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Biomedical subjects

J G Fortner

Publications and source records attributed to J G Fortner.

At least 73 records · Page 4Linked to original sources
PubMed1981

Is gastric cancer generalized at the time of surgery?

Twenty-one patients undergoing gastrectomy for adenocarcinoma of the stomach died during the first two postoperative weeks and were subjected to autopsy. They all had "curative" resections for lesions confined to the stomach and the regional lymph nodes. Autopsy revealed distant metastasis in ten of 13 patients who had (TNM) stage III disease at the time of surgery. There was no residual disease in patients with stage I and II lesions (P less than 0.01). The study suggests that, in most cases, stage III gastric adenocarcinomas have already spread beyond the confines of gastrectomy at the time of operation.

Adenocarcinoma↗
PubMed1981

Local recurrence of gastric adenocarcinomas after gastrectomy.

A study of 257 gastric cancer patients treated with gastrectomy and followed to their death showed that (a) the incidence of local recurrence in the field of gastrectomy was 25%; (b) from the three types of gastrectomy used, extended total gastrectomy resulted in the lowest incidence of recurrence, followed by subtotal and total; (c) recurrences were more common in patients with TNM stages I, II, and III tumors where extended total gastrectomy was proven superior (p less than 0.05); (d) early stage tumors tended to recur in the gastric remnant and the esophagus; (e) narrow surgical margins and margins involved by disease predisposed to recurrence; (f) not every patient with histologically invaded margins developed recurrence; (g) the risk of recurrence did not decrease with time; (h) the longer the disease-free interval the better the prognosis; (i) the more advanced the original lesion the longer the disease-free interval; (j) of all patients with recurrence only 19% had resectable lesions on reexploration; (k) the longer the disease-free interval the higher the resectability rate; (l) the median interval from recurrence to death was 2 months; (m) the same interval of those undergoing resection was 18 months. Patients with early-stage tumors treated with gastrectomy should be followed closely for local recurrence and should recurrence develop they should be reexplored if there is no evidence of metastasis.

Adenocarcinoma↗
PubMed1981

Results of hemipelvectomy for soft tissue sarcoma.

From a series of 89 patients treated with hemipelvectomy at the Memorial Sloan-Kettering Cancer Center during the period 1972--1976, 16 patients with soft tissue sarcoma are discussed. Three patients were operated on for palliative reasons. Most of the remaining 13 patients underwent a hemipelvectomy after other more conservative procedures had failed to control the disease. Mortality rate was zero; the morbidity 50%, but all complications responded to conservative treatment except for two patients with postoperative hemorrhage. The results are discussed, as is the rehabilitation of the patients. Hemipelvectomy seems to have a place in palliative treatment of patients with soft tissue sarcoma. The one-year cumulative survival rate of 69.2% and the five-year cumulative survival rate of 42.6% appear to justify hemipelvectomy for highly selected patients with soft tissue sarcoma who cannot otherwise be treated successfully.

Adult↗
PubMed1981

Activation and inhibition of benzo(a)pyrene and aflatoxin B1 metabolism in human liver microsomes by naturally occurring flavonoids.

The effects of several naturally occurring and synthetic flavonoids on the metabolism of benzo(a)pyrene and aflatoxin B1 were evaluated. Addition of apigenin, chrysin, fisetin, flavonone, galangin, hesperitin, kaempferol, morin, myricetin, haringenin, or quercetin to human liver microsomes inhibited the hydroxylation of benzo(a)pyrene. In contrast to these results, the addition of flavone, nobiletin, tangeretin, or 7,8-benzoflavone to human liver microsomes caused a many-fold stimulation in the hydroxylation of benzo(a)pyrene, the metabolism of aflatoxin B1 to 2,3-dihydro-2,3-dihydroxyaflatoxin B1, and the metabolic activation of aflatoxin B1 to mutagenic products. Quercetin, morin, and kaempferol inhibited cytochrome c (P-450) reductase in human liver microsomes whereas flavone and 7,8-benzoflavone had no effect. These results suggest that the inhibitory effects of quercetin, morin, and kaempferol on monooxygenase activity may be caused at least in part by an inhibition in the reduction of cytochrome P-450. An examination of the structural features required for the inhibition and stimulation of benzo(a)pyrene hydroxylation indicated that all of the 12 flavonoid inhibitors that were studied possessed hydroxyl groups whereas the flavonoid activators were less polar molecules that lacked hydroxyl groups.

Aflatoxins↗
PubMed1980

Malignant soft-tissue tumors of the anterior abdominal wall.

A clinicopathologic study was made of 32 soft-tissue sarcomas of the anterior abdominal wall (ten desmoid tumors and 22 fully malignant sarcomas). Direct invasion of the costal margin or the iliac crest was observed in both types, whereas transperitoneal invasion and metastasis developed characteristically with fully malignant sarcomas. Wide monobloc resection of the abdominal wall, including, where necessary, resection of adjacent bony parts and reconstruction with a prosthetic mesh, satisfactorily controlled local disease in nine of ten patients with desmoid tumor, and in three of four patients with primary operable, fully malignant sarcoma. Adjunctive therapy with radiation and chemotherapy may improve the outcome in patients with recurrent or high-grade sarcomas, but adequate monobloc resection of the primary tumor remains the most important therapeutic objective.

Abdominal Muscles↗
PubMed1980

Regulation of human drug metabolism by dietary factors.

Several dietary factors influence the oxidative metabolism of chemicals in humans. Increasing the ratio of protein to carbohydrate or fat in the diet, feeding cabbage and brussels sprouts or feeding charcoal-broiled beef for several days stimulates human drug metabolism. The chronic ingestion of ethanol stimulates drug metabolism whereas the chronic ingestion of methylxanthine-containing foods inhibits drug metabolism. In contrast, an increase in the ratio of fat to carbohydrate in the diet of normal subjects or the fasting of obese individuals for several days has little or no effect on drug metabolism. Flavonoids in edible plants influence the metabolism of foreign chemicals by human liver in vitro. The addition of flavone, tangeretin or nobiletin to human liver microsomes activates both the hydroxylation of benzo[alpha]pyrene and the metabolism of aflatoxin B1 to mutagens. On the other hand, quercetin, kaempferol, morin and chrysin, which are also normally occurring flavonoids, inhibit the hydroxylation of benzo[alpha]pyrene by human liver microsomes.

Adult↗
PubMed1980

Ligation of the pancreatic duct in pancreatectomy.

This study was undertaken to determine the safety of duct ligation in pancreatic surgery. Duct ligation was performed in 43 patients after pancreaticoduodenectomy and in 108 patients after distal pancreatectomy; 33 patients had a pancreaticojejunostomy after a pancreaticoduodenectomy. All procedures were performed between 1965 and 1975; the analysis was retrospective. The mortality and morbidity for the duct ligation group after pancreaticoduodenectomy were 19 per cent and 77 per cent and after distal pancreatectomy were 4 per cent and 9 per cent respectively. After pancreaticoduodenectomy with pancreaticojejunostomy the mortality was 18 per cent with a morbidity of 33 per cent. It is concluded that distal pancreatectomy with duct ligation is a relatively safe procedure, while after pancreaticoduodenectomy the morbidity is significantly reduced (P less than 0.001) by a pancreaticojejunostomy.

Duodenum↗
PubMed1980

Gastric carcinoma after treatment of ulcer.

In a study comparing 1,496 gastric cancer patients with 1,496 matched control patients, gastrectomy or simple gastrojejunostomy for ulcer predisposed to gastric cancer whereas medical ulcer treatment did not. Gastric carcinomas after ulcer surgery appeared after age 50 years. The time interval between ulcer treatment and the appearance of gastric cancer gradually decreased as the patients' age approached 50 years. The selection of operated ulcer patients for gastroscopic evaluation should be based on age rather than sex, location of the ulcer, ulcer-cancer interval or type of ulcer operation. Gastroscopy was the most effective diagnostic tool in the management of such patients.

Age Factors↗
PubMed1980

A simple method of pancreatic transplantation in the dog.

Canine pancreatic organ transplantation can be performed without resection of adjacent structures or transection of major blood vessels. The graft consists of the entire gland except the distal tail and is based on the superior pancreaticoduodenal vessels. Devascularization of the duodenal loop does not result in ischemic necrosis. The duct-ligated graft is placed in the groin.

Animals↗
PubMed1980

Histologically positive esophageal margin in the surgical treatment of gastric cancer.

Histologically positive esophageal margins caused by transection of the esophagus in an area involved by disease were encountered in 20 percent of 350 patients undergoing total or proximal subtotal gastrectomy for gastric cancer. There was a significant increase in the incidence of positive margins in patients with neoplasms of the cardia and in those who were managed without frozen-section examination of the resected esophagus. Positive margins were avoided only with resection of 12 cm or more of macroscopically tumor-free esophagus above the primary. Despite the presence of tumor at the margin, anastomotic recurrences appeared in only 23 percent of the patients at risk. Recurrences affected mainly those who had TNM stage I and II lesions. Patients with more advanced disease usually died from metastasis without developing anastomotic recurrence. Positive margins were associated with a poor prognosis that was not influenced by adjuvant postoperative treatment. The avoidance of positive margins by wide esophagectomy is important in patients with TNM stage I and II disease, particularly if the primary lesion is located in the cardia. Patients with positive margins should be watched closely rather than subjected to further treatment.

Adenocarcinoma↗
PubMed1980

Adenocarcinoma of the gastric cardia. The choice of gastrectomy.

A retrospective study of 101 patients with adenocarcinoma of the gastric cardia treated with proximal subtotal, extended proximal subtotal, total, and extended total gastrectomy demonstrated the following: 1) There were no five year survivors among patients with TNM stage III and IV disease. 2) Surgical treatment was curative only in the presence of stage I and II disease, where extended total gastrectomy resulted in a significantly higher survival rate than proximal subtotal gastrectomy (p less than 0.03). 3) Proximal subtotal gastrectomy resulted in a high incidence of local recurrence, particularly when it was applied in patients with stage I and II neoplasms. 4) There were no significant differences in operative mortality between the four procedures. Since the choice of operative procedure makes a difference only in patients with TNM stage I and II disease, intraoperative classification should be considered in the management of adenocarcinoma of the cardia. Classification should be based on lymph node biopsy unless the neoplasm has spread beyond the confines of gastrectomy.

Adenocarcinoma↗
PubMed1980

Prevention of postoperative pancreatic fistulae by intraductal injection of a tissue-adhesive polymer.

Ligation of the intact horizontal segment of the pancreas in 8 dogs caused enlargement and then atrophy of the gland. Ligation of dissected pancreases in 9 dogs caused pseudocysts, fistulae and pancreatic ascites in 6. Ligation following obliteration of the ductal system with cyanoacrylate tissue adhesive in 8 dissected pancreases caused no pancreatic complications. Both ligation and obliteration reduced the glucose consumption coefficient (k-value) below the preoperative levels (p less than 0.01), there was no difference, however, between the two methods as far as glucose consumption is concerned. Ductal obliteration might prevent the development of pancreatic fistulae following the Whipple procedure offering an alternative to either simple ligation or pancreatojejunostomy.

Animals↗
PubMed1980

Advances in the treatment of pancreatic cancer.

Conventional pancreatic resections have proved unsatisfactory in the treatment of pancreatic cancer. A new operative approach that includes resection of the pancreas en bloc with the regional nodes and pertinent vascular structures has been developed. The procedure was carried out in 27 patients, the majority of whom had advanced neoplasms. The two-year actuarial survival of those who escaped complications of the procedure and lived was 46%. The technical details, postoperative problems, and the benefits of this operation are discussed.

Aged↗