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PubMed1992

[Conservative treatment of bronchogenic cancers: lobectomy with excision-anastomosis and limited excision].

Lung cancer resection surgery often reduces the respiratory function to the point that it can preclude pneumonectomy or even standard lobectomy. When these usual operations are impossible for functional reasons more restricted procedures can be performed, local conditions permitting. Thus, lobectomy with resection anastomosis may be a suitable alternative to pneumonectomy, and segmental resection may be considered when standard lobectomy is rejected. However, this conservative surgery can be envisaged only when it does not risk to affect the quality of the long-term results. While lobectomy enlarged to the bronchial tree has proved to be justified for the treatment of cancers without lymph node invasion, limited resections give uncertain results and must be regarded as an alternative to surgical abstention.

Anastomosis, Surgical↗
PubMed1989

[Single-stage excision anastomosis of left colonic obstruction excision treated as an emergency].

The results of four different types of operation were compared retrospectively in terms of mortality, morbidity, duration of hospital stay. Eighty-eight consecutive patients suffering from left colonic obstruction underwent emergency surgery from December 1976 to January 1988. There were 36 male and 52 female patients, aged from 41 to 93 years (mean 71), 25% of them being 78 or older. Carcinoma was the most frequent lesion (75/88, 85%). 1) One-stage resection and anastomosis was carried out in 23 patients with only one temporary ileostomy; there were two fatalities (8.7%) and one clinical anastomotic leak (4%) treated conservatively with success; mean hospital stay was 21.5 days. 2) Thirty-six patients underwent a Hartmann procedure, with four fatalities (11%) and a mean hospital stay of 23.0 days; 17 of the surviving 32 (53%) later had the second stage procedure, with no fatality, one clinical leak (6%), and mean stay of 20.7 days. 3) Twenty-six patients had simple decompressing colostomies with nine fatalities (35%); eight of the surviving 17 (47%) had colectomy and colostomy closure during the same hospitalization, with one fatality (6%); mean hospital stay was 41.4 days. 4) Finally, subtotal colectomy imposed by caecal ischemia (twice) or a previous right colectomy (in one instance) was performed three times with no death. Since january 1986, resections and primary anastomoses have been performed 20 times for 26 consecutive obstructions (77%). Our overall results in terms of mortality, morbidity and duration of hospital stay appear to favor resection and primary anastomosis in the treatment of selected cases of left colonic obstruction.

Adult↗
PubMed2004

Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients.

PURPOSE: To assess the pelvic failure among patients with T3 rectal cancer treated with local excision after preoperative chemoradiation. METHODS AND MATERIALS: Between January 1990 and June 2002, 431 patients with clinically staged T3 rectal cancer were treated with preoperative chemoradiation followed by surgical resection. Full-thickness local excision [Kraske (n = 3) or a transanal excision (n = 23)] was performed in 26 patients because of patient refusal of abdominoperineal resection (APR) (n = 13), medical comorbidity (n = 4), physician preference after a complete clinical response (n = 6), and other reasons (n = 3). All patients were treated with continuous-infusion 5-fluorouracil (5-FU) (300 mg/m(2) Monday to Friday) and concomitant pelvic radiation (45 Gy in 25 fractions with a 3-field belly board technique). Ten local-excision patients received a concomitant boost during the last week of therapy (1.5-Gy second daily fractions) for a total dose of 52.5 Gy. Similar preoperative treatment was followed by total mesorectal excision in 405 patients. Among the local-excision patients, the median tumor size was 3.5 cm (range, 0.5-7 cm). Well-differentiated or moderately-differentiated histology was present in all but 3 cases, and endoscopic ultrasound staging examination was performed in 25 of 26 patients. Based on CT findings, 1 patient was node positive. The median circumference involved by tumor was 33%, (20%-75%). The median distance from the anal verge was 3 cm (range, 1-8 cm). RESULTS: The mean follow-up was 46 months (range, 5-109 months) in the local-excision group. In the local-excision group, 19 of 26 patients had only residual scarring noted on digital rectal examination and rigid proctoscopy before surgery. Fourteen patients (54%) had a complete histologic response to chemoradiation, 9 patients (35%) had microscopic residual disease, and 3 patients (12%) had gross residual disease. Two intrapelvic recurrences occurred at 76 and 20 months among the 26 patients treated with local excision (6% 5-year actuarial pelvic recurrence rate). This rate compared with an 8% 5-year actuarial pelvic recurrence rate among T3 patients treated with mesorectal excision and a 6% pelvic recurrence rate in the subgroup of mesorectal-excision patients with a complete clinical response to preoperative chemoradiation. One additional local-excision patient recurred in an inguinal lymph node after local excision and subsequently died of metastatic disease. A total of 2 local-excision patients died of metastatic rectal cancer. Actuarial overall survival at 5 years was 86% in the local-excision group compared with 81% among mesorectal-excision patients (p = NS), and 85% in patients with a complete clinical response to chemoradiation followed by mesorectal excision by APR or LAR (p = NS). CONCLUSIONS: In an experience stimulated by patient refusal of APR, highly selected patients who responded well to conventional external-beam radiotherapy (CXRT) were selected to undergo local excision. Most of these patients had pathologic complete response. Local control and survival rates are comparable to those achieved with chemoradiation followed by mesorectal excision. This strategy should be prospectively studied in a group of patients with low rectal cancer who have no clinical evidence of tumor after chemoradiation.

Adenocarcinoma↗
PubMed2000

Multiple gene products and sequences required for excision of the mobilizable integrated Bacteroides element NBU1.

NBU1 is an integrated 10.3-kbp Bacteroides element, which can excise and transfer to Bacteroides or Escherichia coli recipients, where it integrates into the recipient genome. NBU1 relies on large, >60-kbp, conjugative transposons for factors that trigger excision and for mobilization of the circular form to recipients. Previously, we showed that a single integrase gene, intN1, was necessary and sufficient for integration of NBU1 into its target site on the Bacteroides or E. coli genome. We now show that an unexpectedly large region of NBU1 is required for excision. This region includes, in addition to intN1, four open reading frames plus a large region downstream of the fourth gene, prmN1. This downstream sequence was designated XRS, for "excision-required sequence." XRS contains the oriT of the circular form of NBU1 and about two-thirds of the adjacent mobilization gene, mobN1. This is the first time an oriT, which is involved in conjugal transfer of the circular form, has been implicated in excision. Disruption of the gene immediately downstream of intN1, orf2, completely abolished excision. The next open reading frame, orf2x, was too small to be disrupted, so we still do not know whether it plays a role in the excision reaction. Deletions were made in each of two open reading frames downstream of orf2x, orf3 and prmN1. Both of these deletions abolished excision, indicating that these genes are also essential for excision. Attempts to complement various mutations in the excision region led us to realize that a portion of the excision region carrying prmN1 and part of the XRS (XRS(HIII)) inhibited excision when provided in trans on a multicopy plasmid (8 to 10 copies per cell). However, a fragment carrying prmN1, XRS, and the entire mobilization gene, mobN1, did not have this effect. The smaller fragment may be interfering with excision by attracting proteins made by the intact NBU1 and thus removing them from the excision complex. Our results show clearly that excision is a complex process that involves several proteins and a cis-acting region (XRS) which includes the oriT. We suggest that this complex excision machinery may be necessary to allow NBU1 to coordinate nicking at the ends during excision and nicking at the oriT during conjugal transfer, to prevent premature nicking at the oriT before NBU1 has excised and circularized.

Bacterial Proteins↗
PubMed1982

Mutants of Escherichia coli K12 which affect excision of transposon Tn10.

We have described three illegitimate recombination events associated with, but not promoted by, transposon Tn10: precise excision, nearly precise excision, and precise excision of a nearly precise excision remnant. All three are structurally analogous: excision occurs between two short direct repeat sequences, removing all intervening material plus one copy of the direct repeat. In each case, the direct repeats border a larger inverted repeat. We report here the isolation of host mutants of Escherichia coli K12 which exhibit increased frequencies of precise excision of Tn10. Nineteen of the 39 mutants have been mapped to five distinct loci on the E. coli genetic map and have been designated texA through texE (for Tn10 excision). Mapping and genetic characterization indicate that each tex gene corresponds to a previously identified gene involved in cellular DNA metabolism: recB and/or recC, uvrD, mutH, mutS, and dam. The role of these various DNA repair and recombination genes in an illegitimate recombination process such as Tn10 excision will be discussed. In addition to an increase in precise excision frequency, all 39 tex mutants display an increased frequency for nearly precise excision. However, none of the mutants are increased for the third excision event, precise excision of a nearly precise excision remnant, supporting the idea that precise and nearly precise excision occur by closely related pathways which are distinct from those pathways which promote the third type of excision event.

Alleles↗
PubMed2003

Effects of burn wound excision on bacterial colonization and invasion.

Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still under debate. It was hypothesized that acute burn wound excision (in the first 24 hours after burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion. Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute burn wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postburn day 6. Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 10 bacteria per gram of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 10 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that burn wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed burn wound excision exhibit greater bacterial colonization and increased rates of infection. Acute burn wound excision should be considered for all full-thickness burns.

Bacteriological Techniques↗
PubMed1992

Excision biopsy of malignant melanoma by general practitioners in south east Scotland 1982-91.

OBJECTIVE: To examine the management of patients who had a malignant melanoma excised initially by general practitioners in south east Scotland over the past 10 years and to assess the impact of the April 1990 contract on this. DESIGN: A retrospective case-control study. SETTING: South east Scotland. SUBJECTS: All patients in south east Scotland who had malignant melanomas excised by general practitioners in 1982-91. OUTCOME MEASURES: Demographic details of patients; Breslow thickness, clearance of excision. RESULTS: 42 patients had malignant melanomas excised by general practitioners in 1982-91: 15 in 1982-9 and 27 in 1990-1. These patients were significantly younger than those who had their tumours excised initially in hospital. Although the longest diameter of melanomas excised by general practitioners was significantly less than of those excised in hospital, the Breslow thicknesses were similar. Completeness of initial excision was doubtful or incomplete in nine (23%) general practitioner excisions compared with 4% of hospital excisions, but the time interval between excision biopsy and wide excision was similar. Pathology requests accompanying excision biopsies mentioned melanoma as a possible diagnosis in 15% (6/40) of general practitioner cases compared with 79% of hospital cases. Thirty nine general practitioners responded to a questionnaire and only 12 had considered melanoma in the differential diagnosis. CONCLUSIONS: General practitioners need to think more often of malignant melanoma when they excise pigmented lesions and when they consider this tumour a possibility should perform an excision biopsy with a lateral clearance of at least 2 mm.

Adult↗
PubMed2004

Incomplete primary excision of cutaneous basal and squamous cell carcinomas in the Bay of Plenty.

AIM: To investigate factors associated with pathologically reported incomplete primary excision of squamous and basal cell carcinomas. METHODS: All Medlab Bay of Plenty histology reports were obtained for all primarily excised cutaneous basal and squamous cell carcinomas of the skin for the Tauranga and Western Bay of Plenty regions covering the period 1 January through 30 June 2001. Data were analysed according to surgical training, site of lesion, pathology, and location of positive margin involvement. RESULTS: 1833 non-melanoma skin cancer excisions occurred during the 6-month study-including 1126 basal cell carcinomas, 705 squamous cell carcinomas, and 2 basosquamous carcinomas. 257 (14%) were reported as incompletely excised. There was no difference in rates of positive margin involvement for gender or histology. Proportionately, excisions from the nose and ear revealed the highest incomplete excision rates. General practitioners excised 1003 lesions, with a 16% incomplete excision rate. Consultant surgeons excised 695 lesions, with a 12% incomplete excision rate. Surgical registrars excised 123 lesions, incompletely excising 8%. These data are statistically significant (p <0.01). Tumour was most often found at lateral (rather than deep) margins. CONCLUSION: The incidence of non-melanoma skin cancer is known to be very high in the Bay of Plenty. Pathologically reported incomplete excision rates are nevertheless comparable with other studies. Of all skin cancers, those on the head and neck are most commonly associated with incomplete excision. Trained surgeons have significantly higher complete excision rates.

Aged↗