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Biomedical subjects

G T Ujiki

Publications and source records attributed to G T Ujiki.

At least 19 recordsLinked to original sources
PubMed1996

Preoperative "chemoradiation" for stages II and III rectal carcinoma.

OBJECTIVE: To determine whether preoperative administration of combination chemotherapy and external beam irradiation ("chemoradiation") for patients with stage II or stage III rectal carcinoma had an impact on perioperative morbidity on oncologic outcome, as compared with patients not receiving preoperative chemoradiation. DESIGN: A group of patients with stage II or stage III rectal carcinoma receiving preoperative chemoradiation were followed up prospectively and compared in a nonrandomized fashion with an inception cohort group of similar patients. SETTING: Northwestern Memorial Hospital, Chicago, Ill, a tertiary care academic medical center. PATIENTS: Thirty patients with rectal carcinoma undergoing preoperative chemoradiation were compared with 56 patients not undergoing preoperative chemoradiation, and also with a subset group of 24 patients who received standard postoperative adjuvant chemoradiation. INTERVENTION: External beam radiation, 45 to 50 Gy, was delivered concurrently with fluorouracil and mitomycin 4 to 8 weeks prior to surgical resection. MAIN OUTCOME MEASURES: Patients were followed up at regular intervals for either tumor recurrence or death. In addition, the group receiving preoperative chemoradiation was evaluated for major preoperative morbidity. RESULTS: All patients agreeing to preoperative chemoradiation completed therapy. Perioperative major morbidity in this group (13%) was comparable to previously published results. Of the 56 patients with stage II or stage III rectal carcinoma not receiving preoperative chemoradiation, only 24 (43%) completed standard postoperative adjuvant chemoradiation. Patients receiving preoperative chemoradiation (n = 30), patients not receiving preoperative chemoradiation (n = 56), and the subset of the group not receiving preoperative chemoradiation who completed standard postoperative chemoradiation (n = 24) were followed up for a mean of 39 months, 31 months, and 32 months, respectively. Five-year actuarial local control rates were 96%, 83%, and 88%, respectively. Disease-free-survival rates were 80%, 57%, and 47%, respectively. Overall survival rates were 85%, 48%, and 78%, respectively. CONCLUSIONS: Preoperative chemoradiation in the treatment of stage II or stage III rectal carcinoma is well tolerated and not associated with an increase in subsequent perioperative major morbidity. In addition, local control, disease-free survival, and overall survival compare favorably with a nonrandomized inception cohort group of patients receiving standard postoperative adjuvant chemoradiation.

Adenocarcinoma↗
PubMed1992

A comparison of general versus local anesthesia during inguinal herniorrhaphy.

The current study was done to compare the hemodynamic changes, recovery events and economic impact of elective inguinal herniorrhaphy performed with general anesthesia (GA) or regional field block (RB) in 20 patients (American Society of Anesthesiology class I). In the GA group, anesthesia was induced with thiopental and the trachea was intubated after intravenous administration of 0.08 milligrams per kilogram of vecuronium. GA was maintained with 1.2 +/- 0.25 per cent enflurane in 50 per cent nitrous oxide and oxygen, and ventilation was controlled to keep PECO2 at 36 +/- 2 millimeters of mercury. Anesthesia in the RB group was accomplished by local injection of 3.5 +/- 0.5 milligrams per kilogram of 0.5 per cent bupivacaine. In each patient, a suprasternal ultrasonic Doppler probe was used to measure cardiac output before induction of anesthesia, during and after operation. Total peripheral resistance was calculated from mean arterial pressure and cardiac output. There were no statistically significant differences between cardiac output, mean arterial pressure, total peripheral resistance and heart rate in the two groups at any time period during the study. Patients in the RB group did not require parenteral medication for relief of postoperative pain, whereas all those in the GA group did. Significant cost benefits were realized by the RB group because of elimination of general anesthetic and reduction of recovery room fees.

Adult↗
PubMed1988

Gastrointestinal endometriosis. Incidence and indications for resection.

Of 1573 consecutive patients with endometriosis diagnosed at laparoscopy or celiotomy, 85 patients (5.4%) had gastrointestinal involvement and 11 patients (0.7%) required bowel resection due to recurrent gastrointestinal symptoms (usually obstructive in nature) and/or suspicion of malignancy. Of 63 patients with gastrointestinal involvement at sites other than the appendix, who did not undergo bowel resection, only two patients had gastrointestinal symptoms at the time of diagnosis (neither patient had obstructive symptoms); follow-up has revealed that only one patient subsequently developed significant gastrointestinal symptoms. Fifteen patients had appendiceal endometriosis, but none had symptoms suggestive of appendicitis. Indications for resection of gastrointestinal endometriosis include the presence of clear-cut obstructive symptoms or the inability to exclude malignancy. The absence of gastrointestinal symptoms appears to be predictive of the absence of clinically significant intestinal endometriosis, and bowel resection is not indicated in the asymptomatic patient. Appendiceal endometriosis appears to be an incidental finding and one that is not clinically important.

Adult↗
PubMed1987

Mortality and morbidity of gastric 'pull-up' for replacement of the pharyngoesophagus.

Forty-two patients have undergone gastric interposition to replace the pharyngoesophagus; 39 patients had primary or recurrent malignant tumors of the hypopharynx, cervical esophagus, postcrioid area, or tracheal stoma, while three patients had benign disease. The operation consisted of resection of the local neck disease, along with a transhiatal esophagectomy and gastric "pull-up" for restoration of gastrointestinal tract continuity. Eight hospitalized patients died, for a mortality rate of 19%, of which six patients died of complications from local sepsis. The more common nonfatal complications were related to the neck wound, the anastomosis, and the stomach. The complication rate per patient, excluding postoperative deaths, was 40%. The average length of stay was 44 days for the patients with nonfatal complications and 23 days for those without complications. The success rate of the operation with relief of the patients' presenting symptoms was 81%.

Adult↗
PubMed1984

Multimodality approach to treatment of carcinoma of the esophagus.

We conducted a combined treatment pilot project in 17 patients with squamous cell carcinoma of the thoracic esophagus. Thirteen of the patients initially had stage I or II disease, and four had stage III disease. Each patient received three cycles of chemotherapy consisting of a high dose of cisplatin (100 mg/sq m), followed by continuous infusion of fluorouracil (1,000 mg/sq m/day for five days). Thirteen patients had a favorable response to the chemotherapy, and ten of the 11 responding patients with stage I or II disease were offered surgical resection. Total thoracic esophagectomies and cervical gastroesophagostomies were done in the six patients who accepted the surgical recommendation. Pathologically, five patients had stage I disease, and one had stage III disease (even in this patient the local tumor was confined within the wall of the esophagus). All six patients were alive, without evidence of disease, four to 34 months after diagnosis. Two patients with stage II disease had tumor progression, as did two of the four patients with stage III disease. Three of the nonresponding patients died of their disease two to seven months after diagnosis. The eight remaining patients, three of whom received irradiation after chemotherapy, were alive, but with evidence of persistent disease, one to seven months after entrance into the study.

Aged↗
PubMed1981

Roux-en-Y operation in the management of postoperative fistula.

Four patients had complicated gastric and duodenal fistulas. In each patient, factors including marked inflammation and dense adhesions made dissection and mobilization difficult and hazardous. As a result, the standard recommended management of the fistulas was impossible. In each of these patients a Roux-en-Y operation was used successfully as an alternative procedure to seal the fistula. A successful outcome was experienced in each patient.

Aged↗
PubMed1977

Palliative resections in the treatment of primary colorectal cancer.

Seventy-eight patients underwent palliative resections for adenocarcinoma of the colon or rectum. The operative mortality was 6.4 per cent. The high morbidity rate of 43.5 per cent, mostly attributable to errors in operative technic and sepsis, could not be related to the extent of tumor spread. In fifty-nine patients long-term follow-up revealed a mean survival time of 12.4 months and a median of 9.1 months. Thirty-eight patients (64.4 per cent) survived six months, twenty patients (33.8 per cent) one year, seven patients two years, and one patient five years. Patients with only local extension of disease had the most favorable duration of survival. Hepatic or peritoneal involvement alone did not preclude long-term survival, but with the two combined the outlook was less favorable. There is a small group of patients with extensive metastatic disease who will not benefit from resection. Otherwise, adenocarcinoma of the colon or rectum with local or distant metastases should be resected when feasible.

Adenocarcinoma↗
PubMed1976

Double pyloroplasty and vagotomy for gastric ulcers.

A group of 31 patients with a variety of gastric ulcers were treated by vagotomy, biopsy, oversewing of bleeding points and a wide double pyloroplasty. On patient, a quadriplegic with multiple stress ulcers, rebled and had to undergo resection. He died a month later of progressive respiratory problems. A second quadriplegic died a month after a bleeding episode from myelitis and encephalitis resulting from a gunshot wound of the neck. He had no rebleeding. A third patient died two years after a gastric operation as a result of bronchial carcinoma. He had no recurrence of the ulcer problem. The remaining 28 patients were observed from six months to five years, an average of two and one-half years. There were no recurrences and only minimal untoward symptoms. It would appear that, for this period of observation, vagotomy with double pyloroplasty offers good treatment for patients with benign gastric ulcers.

Adult↗
PubMed1975

A study of experimental colovesical fistula.

An experimental study of colovesical fistulas in dogs was undertaken to gain insight into the clinical implications of such a fistula. The fistula itself was well tolerated by the animals. However, distal urinary tract or gastrointestinal obstruction led to sepsis and death.

Animals↗