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Biomedical subjects

L F Urdaneta

Publications and source records attributed to L F Urdaneta.

At least 37 records · Page 2Linked to original sources
PubMed1985

Specimen xeroradiography after needle localization and biopsy of noncalcified, nonpalpable breast lesions.

Xeroradiography was used to detect and aid in needle localization of 63 nonpalpable breast lesions over an 8-year period. In 28 patients (44%), no microcalcifications were present in the lesion biopsied. Xeroradiographs of these noncalcified lesions after their submersion in water carried a clean and close resemblance to their in vivo appearance and aided the pathologist in localizing the abnormality within the biopsy specimen. This simple method improved the accuracy of the needle-guided biopsy while allowing excision of minimal breast tissue. A total of 17 (27%) lesions revealed malignancy. At the time of mastectomy, all carcinomas were at an early stage with no nodal involvement. No recurrence has been detected to date with a mean follow-up period of 24 months. This procedure requires close cooperation between the surgeon, radiologist, and pathologist.

Adult↗
PubMed1984

Hepatic artery ligation and chemotherapeutic infusion in the treatment of hepatic malignancy.

This report reviews the results of treatment of hepatic malignancies by intra-arterial infusional chemotherapy and hepatic artery ligation. Seventy-nine patients with liver metastases or primary hepatomas were treated by this technique between the years 1970 and 1982. The majority of patients had metastatic disease from colon and rectal cancers. The median and mean survivals in the total group was 10 and 14 months, respectively (including operative deaths). Patients with metastatic disease from colon and rectal cancers had better survival than those with metastases from other primaries. Patients with synchronous liver malignancy had better survival than those with metachronous disease. Length of survival correlated positively with the duration of chemotherapeutic infusions, the latter being frequently (in 42% of patients) interrupted because of catheter complications. A new technique utilizing implantable pumps can be expected to further improve the results by reducing catheter malfunction and prolonging treatment courses.

Antineoplastic Agents↗
PubMed1984

Evaluation of an emergency air transport service as a component of a rural EMS system.

The authors reviewed the records of 569 patients transported by an emergency helicopter service to evaluate its impact on the outcome of patients with multisystemic injuries. A Total Trauma Score for each patient was computed. A number of other factors were also considered, including the nature of the injury, number of systems injured, origin and duration of flight, resuscitative maneuvers, number of blood transfusions given and the timing of operations required to treat the injury. The service was then rated utilizing strict specific guidelines as either essential, helpful or not a factor, in the preservation of life and/or limb in each case. A fourth group was comprised of patients who expired as a result of their injuries. The air transport service was essential to 16.5% and helpful to 10.9% of patients. In spite of rapid evaluation and maximal intervention, 102 (17.9%) of the patients died. The group for which air transport was judged "not a factor" (54.7%) consisted of patients whose injuries would not have proven fatal had their transportation to the tertiary care center been delayed. Retrospective analysis of the data available to the tertiary care center at the time of the decision to transfer the patients by air revealed that it was not possible to differentiate those patients who did not benefit from the service from those for whom the service was judged essential or helpful. Even though 17.9% of the helicopter transported patients died at some time during their period of hospitalization, they did receive the benefit of prompt sophisticated evaluation and management of their injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

A search for malignant cells in peritoneal fluid from patients with colorectal adenocarcinoma.

Cytologic examination of peritoneal fluid aids in staging ovarian malignancies and in selecting gastric adenocarcinoma patients for intraoperative adjuvant chemotherapy. Tissue culture of peritoneal fluid could be potentially valuable in confirming cell viability and establishing sensitivity to a variety of anti-cancer agents. It also could be a more sensitive diagnostic tool than cytologic examination alone. We obtained peritoneal fluid specimens from 29 patients at the time of celiotomy: 22 had colorectal adenocarcinoma and seven were controls. Cytologic examination on a portion of each specimen produced only one positive result for malignant cells. Tissue culture of the remainder of the specimens grew cells from all but one of the patients with colon cancer; however, their morphology was similar to the fibroblasts and mesothelial cells that grew from the seven controls. We speculate that these negative results stem from the absence or reduced number of tumor cells in the specimens. Without additional refinement of our methods of specimen collection and processing, cytologic examination and tissue culture of peritoneal fluid from patients with colorectal cancer are of minimal value. Nevertheless, we believe that, with the necessary refinements, they may eventually become invaluable in the management of these patients.

Adenocarcinoma↗
PubMed1983

Duodenal trauma in the rural setting.

During the past 15 years, 21 patients with duodenal injuries were treated at the University of Iowa Hospitals and Clinics. The major cause of injury (66.6%) was blunt abdominal trauma. Eighteen patients (85.7%) underwent celiotomy. Only one patient (4.7%) had an isolated duodenal injury. In most cases, a careful exploration of the periduodenal area and lesser sac was necessary to diagnose and treat the injury. No one specific procedure was used in these patients. The use of Penrose drains did not prevent abscess formation in three of nine patients. Overall mortality was 23.8 per cent, but most deaths were related to other serious injuries. Only one death (4.7%) was directly related to the duodenal injury. In the rural setting, duodenal injuries are rare, but when they occur they are frequently the result of blunt trauma. These injuries are commonly associated with other obvious problems and may be easily overlooked. Because the preoperative diagnosis is difficult, careful intraoperative examination of the entire duodenum is mandatory.

Adult↗
PubMed1982

Cystosarcoma phylloides of the breast: a new therapeutic proposal.

An analysis of forty cases of cystosarcoma phylloides of the breast was undertaken to clarify the relationship between histology, surgical treatment and prognosis of this fibroepithelial tumor. Thirty-eight female patients 12 to 85 years of age, treated for this diagnosis over a 17-year period, were studied retrospectively. Histologically malignant lesions were diagnosed in 17 cases: six were treated by local excision, one by subcutaneous mastectomy with prosthetic implant, four by simple mastectomy, three by modified, two by radical mastectomy, and one by biopsy only. Of the 23 histologically benign tumors, 18 were treated by local excision, three had simple mastectomy, and one had subcutaneous mastectomy with prosthetic implant. Three recurrences, observed (7.5%) among patients with benign tumors, were locally excised. Wide local reexcision has controlled the disease to date after average follow-up of 32 months. In the malignant group, metastases developed in four patients (10%). Three of these patients are dead of disease and one is being treated by chemotherapy. Malignant histology seemed to correlate directly to the presence of pain (46.6%), size of the tumor (average 7 cm in diameter), and older age (average 52 years), but there was no correlation with prognosis. Recent reports on the subject advocate wide local excision for small benign lesions and simple mastectomy for larger or malignant ones. Our data indicates that the histologic appearance does not correlate with the clinical behavior of this neoplasm, and the choice of the procedure does not alter the long-term result, provided that the tumor is completely excised. More radical procedures than wide local excision are not justified for cystosarcoma phylloides which behaves more like a soft tissue sarcoma than a breast gland tumor.

Adolescent↗
PubMed1981

Pregnancy during adjuvant chemotherapy for breast cancer.

Two patients became pregnant while receiving adjuvant chemotherapy for breast cancer following mastectomy. These cases suggest that the significant prolongation of disease-free survival seen in young premenopausal patients may not be ascribable to ovarian failure alone. While the degree to which these patients will benefit from adjuvant therapy is unknown, it is clear that the agents used did not affect fertility. The need to instruct such patients in the necessity for using nonoral contraceptive techniques is stressed.

Adult↗
PubMed1981

Factors influencing survival in bilateral breast cancer.

One hundred and four patients with bilateral breast cancers, detected clinically, were studied. Patients with synchronous lesions experienced the worst survival. Lymph node metastases in the second mastectomy had obvious adverse effect on survival. The development of scirrhous carcinoma in the second breast did not alter survival. A maximum of 21 patients might have been adversely affected by the development of a second cancer because of lymph node metastases in the second breast only. Survivorship data suggest the adequacy of treatment of contralateral breast cancers when they become detectable by clinical means alone.

Age Factors↗
PubMed1981

Familial bilateral breast cancer.

The occurrence of bilateral breast cancers in three members of one family is reported. In two members, evidence of a distinct primary lesion in each breast was verified. The occurrence of unilateral breast cancer and other cancers in other members of the family was surveyed. Recommendations for early detection and surveillance in familial breast cancer at the present time should be aggressive and close follow-up of the affected members. Absence of reliable markers preclude effective surveillance for early detection or susceptibility.

Breast Neoplasms↗
PubMed1980

Current management of trauma to the colon.

In a review of 72 cases of trauma to the colon we have demonstrated that a 51 per cent primary closure rate can be obtained if the following considerations are used: 1) anatomic location of colon injury, 2) degree of fecal contamination, 3) number of associated organs injured. Considering these factors individually or in combination we were able to perform primary closure in 51 per cent of our patients, without colostomy and without increasing morbidity and mortality. As a result, the number of hospital days and surgical procedures have been reduced.

Adolescent↗
PubMed1978

Pancreatic injury.

During the ten-year period from 1967 to 1977, 50 cases of pancreatic trauma were reviewed. There were 40 gunshot wounds, six stab wounds, and four cases of blunt abdominal trauma. Ten of the patients died, a mortality of 20%. The overall complication rate was 57%, but only 27% had complications attributable to the pancreatic injury. As has been reported by most authors, there is a high incidence of associated injuries. In our series only one patient had isolated pancreatic injury, while 30% had a major vascular injury, and the mortality for this group was 50%. Several methods of treatment were used, but the majority (36 patients) had drainage alone. The others had either resection (five) or Roux-en-Y pancreaticojejunostomy (five). Of particular interest were results of treatment of severe injuries to the head of the pancreas. Early in the series two patients were treated by pancreaticoduodenectomy and both died within 24 hours. During the last year we have treated five similar injuries using a Puestow type of Roux-en-Y pancreaticojejunostomy, with one death and no pancreatic complications. At present we advocate sump tube drainage for most injuries but rely on a Roux-en-Y pancreaticojejunostomy for severe injury to the head of the pancreas rather than resection.

Adult↗
PubMed1978

Indications for choledochoduodenostomy.

In summmary, at University Hospital of Jacksonville, we have performed 36 side-to-side choledochoduodenostomies over the past five years. We have repeatedly demonstrated that choledochoduodenostomy is the procedure of choice for obstructing or partially obstructing lesions of the distal or mid common bile duct, and our extensions of the original indications have not affected the morbidity or mortality as previously reported.

Adolescent↗