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Biomedical subjects

J G Fortner

Publications and source records attributed to J G Fortner.

At least 91 records · Page 5Linked to original sources
PubMed1980

Immunologic function in patients with carcinoma of the pancreas.

The immune fuction of 41 patients with duct cell adenocarcinoma of the pancreas or carcinoma of the periampullary region was studied by skin testing with 2,4-dinitrocholorobenzene and common microbial antigens, in vitro lymphocyte reactivity to mitogens, T-lymphocyte and B-lymphocyte cell counts and measurements of complement levels. Results show that a great proportion of patients had depressed immune function. Depression is particularly severe in lymphocyte reactivity. Positive response to skin tests with a microbial antigen carries a slightly better prognosis. The complement level is usually normal or elevated. Correlation between immune function, prognosis and tumor resectability in individual patients is generally poor.

Adenocarcinoma↗
PubMed1980

Wound coverage by a sheet of epidermal cells grown in vitro from dispersed single cell preparations.

Epidermal cells have been grown into multilayered sheets resembling full-thickness human epidermis using a new tissue culture technique. To evaluate their viability in an in vivo situation, such cells were transplanted under the kidney capsule and into a subcutaneous position in the nude mouse. In both locations cells survived and limited growth was observed. Maturation of the epidermal cells resulted in the appearance of keratohyalin granules and cell desquamation. To assess the potential use of tissue cultured cells for wound treatment in man, the same method was used to grow dog cells in vitro. Sheets of multilayered dog epidermal cells grown in vitro from a single cell suspension were used to cover fresh or granulating wounds. The epidermal cells transplanted in this way remained viable and wound coverage was achieved within 1 week. No clinical or histological signs of rejection of allograft tissue were observed during a 6-week period of observation.

Animals↗
PubMed1980

Treatment of regionally advanced epidermoid carcinoma of the extremity and trunk.

A retrospective study was made of 106 locally and regionally advanced epidermoid carcinomas of the trunk and extremity treated from 1949 to 1970. Forty-six of the tumors had a known cause, of which radiation exposure was the most common. In addition to axillary and inguinal nodal metastases, these cancers also manifested intransit, epitrochlear and popliteal lymphatic metastatic disease. Surgical treatment consisted of wide monobloc resection for the majority of the primary neoplasms, amputation being necessary for tumors fixed to skeletal or neurovascular structures. Clinically enlarged regional lymph nodes were subjected to biopsy, but elective regional node dissection did not offer therapeutic benefit. Patients with biopsy proved nodal metastases were treated by either radical nodal dissection or high exarticulation, with similar results. Actuarial five year survival rates after definitive surgical treatment were 71 per cent for patients with regional node-negative and 57 per cent for those with regional node-positive tumors. Local and regional recurrences of tumors were frequent in patients who had deep seated tumors of the trunk and postsacral region, or bulky nodal disease, despite pathologically negative resection margins. Uncontrolled recurrent tumor with sepsis and compromise of vital organ function was the most common cause of death. Radiation therapy achieved partial regression of the tumor in eight patients and complete regression in one of 15 patients. A critical analysis is made of the various clinicopathologic factors which affect prognosis, and the possible means of improving the results of treatment are discussed.

Adult↗
PubMed1980

Intraperitoneal hyperthermic treatment of implanted peritoneal cancer in rats.

The feasibility and efficacy of treating peritoneal cancer implants by applying heat to the peritoneal surfaces were studied in inbred Buffalo A rats given i.p. injections of Morris hepatoma 5123TC tumor cells. Heat was delivered to the peritoneum by contact with a heated physiological salt solution (Normosol-R) in the peritoneal cavity. A treatment temperature of 43.3 +/- 0.3 degrees was maintained for 30 min by an immersed stainless steel coil through which hot liquid circulated. Rats implanted with 0.5 to 1.0 x 10(8) tumor cells were treated at 1 to 4 hr (Group I), 4 to 5 days (Group II), and 22 to 24 days (Group III) after tumor implantation to simulate treatment for the clinical conditions of surgically spilled cancer cells, established microscopic cancer implants, and macroscopic cancer implants, respectively. A statistically significant improvement in survival was observed in Groups I and II compared with sham-treated control animals; 58% of the heat-treated animals were cured. Only a slight but statistically insignificant improvement was noted in Group III. These observations indicate that i.p. surface heat treatment of peritoneal implanted cancer is feasible and effective.

Animals↗
PubMed1979

Effect of postoperative wound infection on the course of stage II melanoma.

Microbial infections reportedly have a favorable effect on the course of certain malignant diseases. Intralesional inoculation of micro-organisms can bring about tumor regression in certain clinical and experimental situations. In order to evaluate the influence of immediate postoperative wound infection on the course of Stage II melanomas, a retrospective study was undertaken of 211 patients who had undergone axillary or groin dissection. None had any antibiotic, steroid, chemoimmunotherapy, or cryosurgery and there was no history of a second primary neoplasm, pregnancy, immunodeficiency, or administration of immunosuppressive drugs. Forty of these patients developed significant postoperative wound infections. Although their representation according to sex, tumor location, number of nodes involved, and other parameters was comparable to that of the remaining 171 patients who did not develop wound infections, the incidence of local recurrence in the group with infections was significantly lower (p less than 0.01). Patient survival and disease-free interval following node dissection were not influenced by infection. Postoperative infections in the groin or axilla offered only local protection from tumor recurrence; the ultimate course of the disease was not affected.

Escherichia coli Infections↗
PubMed1979

Surgical treatment of tendosynovial sarcoma.

Tendosynovial sarcoma is notorious for its high rates of local recurrence and metastases after surgical treatment. A retrospective study was made of 109 cases of monobloc wide soft part resection and amputation for primary tumors, and 29 patients who underwent resection of pulmonary metastases. Actuarial five-year survival rates after soft part resection was 70% for untreated, and 61% for previously treated, locally recurrent neoplasms. Corresponding rates after amputation were 47% and 64%. Local tumor recurrence developed in 18% of the primary soft part resections and 4% of the amputations, usually when some basic surgical principle had been violated. 35% five-year survival was achieved with judicious resection of solitary and multiple lung metastases in most cases without chemotherapy. Local control of a tendosynovial sarcoma can be achieved with properly executed surgical procedures which adhere to established tenets of cancer surgery. Resection of pulmonary metastases merits an important position in the management of these patients.

Amputation, Surgical↗
PubMed1979

Melanoma of the nipple and areola.

Fourteen primary melanomas arising in the nipple and areola of the breast were treated by mastectomy and axillary dissection. Four patients had axillary lymph node metastases and all were dead within 3 years of their operation, while the 10 patients with no axillary node involvement were free from recurrent disease 5 years after their operation. On the basis of clinical and anatomical studies, it is suggested that a wide local excision without mastectomy is adequate for the treatment of nipple and areola melanomas.

Adult↗
PubMed1979

Anastomotic recurrence in the oesophagus complicating gastrectomy for adenocarcinoma of the stomach.

Gastric adenocarcinomas often spread to the distal oesophagus. Failure to control the disease in this area during total and proximal subtotal gastrectomy results in recurrence at the oesophageal anastomosis. The incidence of recurrence in a series of 351 such patients was 10 per cent and was influenced by the location of the main lesion, the stage of the disease, the presence of tumour at the margin of resection and the length of clearance of the oesophageal margin. Recurrence were prevented only with in vivo margins greater than 12 cm. Dysphagia combined with radiological signs of oesophageal obstruction was diagnostic of anastomotic recurrence regardless of the results obtained by oesophagoscopy and biopsy. Treatment was seldom effective in patients developing recurrence. Complete excision of the entire recurrent process offered the only hope for a long survival in these patients. Prevention by obtaining adequate oesophageal clearance at the time of gastrectomy is the only reasonable approach to this problem. The adequacy of resection cannot be judged accurately by intraoperative palpation of the oesophagus or by frozen section examination of the surgical margins.

Adenocarcinoma↗
PubMed1979

Anastomotic failure complicating total gastrectomy and esophagogastrectomy for cancer of the stomach.

Anastomotic failure complicated the postoperative course of 11 per cent of 350 gastric cancer patients who underwent total gastrectomy and esophagogastrectomy and was responsible for 33 per cent of all operative deaths. The extent of disease and the presence of tumor at the margin of resection did not prove to be significant factors in regard to the incidence of anastomotic failure. Gastrectomy combined with resection of other organs was associated with a significantly higher risk of failure. End-to-end esophagogastrectomy and esophagoduodenostomy appeared to be prone to failure, while Roux-en Y, jejunal pouch, and jejunal loop reconstructions were safer. Patients with severe intraabdominal or intrathoracic sepsis had a poor prognosis, and their management with surgical or conservative methods was ineffective. On the basis of these findings, alternatives to manual methods of visceral suturing should be considered.

Drainage↗
PubMed1979

Experimental use of free gastric flaps for the repair of pharyngoesophageal defects.

The repair of large pharyngoesophageal defects was accomplished experimentally in 16 dogs with revascularized free flaps from the greater curvature of the stomach. These flaps were based on the gastroepiploic vessels, and they were anastomosed to the carotid artery and external jugular vein in the neck. The procedure had a low mortality and did not lead to peptic ulceration or hyperchlorhydria in these animals.

Animals↗
PubMed1979

Cutaneous melanoma of the breast.

A study of 115 cutaneous melanomas of the breast demonstrated that these neoplasms follow different metastatic patterns than do primary carcinomas of the breast and require a different therapuetic approach. Lesions located below a 3 cm from the clavicle metastasized exclusively to the axillary nodes regardless of location. None of 19 internal mammary node chains examined histologically contained tumor deposits. Microstaging of the primary lesion correlated closely with prognosis and lymph node metastasis. Treatment by mastectomy (radical, modified, extended radical) offered no advantage over local excision of the primary plus axillary dissection. The latter procedure is recommended for all cutaneous melanomas of the breast which require node dissection. Mastectomy is not indicated unless the breast is in the field of wide local excision. Internal mammary node dissections are not indicated.

Adolescent↗
PubMed1979

Gardner's syndrome complicated by mesenteric desmoid tumors.

Mesenteric desmoid tumors present difficult management problems among patients with Gardner's syndrome. Appearance of the problem is associated with prior abdominal surgery and with pregnancy. In the authors' experience, radical surgery alone has failed to control the disease and they recommend that it should be avoided when possible. Bypass procedures, interstitial implantation of radioactive materials, and chemotherapy represent alternatives which require further evaluation.

Adult↗
PubMed1979

Surgery of liver tumors.

Hepatic neoplasms, primary and metastatic, are best treated with surgery. The present report summarizes the results of various surgical procedures used during the last eight years in the management of 310 patients with liver neoplasms. Exploratory laparotomy was the ultimate diagnostic test, determining resectability of the lesion. Percutaneous liver biopsy was discouraged and was used only in the presence of obvious distant metastasis. Primary and metastatic neoplasms confined to the liver were managed with lobectomy, hepatic trisegmentectomy, or left lateral segmentectomy whether they were solitary or multifocal; the choice of procedure depended on their location. Tumors invading major vascular structures were resected using a new method of hepatic isolation/hypothermic perfusion. Neoplasms involving the entire liver were managed with intrahepatic infusion chemotherapy administered directly into the hepatic circulation through percutaneous catheters. Selected individuals with unresectable lesions were treated with vascular isolation and perfusion of the liver with chemotherapeutic agents. Budd-Chiari syndrome caused by malignant obstruction of hepatic outflow was managed either with isolation/hypothermic perfusion and resection or with hepatic artery ligation and infusion of chemotherapeutic agents. Total hepatectomy with orthotopic liver transplantation was reserved for a few highly selected individuals. The results obtained with these procedures were encouraging. Major hepatic resection was performed with a 9% operative mortality and resulted in an 81% 3-year actuarial survival if the disease was limited to the liver. Palliative major resection in a 31% 3-year actuarial survival. Intrahepatic infusion of chemotherapeutic agents was effective when the dosage was adequate and proved superior to peripheral intravenous treatment. Isolation perfusion of the liver permitted resection of lesions which could not have been managed by conventional procedures. The effectiveness of isolation chemotherapy perfusion of the liver was tempered by leakage of Actinomycin-D into the systemic circulation. The results is this series of patients encourage the judicious use of these procedures in the management of the patient with liver cancer. A pessimistic attitude often based on preoperative evaluation alone without the benefit of exploratory laparotomy ought to be discouraged.

Antineoplastic Agents↗