Biomedical subjects

M A Rodriguez-Bigas

Publications and source records attributed to M A Rodriguez-Bigas.

At least 55 records · Page 3Linked to original sources

PubMed1996

Clinical significance of colorectal cancer: metastases in lymph nodes < 5 mm in size.

BACKGROUND: The clinical significance of metastases in small lymph nodes is not known. Our objective was to evaluate possible relationships between the number and size of lymph node metastases and survival after potentially curative colorectal resection. METHODS: A retrospective chart review was performed in patients with Dukes'C (any T, N(1-3') M0) colorectal cancers from July 31, 1971 to December 31, 1987. All specimens underwent the lymph node clearing technique. Statistical analysis was performed with the log rank test and the Cox proportional hazards model. RESULTS: In 77 patients there were 253 (8%) of 3,087 cleared lymph nodes with metastases. One hundred seventy-five (69%) of these metastatic nodes were 5 mm or less in diameter. The distal margin of resection (p = 0.011) and number of positive lymph nodes (p = 0.036) were statistically significant factors influencing overall survival. There was no significant difference in overall survival (p = 0.73) or disease-free survival (p = 0.56) whether the involved lymph nodes were < or > 5 mm in size. CONCLUSION: Most metastatic lymph nodes were < 5 mm in diameter. Based on our results, the size of lymph node metastases do not affect disease-free or overall survival in colorectal carcinoma.

Adenocarcinoma↗

PubMed1996

Utility of mapping lymph nodes cleared from rectal adenocarcinoma specimens.

The lymph node clearing technique improves the detection of lymph nodes in colorectal cancer specimens. The purpose of this study was to determine the utility of mapping the lymph nodes cleared from rectal adenocarcinoma specimens by evaluating the possible relationship between the pattern of lymph node metastases to the site of the recurrent disease. A retrospective medical record review was performed in 40 patients with primary rectal adenocarcinoma. The specimens were analysed by lymph node clearing technique and mapped after surgery. The lymph nodes were mapped according to their location in the cleared specimens. Statistical analysis was performed using the chi 2-test. A total of 1290 lymph nodes were cleared in 40 specimens. Of these, 1126 (87%) lymph nodes were < or = 5 mm. One-hundred and ten (9%) lymph nodes were metastatic. Sixty-seven (61%) of these 110 lymph nodes were 5 mm or less in size. The majority of lymph nodes with or without metastases were in the pelvis, as opposed to an extrapelvic location (P = 0.0001). Eleven patients recurred. In nine of these patients the recurrence showed a direct relationship between the level of metastatic lymph node location (pelvic vs. extrapelvic) and the site of the recurrent disease (loco-regional or systemic, P = 0.05). The majority of lymph nodes, both normal and metastatic, cleared from specimens from rectal adenocarcinoma were < or = 5 mm in diameter. The lymph node mapping technique may help in predicting the site of recurrence.

Adenocarcinoma↗

PubMed1996

Colorectal cancer in patients aged 30 years or younger.

Colorectal cancer (CRC) is believed to carry a grim prognosis in young patients. A retrospective study of patients diagnosed with colorectal cancer at age 30 years or less between 1971 and 1994 was conducted. Statistical analyses were performed using non-parametric one way ANOVA tests and logistic regression models. Sixty-eight of the patients evaluated at our institution were suitable for this study. Risk factors were identified in 28% of patients. The median age at diagnosis was 27 years (range 14-30 years). Fifty-six patients (82%) were Stage III or IV at the time of diagnosis. Twenty-two of the 34 patients who underwent potentially curative surgery had recurring disease at a median of 12 months (range 1-43 months). At a median follow-up of 21.5 months, 54 patients had died from disease. At the time of death, abdominal carcinomatosis and distant disease were the most common patterns of failure. Stage of the primary tumour (P=0.0006) and recurrence (P=0.0001) were the only variables noted to be associated with survival. The stage of the primary tumour and whether the tumour recurred were each associated with survival in patients with colorectal cancer at age 30 years or less.

Adenocarcinoma↗

PubMed1996

Postoperative complications after splenectomy for hematologic malignancies.

OBJECTIVE: The authors analyzed the frequency and character of postoperative complications after splenectomy in patients with hematologic malignancies, and correlated these findings with preoperative conditions that could have predicted their outcome. SUMMARY BACKGROUND DATA: Splenectomy is performed for hematologic malignancies for diagnostic and therapeutic indications. The role of splenectomy for lymphoproliferative and myeloproliferative malignancies is complex and sometimes controversial. METHODS: The medical records of 135 patients undergoing splenectomies for hematologic malignancies at Roswell Park Cancer Institute from January 1, 1984 to December 31, 1993 were reviewed retrospectively. These included Hodgkin's disease (HD), hairy cell leukemia (HCL), non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), and a miscellaneous group. RESULTS: The overall postoperative complication and mortality rates for all patients were 52% and 9%, respectively. The complication rate was 63% for patients whose spleens weighed greater than 2000 g, and 29% for patients whose spleens weighed less than 2000 g (p = 0.001). Seventy-three percent of the postoperative deaths were due to septic complications, only one of which was caused by an encapsulated organism. Complications occurred in less than 20% of patients with the diagnosis of HD and HCL; more than 50% of patients with NHL, CLL, and CML suffered postoperative complications. CONCLUSIONS: Splenectomy performed in patients with hematologic malignancies is a potentially morbid procedure. Splenic size was the only preoperative factor found to be predictive of postoperative complications. The complication rate differed significantly between the different diagnostic subgroups.

Adolescent↗

PubMed1996

Desmoid tumors.

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Diagnosis, Differential↗

PubMed1996

The management of infectious and noninfectious anorectal complications in patients with leukemia.

BACKGROUND: Infectious and noninfectious anorectal complications may occur in patients undergoing therapy for leukemia. Controversy surrounds the treatment of this problem in immunocompromised patients. STUDY DESIGN: A retrospective review of the medical records of 83 patients with acute or chronic leukemia in whom anorectal disease developed during inpatient therapy for leukemia was performed to determine the initial signs and symptoms, treatment, and outcomes. RESULTS: During a 12-year period, 92 patients with anorectal complications were treated. This series included 25 patients with perirectal abscesses, 22 patients with anal fissures, 18 patients with symptomatic external hemorrhoids, 12 patients with perianal ulcerations, 12 patients with symptomatic internal hemorrhoids, and three patients with fistulas in ano. Overall, 79 (86 percent) of the 92 anorectal complications resolved in 68 of the 83 patients. Increasing periods of neutropenia did not adversely affect the resolution of anorectal disease. Thirteen patients (16 percent) required surgical intervention, most commonly secondary to a perirectal abscess. Incision and drainage was necessary in ten (40 percent) of 25 patients with perirectal abscess, which included five patients with fluctuation and five patients in whom infection failed to respond to medical therapy. CONCLUSIONS: Noninfectious anorectal complications in patients with leukemia respond to nonoperative intervention and rarely progress to a life-threatening infection. Nonoperative intervention in the form of systemic antibiotics and sitz baths is successful in the treatment of infectious anorectal complications. Incision and drainage should be performed when fluctuation is present and in patients whose complications fail to respond to medical therapy.

Abscess↗

PubMed1995

Patterns of colorectal liver metastases according to Couinaud's segments.

PURPOSE: It is commonly believed that the right lobe of the liver is the most frequent site of colorectal liver metastases. However, direct evidence for this is lacking in the literature. This study was designed to document and evaluate the pattern of liver metastases according to liver segments. METHODS: A retrospective medical records review of 270 patients with hepatic metastases from colorectal adenocarcinoma was performed to determine the pattern of metastases according to Couinaud's segments. There was operative confirmation of liver metastases in 202 patients (75 percent). A total of 1,166 segments were involved with liver metastases and were used in this analysis. Segment I was excluded from calculations because of its dual blood supply. When groups contained different numbers of Couinaud's segments an appropriate correction was made in the statistical comparison. RESULTS: There were 736 (63 percent) right lobe segments (V, VI, VII, VIII) and 430 (37 percent) left lobe segments (II, III, IV) involved with metastases (P < 0.001). Of 430 left lobe segments, 298 (69 percent) involved the left lateral segment (II, III) and 132 (31 percent) involved the medial segment (IV) of the left lobe (P = 0.25). When evaluating patients with 4 or less segments involved, there were 258 right lobe segments (75 percent) and 88 left lobe segments (25 percent) involved with metastases (P < 0.0001). Of 88 left lobe segments with 4 or less segments involved, there were 68 segments (77 percent) involving the left lateral segment and 20 segments (23 percent) involving the medial segment of the left lobe (P = 0.035). All of these relationships were statistically independent of the primary tumor site. CONCLUSIONS: We have documented an overall predominance of right hepatic lobe metastases independent of site of the primary colorectal carcinoma. However, when metastases occurred in the left lobe, the left lateral segment (II, III) was more commonly affected than the medial segment (IV), but this difference was statistically significant only when there were four or less segments involved with liver metastases.

Adenocarcinoma↗

PubMed1995

Prognosis and recurrence patterns of anal adenocarcinoma.

BACKGROUND: Anal adenocarcinomas are rare cancers, constituting fewer than 10% of all anal cancers. This is a retrospective review of 10 patients with anal adenocarcinoma. PATIENTS AND METHODS: Seven men and 3 women with a median age of 59 years (range 38 to 82) participated in the study. Using the 1976 World Health Organization classification, 4 patients had the rectal type of cancer, 2 had the anal duct type, and 1 had the anorectal fistula type. The 3 remaining patients had unclassifiable tumors with solely extramucosal disease. Seven patients underwent abdominoperineal resection, 1 had a radical vulvectomy and proctectomy, and 2 had local excision. RESULTS: The median survival was 29 months (range 5 to 249). Seven patients developed a recurrence at the following sites: 2 perineal, 5 inguinal, and 5 distant metastases. Five patients died from their disease a median of 28 months after surgery, and 2 patients died of unrelated causes. Three patients are alive at a median of 54 months; 2 of these patients are free of disease and 1 has a perineal recurrence. CONCLUSION: Anal adenocarcinomas were found to be a rare, heterogeneous group of tumors with a poor prognosis despite radical surgery.

Adenocarcinoma↗

PubMed1995

The clinical and genetic manifestations of hereditary nonpolyposis colorectal carcinoma.

BACKGROUND: Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that affects a significant percentage of the total cancer population but is not easily recognized because of a lack of a distinctive clinical marker such as multiple polyps. DATA SOURCES: The present review discusses the clinical characteristics, pathology, genetics, management, and surveillance of HNPCC. The diagnosis of HNPCC is dependent upon family history. It is defined by the Amsterdam criteria consisting of: (1) 3 or more relatives with histologically verified colorectal carcinoma, 1 of whom is a first-degree relative of the other 2; (2) colorectal carcinoma involving at least two generations; and (3) one or more colorectal carcinoma cases diagnosed at less than 50 years of age. CONCLUSIONS: The diagnosis of HNPCC requires the demonstration of vertical transmission of the syndrome in the family pedigree. Attention should be focused on reports of cancer of all anatomic sites and the determination of site, histology, and age at diagnosis.

Aged↗

PubMed1995

Intraoperative small bowel enteroscopy in familial adenomatous and familial juvenile polyposis.

BACKGROUND: In familial adenomatous polyposis and juvenile polyposis, polyps can occur throughout the gastrointestinal tract. METHODS: We report seven patients with familial adenomatous polyposis and two patients with juvenile polyposis who underwent small bowel enteroscopy at the time of exploratory celiotomy either for colectomy or other pathology. RESULTS: Polyps in the jejunum and/or ileum were noted in five of nine (56%) patients at enteroscopy. In three of nine (33%) patients these polys were adenomatous. Two of these patients had polyps in the jejunum and in the ileum, whereas one patient had jejunal adenomas alone. These polyps were from 3 mm to 30 mm in size. The remaining two patients with polyps had lymphoid hyperplasia in the ileum. All three patients who had adenomas at intraoperative small bowel enteroscopy had duodenal adenomas at esophagogastroduodenoscopy. At the age of 14 years, one patient had an intramucosal carcinoma in a small bowel juvenile polyp. CONCLUSION: Baseline small bowel enteroscopy should be considered at the time of surgical exploration in patients with asymptomatic familial adenomatous polyposis and juvenile polyposis. In patients with duodenal polyps, enteroscopy should be performed at the time of surgery. Biopsy and/or excision of larger polyps should be performed because these polyps may harbor a carcinoma.

Adenomatous Polyposis Coli↗

PubMed1994

Desmoid tumors in patients with familial adenomatous polyposis.

BACKGROUND: Sporadic desmoid tumors occur mainly in the abdominal wall and in extraabdominal sites. Desmoid tumors in patients with familial adenomatous polyposis (FAP) usually occur in the abdominal wall and in the bowel mesentery. Surgical resection of desmoids in patients with FAP has been controversial. METHODS: A retrospective review of patients with FAP and desmoid tumors treated from 1950 to 1991 was performed. Patients were evaluated for gender, age, site of desmoid tumors, treatment, recurrence, and survival. RESULTS: Twenty-one of 24 patients underwent 60 surgical procedures related to the desmoid tumors. Seven of nine patients who underwent potentially curative surgery had recurrences; three were reresected. Major morbidity after palliative or curative surgery was 47%. Five patients were alive with no evidence of disease at a median of 198 months, 10 patients were alive with disease at a median of 102 months, and 5 patients died with disease at a median of 31 months after diagnosis. CONCLUSIONS: Desmoid tumors are common in patients with FAP. Unresectability and recurrence are more common than cure. Palliative and curative resections have a high morbidity. Surgery should be reserved for those patients with symptomatic mesenteric desmoids.

Abdominal Neoplasms↗

PubMed1994

Decompression of the large intestine in Ogilvie's syndrome by a colonoscopically placed long intestinal tube.

A technique whereby a long intestinal tube piggy-backed on the colonoscope was placed in the cecum for decompression of the large bowel in Ogilvie's syndrome is described. This technique eliminates the need for fluoroscopy as a KUB can easily confirm the placement of the tube. Although the tube can be potentially dragged back out by the colonoscope, we have not found this to be a problem. This technique appears to be safe and effective in the management of colonic pseudo-obstruction. It can be added to the physicians' armamentarium in managing this clinical entity.

Colonic Pseudo-Obstruction↗

PubMed1994

Inguinal lymph node metastases from adenocarcinoma of the rectum.

This study is a retrospective review of 18 patients treated from 1964 to 1990 with inguinal lymph node metastases from rectal adenocarcinoma. Statistical analyses were performed to determine the effects of sex, disease-free interval, extent of inguinal lymph node metastases, and the presence of extranodal disease upon survival. The mean age of patients was 61 years (range 32 to 87). Lymph node metastases were unilateral in 12 patients and bilateral in 6. All 18 patients developed disease at loco-regional sites (pelvis/perineum) either synchronous or metachronous to their development of inguinal lymph node metastases. Survival from the time of diagnosis of inguinal lymph node metastases ranged from 2 to 54 months (median 13.5). There was no statistically significant difference in survival for unilateral versus bilateral inguinal metastases (P = 0.37). The median survival when inguinal lymph node metastases occurred > or = 12 months from diagnosis of the primary tumor was 16 months and 10.5 months when metastases occurred < 12 months after the diagnosis of the primary tumor (P = 0.033). The median survival for patients with isolated metachronous inguinal lymph node metastases was 20 months versus 12 months for patients who developed metachronous inguinal metastases concurrent with other areas of disease (P = 0.045). Although patients with disease-free intervals > or = 12 months and those with isolated inguinal metastases had statistically significant longer median survivals, the overall survival remains poor and all patients died with disease.

Adenocarcinoma↗

PubMed1993

Isolation of Inoue-Melnick virus from colorectal carcinoma tissues.

BACKGROUND: Isolation of Inoue-Melnick virus (IMV) Type 1 from tumor tissues of patients with colorectal carcinoma in Japan was reported. A high prevalence of IMV antibodies has been found among patients with colorectal carcinoma in Buffalo, New York. METHODS: IMV was isolated from homogenates of colorectal carcinoma and other tissues, inoculated into MRC-5 human fibroblast cultures. IMV-specific cytopathic effects were detected and titrated following 7 days of incubation in a roller-tube apparatus. RESULTS: IMV was isolated from all nine (100%) colorectal carcinoma tissues tested and all four (100%) normal parts of colon mucosa tissues obtained from patients with cancer. Biopsy specimens of normal colon mucosa from 10 patients without colon carcinoma were negative for IMV (0%). Average infectious titers of IMV in these tissue homogenates were 4.41 for tumor tissue and 2.55 log10 tissue culture infectious dose by 50% (TCID50)/0.1 ml for colon mucosa, respectively. Most of the isolates were the IMV intermediate type. CONCLUSIONS: Our results confirmed the production of infectious IMV in colorectal carcinoma tissues, as reported recently in Japan. The role of IMV in colorectal carcinogenesis is currently unknown.

Adenocarcinoma↗

PubMed1993

Problems encountered in teaching the use of the 65 cm flexible sigmoidoscope in a surgical oncology training program.

Flexible sigmoidoscopy after age 50 has been recommended by the American Cancer Society for colorectal cancer screening. A questionnaire to assess the difficulties encountered in learning to perform this procedure was given to 19 surgical oncology fellows after a 3-month rotation in the Division of Colorectal Surgery. Sixteen (84%) trainees related that between 10-20 flexible sigmoidoscopies were necessary before they felt competent. The most difficult aspect of learning flexible sigmoidoscopy was the torquing technique followed by the ability to determine the location of the proximal bowel lumen. All 19 trainees rated the ability to recognize pathology as not difficult. In this group of surgical trainees, the mean number of flexible sigmoidoscopy performed before competency was established was 15; torquing the shaft of the sigmoidoscope was the most difficult aspect to learn. The majority of the trainees recorded that following the performance of 15-20 endoscopies, torquing became easier.

Clinical Competence↗

PubMed1992

High prevalence of Inoue-Melnick virus antibodies in patients with colorectal carcinoma.

The high prevalence of serum neutralizing antibodies against Inoue-Melnick virus (IMV) among American patients with colorectal carcinoma has been confirmed. Sera from 26 patients with colorectal carcinoma along with the identical number of age- and sex-matched patients with non-colorectal neoplasia and normal healthy controls were collected in the Buffalo area. All of the colorectal carcinoma group possessed antibodies against IMV (100%), while antibody positivity for non-colorectal neoplasia and for normal controls were 34.6% and 38.5%, respectively. Geometric mean titers of antibodies to IMV type 1 and type 2 for colorectal carcinoma were 266 and 338, respectively, whereas the mean titers in the other two control groups were less than 10.3. These differences between colorectal carcinoma and the two controls were highly significant (P less than 0.001). The majority of patients with colorectal carcinoma had antibodies to both IMV types 1 and 2.

Adenocarcinoma↗

PubMed1992

99mTc-IMMU-4 monoclonal antibody scan in colorectal cancer. A prospective study.

A blinded prospective study of 34 patients with colorectal adenocarcinoma using the Fab' fragment of the anticarcinoembryonic antigen monoclonal antibody type IMMU-4 labeled with technetium 99m was conducted to compare, on a lesion-by-lesion basis, the findings of radioimmunoscintigraphy, preoperative computed tomography, and exploratory celiotomy. Of 115 lesions detected at surgery, 113 were adenocarcinoma. Radioimmunoscintigraphy detected 59 lesions and computed tomography detected 62; both studies combined detected 72. Twenty-nine (54%) lesions missed by radioimmunoscintigraphy and 24 (45%) missed by computed tomography were 1 cm or smaller. When both studies were combined, the sensitivities were 90%, 24%, and 42%, and the specificities were 52%, 86%, and 61% for hepatic, extrahepatic intra-abdominal, and pelvic lesions, respectively. In 10 patients, additional information obtained with the radioimmunoscintigram could have altered the treatment of these patients. In this study, radioimmunodetection scan was complementary to computed tomographic scan in the examination of patients with colorectal carcinoma.

Adenocarcinoma↗

PubMed1992

Prognostic significance of anastomotic recurrence from colorectal adenocarcinoma.

A retrospective analysis of the prognostic significance of anastomotic recurrence in 50 patients with colorectal adenocarcinoma was conducted from 1970 to 1987. All primary cancers were located above 10 cm from the anal verge. Forty anastomotic recurrences (80 percent) followed resection of sigmoid or proximal rectal tumors. The overall disease-free interval was 13 months, with 90 percent of recurrences diagnosed within 24 months of the primary resection. Forty-five recurrences (90 percent) were associated with synchronous or metachronous metastases. Overall median survival following the recurrence was 16 months--37 months if the anastomosis was the only recurrence site. Of five patients alive without evidence of disease, all were asymptomatic, and recurrence was confined to the anastomosis. In conclusion, anastomotic recurrence following resection of colorectal adenocarcinoma frequently heralds disseminated disease but can be potentially resected for cure if it is the only site in an otherwise asymptomatic patient.

Adenocarcinoma↗