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Biomedical subjects

H S Moseley

Publications and source records attributed to H S Moseley.

At least 19 recordsLinked to original sources
PubMed1992

An evaluation of two methods of limb salvage in extremity soft-tissue sarcomas.

Between 1983 and 1990, 38 sequential patients with stage II to III soft-tissue sarcoma of the extremities, as defined by the American Joint Committee on Cancer, were treated. Eighteen patients were treated with intra-arterial doxorubicin hydrochloride, limb salvage surgery, and radiation (group A). Twenty patients in group B were treated with cisplatin, isolated limb perfusion, limb salvage surgery, and radiation. The study was not randomized, but all patients were treated prospectively using one of the two protocols. The two groups were similar demographically and had similar lengths of survival without disease. There was only one local recurrence in the series, and this occurred in a group B patient who underwent perfusion with the lowest dose of cisplatin. Regional perfusion with either intra-arterial doxorubicin hydrochloride or cisplatin combined with limb salvage surgery and postoperative radiation are highly effective in preventing local recurrences and preserving functional extremities in patients with soft-tissue sarcoma. There was no difference in results between these two methods.

Adolescent↗
PubMed1992

Inspiratory valve malfunction in a circle system: pitfalls in capnography.

Capnography is a useful technique in monitoring the integrity of anaesthetic equipment such as the malfunctioning of unidirectional valves in circle system. However, the lack of a precise mechanism in existing capnographs to identify the start of inspiration and the beginning of expiration in the capnograms, makes the analysis of the carbon dioxide waveforms during inspiration difficult and thus results in inaccurate assessment of rebreathing. We report a case where, during the malfunction of the inspiratory unidirectional valve in the circle system, the capnograph failed to detect the presence of substantial rebreathing. Critical analysis of the capnogram recorded during the malfunction revealed that there was substantial rebreathing which was underestimated by the capnograph as it reports only the lowest CO2 concentration rebreathed during inspiration in such abnormal situations.

Anesthesia, Closed-Circuit↗
PubMed1991

MR imaging in fibromatosis: results in 26 patients with pathologic correlation.

Fibromatoses are a diverse group of soft-tissue lesions that have been inconsistently categorized and treated. The purpose of our study was to establish the range of appearances of fibromatoses on MR images and perform a pathologic correlation to explain the variable signal-intensity patterns. During a 3-year period, 26 patients with deep fibromatoses were examined with MR. The MR images were evaluated for signal-intensity characteristics, and findings were correlated retrospectively with the pathologic diagnoses. The results showed that the MR appearance of fibromatoses is similar to that of other soft-tissue lesions, and the signal intensities vary greatly from lesion to lesion and within lesions themselves. The fibromatoses were either hyperintense, isointense, hypointense, or of mixed signal intensity relative to adjacent skeletal muscle. The hypointense areas appear to be zones of hypocellularity and dense collagen deposition. Microscopically all of the lesions invaded adjacent structures, but the MR appearances of the margins varied and were judged to be well demarcated (n = 14), intermediate (n = 5), or poorly demarcated (n = 6). Our experience shows that fibromatoses have a variable MR appearance no different from that of other soft-tissue lesions, and this variability reflects the composition and cellularity of the lesions.

Adult↗
PubMed1990

Malignant melanoma metastatic to the thyroid as initial evidence of disseminated disease.

A 48-year-old Caucasian male with a 3 mm sub-ungual right middle finger melanoma underwent cisplatin forequarter perfusion, ray amputation, and ipsilateral axillary node dissection. Two months post-operatively he presented with a thyroid mass as initial evidence of disseminated disease. Subsequent workup also demonstrated pulmonary metastases. A total thyroidectomy radical neck dissection and multi-agent chemotherapy has controlled the disease in his neck. As far as we are aware, this is the first case report of malignant melanoma metastatic to the thyroid. The potentially beneficial role of surgery in the management of metastatic melanoma and the relation of melanoma to the hormonal axis is discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Problems in diagnosis and management of desmoid tumors.

Thirty-two primary desmoid tumors occurred in 29 patients. The median patient age was 32 years, and 55% of the patients were females. An antecedent history of trauma at the tumor site was elicited from 28% of patients. Thirty-one of 32 primary tumors were completely excised at initial presentation. Five tumors were treated with adjuvant radiotherapy. The overall recurrence rate for primary and recurrent lesions was 60%. The recurrence rate in children (88%) was more than twice that found in adults (38%). A single recurrence did not significantly increase the likelihood of a subsequent recurrence. Greater than 90% of all recurrences took place within 3 years of treatment. The rate of recurrence was not clearly influenced by the status of histologic margins, although this was examined in less than half the tumors. Desmoid tumors are aggressive neoplasms that exhibit a strong propensity for local recurrence. They should be treated as low-grade malignancies with documentation of histologic margins and close clinical follow-up within the framework of a tumor registry.

Abdominal Muscles↗
PubMed1989

Brunner's gland hyperplasia.

Brunner's gland adenomas are uncommon benign duodenal tumors. They are an infrequent cause of upper gastrointestinal hemorrhage and duodenal obstruction but can occasionally mimic duodenal malignancy in their presentation. Conservative endoscopic or surgical resection followed by a regimen of antacids and H2 antagonists is the treatment of choice.

Adenoma↗
PubMed1988

Pharmacokinetics, toxicity, and short-term results of cisplatin hyperthermic isolated limb perfusion for soft-tissue sarcoma and melanoma of the extremities.

Fifty-nine patients with melanoma or soft tissue sarcoma of the extremities underwent hyperthermic isolated limb perfusion utilizing cisplatin and wide local excision. Doses of cisplatin ranged from 0.75 to 2 mg/kg. The mortality and morbidity rates were 0 and 6.8 percent, respectively. Pharmacokinetic studies indicate that cisplatin is rapidly bound to perfused tissues and remains bound for 1 month. Maximum tumor response in sarcomas occurs 1 to 2 weeks after perfusion, compared with 1 month after perfusions with l-phenylalanine mustard and actinomycin D. Local and regional recurrence rates were 0 and 3.4 percent, respectively, at 1 year. Further studies of hyperthermic limb perfusions with cisplatin are warranted.

Adult↗
PubMed1986

Flow requirements for the Bain breathing circuit during anaesthesia for caesarean section.

We studied the relationship between arterial carbon dioxide tension (PaCO2) and fresh gas flow (FGF) during use of the Bain breathing circuit for Caesarean section anaesthesia. Thirty-one patients undergoing Caesarean section were anaesthetised using the Bain circuit with intermittent positive pressure ventilation. The PaCO2 were measured at FGF of 70 ml X kg-1 X min-1, 80 ml X kg-1 X min-1, and 100 ml X kg-1 X min-1. The FGF requirement to maintain a given PaCO2 during Caesarean section anaesthesia is the same as the requirements for nonpregnant subjects, despite the increase in carbon dioxide production associated with pregnancy. This is probably because the total FGF determined by body weight and given during Caesarean section anaesthesia is 15-20 per cent higher than nonpregnant levels, due to the weight gain associated with pregnancy. A FGF of 100 ml X kg-1 of pregnant weight/min maintains PaCO2 of 4.44 kPa predelivery, which is in the desirable range of PaCO2 during Caesarean section.

Adult↗
PubMed1986

Improved survival for soft tissue sarcoma of the extremities by regional hyperthermic perfusion, local excision and radiation therapy.

Soft tissue sarcomas continue to present problems with both local control of disease and death from distant metastases after accepted surgical therapy. Multimodality management has been established in the literature to be superior to traditional therapy of wide excision or amputation. The results of the treatment of 64 patients at Oregon Health Sciences University using regional hyperthermic perfusion with l-phenylalanine mustard and actinomycin D, wide local excision and external radiation therapy are reviewed. Histologic tumor types included: 19 liposarcomas, 14 malignant fibrous histiocytomas, eight fibrosarcomas, five leiomyosarcomas, four malignant schwannomas and 14 other sarcomas of the extremities. Minimum follow-up study has been 24 months and the mean follow-up time is more than five years. One-third of the patients presented with local recurrent disease after unsuccessful primary treatment. Over-all local recurrence for all patients treated by a combination of the aforementioned modalities was 3.4 per cent at two years and 11.1 per cent at five years. The over-all survival rate for all patients was 88 per cent at two years and 67 per cent at five years compared with a published over-all five year survival rate of 41 per cent. Patients with malignant fibrous histiocytomas had both two and five year local recurrence rates of 7.7 per cent and survival rates at two and five years of 79 and 63 per cent, respectively. This is compared with a previously published over-all five year survival rate with malignant fibrous histiocytomas of 46 per cent. The results with the treatment of liposarcomas were also superior to the published literature. Not only are the treatment results with regional hyperthermic perfusions excellent for both primary and locally recurrent sarcomas of the extremities, but limbs previously considered unsalvagable can be spared.

Adolescent↗
PubMed1985

Breast carcinoma in situ. A retrospective review of 112 cases with a minimum 10 year follow-up.

We have retrospectively reviewed 112 cases of in situ carcinoma of the breast treated between 1960 to 1972, with a minimum 10 year follow-up to correlate treatment with outcome. We concluded that bilateral simple mastectomy with low axillary dissection is the treatment of choice for intraductal or lobular carcinoma in situ. This conclusion was based on the early age at diagnosis, the high incidence of bilaterality, and the long latency and probable progression from the in situ stage to the invasive stage. Lesser procedures can be endorsed for those patients of advanced age or who have associated medical problems whose life expectancy is estimated to be 10 years or less. Patients who refuse bilateral mastectomy should undergo biopsy of the involved or opposite breast at 3 to 5 year intervals regardless of physical findings or mammographic suspicions, especially when severe epithelial dysplasia is encountered in the biopsy specimens. This nonpalpable but potentially curable lesion remains difficult to detect even by mammography.

Adult↗
PubMed1979

Multiple primary melanoma.

From a series of 712 patients with melanoma, 38 patients (5.3%) had more than one primary melanoma. Twenty-four patients had two primaries, 11 patients had three, 2 patients had four, and 1 patient had eight. Twelve patients (32%) had one or more synchronous primaries. Forty-five percent of all multiple primaries were diagnosed within the first year. Microstaging by level and depth was determined prior to treatment and in patients with nonsynchronous primaries, 83% had a subsequent melanoma equal or less advanced than the original. Twenty-six patients with Stage I primaries were skin-tested with DNCB prior to therapy. No significant differences in delayed cutaneous hypersensitivity reactions were found between multiple primary and matched controls with only a single melanoma. Four of 10 patients with multiple primaries treated with adjuvant BCG or BCG-tumor cell vaccine developed subsequent melanomas suggesting that immunotherapy with BCG will not prevent the development of a new primary melanoma. Survival in patients with Stage I and II multiple primary melanomas was improved compared to Stage I and Stage II patients with a single primary. This study suggests that prognosis in multiple primary melanomas is better reflected by the most advanced primary based on microstaging and the presence or absence of regional lymph node metastases than by multiplicity.

Adult↗