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Biomedical subjects

J G Fortner

Publications and source records attributed to J G Fortner.

At least 55 records · Page 3Linked to original sources
PubMed1982

Selection of gastrectomy for adenocarcinomas arising in the gastric fundus.

A retrospective study involving 174 patients with adenocarcinoma of the gastric fundus treated with proximal subtotal (PS), extended proximal subtotal (EPS), total (T), and extended total (ET) gastrectomy showed that 1)there were no statistically significant differences in operative mortality between the four gastrectomy types; 2)ET was associated with a significantly lower incidence of local recurrence than T (P less than 0.05) and PS (P less than 0.001); 3)ET resulted in a significantly higher survival rate than PS or T (P less than 0.01) when the three procedures were applied in patients who had TNM stage I and II tumors; 4)patients with stage III and IV tumors did poorly regardless of gastrectomy type. The study implies that intraoperative tumor staging might identify stage I and II patients who benefit the most from radical surgery and those with stage III and IV tumors who should receive palliative surgery.

Adenocarcinoma↗
PubMed1982

Melanoma arising under the nail.

Subungual melanoma, a rare and easily misdiagnosed neoplasm, affected 52 patients. The lesion usually appeared as a dark spot under the nail, causing its destruction at a later stage. Diagnosis was missed by primary care physicians in 42% of the cases. Management in the hospital consisted of amputation of the involved finger or toe with or without regional node dissection. The study indicated that proper amputation should be at the tarsometatarsal or the carpometacarpal level. It also showed the node dissection should best be performed at the time of amputation, regardless of whether the nodes are clinically involved or not. Besides nodal metastasis, prognosis is adversely affected by nail destruction caused by the tumor. Subungual melanomas of the fingers have a better prognosis.

Adult↗
PubMed1982

Choice of operative procedure for adenocarcinoma of the gastric antrum: a study based on TNM classification.

This is a retrospective study comparing the results of distal subtotal (DST), total (T), and extended total (ET) gastrectomy in a group of 143 patients with adenocarcinomas of the antrum. Of those, 52 had TNM stage I and II tumors and 91 had stage II and IV tumors. Operative mortality was 10% with DST, 23% with T, and 16% with ET. The incidence of recurrence of the tumor at the gastrectomy site was 26% for DST, 27% for T, and only 9% for ET. In stages I and II, the difference of recurrence in favor of ET was significant (P less than 0.05). Analysis of survival data without TNM staging showed no significant difference between the three procedures. TNM staging indicated that that surgical treatment, regardless of procedure, salvaged only five out of 91 stage III and IV patients. The choice of procedure made a difference only in stages I and II, where ET was associated with a significantly higher survival than DST (P less than 0.02). The study suggested that intraoperative staging might be of value in selecting the proper type of gastrectomy. This could be accomplished with node sampling because tumor size corresponds poorly with TNM stage.

Adenocarcinoma↗
PubMed1982

Cyclomunine: a potent inhibitor of rat and canine lymphocytes.

In the present study we examined the effect of a recently isolated hexacyclodepsipeptide, Cyclomunine (Servier, France), on certain parameters which assess cellular and humoral immunity in the rat and dog. Our data establish Cyclomunine as a potent in vitro inhibitor of 3H-thymidine incorporation by lymphocytes. The concentrations of Cyclomunine required to abrogate mitogen or allogeneic lymphocyte stimulated 3H-thymidine incorporation was greater in the dog than in the rat, 15 micrograms/ml versus 10 micrograms/ml, respectively, to achieve greater than 99% inhibition. Little cytotoxicity was noted at concentrations below 25 micrograms/ml. Oral administration of Cyclomunine to rats (50 mg/kg dissolved in corn oil) did not significantly alter white blood cell count, lymphocyte-polymorphonuclear cell differential, body weight, or histological architecture of the liver, spleen, lymph node or kidney. Our results show that in vitro, Cyclomunine is highly effective in suppressing lymphocyte proliferation. In vivo, Cyclomunine appears to have little myelosuppressive effect a property shared with Cyclosporin A. Cyclomunine may hold promise as a clinically useful immunosuppressive agent.

Animals↗
PubMed1982

Reconstruction of cervical esophagus with a segment of colon based on a long vascular pedicle: an experimental study in ten monkeys.

The cervical esophagus can be reconstructed with a short segment of colon which, passed subcutaneously anterior to the sternum, is interposed between the pharynx and the upper thoracic esophagus. The segment is supported by a long vascular pedicle composed of the left colic and marginal vessels. The method is more acceptable cosmetically than subcutaneous colon interposition. It is less risky than substernal or mediastinal interposition and less difficult than colon autotransplantation. Its application in the monkey gave satisfactory results.

Animals↗
PubMed1982

A simple method of orthotopic liver transplantation in dogs.

Orthotopic liver transplantations were performed by one team in 18 dogs using a cuff method to anastomose the portal vein, the suprahepatic vena cava and the infrahepatic vena cava without external or internal shunts. Total and warm ischemic times of donor liver averaged 124 and 32 minutes, respectively. The average occlusion time of the portal vein and the infrahepatic vena cava were 9.7 and 13.9 minutes, respectively. During this time, uncontrolled hypotension, petechiae or hemorrhagic enterogastritis did not develop. Sixteen of 18 dogs survived more than five days, and five dogs lived more than three weeks. The cause of death was not related to the cuff method in any instance. This approach proved to be a technically simple and satisfactory procedure.

Animals↗
PubMed1981

Surgical adjuvant therapy of malignant melanoma with corynebacterium parvum.

The authors' previous surgical adjuvant trial in patients with malignant melanoma at high risk of recurrence has shown no difference in disease-free interval or survival between patients randomized to surgery + BCG or surgery alone. Reported here is a subsequent nonrandomized trial in 30 similar patients who received surgery + Corynebacterium parvum (CP) 4 mg I.V. daily x 5, followed by 4 mg S.C. weekly for up to three years. After I.V. C. parvum, chills, fever, headache, and hypertension were common. After S.C. C. parvum, varying degrees of local induration, erythema, and pain were experienced. Dose reduction was necessary for 14 patients during I.V. treatment and for six patients during S.C. treatment. A marked decrease in absolute lymphocyte count and a decreased proliferative response of lymphocytes to common antigens in vitro was observed after 2-3 days of I.V. C. parvum. Lymphocyte reactivity to mitogens decreased, particularly with Con A. Marked increase in nitroblue tetrazolium reduction by granulocytes was seen in 20 patients. Although changes in delayed cutaneous hypersensitivity reactions to recall antigens followed no consistent pattern, reactivity to DNCB increased in 18 patients. In addition, median time to recurrence was 33 weeks, significantly shorter than in the previous trial, but the survival distribution was no different from before. It can be concluded, therefore, that the administration of C. parvum in this dose and schedule had essentially no effect on the outcome of these patients.

Adolescent↗
PubMed1981

DNCB reactivity and prognosis in 419 patients with malignant melanoma.

Delayed cutaneous hypersensitivity to 2,3-dinitrochlorobenzene (DNCB) was tested in 419 patients with malignant melanoma to determine whether DNCB reactivity was associated with prognosis. At the time of definitive surgery, a positive DNCB test was seen in 82% of the patients in State I (regional lymph node histologically negative) and in 81% of patients in Stage II (regional lymph node positive). A positive DNCB test, obtained at the time of staging in patients with more advanced disease, was seen in 70% of patients in State III (metastases in, at most, on internal organ) and in 68% of patients in Stage IV (metastases in more internal organ). Using the chi 2 test, the trend of a decrease in DNCB reactivity from Stage I to Stage IV is significant (P less than 0.04). In regard to DNCB reactivity and prognosis, the following statistical differences (P less than 0.05) were obtained: In Stage II, the recurrence distribution for DNCB-positive patients is more favorable than for DNCB-negative patients (estimated median time to recurrence 16 vs. 7 months); the survival distribution again in Stage II was more favorable for DNCB-positive patients tha DNCB-negative patients (estimated survival time 31 vs. 18 months). When the group of State II patients was divided into subgroups with different prognoses (state of primary at the time of lymphadenectomy), a survival advantage was seen in all substages but was statistically significant (P less than 0.05) only in Stage II d (regional lymph node involvement diagnosed more than two months after resection of primary melanoma). The results of DNCB tests in patients with malignant melanoma correlate with stage of disease and, in Stage II, with prognosis.

Dinitrochlorobenzene↗
PubMed1981

The continuing challenge of retroperitoneal sarcomas.

Treatment of 158 patients with retroperitoneal sarcomas (1951--1977) resulted in a mean five-year survival of 40% (range 37--45%) after complete excision. Only 22% (range 19--25%) of the patients were free of disease. Survival for five years after incomplete excision was 3%. Operative mortality after complete excision declined from 21 to 2% during this period. Anatomical barriers to wide resection, high-grade histology, and local recurrence were the most important factors determining survival. The need for adjuvant therapy is emphasized by a 77% recurrence rate among patients with apparent complete excision. Brachytherapy (125Iodine, 192Iridium) afterloading techniques and supplemental external radiation are recommended to improve local control and chemotherapy is indicated to diminish the potential for metastatic spread. The contribution of adjuvant therapy after complete excision in this series was difficult to assess because of the number of uncontrolled variables, different histologic types, and limited number of patients treated by multimodality therapy. Although radiation and chemotherapy may be beneficial after incomplete resection, prolonged survival was only seen in patients with liposarcoma and low-grade fibrosarcoma.

Adolescent↗
PubMed1981

The seventies evolution in liver surgery for cancer.

During the past decade, one of the major changes in the field of oncology has been in the surgical approach to primary and secondary cancer of the liver. As a result of data and experience gained in liver transplantation programs and with the application of vascular surgical principles, resectability rates have been increased. The present rate of 32% has been achieved with an overall 30-day operative mortality rate of 9%. More sophisticated intraoperative and postoperative supports have been essential in achieving these results. The median operating time is now 4 3/4 hours in length. Complications are minimal. The median postoperative hospital stay is now 13 days. During the past decade, 436 patients with liver tumors were treated by the authors. It has become apparent in this experience and in that reported by others that an increasing number of patients with primary liver cancer or metastatic cancer in the liver can be cured by surgery with minimal operative risk. Adjuvant chemotherapy may increase the salvage rate. Current therapeutic results are best evaluated after staging of the liver disease: Stage I (no involvement of margins of resection, hepatic vascular structures or bile ducts; all gross disease removed): 85% three-year survival estimate, using the Kaplan-Meier method, for individuals with primary liver cancer; 71% for those with metastatic colorectal cancer. Stages II and III (regional or extrahepatic spread): 22% three-year survival for individuals with primary liver cancer but no survivors at two years with metastatic colorectal cancer. These data permit better selection of patients who are most likely to benefit from surgery.

Adolescent↗
PubMed1981

A modified circular stapler for gastrointestinal anastomosis.

A circular stapler, which avoids the use of a purse-string suture, is described. The gut to be anastomosed is kept in position by a series of hooks. To avoid anastomotic bleeding two rows of B-shaped staples are inserted. The instrument is loaded manually with individual staples to reduce the cost. Experience with oesophageal anastomoses in 40 dogs showed that bleeding did not occur from the suture line and that there was only one leak from the anastomosis. Late stricture formation occurred in 1 dog.

Animals↗
PubMed1981

Pancreatic fistula complicating pancreatectomy for malignant disease.

The incidence of pancreatic fistula in a series of 178 pancreatic resections was 25 per cent and was influenced by the type of pancreatectomy, the management of the remaining pancreas and the size of the pancreatic duct. Thus, fistulas appeared in 52 per cent of patients undergoing pancreatoduodenectomy as compared to only 7 per cent of those undergoing distal pancreatectomy (P less than 0.001). Ligation of the pancreatic, duct in pancreatoduodenectomy led to a 70 per cent incidence; the incidence was 33 per cent if the pancreas was anastomosed to the jejunum instead (P less than 0.001). Fistulas were rare in patients who had dilated pancreatic ducts. Fistulas, once they were established, were rarely influenced by treatment. One out of 5 patients developing pancreatic fistula died, while fistulas were responsible for half of the operative deaths. The study indicated that pancreatojejunostomy is safe in the presence of ductal dilatation; it does not, however, protect from fistula if the pancreatic duct is normal. It also indicated that radiation of the pancreatic remnant in selected patients with persistent fistulas might be a useful therapeutic alternative.

Duodenum↗
PubMed1981

Management of the pancreatic remnant in pancreatoduodenectomy.

Of the various methods used for the management of the remaining pancreas in 70 patients who had pancreatoduodenectomy for cancer, pancreatojejunostomy (P/J) was associated with the lowest morbidity and closure of the remnant with the highest. End-to-end and end-to-side P/J were equally satisfactory, the use of stents, however, doubled the morbidity. P/J was particularly safe in the presence of a dilated pancreatic duct. Closure of the remnant caused a very high morbidity regardless if the pancreas was closed with sutures or staples. Despite their differences in morbidity, P/J and closure had the same mortality and approximately the same impact on pancreatic function, exocrine as well as endocrine. The study indicated that although closure of the remnant, as it is practiced today, gives results inferior to those obtained with P/J, with some modification it might offer a simple alternative to P/J in the future.

Common Bile Duct Neoplasms↗