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T M Talbott

Publications and source records attributed to T M Talbott.

11 recordsLinked to original sources
PubMed1994

Can preoperative and postoperative CEA predict survival after colon cancer resection?

Although elevated preoperative carcinoembryonic antigen (CEA) levels are associated with a poor prognosis, little has been written regarding the correlation of CEA response following curative resection of colorectal cancer and its relationship to survival. The purpose of this study, therefore, was to retrospectively evaluate survival in three groups of patients undergoing curative resection (Dukes B and C) for colorectal carcinoma: 1) elevated preoperative CEA/elevated postoperative CEA (EL/EL); 2) elevated preoperative CEA/normal postoperative CEA (EL/NL); and 3) normal preoperative CEA/normal postoperative CEA (NL/NL). A normal CEA was defined as a value < 5.0 ng/mL. Levels were drawn the day before surgery and between 2 and 4 weeks postoperatively. Patients were evaluated for age, sex, histologic grade, CEA levels (pre and postoperative), nerve and venous invasion, tumor site, and survival. There were no significant differences with respect to age, sex, Dukes stage, tumor site, histologic grade, or incidence of nerve or vascular invasion among the three groups. Five-year survival was significantly worse for patients with elevated preoperative CEA levels compared to those with normal preoperative CEA (53% versus 64%, P < 0.05), and for the EL/EL group compared with either of the other two groups (EL/EL: 66.6 +/- 11.8; EL/NL: 87.7 +/- 10.2; Group 3: 93.4 +/- 9.5, P < 0.05 ANOVA). The results indicate that a preoperative elevated CEA, particularly one that fails to decrease to normal postoperatively following a curative resection for colorectal carcinoma, represents a poor prognostic factor. Use of the CEA response may be useful for identifying a subgroup of colorectal cancer patients who are candidates for adjuvant chemotherapy.

Adenocarcinoma↗
PubMed1991

Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma.

The optimal laboratory evaluation for the early detection of liver metastases from colorectal cancer is controversial. This investigation was undertaken to compare the efficacy of liver function tests (LFTs) with that of carcinoembryonic antigen (CEA) levels for the early detection of liver metastases. Patients who developed liver metastases after potentially curative resections of adenocarcinoma of the colorectum between 1974 and 1988 were reviewed. The following laboratory tests were serially evaluated during the follow-up period: CEA, alkaline phosphatase (AP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and lactic dehydrogenase (LDH). These values were retrospectively assessed from the time of documented liver metastases to identify which lab value(s) were elevated initially. Ninety-two patients were available for study. Average time for the occurrence of liver metastases was 20 months (range, 3-72 months). The incidence of elevation of individual tests at the time of suspicion of liver metastasis was: CEA, 94.6 percent (P less than 0.25, chi-squared); AP, 18.5 percent; SGOT, 12.0 percent; SGPT, 5.4 percent; and LDH, 29.3 percent. When comparing CEA with a battery of LFTs at the time of suspicion of liver metastasis, CEA was elevated with normal LFTs in 64.1 percent (P less than 0.05, chi-squared), the most frequent occurrence. At least one LFT was elevated with a normal CEA in only 2.2 percent; CEA and at least one LFT were increased in 30.4 percent; and both tests were normal in only 3.3 percent. These results indicate that, of the individual laboratory tests performed, CEA elevation heralds liver metastases significantly more frequently. LDH is the liver function test most frequently elevated when liver metastases are first suspected. When CEA is directly compared with a battery of LFTs, CEA is statistically significantly more frequently elevated. In fact, suspicion of liver metastases would have been delayed by the omission of LFTs in only 2.2 percent of patients. Therefore, we conclude that LFTs should be deleted from the follow-up of colorectal cancer patients, decreasing costs without significantly decreasing accuracy.

Adenocarcinoma↗
PubMed1990

A critical review of chemical lymph node clearance and staging of colon and rectal cancer at Ferguson Hospital, 1977 to 1982.

A unique opportunity to evaluate the method of chemical lymph node clearance for colorectal cancer exists at Ferguson Hospital. Lymph node clearance has been used at the institution since 1977, and this retrospective analysis was undertaken to ascertain its validity there. Furthermore, the node positive group was evaluated to ascertain if the current staging system (Turnbull, 1967) is prognostically accurate for the Dukes' C group. Specifically evaluated for possible prognostic variance was the survival of those patients whose tumors demonstrated partial bowel wall penetration and only one to four positive nodes, a "C1 subset," previously reported to have favorable prognosis. Eight hundred sixty-four cases of colon and rectal cancer treated surgically from 1977 to 1982 were analyzed. There was a mean of 27 lymph nodes retrieved per specimen and a mean of 4.5 positive nodes per Dukes' C specimen. There were 43 C1 and 201 C2 cases with five-year survival rates of 73 and 38 percent, respectively. The results of chemical clearance at Ferguson Hospital were found to be comparable with that of other centers using chemical clearance and superior to hand dissection. The C1 subset clearly is noted to have prognostic advantage and should occupy a separate designation in any staging system.

Adenocarcinoma↗
PubMed1988

Patient-controlled analgesia vs. conventional intramuscular analgesia following colon surgery.

Though patient-controlled analgesia (PCA) has been in use for over a decade, it has been popularized only recently. Conventional techniques of intermittent intramuscular (IM) administration of analgesia have fallen short of meeting the needs of patients following major abdominal surgery. This has prompted a search for methods to improve postoperative pain management. Though PCA has been accepted in many hospitals, few studies comparing conventional IM administration of morphine with PCA have been performed. A prospective randomized study comparing IM- and PCA-administered morphine in 62 patients undergoing colon surgery was performed. A comparison of the efficacy of analgesia and extent of sedation using these approaches shows that PCA allows for analgesia with less sedation and less drug requirement than that of IM administration. No differences were noted in postoperative duration of ileus, duration of hospitalization, and total hospital costs. This study confirms the safety and efficacy of PCA, and should be considered the current optimal method of controlling pain following major colonic surgery.

Adult↗
PubMed1988

Intrarectal ultrasonography in the staging and management of rectal tumors.

Intrarectal ultrasonography (IRUS) was used in the preoperative staging of 17 patients with rectal neoplasms. Fourteen patients had biopsy proven adenocarcinoma, and three others had large villous adenomas. Comparisons were made between clinical examination, IRUS staging and subsequent histopathologic staging. IRUS was performed with a Bruel and Kjaer radial scanner, type 1849, equipped with a 7.0 MHz transducer. IRUS accurately staged 3/3 rectal villous adenomas, and 11/13 rectal adenocarcinomas compared with histopathology. Clinical exam correctly staged all three villous tumors, and 6/9 carcinomas (24% of lesions were not palpable). IRUS correctly diagnosed the status of regional nodes in 88% of patients. IRUS is a highly accurate preoperative staging tool for rectal cancers both in delineating depth of bowel wall invasion and in assessing regional lymph nodes. It is easy to perform, safe, and well tolerated by the patients. IRUS has definitely arrived as the state of the art in evaluating rectal neoplasms and may impact heavily on surgical decision making for these neoplasms.

Adenocarcinoma↗
PubMed1978

Characteristics of adenocarcinomas of the colorectum with low levels of preoperative plasma carcinoembryonic antigen (CEA).

Carcinoembryonic antigen (CEA) is evaluated preoperatively and then serially postoperatively in 97 patients with colorectal carcinoma. CEA is initially elevated (greater than 2.5 ng/ml) only in 58% of the these patients. The group without preoperative CEA elevation has a statistically significant higher proporation of Dukes A lesions (p less than 0.05), seems less likely to suffer recurrence or have CEA elevation at the time of recurrence, and has a longer disease-free interval, than the group with preoperative CEA elevation. However, no distinction between the two groups can be made on the basis of the patients age, sex, presenting signs and symptoms, or location and size of their primary lesions. Higher postoperative CEA values are associated with liver metastases in both groups.

Adenocarcinoma↗
PubMed1978

Colonic endoscopy in perspective.

Sigmoidoscopy is an easy procedure and should be utilized more frequently. Barium enema examination is incomplete without sigmoidoscopy. Flexible fiberoptic sigmoidoscopy may have a role in the detection of disease of the descending, sigmoid, and rectosigmoid colon. The necessity for its routine usage remains to be determined. The control of colonic polyps by colonoscopy has been the greatest contribution to date by the fiberoptic instrument. Colonoscopy has improved the accuracy of diagnosis of colonic disease and, in certain instances, is helpful in the early detection of cancer of the colon. Colonoscopy complements the use of barium enema examination. Colonoscopy only for the purpose of confirmation of clinical or radiological diagnosis is often unnecessary. While the benefits of endoscopy are obvious, there are definite practical and technological limitations to its use. Complications, although infrequent, are major. Indications for colonoscopy must be clear and findings interpreted with knowledge of the limitations.

Colonic Diseases↗
PubMed1977

Lymphocyte blastogenic responses to allogeneic leukocytes and autochthonous tumor cells in colorectal carcinoma.

The blastogenic reactivity of peripheral blood lymphocytes (PBL) and mesenteric lymph node lymphocytes (LNL) against normal allogeneic leukocytes and autochthonous colorectal carcinoma cells is evaluated in 36 patients, and correlated with the patient's Dukes classification. Mesenteric LNL react significantly better than PBL to allogeneic leukocytes in both Dukes B and C (p less than 0.05). There are too few patients in Dukes A and D to permit statistical evaluation but the trend is the same. By contrast, LNL fail to react to autochthonous tumor cells in all classes, except in a few Dukes B patients. The proportion of PBL reactivity to autochthonous tumor cells seems to increase for Dukes C and D. It is possible that specific lymphocyte reactivity in colorectal carcinoma may be related to the antigenicity and immunogenicity of the tumor.

Antigens, Neoplasm↗
PubMedDate not supplied

Multicenter evaluation of training of non-endoscopists in 30-cm flexible sigmoidoscopy.

An estimated 145,000 patients will be diagnosed with colorectal cancer in the United States in 1987. Although half of these cancers are potentially detectable by sigmoidoscopy, rigid sigmoidoscopy is not widely used for early detection, largely because of discomfort it causes patients. Flexible sigmoidoscopy has been shown to be more acceptable and more efficient in detecting cancers. In order for flexible sigmoidoscopy to be of more value in cancer control, however, primary care physicians must learn the technique and incorporate it into their complete physical examinations. This paper reports the results of a multicenter trial that evaluated the training required for non-endoscopists to learn how to use the 30-cm flexible sigmoidoscope. Instructions with plastic models, followed by an average of six supervised patient examinations, proved sufficient for them to learn the necessary skills.

Colonic Neoplasms↗