PubMed Health⌕ Search

Biomedical subjects

G W Carlson

Publications and source records attributed to G W Carlson.

48 records · Page 3Linked to original sources
PubMed1993

The detection of breast cancer after augmentation mammaplasty.

Thirty-five patients treated for 37 cases of breast cancer after augmentation mammaplasty were analyzed. All augmentations were performed with silicone gel prostheses at a mean age of 38 years (range 24 to 59 years). The mean interval from breast augmentation to the detection of breast cancer was 7.5 years. Physical examination demonstrated a palpable breast mass in 35 of the 37 cases (95 percent). The pathologic staging was in situ 3 (8 percent), local 18 (49 percent), and nonlocal 16 (43 percent). Standard compression mammography was performed in 31 patients prior to breast biopsy. Abnormalities were detected in 17 (54.8 percent). Palpable masses were visualized in only 12 (38.7 percent). Ultrasound was utilized successfully in 3 patients with palpable masses to guide fine-needle aspiration biopsy. Standard two-view mammography has a low sensitivity in detecting palpable cancers in patients who have undergone augmentation mammaplasty. Ultrasound should be evaluated as a routine adjunctive screening method in this group of patients. The clinical detection of breast cancer, as evidenced by pathologic staging, is not delayed.

Adult↗
PubMed1993

Locally advanced carcinoma of the colon and rectum involving the urinary bladder.

We reviewed the records of 70 patients who underwent resection of a carcinoma of the colon and rectum with en bloc total cystectomy (36 patients) or partial cystectomy (34 patients) because of tumor directly extending into the urinary bladder. Preoperative genitourinary symptoms were present in 33 of the 70 patients (41.7 percent) and were highly predictive of malignant invasion of the bladder (97.0 percent). Duration of catheter drainage after partial cystectomy correlated with early postoperative bladder function; all 25 patients who had the catheter remain in place at least ten days had normal voiding after catheter removal, while five of nine patients whose catheter was removed before ten days had retention requiring catheter reinsertion (p < 0.01). Urologic complications occurred in two patients after total cystectomy and in three patients after partial cystectomy. There were three postoperative deaths in the total cystectomy group but none after partial cystectomy. Sixty-four patients with negative resection margins had a median survival period of 34 months and a five-year actuarial survival rate of 51.8 percent. In contrast, the median survival period for six patients who had positive margins was 11 months, with no survivors at five years.

Adult↗
PubMed1992

Extended resection for locally advanced colorectal carcinoma.

We reviewed the medical records of 101 patients who underwent extended resection for locally advanced colorectal carcinoma between 1965 and 1989. Preoperative symptoms related to the genitourinary system were present in 46 patients. Malignant invasion of genitourinary structures by colorectal carcinoma was found in 43 of these 46 patients (93%). In contrast, 51% of the patients without such symptoms had malignant invasion of contiguous structures. Preoperative intravenous pyelography, computerized tomographic scans, and cystoscopy correctly predicted the presence or absence of malignant invasion in 89%, 83%, and 87% of patients, respectively. Tumor-positive resection margins had a negative impact on survival (mean survival: 11.4 months). The 5-year actuarial survival rate for the patients who underwent a curative extended resection (margins tumor negative) was 54%. A thorough preoperative evaluation can identify a significant number of patients with colorectal cancer extending into adjacent organs and structures. Such evaluation is vital for operative planning and patient preparation, since an appropriate extended resection can produce long-term local control and patient survival.

Adult↗
PubMed1992

Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience.

We have reviewed 145 patients who underwent 148 total reconstructions of the hypopharynx and cervical esophagus between 1970 and 1989. The types and numbers of reconstruction included 45 deltopectoral (DP) flaps, 35 musculocutaneous (MC) flaps, 19 colon interpositions, 23 gastric transpositions, and 26 free jejunal transfers. Median hospitalization was 51 days for DP flaps, 24 days for MC flaps, 28 days for colon, 30 days for gastric, and 14 days for jejunum. Median resumption of oral intake was 92 days for DP flaps, 19 days for MC flaps, 12 days for colon, 13 days for gastric, and 9 days for jejunum. Functional failure, defined as the inability to maintain adequate nutrition without tube feedings, was 40% for MC flaps, 42% for colon interposition, 17% for gastric transposition, and 20% for free jejunal transfer. Microvascular free jejunal transfer has become our method of choice for reconstruction of the hypopharynx and cervical esophagus. Gastric transposition is an alternative when resection of the thoracic esophagus is necessary.

Adenocarcinoma↗
PubMed1991

Endoscopic laser recanalization is effective for prevention and treatment of obstruction in sigmoid and rectal cancer.

Patients with obstructing cancers are ineligible for preoperative chemotherapy and radiation unless they undergo surgical diversion. Endoscopic laser therapy (ELT) may provide an alternative to colostomy for these patients. We retrospectively reviewed all patients with distal sigmoid and rectal carcinomas who underwent ELT from January 1988 through April 1990. The majority of patients were referred for palliation of advanced disease. Thirty-seven patients underwent 123 ELT sessions (median, 2.5; range, one to 18). In 84% of patients, patency was maintained during a median follow-up of 31.5 weeks (range, one to 123). Morbidity and mortality were 2.5% (3/123) and 5% (1/37), respectively. Sixty-two percent had radiotherapy, chemotherapy, and/or surgery concurrent with ELT. Endoscopic laser therapy can safely and effectively reestablish and maintain luminal patency in patients with obstructing distal cancers. In addition, ELT can enable the administration of preoperative adjuvant radiotherapy and chemotherapy.

Adenocarcinoma↗
PubMed1991

The prognostic implications of location for scalp melanoma.

The clinical and pathologic records of 95 patients with primary cutaneous melanoma isolated to the scalp and regional lymph nodes treated at the MD Anderson Cancer Center between 1976 and 1985 were reviewed to assess the effect of lesion location on the prognosis of scalp melanoma. The scalp was defined as an area bounded by the supraorbital ridges, superior nuchal line, zygoma, and mastoid, thereby including a large non-hair-bearing area. Patients were grouped according to lesion location: hair-bearing or non-hair-bearing; anterior or posterior to the mid-tragal line; and parietal versus frontal, temporal, or occipital. There was a similar distribution of prognostic factors between the anatomic subsites. Analysis by univariate and multivariate methods demonstrated that, in a hair-bearing area, in an area posterior to the mid-tragal line, or in the parietal region, lesion location was highly predictive of the patient's survival. For example, the 5-year, melanoma-specific survival rate was 65% overall, 86% for patients with lesions located in non-hair-bearing regions and 47% for those with lesions in hair-bearing regions (p = 0.0019).

Female↗
PubMed1989

Microvascular free-tissue transfer. The Atlanta Veterans Administration Medical Center experience.

The entire microvascular tissue transfer experience from 1977 through 1987 at the Atlanta Veterans Administration Medical Center has been reviewed. Seventy-four free flaps were done in 68 patients. Assessable records were available in 52 patients who had 58 reconstructive procedures. The most frequently used flaps were jejunum in 15 patients (25.8%), latissimus dorsi in 11 patients (18.9%), rectus abdominis in eight patients (13.8%), and gracilis in seven patients (12.1%). Major complications occurred in 43.1% of the cases. Total flap loss occurred in eight patients (13.8%); from 1977 through 1982, four (28.6%) of 14 patients had total flap loss, and from 1983 through 1987, four (9.1%) had total flap loss. Partial flap loss occurred in four cases (6.9%). Of the 52 patients, 43 had their problems resolved expeditiously by free-tissue transfer. We conclude that in a university-affiliated Veterans Administration medical center, microvascular reconstruction is an important and necessary surgical tool. Failure rates have decreased markedly with time and increasing experience. Definition of new anatomic microvascular units for transfer has increased the number of reconstructive choices.

Bone Transplantation↗
PubMed1988

Perianal infections in acute leukemia. Second place winner: Conrad Jobst Award.

Perianal infections in patients with acute leukemia and granulocytopenia are potentially lethal conditions. To evaluate the management of perianal infections in patients with granulocytopenia and acute leukemia, all such patients treated at Emory University Hospital between January 1, 1980, and December 31, 1985, were reviewed. Twenty patients were found to have severe granulocytopenia (fewer than 500 polymorphonuclear leukocytes/mm3) and perianal infection, representing 5.7 per cent of all hematology service admissions during that period. Eleven patients were managed conservatively with broad-spectrum antibiotics and supportive measures, and nine patients underwent operative drainage of the perianal infection in addition to conservative measures. The two groups were similar in respect to age, associated conditions, length of hospitalization, and degree of perianal infection, with the exception that operatively drained patients were more likely to have positive blood cultures (7/9 operatively drained; 4/11 conservatively managed). Mortality was higher in the operatively drained group (44.4% vs 9% in the conservatively managed), and three patients had progression of the local infection after drainage, two of whom required a diverting colostomy. The overall mortality attributed to perianal disease in these severely granulocytopenic patients was 25 per cent. From this review, operative drainage of perianal infection does not appear to increase survival or decrease morbidity in patients with severe granulocytopenia.

Acute Disease↗
PubMed1987

Needle aspiration cytology of breast masses.

Needle aspiration cytology has been reported to be a highly sensitive and specific method of evaluation of solid breast masses when used by a single individual or closely knit group of clinicians and cytopathologists. This report summarizes the experience in 86 patients in whom needle aspiration cytology and excisional biopsy of solid breast masses were performed. All clinical evaluations, including needle aspirations and excisional biopsies, were performed by surgical residents in the Breast Clinic of Grady Memorial Hospital. The cytologic and histologic interpretations were performed by members of the Department of Pathology without direct interaction with the patients. Of the entire group of 86 patients, 27 had cancer and 59 had benign breast disease. There were no false-positive findings and five (11.9%) false-negative findings. The sensitivity of fine-needle aspiration was 73.7 per cent and specificity 100 per cent. The results are compatible with previously reported studies and it is believed that needle aspiration cytology is an integral part of evaluation of breast masses.

Adult↗