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Biomedical subjects

I M Ariel

Publications and source records attributed to I M Ariel.

16 recordsLinked to original sources
PubMed1979

Results of treating 1,178 patients with breast cancer by radical mastectomy and postoperative irradiation where metastases to axillary lymph nodes occurred.

A retrospective study of 1,178 females suffering from cancer of the breast and treated by radical mastectomy is presented. All operations were performed by essentially one group of four senior surgeons, each either trained or connected with Memorial Sloan Kettering Hospital in New York and spent practically all of his professional career in the treatment of cancer. The same techniques of surgery were practiced. The same principles of the overall treatment were utilized; namely, if there were no metastases to lymph nodes detected on histologic studies, no radiation therapy was given. If metastases were present in the axillary lymph nodes, each of the patients received postoperative radiation therapy. None received either chemotherapy nor immunotherapy, as primary treatment. The study includes all patients treated between 1930 and 1965 and complete follow-up data were obtained in 94.6% of all patients. Five hundred and ninety-six patients were classified histologically as Stage I (50.6%), 291 as Stage II (24.7%), 74 as Stage III (6.3%), and 217 patients (18.4%) were undetermined. The total number of patients who developed a second primary cancer in the remaining breast was 91 (7.7%), and only 51 patients (4.3%) developed local recurrences in the chest wall or axilla. The mean age of the patients was 51.9 years. The absolute 5-year survival of all patients was 64% and the 10-year survival equaled 54.6%. The 9.4% mortality between the 5- and 10-year survival emphasizes that the 10-year survival figures are a more accurate index of survival. The larger the tumor, usually the poorer the prognosis, except where the tumor was 8 cm or larger where the prognosis was rather good. This indicates some biologic resistance to the tumor, making patients with large tumors candidates for "curative" radical mastectomy. The delay in seeking treatment had minimal effect on the overall survival. Staging had a significant effect and the 5-year survival for the Stage I group was 81.7% which declined to 60.3% at the 10-year period. In the Stage II group, these values were less and averaged 63.7% 5-year survival and 47.2% 10-year survival. The 74 patients wiival at the 10-year period. It is concluded that radical mastectomy plays an important role in curing a significant number of patients with breast cancer. Whether it should be abandoned for more conservative surgery is a matter which further studies will indicate. This study presents a baseline investigation, under a more-or-less standard clinical situation for evaluating the accomplishments of the radical mastectomy.

Adult↗
PubMed1978

Treatment of symptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes.

Sixty-five patients were referred for treatment with symptoms resulting from metastatic cancer to the liver from the GI tract. Two groups of patients were analyzed. The first group of 40 patients were subjected to a laparotomy and insertion of a catheter into the hepatic artery and a second group had the catheter inserted percutaneously and a bolus of cancer chemotherapeutic agents injected into the catheter. In both groups, chemotherapy in the form of 5-fluorouracil was supplemented by internal irradiation delivered from the intraarterial administration of Yttrium 90 microspheres. Forty percent of the patients who had an indwelling catheter performed at celiotomy manifested an objective response and in 60% a significant subjective improvement occurred. In the 25 patients whose catheter was inserted percutaneously, the response rate was roughly similar, in that 35% demonstrated an objective response and 65% demonstrated a subjective response.

Catheters, Indwelling↗
PubMed1977

Obesity obscuring breast cancer: a case report.

There is normally a layer of fat in the breast between the parenchyma of the breast and the skin. This is frequently thin and does not preclude the palpation of a tumor mass which involves the breast parenchyma. In patients suffering from obesity this fat pad becomes much thicker and obscures any underlying masses arising from the breast parenchyma. A case is reported in which a woman who was markedly obese lost a significant amount of weight and presented a bulge which was found to be carcinoma. This situation, in which fat obscures underlying breast lesion, has been observed in a number of patients. Attention is called to the limited value of physical examination of the breast in markedly obese patients. If any suspicion exists or if the patient is a candidate for cancer from a familial standpoint, mammograms are indicated.

Breast Neoplasms↗
PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗
PubMed1976

The disparity of the size of the liver as determined by physical examination and by hepatic gammascanning in 504 patients.

The liver extended a minimum of 5 cm inferior to the right costal margin in 51% of the 504 patients studied. In 53% of these patients, experienced, mature physicians declared that the liver was not palpable on physical examination. In 3% of the cases, a mass was palpated which was believed to be liver by the examining physician but was found to be extrahepatic upon scanning and laparotomy. The unreliability of physical examination in determining whether or not the liver extends inferior to the costal margin in many instances is demonstrated.

Humans↗
PubMed1975

Disseminated melanoma with unique unilateral distribution.

This is a case report of extensive metastases of dermal and subcutaneous malignant melanomas limited to the right side of the body, with the left side remaining singularly free of any evidence of tumor. The primary melanoma, which had been excised 7 years before the development of metastases, existed on the posterior aspect of the chest, slightly to the right of the midline. This is the only case of its kind noted.

Adult↗
PubMed1975

Chordoma: an analysis of twenty cases treated over a twenty-year span.

Chordoma is a recurring malignancy which does not play by the rules. A five-year survival or even a survival of ten years or longer without evidence of tumor cannot assure the surgeon that the malignant growth has been laid to rest. Recurring local episodes as well as metastases may continue to yield to surgery, irradiation, and other forms of treatment for an astonishing length of time. Thus, situations that may be cause for despair in other malignancies are often a challenge for renewed vigorous treatment in chordoma.

Adult↗
PubMed1975

Rhabdomyosarcoma of the extremities and trunk: analysis of 150 patients treated by surgical resection.

This report details the clinical experience of 150 patients with rhabdomyosarcomas treated by one group of surgeons. Of the 150 patients, 103 suffered from pleomorphic rhabdomyosarcomas, 40 patients had embryonal rhabdomyosarcomas, and 7 had alveolar cell type of rhabdomyosarcoma. The males suffered almost twice as much as the females from this form of cancer (96 males to 54 females). The fifth decade had the highest incidence of all rhabdomyosarcomas. The younger patients generally suffered from embryonal rhabdomyosarcomas and the older ones from pleomorphic rhabdomyosarcomas, although age was no barrier to the occurrence of embryonal rhabdomyosarcomas in some of the older patients and pleomorphic rhabdomyosarcomas in some of the younger patients. Caucasians were almost exclusively afflicted by this form of cancer (93% of this series). The lower extremity was the most frequent site of the lesion, occurring in 50.7% of the 150 cases. The upper extremity was the second most frequently involved site (28%), and the trunk was the least involved site (21.3%). Of the 150 patients studied, 40 were considered indeterminate. Thirteen patients are alive and free of cancer, but were treated less than 5 years ago; 12 patients reported for consultation only. There were 13 who were free of sarcomas at periods in excess of 2 years but were lost to follow-up. Two patients in this series died before the 5-year period, and autopsy revealed the death to be due to causes other than the rhabdomyosarcoma. Of the 110 determinate patients, 75 (68%) died as a result of the cancer. The 5-year survival rate equals 32%. The fact of the 30% 5-year survival after treatment for recurrences should help dismiss the pessimism which prevails once a recurrence is noted subsequent to major therapy. Age per se had no great effect on prognosis. The poorest results occurred in the 11-20 age range, with a 5-year survival of 15%. This value reflects on increased incidence of embryonal rhabdomyosarcomas which tend to be more malignant and metastasize earlier than do the pleomorphic type. The effect of location upon survival revealed that of 76 patients with involvement of the lower extremity, 34% survived 5 years or longer, and those with sarcomas of the trunk had the poorest survival (26%). The fact that the trunk, by virtue of its anatomy, limits the degree of surgery that can be perfomred, probably helps to explain this difference. The role of radiation therapy and chemotherapy awaits elucidation. Reports of combined surgery, radiation therapy, and chemotherapy are encouraging.

Adolescent↗
PubMed1975

Treatment of disseminated cancer by intravenous hydroxyurea and autogenous bone-marrow transplants: experience with 35 patients.

Massive doses of hydroxyurea (Hydrea) were given to 35 patients suffering from different cancers. Protection to the hematopoietic system was obtained by autogenous marrow transfusions. The clinical response obtained was not considered superior to the results obtained by administering the drug orally over a prolonged period. The described technique is safe and relatively atraumatic, and it may be advisable to administer a large priming dose by this technique to be followed by smaller maintenance doses of a given anticancer chemotherapeutic agent.

Bone Marrow Cells↗