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Biomedical subjects

Walter Lawrence

Publications and source records attributed to Walter Lawrence.

10 recordsLinked to original sources
PubMed2004

Gastric Adenocarcinoma.

Adenocarcinoma of the stomach is advanced enough in some patients to preclude curative treatment, but many gastric cancer patients have what appears to be localized disease that is amenable to surgical resection, which is the only truly effective treatment. Long-term results of what appear to be "curative resections" are relatively poor, however, and new management tools such as sentinel lymph node biopsy, recently promising adjunctive therapies (such as radiochemotherapy), and the organization of the order of treatment combinations do require further study with an eye to improving outcomes. However, there appears to be little hope for a dramatic improvement in treatment results from these innovations for patients with established gastric cancer. Fortunately, gastric cancer in the United States has gone from being the number one cause of cancer death in our population 50 years ago to that of being the number eight cause of cancer death at this time. This intriguing major decrease in the incidence of this disease must be considered secondary to one or more changes in our own environment that we hope will be exploitable in the future. As with cancers of all types and in all sites, a prevention strategy may prove more effective than the treatment strategies that are outlined here. The management strategies outlined are hopefully only temporary ones until we are able to develop a better handle on primary prevention.

Journal Article↗
PubMed2002

Diagnosis and management of patients with thyroid nodules.

Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor. The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.

Adult↗