new node-positive subgroups (IIIA: T1/2, N1; IIIB: T3/4, N1; IIIC: any T, N2). The Cox proportional hazards model was used to test the prognostic strength of selected covariates. RESULTS: Three distinct subcategories within a traditional stage III cohort of colonic cancer were identified. Five-year observed survival rates for these three subcategories were 59.8%, IIIA; 42.0%, IIIB; and 27.3%, IIIC. Differences between subgroups were significant ( <.0001). Similar differences were calculated after stratification for treatment. A multivariate proportional hazards model identified the new stage III subgroups, modality of the first course of therapy, patient age, and tumor grade as significant independent prognostic covariates. CONCLUSIONS: The current stage III designation of colon cancer excludes prognostic subgroups stratified for mural penetration (T1-4) or nodal involvement (N1 vs. N2). Analysis of a large data set supports stratification into three subsets, confirming the benefit of adjuvant chemotherapy in each subgroup. This strategy should be used in the reporting and staging of node-positive colon cancers.

Age Factors↗
PubMedDate not supplied

The staging of colorectal cancer: 2004 and beyond.

Stage is the strongest predictor of survival for patients with colorectal cancer. Accurate staging also is critical for appropriate patient management and meaningful clinical research. Uniform staging criteria applied in a uniform manner are essential for accurate evaluation of therapies and outcomes. Historically, numerous different staging systems for colorectal cancer have been employed, but a single internationally recognized system is required to ensure a common language for cancer that is understood by clinicians in all specialties. For the tumor, node, metastasis system to remain relevant, it has to continuously undergo critical evaluation and change when clinically indicated.

Colon↗