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Biomedical subjects

J F Huth

Publications and source records attributed to J F Huth.

At least 19 recordsLinked to original sources
PubMed2001

Accuracy and effectiveness of laparoscopic vs open hepatic radiofrequency ablation.

BACKGROUND: The purpose of this study was to compare the accuracy (in terms of ultrasound-guided probe placement) and the effectiveness (in terms of pathologic tumor-free margin) of laparoscopic vs open radiofrequency (RF) ablation. METHODS: Using a previously validated tissue-mimic model, 1-cm simulated hepatic tumors were ablated in 10 pigs randomized to open or laparoscopic techniques. Energy was applied until tissue temperature reached 100 degrees C (warm-up) and thereafter for 8 min. A pathologist blinded to technique examined all specimens immediately after treatment. Analysis was by Fisher's exact test and the Mann-Whitney U test; p < 0.05 was considered significant. RESULTS: Off-center distance (3.5 +/- 1.6 vs 4.2 +/- 1.4 mm), size (24.7 +/- 3.1 vs 25.6 +/- 3.8 mm), symmetry (40% vs 73%), margin positivity (33% vs 9%), and margin distance (1.1 +/- 1.2 vs 2.2 +/- 1.6 mm) were not significantly different between laparoscopic (n = 15) and open (n = 11) ablations, respectively. The proportion of round/ovoid lesions (20% vs 64%) was lower (p = 0.043), and warm-up time (20.2 +/- 14.0 vs 10.7 +/- 7.5) was longer (p = 0.049) for the laparoscopic than for the open groups, respectively. CONCLUSION: Accurate probe placement can be achieved using laparoscopic and open RF ablation techniques. The physiologic effects of laparoscopy may alter ablation shape and warm-up time. Additional studies are needed to establish effective ways of achieving complete tumor destruction.

Animals↗
PubMed1997

Surgical treatment of malignant melanoma.

The surgical treatment of malignant melanoma is dependent on early diagnosis and a thorough understanding of the options available to patients who present with more deeply invasive lesions. There has been a shift in therapy of primary skin lesions to using narrower (1-2 cm) margins of excision. Decisions regarding treatment of the regional lymph nodes are predicated upon understanding the overall risk of metastatic spread and delineating the pattern spread of the malignant cells. The concept of intraoperative lymphatic mapping can greatly aid the clinician in deciding (1) which lymph node group is the primary drainage basin for any particular area of skin, and (2) which lymph node is the first node to receive lymphatic drainage from any given area (the so-called "sentinel lymph node."). Surgical resection of metastases can result in prolongation of survival in carefully selected patients.

Decision Making↗
PubMed1995

Insulinoma: pitfalls in preoperative localization.

In patients with biochemical evidence of insulinoma, many techniques have been advocated as the procedures of choice for diagnostic localization without a clear-cut consensus as to their utility. Despite the small size of insulinomas, 90% are solitary and nearly 100% are intrapancreatic. A commonly held belief is that once the diagnosis of autonomous hyperinsulinism is confirmed, it is necessary to secure as much information as possible about the precise location prior to surgery. Although frequently used, preoperative localization studies are expensive, potentially morbid, and worse yet, may be misleading. We present a case study in which the preoperative studies falsely localized the insulinoma to the pancreatic head. Since the introduction of intraoperative ultrasound (IOUS), it is now unusual not to identify and excise the insulinoma in patients undergoing exploration for functioning beta-islet cell lesions. Our experience, along with support from the literature, led us to recommend a simplified localization approach, namely IOUS combined with surgical palpation.

Female↗
PubMed1995

Breast cancer screening practices for hospitalized women.

The increasing prevalence of breast cancer and the demonstrated benefits of routine breast screening activities have prompted considerable attention to the use of screening procedures. In addition to public education efforts, physicians have been encouraged to incorporate breast screening guidelines into their daily practice. This study was undertaken to examine the current practice of breast screening activities for women hospitalized on a general medical or surgical unit at a university medical center. A retrospective chart review of 159 women hospitalized during a six-month period demonstrated that breast screening activity in the sample was similar to national rates of breast cancer screening. Within the year, 43% of these women had had a clinical breast examination and 21% had had mammography. This suggests that the period of hospitalization had not been used by practitioners as an opportunity to initiate breast screening activities in the patient's care.

Adult↗
PubMed1995

Retroperitoneal fibrosis treated with tamoxifen.

Retroperitoneal fibrosis, although histologically benign, has a malignant course due to encasement and compression of tubular retroperitoneal structures, particularly the urinary system. The etiology of this neoplastic process is unclear, but clinical symptoms result from fibroblast proliferation with excessive collagen deposition. Because of the diffuse nature of this disease, surgical resection is technically impossible, and past medical therapies have been inconsistent. Tamoxifen has been shown to be effective in the treatment of desmoid tumors, and we present a patient with retroperitoneal fibrosis who was treated successfully with this anti-estrogen. Because of its minimal side effects and simplicity of dosing, tamoxifen may be a useful treatment in this disease.

Female↗
PubMed1992

Rapid assay for immune complex bound antigens from urine of cancer patients.

Concentrated urine from patients with various types of cancer was fractionated by S-500 gel filtration chromatography to yield high molecular weight (mw) immune complexes (IC) and lower mw immunoglobulin (Ig) fractions. Column fractions were assayed for the presence of IgM and IgG by immunoblot probing using anti-human IgM and anti-human IgG alkaline phosphatase conjugates. These results were used to define IC fractions (those from high mw S-500 fractions which were positive for immunoglobulin) and Ig fractions (those from medium mw S-500 fractions which were positive for immunoglobulin). Antigen components of high mw S-500 IC fractions were then determined by immunoblot probe using medium mw S-500 Ig fractions as the antibody probe (i.e. autoantibody). This method for identification of immune complex antigens has the potential to probe for tumor-associated antigens, autoantigens, or foreign antigens from starting material which contains both immune complex and free immunoglobulin.

Antigen-Antibody Complex↗
PubMed1991

Identification of an immunoreactive glycoprotein in the urine of sarcoma patients.

Tumor-associated antigens (TAA) can be detected in the urine of sarcoma patients by a variety of assays. This study was designed to correlate antigen activity in three assays: complement fixation assay (CFA), enzyme-linked immunosorbent assay (ELISA), and Western blot (WB). This study identifies the antibody class responsible for TAA identification in these assays and characterizes the nature of the antigen. One hundred eighty-nine urine samples from eight sarcoma patients with known levels of TAA in CFA were tested in ELISA and WB. Allogeneic anti-TAA containing sera (1 degree antibody) from a sarcoma patient was reacted with urine samples followed by detection with alkaline phosphatase-linked goat anti-human IgG and IgM (2 degree antibody in both assays). Reactivity in CFA correlated to IgM reactivity in ELISA and WB (chi 2 test, P less than 0.001). No correlation was found to IgG reactivity in either assay. Reactivity in WB vs ELISA was also highly correlated for IgM (P less than 0.001). TAA was visualized in WB as a distinct pattern of repeating bands, with most bands being detected in the range 30,000-60,000 Da. The separation between bands approximated 2500-3000 Da, suggesting a molecule composed of repeating subunits. This study suggests that the antigen is glycoprotein in nature, and that the detecting antibody is of the IgM class.

Antigens, Neoplasm↗
PubMed1991

Impact of the Cancer Education Program on career paths of students.

A questionnaire sent to former University of North Carolina students who participated in the Cancer Education Program, a National Cancer Institute sponsored program designed to provide integrated educational opportunities in oncology for students in the health science schools, ascertained the career paths taken by students and elicited opinions regarding the impact of the program on those decisions. One hundred five surveys were returned. The opportunity to be involved in cancer research was the most common reason given for participation in the program (65 respondents). The opportunity to work with a specific faculty member (48) and improving academic credentials (44) were also important. Twenty-three individuals changed their career goals after participation in this program, 20 decided to pursue cancer-related careers, and 3 decided to avoid this field. One hundred three individuals were currently in health professions, 58 in academic, and 45 in community-based practice. Twenty-seven were not involved with cancer, while 56 spent up to 25% of their professional time, 8 spent 25%-50%, and 9 spent over 50% of their professional time in cancer-related activities.

Career Choice↗
PubMed1990

Progress in the recognition and treatment of soft tissue sarcomas.

Over the past 10 years there has been significant progress made in the recognition and treatment of soft tissue sarcomas. With the advent of CAT scans and MRI, preoperative delineation of soft tissue tumors has become readily available. The diagnostic use of these modalities in patients presenting with an ill-defined asymptomatic mass has been extremely helpful in terms of screening patients to decide whether or not a biopsy is indicated. These techniques have also provided a much clearer delineation of the anatomic extent of the primary tumor, which has been of great assistance both in radiation therapy treatment calculations as well as in preoperative surgical planning. The recognition that tumor grade is the dominant prognostic variable has resulted in the more common use of a grading system, and a more uniform reporting and stratification of end results. Recent studies with immunohistochemical staining have proven of value in determining the histogenesis of many tumors that in the past were difficult to classify accurately. Most recently the use of flow cytometry suggests that this will also be a valuable adjunct in determining tumor grade and thereby prognosis. The most recent investigations of molecular biologic evaluation of genetic DNA and RNA sequences, as well as of oncogenes are extremely interesting from a diagnostic standpoint and in demonstrating the potential of molecular biologic evaluation for understanding the origin of these tumors. Multimodality therapy with surgery, radiation, chemotherapy, or all three has resulted in a marked improvement in local tumor control for patients with soft tissue sarcomas. The combination of modalities has allowed smaller surgical excisions of the tumor and thereby preservation of the extremity and much of its function. There are currently several different methods of multimodality therapy used including neoadjuvant therapy and postoperative therapy, both of which have been proven efficacious. Chemotherapy is now playing an increased role in clinical investigation and treatment. The availability of Adriamycin, DTIC, cisplatin, and most recently ifosfamide has added several chemotherapeutic agents for use by the clinician. Combination chemotherapy and radiation is of value in the neoadjuvant setting, and several studies are now underway to determine whether postoperative adjuvant chemotherapy is of similar value in reducing systemic spread of disease. Finally, surgical resection of pulmonary metastases has been proven of value in 20% to 25% of patients who subsequently develop metastatic disease. As a result of these advances in several different treatment disciplines, the overall survival rate and quality of life of patients with soft tissue sarcoma have improved markedly over the past 10 years.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Patterns of recurrence after resection of osteosarcoma of the extremity. Strategies for treatment of metastases.

We studied recurrence patterns in 255 patients with high-grade osteosarcoma of the extremity and the efficacy of the treatment of these recurrences. One hundred seven patients developed metastatic disease: 77 had isolated pulmonary metastases, 17 had simultaneous metastases to lung and elsewhere, and 13 had metastases to other sites. Of the 77 patients with metastases confined to the lung, 51 (66%) underwent thoracotomy for resection of the metastases, and 13 (17%) are long-term disease-free survivors. Patients with simultaneous metastases to lung and other sites, and patients with metastases to sites other than lung, have a poor prognosis with only one long-term disease-free survivor in these groups. Thoracotomy has a limited role in the treatment of metastatic disease. Improvements in aggressive, systemic chemotherapy are essential for improving the prognosis in these patients.

Adolescent↗
PubMed1989

Preoperative intra-arterial chemotherapy.

The major factors affecting prognosis of patients with soft tissue sarcomas are local control, size of the primary tumor, and the grade of the tumor. The only factor that can be influenced following appropriate diagnostic procedures is local control. Surgery alone, even radical surgery or amputation, is insufficient to control large, poorly differentiated tumors in many cases. Preoperative therapy has been shown to be a highly effective method for local disease control. Intra-arterial therapy appears to have several advantages in the treatment of extremity sarcomas. (1) Intra-arterial therapy results in at least a sixfold increase in the concentration of drug in the blood perfusing the tumor. If combined with proximal occlusion of blood flow (balloon occlusion or tourniquet occlusion), the concentration of drug being delivered to the tumor may increase by 30-fold [32]. This high local concentration of chemotherapy is achieved in most cases without the high systemic toxicity that would be required by intravenous therapy. (2) Chemotherapy infusion prior to surgery allows administration of cytotoxic therapy through an undisturbed blood supply. This allows for an improved effect of therapy at the tumor margin, which is the area at risk for seeding the wound at the time of extirpative surgery. This may facilitate limb salvage in patients with bulky tumors. (3) Responses to this preoperative therapy allows an in vivo evaluation of the efficacy of the drug against the individual tumor. This may aid in determining efficacy of using the drug for postoperative adjuvant therapy. (4) Preoperative therapy allows treatment of the tumor while awaiting construction of custom prostheses, especially in patients with osteosarcomas of the extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1988

Resection of malignant bone tumors of the pelvic girdle without extremity amputation.

Fifty-three patients with malignant tumors of the pelvis ossea were evaluated for location of tumor, extent of resection, postoperative function, local recurrence, and survival. Three tumors were unresectable, 17 required a wide local excision, 27 required resection of the hemipelvis without extremity amputation (internal hemipelvectomy), and six required a classical hemipelvectomy with amputation. The incidence of local recurrence was 11.8% for wide local excision, 7.4% for internal hemipelvectomy, and 33% for classical hemipelvectomy. Survival following wide local excision or internal hemipelvectomy was 58% and 41%, respectively, at five years compared with 17% for patients undergoing classical hemipelvectomy. Patients who underwent wide local excision had good to excellent functional results. Patients requiring internal hemipelvectomy initially required ambulatory supports, but many can now ambulate independently, with a neurologically intact extremity, despite a noticeably abnormal gait.

Adolescent↗
PubMed1988

Patterns of metastatic spread following resection of extremity soft-tissue sarcomas and strategies for treatment.

This study examines recurrence patterns in 255 patients with soft-tissue sarcoma treated with preoperative chemotherapy and radiation, followed by limb-sparing surgery. Eighty-five patients developed metastatic disease: 13 had isolated local recurrence, 43 had isolated pulmonary metastases, 11 had metastases to lung and elsewhere, and 18 had metastases to multiple sites. Of the patients with isolated pulmonary metastases, 19/43 had resection of the metastases, and 9 are disease free. All 13 patients with local recurrences had resection of the recurrence, and 9 remain disease-free. Patients with multiple sites of recurrence had a 2-year survival of less than 10%. Resection of metastases is beneficial to a small number of patients who develop metastatic disease.

Actuarial Analysis↗
PubMed1988

A randomized prospective trial using postoperative adjuvant chemotherapy (adriamycin) in high-grade extremity soft-tissue sarcoma.

From March 1981 to December 1984 119 patients with primary grade III extremity soft-tissue sarcoma were randomized postoperatively to single agent Adriamycin (57) or to control, no adjuvant chemotherapy (62). Adjuvant therapy was begun within 6 weeks of surgery, and consisted of Adriamycin 90 mg/m2 given over 2 days, once a month for 5 months. All patients had received preoperative intraarterial Adriamycin, radiation therapy (1,750 cGy) and subsequent surgical excision. At a median follow-up of 28 months there was no difference between the two groups in overall survival (Adriamycin = 84%, control = 80%), local tumor recurrence, or in the disease-free survival (Adriamycin = 58%, control = 54%). This study indicates that the use of single-agent Adriamycin as postoperative adjuvant chemotherapy has no significant clinical benefit in patients with high-grade extremity soft-tissue sarcoma treated with preoperative Adriamycin, radiation, and surgical excision. Although the Adriamycin postoperative adjuvant chemotherapy did not significantly benefit the experimental group relative to the control group, both groups of patients had an improved disease-free and overall survival rate compared to historical controls.

Adolescent↗
PubMed1985

Assessment of in vivo response to preoperative chemotherapy and radiation therapy as a predictor of survival in patients with soft-tissue sarcoma.

Current histologic methods for staging soft-tissue sarcomas are based on histologic criteria such as number of mitoses or nuclear and cytoplasmic morphology, without taking into account the inherent biologic variability of tumors within a given histologic classification. This study demonstrated that patients whose tumors were effectively destroyed by preoperative chemotherapy and radiation therapy had an improved prognosis compared to patients whose tumors did not respond to the therapy. Four-year survival for the group that responded was 82%, compared to only 55% for the group that had a poor response. The response to preoperative chemotherapy and radiation therapy did not predict an improved sensitivity to postoperative adjuvant therapy, since the addition of postoperative chemotherapy in the high-responding group did not improve survival. Our results indicate that grade III soft-tissue sarcomas are a heterogeneous population of tumors with varying degrees of innate biologic aggressiveness and sensitivity to radiation therapy and chemotherapy, despite their apparently similar histologic appearance.

Antineoplastic Agents↗
PubMed1985

Limb salvage for malignant tumors of bone.

With the use of preoperative therapy of chemotherapy and radiation, limb salvage has been possible in more than 95% of patients with highly malignant bone tumors. Without preoperative treatment, limb salvage is possible in only 40% of the patients. In our experience, improved limb salvage is a direct result of the preoperative therapy. We are not sure this preoperative therapy is the ideal one, or whether the intraarterial Adriamycin is superior to intravenous administration, or whether the dose of radiation is the proper one, or even whether radiation is necessary at all. These questions remain unanswered at this time. However, the pathologist's evaluation of the excised specimens shows that the preoperative treatment has definite beneficial effect for more than 80% of the patients on this program. Local control is equal with either amputation or limb salvage. Additionally, the overall survival rate is identical for either limb salvage or primary amputation. The major factor for patient survival appears to be the systemic adjuvant chemotherapy. Limb salvage as practiced at UCLA is as effective as amputation for control of malignant bone tumors. The selection of patients for our limb salvage program has not adversely affected the rate of disease progression or ultimate survival. The cosmetic and functional results of limb-salvage surgery is at least comparable to if not better than external prostheses. Finally, the only factor that appears to influence long-term survival in a positive manner is participation in a polydrug postoperative adjuvant chemotherapy program.

Amputation, Surgical↗
PubMed1984

A prospective postoperative evaluation of urinary tumor-associated antigens in sarcoma patients. Correlation with disease recurrence.

Tumor-associated antigens (TAA) excreted into the urine of sarcoma patients can be detected by the complement-fixation assay. The authors prospectively measured TAA levels in the urine of 50 sarcoma patients postoperatively to determine whether reappearance of antigen in the urine would be predictive of disease recurrence. Twenty-five patients developed recurrence of their disease in the postoperative period, and 24 (96%) had reappearance of antigen in the urine 10.1 +/- 9.2 months prior to clinical evidence of recurrence. Of the 25 patients who remained disease free (mean follow-up, 48 months), 23 of 25 (92%) were urinary-antigen negative at last follow-up, although 8 patients had transient elevations of urinary TAA early in the postoperative period. Results indicate that postoperative measurement of urinary TAA in sarcoma patients permits selection of a subset of individuals at high risk for the development of recurrence. This knowledge can be of assistance in the postoperative management of these patients.

Adolescent↗