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J Starr

Publications and source records attributed to J Starr.

43 records · Page 3Linked to original sources
PubMed1967

A re-evaluation of the place of major extirpation in the management of patients with metastatic mammary carcinoma.

Clearly defined indications for major extirpation procedures in metastatic mammary carcinoma are lacking. A reassessment of experience with 222 patients (133 after adrenalectomies and 89 after hypophysectomies) was therefore undertaken. This experience has changed our previous opinions that such procedures should be used only at the end of a sequential program of treatment.It is now felt that extirpation is only contraindicated in menopausal women with a duration of disease less than two years or when there is symptomatic disease of vital organs. Otherwise, early extirpation is recommended. When vital organ involvement is recognized in the asymptomatic stage or when screening of premenopausal women by castration indicates continuing hormonal dependency, then early extirpation is indicated.Both the qualitative and the quantitative responses achieved exceed those obtained by other measures when widely disseminated disease is present. The objective remission rate (34% after adrenalectomy and 19% after hypophysectomy) for longer than six months is worth while.

Adenocarcinoma, Mucinous↗
PubMed1967

A review of some important problems concerning lung cancer. The importance of complete preoperative assessment in bronchogenic carcinoma.

Part I of this review described the pathogenesis of lung cancer and emphasized that it was largely a preventable disease. In the present paper, attention is drawn to the prevalent but false impression that treatment of established disease is quite in-effective. In eight consecutive series of cases (over 2300 patients) the authors have seen a change in the clinical environment in which lung cancer is treated-from one of discouragement and apathy to one of outspoken encouragement and enthusiasm.Complete preoperative assessment-an evaluation of the biology of the tumour-host relationship as well as technical resectability-avoids unnecessary surgical intervention and stimulates a trend to earlier referral. This has permitted increasing use of resection with a declining mortality and a continuing improvement in overall survival. On the basis of present resectability rates (37.5%) and a 39% five-year survival rate in those who have had curative resection, it is estimated that current over-all five-year salvage should exceed 13%. This is more than a five-fold increase in survival for all patients compared to that achieved by treatment before 1952.

Angiography↗
PubMedDate not supplied

The effect of respiratory alkalosis on oxygen consumption in anesthetized patients.

STUDY OBJECTIVE: To investigate whether hyperventilation significantly altered oxygen consumption in anesthetized and paralyzed patients undergoing surgery. DESIGN: Open crossover trial with 1 hour of hyperventilation preceded and followed by 1 hour of normoventilation. SETTING: University medical center. PATIENTS: Eight patients (five men and three women) undergoing lengthy orthopedic surgery with general anesthesia and muscle paralysis. INTERVENTIONS: After baseline normoventilation for 1 hour (Period 1), the anesthetized patients were hyperventilated to an arterial carbon dioxide tension (PaCO2) of 20 to 25 mmHg for 1 hour (Period 2). Patients then experienced another hour of normoventilation (Period 3). MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, electrocardiography, temperature, end-tidal partial pressure of CO2 (PETCO2), oxygen consumption (VO2), carbon dioxide production, and minute ventilation were continuously followed throughout the study, and arterial blood gases were drawn at the beginning and end of each study period. During the period of hyperventilation, pH was significantly higher and P.ETCO2 and PaCO2 significantly lower compared with the periods of normoventilation. VO2 was significantly increased during hyperventilation compared with the periods of normoventilation. Hemodynamic variables and temperature were similar in the three study periods. CONCLUSIONS: In anesthetized paralyzed patients, there is an increase in whole-body VO2 with hypocapnic alkalosis.

Adult↗