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N Altorki

Publications and source records attributed to N Altorki.

22 records · Page 2Linked to original sources

Infrequent point mutations of ras oncogenes in gastric cancers.

Adenocarcinomas of the proximal and distal stomach have significant clinical and biological differences. A study was undertaken to determine if a difference in the incidence of mutated ras oncogenes exists between proximal (gastroesophageal junction or cardia) and distal (body or antrum) gastric tumors, and to assess the overall incidence in gastric cancers from non-Asian patients. Deoxyribonucleic acid from 28 primary gastric adenocarcinomas were analyzed for point mutations in codons 12, 13, and 61 of the Ha-ras, Ki-ras, and N-ras protooncogenes using polymerase-catalyzed chain reaction methodology. Twelve tumors were located at the gastroesophageal junction or cardia, and 16 in the body or antrum. Mutated ras genes were detected in 2 of 28 tumors for an overall incidence of 7%. The mutations occurred in codon 61 of the N-ras gene in a proximal gastric cancer and in codon 12 of the Ki-ras gene in a distal gastric cancer. These data indicate that mutations in ras genes are an uncommon event in primary gastric cancers and that there is no meaningful difference in the incidence of ras mutations in proximal and distal stomach cancers.

Adenocarcinoma↗

Pancreatic biopsy.

The necessity, value, and safety of various techniques of pancreatic biopsy are evaluated. The authors also offer a general policy on pancreatic biopsies.

Biopsy↗

CT-guided transthoracic needle biopsy following indeterminate fiberoptic bronchoscopy in solitary pulmonary nodules.

We evaluated the role of computed tomography (CT)-guided transthoracic needle biopsy (TNB) in patients with solitary pulmonary nodule and indeterminate flexible fiberoptic bronchoscopy (FOB). A review of 112 patients with solitary nodules under 3 cm in size who underwent TNB was carried out. A total of 48 patients had prior FOB with negative or indeterminate results. We reviewed the results of CT-guided TNB of these 48 patients with respect to the cytology results, nodule size and location, and complications of the procedure. Among the 48 patients who had FOB with indeterminate cytology, 32 were found to have malignant cytology on subsequent TNB. Among the remaining 16 patients, eight had diagnostic thoracotomy, which showed that six of the nodules were benign and two were malignant. The remaining eight patients who did not undergo surgery have been followed for more than 2 years, without evidence of growth. Results were not influenced by size or location. TNB offers a high yield for diagnosis in this patient population.

Biopsy, Needle↗

Cost containment in cardiac surgery: results with a critical pathway for coronary bypass surgery at the New York hospital-Cornell Medical Center.

PURPOSE: A multidisciplinary project was undertaken at The New York Hospital-Cornell Medical Center to develop critical pathways for open-heart surgery to help reduce cost, shorten hospital length of stay (LOS), and streamline patient care. METHODS: A critical pathway for elective coronary artery bypass grafting instituted on March 1, 1995, was developed through a cooperative effort involving surgeons, anesthesiologists, nurses, social workers, physical therapists, nutritionists, and patient case managers. Prospective data collected on consecutive patients forming a critical pathway group (n = 114) over a 6-month period were compared with retrospective data on consecutive patients forming a cohort group (n = 382) who underwent elective coronary artery bypass grafting in 1994. RESULTS: The critical pathway group of patients experienced a significantly shorter total hospital LOS (7.7 +/- 2.3 days vs 11.1 +/- 6 days, p < 0.0001) and shorter intensive care unit LOS (1.5 +/- 0.9 days vs 2.0 +/- 2.8 days, p < 0.0001). Direct costs were computed by use of hospital charges multiplied by the Medicare cost-to-charge ratio. Mean hospital direct cost (ancillary resources) was $1181 lower in the critical pathway group when compared with the control group (p < 0.0001). The postoperative mortality and readmission rates were similar for the two groups of patients. CONCLUSIONS: The ongoing analysis of cost, LOSs, and outcomes has made possible a process of continuous quality improvement on the cardiothoracic service in which further areas for improvement are identified and studied. The use of a critical pathway for elective coronary artery bypass grafting at our institution significantly reduced hospital LOS and direct costs while maintaining the overall quality of patient care.

Coronary Artery Bypass↗