Is an FDG-PET scan the new imaging standard for colon cancer?
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Carcinoembryonic Antigen↗
Biomedical subjects
R S Swanson
Publications and source records attributed to R S Swanson.
Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease.
HYPOTHESIS: To assess the applicability and efficacy of endoluminal colonic wall stents (ECWSs) in the management of large bowel obstruction (LBO). DESIGN: Inception cohort study. SETTING: University-based tertiary medical center. PATIENTS: Eleven consecutive patients with LBO in the absence of peritonitis. INTERVENTION: Placement of ECWS under endoscopic and fluoroscopic guidance. MAIN OUTCOME MEASURES: The success rate in ECWS placement, the efficacy in decompressing the obstruction, and the patency rate of the ECWS. RESULTS: Successful placement of ECWSs was obtainable in 10 of 11 patients. Once placed, all 10 patients achieved immediate decompression of their LBO. Eight patients had malignant obstructions associated with distant spread of disease; 3 patients had diverticular disease. Among those with malignant obstruction, 6 patients had successful and lasting palliation without colostomy, 1 patient underwent 1-stage resection 1 month later with no evidence of obstruction, and 1 patient could not be stented so diversion was done. None of the patients with diverticular disease required diversion: 2 had complete bowel preparation followed by resection with primary anastomosis, whereas the third declined surgery. Four of the 10 patients required overlapping ECWSs to bridge the stricture. One patient required a second ECWS secondary to recurrence of obstruction after stent migration and has continued palliation of his stage 4 rectal cancer for the last 11 months. No other complications were encountered. CONCLUSIONS: Urgent surgery with colostomy for LBO was avoided in 10 of 11 patients because of successful placement of ECWSs. We believe that endoscopic colonic stenting is safe, effective, and lasting, and should be considered as initial nonoperative management in all patients seen with LBO in the absence of peritonitis.
Adult↗
Neoadjuvant chemoradiotherapy for esophageal cancer: is it worthwhile?
BACKGROUND: With promising results from several institutions, many centers began treating patients with esophageal cancer with neoadjuvant chemoradiotherapy (NC) followed by esophagectomy. This approach is demanding for the patient and has not been proved to be better than esophagectomy alone. OBJECTIVE: To assess survival time and measures of quality of life associated with NC. DESIGN: A retrospective review during 1990 to 1996. SETTING: The 3 tertiary academic hospitals affiliated with the University of Massachusetts Medical School, Worcester. PARTICIPANTS: All patients (N=51) with cancer of the middle or lower esophagus who were treated with NC followed by esophagectomy during this period. MAIN OUTCOME MEASURES: Median and 1-, 2-, and 3-year survival times; median preoperative treatment time (first office visit for surgical consultation before beginning NC to the date of surgery), median hospital stay, and postoperative swallowing function. RESULTS: The median survival time of all patients was 16.3 months; 1-, 2-, and 3-year overall survival rates were 67%, 46%, and 39%, respectively. The median hospital stay was 12 days. The median postoperative treatment time was 3.3 months, which was 20% of the median survival time. Of the 51 patients, 19 were alive with a median follow-up time of 2.5 years. Twenty-nine percent of the patients had a complete pathological response with median and 1-, 2-, and 3-year survival rates of 17.5 months, 73%, 57%, and 57%, respectively. Palliation of dysphagia was excellent, with 44 (93%) of 47 operative survivors taking either a soft diet (18 [38%]) or a regular (26 [55%]) diet by the first postoperative visit. CONCLUSIONS: Median survival time with NC followed by esophagectomy for resectable cancer of the esophagus does not appear to be significantly better than that reported for esophagectomy alone. Further, treatment time with NC consumed 20% of survival time. Examining only these outcome variables suggests that NC is not worth-while. However, examining a longer-term outcome survival variable, such as 3-year survival time, suggests that NC followed by esophagectomy may result in greater long-term survival than that reported for esophagectomy alone. We conclude that further randomized, controlled studies are necessary before NC followed by esophagectomy is considered superior to esophagectomy alone for the treatment of resectable esophageal cancer.
Adenocarcinoma↗
Tumor angiogenesis in stage II colorectal carcinoma: association with survival.
We studied the frequency of microvessels in T3 N0 M0 colorectal carcinomas from patients with widely different survival times. Microvessels (<50 microm diameter) were enhanced by immunostaining with antibody to factor VIII-related antigen and counted in 40x high-power fields in sections of resected carcinomas from 9 patients who died of disease in 24 months or less (short-term survivors) and 13 who had no evidence of disease at 109 months or longer (long-term survivors). The means of the 10 highest counts for each case were compared between the long- and short-term survivor groups. The mean +/- SD microvessel count was 25.4 +/- 6.5 for the short-term survivors and 30.3 +/- 6.4 for the long-term survivors. Median counts were 27.2 and 29.4, respectively. The distribution of microvessel counts was skewed toward higher counts in the long-term survivors. There was no correlation between microvessel counts and tumor site, size, or grade; lymphovascular invasion; or the presence of a mucinous component. Although there was a trend toward a higher frequency of microvessels in patients with longer survival, it is unlikely that microvessel count is an independent prognostic indicator for patients with T3 N0 M0 colorectal carcinoma because there is only a small difference in microvessel frequency between patients with widely different survival times.
Aged↗
Spontaneous splenic rupture following administration of granulocyte colony-stimulating factor (G-CSF): occurrence in an allogeneic donor of peripheral blood stem cells.
Granulocyte colony-stimulating factor (G-CSF) has been used to improve granulocyte count in chronic neutropenia and myelodysplasia, to minimize the incidence and duration of neutropenia during conventional chemotherapy, and to mobilize peripheral blood stem cells prior to leukapheresis for use in autologous and allogeneic marrow transplantation. The most common toxicity is bone pain, and other reactions such as inflammation at the site of injection have also occurred. In patients with chronic neutropenia, splenomegaly has been described with long-term use, and extramedullary hematopoiesis has also been reported. However, thus far, no life-threatening sequelae of these effects are found in the literature. We now describe a case of spontaneous splenic rupture four days following a six-day course of G-CSF therapy in an allogeneic donor of peripheral blood stem cells.
Acute Disease↗
Loss of hIRH mRNA expression from premalignant adenomas and malignant cell lines.
We recently isolated from differential displays and subsequently cloned a human alpha-intercrine (hIRH) whose mRNA is reduced in human hepatocellular carcinomas. We now report that on Northern blots its mRNA is absent from premalignant colonic adenomas and from all of 27 human malignant cell lines (including breast, cervix, colon, duodenal, gastric, leukemia, liver, lung, melanoma, and pancreatic lines). hIRH mRNA was present in most normal human and mouse tissues and fibroblast derived cell lines but absent from leukocytes and brain. Two mRNA signals, at approximately 2 Kb and approximately 3.5 Kb, had variation in signal strength or size between tissues and species.
Adenoma↗
Gastrobronchial fistula in untreated lymphoma.
A 48-year-old man with B-cell lymphoma of the stomach was seen with recurrent pneumonia, weight loss, and anorexia. A barium study revealed a large malignant gastric ulcer with a gastrobronchial fistula. A computed tomography (CT) scan of the abdomen showed a gastric neoplasm invading the left lower lobe of the lung and the spleen.
Biliary Fistula↗
Acute cholecystitis resulting from hemobilia after tru-cut biopsy: a case report and brief review of the literature.
Acute cholecystitis following hemobilia is very rare, with only five cases reported in the literature. A case report of a 22-year-old woman who underwent a liver biopsy for staging of Hodgkin's lymphoma and developed cholecystitis due to hemobilia is presented. The incidence of hemobilia has increased with the advent of more invasive hepatobiliary procedures, but the mortality has been decreasing due to better recognition and therapy. Acute cholecystitis associated with hemobilia is very rare, but will be seen with increasing frequency; and a high index of suspicion needs to be maintained to ensure timely diagnosis and treatment.
Acute Disease↗
Primary aortoduodenal fistula after radiotherapy.
Primary aortoduodenal fistula is an uncommon cause of massive upper gastrointestinal hemorrhage; it is most commonly caused by the erosion of an abdominal aortic aneurysm into the third portion of the duodenum. This report describes a 73-yr-old man who developed uncontrollable hematemesis due to a primary aortoduodenal fistula in the fourth portion of the duodenum approximately 20 yr after radiotherapy and para-aortic lymph node dissection for seminoma. Surgical and postmortem examination revealed encasement of a normal-size aorta by dense fibrous tissue, ischemic necrosis of the aortic wall, and distinct chronic radiation changes of the duodenum. We propose that radiation may have played a significant role in the pathogenesis of the aortoduodenal fistula in this case. A history of radiotherapy may be relevant in the etiology of massive gastrointestinal bleeding and should prompt rapid attempts at visualization of the distal duodenum if the source of bleeding is unclear.
Aged↗
A complication involving a braided hook-wire localization device.
At the authors' institution, needle localization of breast lesions with a braided hook wire involves the wire being cut 1-2 cm from the point of entry before dissection, to avoid contamination of the sterile field with the nonsterile portion of wire. During dissection, the wire is brought through the skin into the area of dissection. In one patient, fragments of wire filaments were left within the breast. Braided hook wires must be cut cleanly, the cut surface should be wiped before dissection, and the surgical area should be cleansed before closure.
Breast Diseases↗
Treatment of carcinoma of the breast in the older geriatric patient.
With recent changes in the management of carcinoma of the breast and a population that is increasingly aging, it behooves us to determine the most appropriate treatment of carcinoma of the breast in the elderly. We reviewed the records of 150 women 80 years of age or greater who were diagnosed between 1970 and 1980 at the Massachusetts General Hospital as having carcinoma of the breast. In these selected patients, treatment with operation or radiotherapy was well tolerated. Of the 103 patients who had mastectomies, only one patient died during the postoperative period. The complication rate from mastectomy was similar to that reported for younger patients. All of the patients who began radiotherapy completed their courses of treatment. Complications from radiotherapy were generally transient and easily tolerated. Five year actuarial survival rates for patients with Stages I and II disease were similar for those receiving primary radiation therapy (67 per cent) or modified radical mastectomy (65 per cent). However, the comparable survival rate for those treated with lumpectomy alone was only 39 per cent. Local and regional failures occurred with lumpectomy, total mastectomy or primary radiation therapy, but not with modified radical mastectomy. We conclude that age alone should not dictate the treatment for carcinoma of the breast. An otherwise healthy elderly woman should be offered the same treatment options for the treatment of carcinoma of the breast as those offered to younger patients.
Aged↗
Outpatient percutaneous central venous access in cancer patients.
A 1-year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability, safety, and cost. There were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients. Catheter insertion was successful in 722 attempts (95%). There were only 13 pneumothoraces (2%). Thirty catheters required repositioning (4%). The average catheter duration was 191 days (range: 0 to 892 days). Fifty-six catheters (8%) were removed because of suspected infection. Documented catheter sepsis occurred in 21 patients (3%); catheter site infection occurred in 8 patients (1%). Thus, only 0.22 infections per catheter year occurred during this 382 catheter-year experience. The estimated cost of catheter insertion was $562, which is one-third the estimated cost for tunneled catheters ($1,403) and for reservoir devices ($1,738). In our experience, percutaneous subclavian catheterization is a reliable, cost-effective method compared with tunneled or reservoir devices, with an equivalent incidence of catheter-related infections. The cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education. In centers where a large number of patients require central venous access, percutaneous catheterization should be the technique of choice.
Ambulatory Care↗
Pancreatic cancer in 1988. Possibilities and probabilities.
Pancreatic adenocarcinoma is increasing in frequency, generally grows without symptoms until late in its natural history, and presents many discouraging unresolved problems in management. This review analyzes the status of current modalities of diagnosis, staging, and treatment. The limitations of those methods are defined, and possible improvements and new directions are suggested. A strategy for a rational and humane approach to pancreatic cancer is developed with the goal of maximizing quality as well as quantity of life.
Adenocarcinoma↗
Emergency intravenous access through the femoral vein.
A study was undertaken to assess the efficacy and safety of femoral venous catheterization for resuscitation of critically ill patients in the emergency department setting. From May 1982 to April 1983, 100 attempts were made at percutaneous insertion of a large-bore catheter into the femoral veins of patients presenting to our emergency department in cardiac arrest or requiring rapid fluid resuscitation. Eighty-nine attempts were successful. Insertion was generally considered easy, and flow rates were excellent. The only noted complications were four arterial punctures and one minor groin hematoma. This study suggests that short-term percutaneous catheterization of the femoral vein provides rapid, safe, and effective intravenous access.
Adolescent↗
das Mutation in bacteriophage T4D does not suppress an amber mutation in T4 gene 59.
Mutations termed das were isolated originally (Hercules and Wiberg, 1971) as partial suppressors of mutants in phage T4 genes 46 and 47. Since mutants in genes 46, 47, and 59 exhibit both an early arrest of phage DNA synthesis and the loss of this arrest in the presence of chloramphenicol or of mutations of T4 genes 33 and 55, we asked whether a das mutation can also suppress a gene 59 mutant. We find that it cannot--either at the level of phage production or DNA synthesis.
Chloramphenicol↗