Combined simultaneous radiotherapy and multidrug chemotherapy have been utilized in an attempt to eradicate or shrink tumors of the head and neck area in advanced stages to allow subsequent surgical extirpation. Thirty-six patients (1 stage II; 11 stage III; 24 stage IV; 1 unknown primary) were treated with simultaneous radiotherapy and fractionalized doses of bleomycin, adriamycin, and 5-fluorouracil. Thirty of 36 patients completed the treatment schedule. Twenty-nine of 30 (97%) had a 75% or greater response to treatment; 20/30 (66%) had 100% response; 9/30 (30%) had 75% response; and 1/30 had 50% response. Of the 30 patients completing the regimen, 19/30 (63%) are alive three to 27 months later, and 12 (40%) of these have no evidence of disease. Six patients died within four months of initiation of therapy, mostly from complications of their disease. This treatment regimen appears effective in the control of locoregional disease or to produce enough shrinkage of tumor to allow subsequent surgical extirpation.

Adult↗

PubMed1979

Affairs of the wounded heart: penetrating cardiac wounds.

During the 10-year period ending 1 March 1978, 100 consecutive patients with penetrating cardiac wounds entered the Bexar County Hospital with some sign of life. The early and late mortality rate, 11%, declined to 8% during the last 4 years. Noncardiac injuries were responsible for six of the eleven deaths. Complications occurred in 17. The most frequently injured chambers were the right ventricle (46) and left ventricle (30). Sixty-nine patients had stab wounds and 26 had gunshot wounds. Pericardiocentesis was falsely positive or negative in 12 of 47 patients. Two distinct syndromes were apparent, hemorrhagic shock and cardiac tamponade. Patients with shock had immediate thoracotomy. Patients with suspected tamponade had a subxiphoid pericardial window, under local or light general anesthesia, for diagnosis and decompression before endotracheal intubation and sternotomy. Most wounds were repaired by direct suture. Cardiopulmonary bypass and thoracotomy before arrival in the operating room were rarely indicated.

Cardiac Tamponade↗

PubMed1977

The treatment of gastric cancer with combined surgical resection and chemotherapy.

A series of 156 patients with gastric cancer during a 15-year period were reviewed retrospectively to determine the effectiveness of combined surgery and adjuvant chemotherapy. The patients were divided into a 9-year prechemotherapy period and a 6-year chemotherapy period. Review of the data revealed an increase in the incidence of distant disease. The utilization of surgery as the only mode of treatment declined. Combination surgery and adjuvant chemotherapy utilization increased. Comparison of survival for surgery vs. adjuvant chemotherapy, expressed as percentage of survivors for each year, revealed an increase at 1 and 2 years with no difference at 3 years for all stages. A similar comparison for patients with regional spread showed an increase at 1,2 and 3 years with no difference therafter. The 5-year survival was 5% for both groups. The data has suggested that surgery and adjuvant chemotherapy increases 1-,2-, and 3-year survival rates but does not affect the longterm results.

Adenocarcinoma↗

PubMed1977

Subxiphoid anterior mediastinal exploration.

A new surgical technique for anterior mediastinal exploration is described. The technique involves application of a Carlens mediastinoscope by means of a subxiphoid incision. The procedure provides complete exploration of the anterior mediastinal compartment and allows the surgeon to obtain a positive biopsy of the tumor or its lymph node metastases without sternotomy.

Anesthesia, General↗

PubMed1975

Management of flail chest without mechanical ventilation.

The pathophysiology of flail chest is usually described only on the basis of paradoxical respiration, ignoring underlying pulmonary contusion. Two groups of comparable patients were treated either with early tracheal intubation and mechanical ventilation (Group 1), or with fluid restriction, diuretics, methylpredinisolone, albumin, vigorous pulmonary toilet, and intercostal nerve blocks, ignoring the paradox and treating only the underlying lung (Group 2). When tracheostomy and mechanical ventilation were not used the mortality rate went from 21% to O(p = 0.01), the complication rate from 100% to 20% (p = 0.005), and the average hospitalization from 31.3 to 9.3 days (p = 0.005). We conclude that most patients with flail chest do not need internal pneumatic stabilization if the underlying lung is treated appropriately and that tracheostomy and prolonged mechanical ventilation with a volume respirator, as practiced in most respiratory care centers, is usually a triumph of technique over judgment.

Adolescent↗

PubMed1974