Biomedical subjects

J P Kavolius

Publications and source records attributed to J P Kavolius.

6 recordsLinked to original sources

PubMed2001

Primary genitourinary melanoma.

OBJECTIVES: To describe the presentation, management, and clinical outcome of patients with genitourinary melanoma. METHODS: We identified 14 patients with genitourinary melanoma treated at Memorial Sloan-Kettering Cancer Center, New York and Tripler Army Medical Center, Honolulu, Hawaii. The presentation, surgical treatment, disease progression, and outcome of these patients were reviewed. Survival was analyzed, using the Kaplan-Meier product limit method. RESULTS: The presentation and management of patients with genitourinary melanoma were varied. Overall, the prognosis was poor, with a median survival of 43 months, and only 3 patients were alive, without disease, at last follow-up. Our findings confirm a poor prognosis in patients with this rare disease. CONCLUSIONS: Genitourinary melanoma is a rare form of the disease with an unfavorable clinical outcome. Less than one third of patients survive long term, although patients with scrotal melanomas may have a better prognosis.

Aged↗

PubMed2001

Surgical extirpation of a chest wall desmoid tumor: a case report.

A case is described of an anterior chest wall desmoid tumor in a 20-year-old Micronesian male that had been previously incompletely resected one year prior to presentation. A radical chest wall resection was performed with reconstruction accomplished using a gortex patch and latissimus dorsi myocutaneous flap. The patient developed a massive local recurrence within eight months following surgery. This report illustrates the local aggressiveness of these benign tumors. A historical perspective, etiology, and treatment principles are discussed.

Adult↗

PubMed1998

Resection of metastatic renal cell carcinoma.

PURPOSE: Resection of solitary metastases from renal cell carcinoma (RCC) is associated with a 5-year survival rate of 35% to 50%. Selection criteria are not well defined. PATIENTS AND METHODS: We retrospectively analyzed our experience with 278 patients with recurrent RCC from 1980 to 1993. RESULTS: One hundred forty-one of 278 patients underwent a curative metastectomy for their first recurrence (44% 5-year overall survival [OS] rate), 70 patients underwent noncurative surgery (14% 5-year OS rate), and 67 patients were treated nonsurgically (11% 5-year OS rate). Favorable features for survival were a disease-free interval (DFI) greater than 12 months versus 12 months or less (55% v 9% 5-year OS rate; P < .0001), solitary versus multiple sites of metastases (54% v 29% 5-year OS rate; P < .001), and age younger than 60 years (49% v 35% 5-year OS rate; P < .05). Among 94 patients with a solitary metastasis, lung (n = 50; 54% 5-year OS rate) was more favorable than brain (n = 11; 18% 5-year OS rate; P < .05). Survival rates after curative resection of second and third metastases were not different compared with initial metastectomy (46% and 44%, respectively, v 43% 5-year OS rates; P = nonsignificant). Favorable predictors of survival by multivariate analysis included a single site of first recurrence, curative resection of first metastasis, a long DFI, a solitary site of first metastasis, and a metachronous presentation with recurrence. CONCLUSION: Selected patients with recurrent RCC who can undergo a curative resection of their disease have a good opportunity for long-term survival, particularly those with a single site of recurrence and/or a long DFI.

Adult↗

PubMed1998

CT demonstration of a pancreatic duct stricture and obstructive pancreatitis with ERCP and intraoperative correlation.

We describe a case of a pancreatic duct stricture in a young female resulting in chronic intermittent obstructive pancreatitis, and requiring repeated hospitalizations over a ten year period. The stricture was identified by computed tomographic (CT) scan and endoscopic retrograde cholangio-pancreatography (ERCP) and noted to be in the distal pancreatic duct. The patient was treated successfully with distal pancreatectomy. This case report illustrates the utility of CT scanning and ERCP in determining the etiology of pancreatitis. When a stricture is identified, these studies give anatomic detail that aid in intra-operative decision making.

Adult↗

PubMed1995

Anorectal melanoma. A 64-year experience at Memorial Sloan-Kettering Cancer Center.

PURPOSE: Operative management of patients with anorectal melanoma is controversial. To formulate a rational approach to patients with this disease, we reviewed our experience from 1929 to 1993. METHODS: Records of all patients treated at our center with anorectal melanoma from 1929 to the present were reviewed. Survival analyses were graphically displayed using the Kaplan-Meier product-limit method, and distributions were compared using the log-rank test. Fisher's exact test was used to compare groups with small sample sizes. RESULTS: Survival for the entire group (n = 85) was poor, 17 percent at 5 years (median, 19 months). Among the 71 patients with resectable disease, the five-year, disease-free survival distribution of patients who underwent abdominoperineal resection (APR) was more favorable than that of patients who underwent local procedures only, although this was not statistically significant (27 percent vs. 5 percent, APR vs. local procedures, respectively; P = 0.11). However, those who had an APR were more likely to survive long term than those who did not (P < 0.05). All ten long-term survivors were women. Nine had undergone APR, and one had a wide local excision. Of the nine survivors following APR, eight had negative and one had positive mesenteric nodes. Median size of the primary tumor in survivors following APR was 2.5 cm, compared with 4.0 cm for patients who did not survive long term following APR. CONCLUSIONS: APR should be considered in patients with localized anorectal melanoma, particularly those with smaller tumors and no evidence of nodal metastases.

Adult↗

PubMed1983

Ultrastructural and functional effects of chronic endogenous stimulation of thyroid cells by thyrotropin.

Following total thyroidectomy, a small quantity of thyroid tissue was transplanted to the spleen in order to study thyroid tissue subjected to chronically elevated levels of endogenous thyrotropin (TSH). Plasma thyroxine (T4) and TSH levels were monitored and correlated with ultrastructural studies of the tissue over a 32-week experimental period. The effects of administration of an iodine-poor diet, and exogenous acute dose of TSH, and suppression of endogenous TSH through thyroxine administration were studied in order to evaluate the plasticity of the experimental model. Plasma T4 decreased after the first week and remained at approximately one half of the initial value until 12 weeks. Plasma TSH increased to a high of 6,220 ng/ ml after 6 weeks and gradually declined to one half of that value. The transplanted tissue remained functional throughout the experimental period. The number of pseudopods decreased, and irregularly shaped, dense bodies increased from the time of surgery until 12 weeks later. Administration of an acute dose of TSH at this time resulted in obvious mitotic activity and the formation of numerous pseudopods. The tissue also maintained the ability to take up radioactive iodine and to iodinate thyroglobulin. Inhibition of TSH secretion through T4 administration from the time of surgery did not affect viability. Some cellular hypertrophy persisted after 32 weeks although TSH and T4 had returned to normal. This study has shown that thyroid tissue remains viable, functional, and experimentally alterable throughout an extended period of chronic stimulation by endogenous TSH, and that it has the reserve capacity to secrete normal levels of T4 at the end of this experimental period.

Animals↗