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J Alexander Palesty

Publications and source records attributed to J Alexander Palesty.

7 recordsLinked to original sources
PubMed2006

Axillary recurrence in women with a negative sentinel lymph node and no axillary dissection in breast cancer.

OBJECTIVES: Sentinel lymph node biopsy (SLNB) is widely used for staging breast cancer. SLNB accurately determines axillary lymph node status with a low false negative rate. There remains concern that omitting axillary dissection may lead to recurrence in the axilla, and impact long term survival. The purpose of this study was to determine the frequency of axillary lymph node recurrence in patients who had a negative sentinel lymph node and did not undergo axillary node dissection. METHODS: Data was collected on all patients who had negative SLNB at Roswell Park Cancer Institute between July 1997 and June 2002. Demographics, type of operation, postoperative systemic, and radiation therapy, co-morbidity score, hormone receptor status, and the pathologic features of the tumor were abstracted for each patient. For each woman with recurrence, the dates of recurrence, the site(s) of recurrence, and the treatment for recurrence were recorded. RESULTS: With a median follow-up of 33 months, 15 of 335 (4.5%) women who had negative SLNBs and who did not undergo completion axillary dissection developed a cancer recurrence. Only two patients (0.6%) had an axillary recurrence. CONCLUSIONS: The rate of axillary recurrence following a negative sentinel node biopsy is the same or less than axillary lymph node dissection (ALND) alone. Concerns that omitting completion axillary dissection following a negative SLNB will increase the rate of axillary recurrence appear unfounded.

Adult↗
PubMed2005

Developments in the management of extremity soft tissue sarcomas.

Soft tissue sarcomas, a rare and extremely low prevalence tumor, has no uniform treatment recommendation because there have been few randomized prospective trials to guide management. Recently, there have been surgical, medical, biologic, and genetic advances toward improved treatment. A multidisciplinary approach at specialized treatment centers should be sought because the skill set necessary to implement these advances can be provided and outcomes improved. Centralized care will be crucial to improving survival and functional outcome because it will allow for patients to be effectively entered into prospective randomized trials and create regional and national tissue banks to generate meaningful data.

Animals↗
PubMed2003

Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma.

Lymphoplasmacytic sclerosing pancreatitis (LP) is a rare cause of benign mass lesions of the pancreas that can resemble adenocarcinoma. This study evaluates and classifies a series of patients with LP. Patients with benign pancreatic disease were identified from a prospective pancreatic database, and these cases were reviewed to identify patients with LP. Patients were subdivided into two groups: (1) classic LP, which included those patients who had all four of the characteristic histologic features of LP, including lymphoplasmacytic infiltration of the pancreas, interstitial fibrosis, periductal inflammation, and periphlebitis; and (2) intermediate LP, which included patients with at least two of these histologic findings. Patient demographics, pathologic and clinical features, and outcome were analyzed. From 1985 to 2001, a total of 1287 pancreatic resections were performed at our institution, of which 159 were for benign disease. Of these, 31 had pathologic features consistent with LP, and all of these patients had a presumed preoperative diagnosis of pancreatic carcinoma. Most of these patients presented with jaundice (n = 21) or abdominal pain (n = 7). In 29 of 31 patients, curative resection was possible. Of these, 28% (8/29) developed recurrence after resection: seven with jaundice and one with recurrent pancreatitis (median time to recurrence, 11 months; median follow up, 38 months). All patients with recurrent jaundice appeared to have biliary strictures at the time of direct cholangiography and no patient had malignancy. A review of the pathology reports identified 19 patients with classic LP and 12 patients with intermediate LP, and there was no difference between these two groups. LP is a rare cause of pancreatitis that is difficult to differentiate from carcinoma preoperatively. Patients with classic and intermediate LP appear to demonstrate a similar clinical behavior. Nearly one third of patients have a progressive course after resection, with 25% developing recurrent jaundice; thus close follow-up is mandatory for all patients.

Adenocarcinoma↗
PubMedDate not supplied

Fifty-five consecutive laparoscopic appendectomy procedures without conversion.

BACKGROUND: In patients with suspected appendicitis, laparoscopic appendectomy is gaining increasing acceptance primarily because it is associated with less postoperative pain and a shorter hospital stay. Experience with 55 consecutive laparoscopic appendectomies, performed without conversion by the same surgeon, is herein examined and analyzed. METHODS: The medical records of 55 consecutive patients with suspected appendicitis who underwent laparoscopic exploration (from 2000 to 2002) were analyzed for demographic information, clinical findings, laboratory/computed tomography scan results, intraoperative diagnosis, clinicopathologic correlation, complications, incidental findings, and operative time. RESULTS: Twenty-six males (47%) and 24 females (53%) underwent surgery. Mean age was 25.2 years (range, 6 years to 67 years). Computerized tomography scans obtained in 37 cases (74%) had a sensitivity of 86.7% and a specificity of 62.5%. Average length of stay was 2.3 days (median, 1 day). Average operating room time was 69 minutes (range, 40 to 173 minutes). Five patients experienced postoperative complications: 2 had intraperitoneal abscesses, 1 had urinary retention, and 2 had postoperative ileus. No operative conversions or postoperative wound infections occurred. CONCLUSION: Laparoscopy confirmed the clinical diagnosis of acute appendicitis and allowed the safe, effective treatment of both complicated and uncomplicated appendicitis with minimal hospitalization, recovery and convalescent times, and zero open conversion and wound infections. Laparoscopic appendectomy is advocated as the procedure of choice for patients with clinically suspected appendicitis.

Adolescent↗