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Biomedical subjects

S G ReMine

Publications and source records attributed to S G ReMine.

17 recordsLinked to original sources
PubMed1991

Carcinoid tumors: the relationship between clinical presentation and the extent of disease.

In this study the relationship between the initial clinical presentation and the extent of tumor progression was determined in a group of 31 patients with carcinoid tumors. The proportion of patients with symptomatic tumors was similar to those patients with carcinoid tumors that were incidentally found (55% versus 45%; SE = 0.089). Symptoms were caused by metastatic tumor in nine (30%) of the patients and by local effects of the primary tumor in eight (26%) of the patients. The patients with symptoms had a significantly increased frequency of metastatic disease, even when the symptoms were due to the primary tumor, compared to patients with no symptoms (76% versus 7%; p less than 0.001). Tumor size was related to the presence of symptoms and metastases. Symptoms were most common when the size of the primary tumor was greater than 1.0 cm (p less than 0.005), although the rate of metastases increased when primary tumors were 2.0 cm and larger (p less than 0.01). These results indicate that the presence of symptoms or a primary tumor 2.0 cm or larger are associated with an increased risk of metastatic disease in patients with carcinoid tumors. These patients should be treated with wide resection of the primary tumor and its lymphatic drainage.

Adolescent↗
PubMed1989

Management of pancreatic fistulas.

Conservative management of pancreatic fistulas resulting from trauma, operation for tumor, or operation for pancreatitis has met with variable success. To assess optimal management strategies and outcome, we reviewed the records of 35 patients with external pancreatic fistulas (26 patients), pancreatic ascites (6 patients), or pancreatic pleural effusion (3 patients). Treatment included no operation in 5 patients, oversewing of the fistula in 7 patients, internal drainage in 11 patients, and resection in 12 patients. One (3%) postoperative death occurred. The overall rate of operative success was 83% (25 patients). The incidence of recurrent fistulas was about the same regardless of the procedure. Patients treated successfully without operation did not have pancreatitis as an underlying disease. Patient selection is of great importance in the decision to resect or to drain and is based in part on imaging the pancreatic duct and fistula.

Adult↗
PubMed1989

Long-term results with primary retroperitoneal tumors.

Primary retroperitoneal tumors represent a variety of lesions, with different treatments and prognoses. Of 182 patients in our study, retroperitoneal tumor was recognized preoperatively in only 39% of them. Sarcomas were most common (43% of patients), followed by lymphomas (23%), benign tumors (11%), undifferentiated malignant tumors (11%), carcinomas (8%), and germ cell tumors (4%). In 81 patients since 1960, the resection rate was 50%. Operative determinants of resectability were pathologic category and grade and extent of tumor. Resection included segments of the gastrointestinal tract (30% of the patients), kidney (25%), and pancreas, bladder, spleen, aorta, and vena cava (for each, 5% or less of the patients). The operative mortality was 6%. Tumor caused late death in 95% of the patients. Pathologic findings were a significant determinant of survival in the 81 patients. For sarcomas, 69% of the patients underwent resection, and the 1- and 5-year actuarial survival rates were 80% and 43%, respectively. Sixty percent of these patients underwent multiple operations. For lymphomas, most patients were treated with radiotherapy and chemotherapy; the 1- and 5-year survival rates were 67% and 35%, respectively. Benign tumors, almost all resected, yielded a 5-year survival rate of 100%. Undifferentiated tumors and carcinomas, most treated with radiotherapy and chemotherapy, had a 1-year survival rate of less than 33%. Other determinants of survival were age, weight loss, grade of tumor, and extent of tumor. Patients who underwent palliative resection had the same survival rate as patients who underwent biopsy alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Surgical treatment of biliary cystadenoma. A report of 15 cases.

Mucinous biliary cystadenomas are rare intrahepatic or, less commonly, extrahepatic neoplasms that may produce massive enlargement, hemorrhage, rupture, secondary infection, jaundice, or vena caval obstruction. Radiologic criteria differentiate biliary cystadenomas from more common parasitic or simple cysts. Treatment has included sclerosis, marsupialization, internal drainage, or resection, but without resection the patient is at risk for enlargement, infection, or progression of an unrecognized malignant neoplasm. We report the course of 15 patients who underwent resection for biliary cystadenoma to elucidate the clinical presentation, preoperative evaluation, and surgical treatment. Nine patients had had previous radiologic or surgical intervention other than excision, and complications of sepsis and tumor recurrence had developed. Following complete resection, however, only five postoperative complications were encountered, and no patient experienced recurrence of tumor. Thus, we recommend complete surgical resection as the preferred therapy.

Adult↗
PubMed1988

Surgically incurable well-differentiated thyroid carcinoma. Prognostic factors and results of therapy.

A series of 97 consecutive patients with well-differentiated thyroid carcinoma treated between 1941 and 1970 presented with distant metastatic disease or extensive nonresectable local neck disease or had residual carcinoma after thyroid resection. Men 40 years of age or younger and women 50 years of age or younger were considered at low risk for dying of disease; older patients were considered at high risk for dying of disease. Of 17 patients with distant metastatic carcinoma, 40% of younger patients in the low-risk group and 92% of older patients in the high-risk group died. Of 80 patients with unresectable or residual local neck cancer, only 13% of younger patients but 71% of older patients died. Survival related better to risk group classification as defined by age and sex than to any details of disease presentation or management. Treatment was far more successful in patients in the low-risk group.

Adenocarcinoma↗
PubMed1988

Gastric mucosal dissection using the Nd-YAG laser synthetic sapphire crystal contact probe. Development of an endoscopic method for the treatment of pancreatic pseudocysts.

A canine gastric-ulcer model was developed to evaluate the safety and effectiveness of the neodymium yttrium-aluminum-garnet (Nd-YAG) laser synthetic sapphire crystal contact probe in intraluminal gastric dissection. The purpose of the study was to assess the potential endoscopic application of the Nd-YAG contact probe in cystogastrostomy for the treatment of selected patients with pancreatic pseudocyst. Seven dogs were used in the study. In the first two dogs, full-thickness linear incisions through the gastric wall demonstrated the Nd-YAG contact probe could be used for a full-thickness gastrostomy dissection. In the other five dogs, gastric ulcers were created by injection of morrhuate sodium (5%). Gastric mucosal dissection with the Nd-YAG contact probe was performed without difficulty. Hemostasis was obtained with either the Nd-YAG contact probe or noncontact fiber, and all areas of dissection and ulcer beds healed within 35 days. The Nd-YAG laser contact endoscopic delivery system appears to be a promising technique for intraluminal dissection.

Animals↗
PubMed1987

Pancreatoduodenectomy in the management of chronic pancreatitis.

The records of 73 consecutive patients who underwent pancreatoduodenectomy for chronic pancreatitis between 1960 and 1985 were reviewed. The median size of the pancreatic duct was 5 mm. Two operative deaths (2.7%) occurred early in the series. Eighty-eight percent, 86%, and 79% of the patients had improvement in pain at six months, two years, and five years, respectively. Diabetes was present preoperatively in 25% of patients and postoperatively in 37%, 45%, and 69% of patients at six months, two years, and five years, respectively. Pancreatic enzyme preparations were used preoperatively by 26% of patients; this use increased to 75% by five years. Only four of 17 late deaths could be related to diabetes or malnutrition. In most patients, pancreatoduodenectomy achieves long-term pain improvement and permits return to normal activities. Selection of patients is important to decrease the late morbidity and mortality.

Adult↗
PubMed1987

Cystic neoplasms of the pancreas.

From 1963 to 1983, 26 patients with cystic neoplasms of the pancreas were treated at the Lahey Clinic, Burlington, Mass. Cystadenoma (15 patients) was more common than cystadenocarcinoma (11 patients). Preoperative symptoms, such as abdominal pain, were present for as long as 18 years before diagnosis. The mean size of cysts was 7 cm. Distal pancreatectomy, the most common operation, was performed in ten patients. Eight of the 11 patients with cystadenocarcinoma had metastatic disease at the time of surgical exploration. There was one postoperative death (3.8%). Patients with cystadenocarcinoma had an adjusted median survival time after operation of 6.0 months. The long prodrome in many of the cancer patients suggests that benign cystadenomas, particularly of the mucinous type, may undergo malignant degeneration. Benign cystadenoma seems unlikely to recur after adequate resection. Whenever possible, complete excision of cystadenoma and cystadenocarcinoma is the procedure of choice.

Actuarial Analysis↗
PubMed1987

Unilateral hepatic duct obstruction.

Experience with unilateral hepatic duct obstruction is limited. We reviewed 33 cases of unilateral hepatic duct obstruction from a total of 500 patients with biliary reconstruction treated between 1965 and 1984. The median age of the patients reviewed was 56 years. The most common cause of unilateral hepatic duct obstruction was operative injury (73 percent of patients). Including operations for unilateral obstruction, patients in the series underwent 131 operations related to biliary tract problems. The most common presentation (73 percent of patients) was fever and pain. Obstruction was more common in the right duct than in the left duct by a ratio of 2:1 (22 patients versus 11 patients). The three types of surgical procedures used were hepaticojejunostomy (17 patients), dilatation and drainage (13 patients), and primary hepatic resection (3 patients). Atrophic hepatic lobes resulting in rotational deformity of the portal structures were resected in six patients with combined hepatic duct and arterial injury. No operative deaths occurred, although 51.5 percent of the patients had postoperative complications. Follow-up studies ranging from 1 to 16 years demonstrated that patients who had hepaticojejunostomy required less frequent reoperation compared with those who had dilatation (36 percent versus 64 percent) and had a lower postoperative mortality rate related to biliary tract problems (7 percent versus 18 percent). We conclude that unilateral hepatic duct obstruction continues to occur most commonly because of operative injury and is best treated by hepaticojejunostomy or by resection of chronically obstructed lobes when possible.

Biliary Tract Diseases↗
PubMed1987

Carcinomas arising in cystic conditions of the bile ducts. A clinical and pathologic study.

Thirty patients with cystic disease of the bile ducts operated on between 1965 and 1985 were reviewed. Three patients (10%) had a synchronous adenocarcinoma, and in three patients (10%) a metachronous carcinoma developed for a total incidence of malignancy of 20%. All patients died within 1 year of the diagnosis of malignancy. Of 19 benign cysts available for pathologic examination, one third had proliferative epithelial changes, and in two of these patients a metachronous carcinoma developed. Goblet cell metaplasia was prominent in four patients. This suggests the possibility that dysplastic changes and metaplasia of the epithelium could give rise to carcinoma. Resection of benign cysts of the bile ducts is favored, when feasible, in an attempt to decrease the incidence of malignancy.

Adenocarcinoma↗
PubMed1986

Gastric and small bowel lymphoma.

Despite the vague presentation of gastric and small bowel lymphoma, survival can be achieved by adequate surgical resection of stage I disease. A role still exists for debulking of advanced stage disease by surgical excision. Debulking enhances potential for complete response with chemotherapy, decreases the risk of gastric and small bowel perforation with large exophytic tumors as they necrose with chemotherapy, and prevents gastrointestinal obstruction from limiting patients' ability to receive chemotherapy. All attempts should be made to maintain nutritional support of these patients to allow them an adequate chance of receiving chemotherapy. The increasing frequency of immunodeficiency disorders will continue to produce higher numbers of patients with non-Hodgkin's lymphoma. Awareness of our surgical limitations is important because surgical exploration is frequently the first step. Multimodality therapy of gastric and small bowel lymphoma offers the best chance for successful outcome. Surgical resection should not prevent patients from receiving a complete trial of chemotherapy and radiation if appropriate.

Humans↗
PubMed1985

Abdominal lymphoma. Role of surgery.

Although patients with localized gastrointestinal lymphoma have reasonable 5-year survival rates after resection and these rates seem improved with radiotherapy and chemotherapy, long-term survival rates in patients with advanced disease remain poor. The future of therapy for patients with non-Hodgkin's lymphoma of the gastrointestinal tract lies with the multidisciplinary approach combining resection, debulking, radiotherapy, and multidrug chemotherapy.

Abdominal Neoplasms↗
PubMed1985

Hyperparathyroidism.

A review of hyperparathyroidism and current controversies in diagnosis and management is presented. Accurate diagnosis by the endocrinologist and an experienced surgeon remain the standards for good surgical results. Hyperparathyroidism is a heterogeneous disease, and therapy must be individualized to each patient. Conservative surgical removal of parathyroid tissue is preferred in most patients.

Adenoma↗
PubMed1978

Antecolic or retrocolic anastomoses in Billroth II gastrojejunostomy?

A retrospective study of major postoperative morbidity in two groups (50 patients each) that underwent Billroth II gastrectomy for duodenal ulcer disease showed no difference according to the type of anastomosis used (antecolic vs retrocolic). Prevention was not related to the type of anastomosis used, the main means of prevention being the use of meticulous care during the gastrojejunostomy.

Adult↗