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Biomedical subjects

A G James

Publications and source records attributed to A G James.

At least 37 records · Page 2Linked to original sources
PubMed1985

A simple method for identifying and testing the recurrent laryngeal nerve.

Simultaneous stimulation of the recurrent laryngeal nerve and palpation of an impulse in the homolateral cricothyroid area was performed upon 20 patients. Electrical stimulation of the recurrent laryngeal nerve with currents of 2 milliamperes caused no postoperative deficits in any of the patients studied. This is a simple and reproducible method to help identify the RLN and to confirm that the recurrent nerve is intact and viable at the completion of a surgical procedure. The technique is simpler than checking cord motion at the conclusion of surgical procedures upon the thyroid or parathyroid glands. Due to the variability of the response in some of the patients, we believe that the procedure should be tried on more patients before it is recommended as a conclusive test.

Electric Stimulation↗
PubMed1984

Local cutaneous recurrence after conservative excision of malignant melanoma.

We examined the risk factors for the development of local recurrence in patients treated with a conservative wide local excision, which was defined as being less than the historical 5-cm margin. There were 118 patients with clinical stage I disease followed up for a minimum of 60 months or until death. The extent of wide local excision varied from 0.6 to 8.5 cm. The majority (76.3%) had a resection margin of 30 mm or less. Four patients (3.4%) had local recurrence within 5 cm of the primary closure scar or skin graft edge. The primary lesion in the patients with local recurrence had deeper invasion and larger diameters than the lesion in patients who did not have local recurrence. Other recognized risk factors, such as ulceration, satellitosis , and unrecognized subclinical stage II disease, at the time of initial diagnosis were noted in the patients eventually displaying local recurrence. Tumor aggressiveness was recognized. The patients who had local recurrence had excisions with wider margins (mean, 4.75 cm; range, 2.5 to 8.5 cm) than the patients without local recurrence (mean, 2.87 cm; range, 0.6 to 6.0 cm). A tumor-field effect did not contribute to local recurrence.

Adolescent↗
PubMed1984

A method for intraoperative identification of the recurrent laryngeal nerve.

Thyroid and parathyroid surgery is associated with a 1 to 6 percent incidence of injury to the recurrent laryngeal nerve. Electrical stimulation of the recurrent laryngeal nerve produces vocal cord motion that can be monitored by means of a double-cuffed endotracheal tube. Twelve patients underwent prospective evaluation with this monitoring system, and in all 12, the recurrent laryngeal nerve was accurately identified and localized. The nerve could be stimulated from a mean distance of 1.7 cm by a mean amperage of 1.3 mA. Postoperative indirect laryngoscopy demonstrated normal vocal cord function in all patients.

Adolescent↗
PubMed1984

Prevention of seromas following mastectomy and axillary dissection.

Controlling seroma formation by the use of closed suction drainage and flap attachment to the chest wall lowered the incidence of seroma formation after mastectomy and axillary dissection below that in other reports. The presumed advantage would be fewer seroma-associated complications, such as infection, impaired shoulder motion and lymphedema.

Axilla↗
PubMed1984

An autologous hemostatic agent.

The use of autologous muscle as a thromboplastic agent in operations upon the head and neck has proved to be a safe, cost effective means to accomplish hemostasis in an area where it is absolutely necessary.

Hemostasis↗
PubMed1983

Fructosamine in diabetic pregnancy.

Fructosamine, an indicator of glycosylated serum protein, was measured in 79 non-diabetic pregnant women and 20 women with gestational diabetes. The test provided a clear discrimination between groups; it detected 17 (85%) of the women with gestational diabetes and gave only 4 (5%) false-positive results. 19 women with established diabetes before pregnancy had very high levels. Maternal fructosamine at 29 weeks' gestation correlated significantly with both fasting blood glucose levels at the time and birthweight ratio. Levels of fructosamine in cord blood were significantly higher in gestational diabetic than in normal pregnancies, suggesting a possible additional role for fructosamine in retrospectively detecting the hyperglycaemic fetus. Fructosamine estimation is fully automated and may provide a simple, inexpensive means to screen for diabetes in pregnancy.

Adult↗
PubMed1983

Human breast cancer and impaired NK cell function.

Recent advances in tumor immunology have led to the discovery of a new lymphoid cell with unique antitumor activity. Natural killer (NK) cells form an antitumor surveillance system and appear to be vital in preventing tumor growth and metastasis in animal models. We studied NK activity in patients with benign and malignant breast disease, using a chromium-51 release microtiter cytotoxicity assay with K562 cells as targets. Compared with benign controls, patients with malignancies had significantly depressed NK-mediated lysis (P less than 0.01). Furthermore, lysis in those with advanced disease (stages II, III, and IV) was significantly less than in those with limited disease (stage I) (P less than 0.01). NK activity was not correlated to estrogen or progesterone receptor states. Positive correlation of a depressed natural killer activity with the extent of tumor spread supports the concept of an NK cell immune surveillance system in breast cancer and emphasizes its importance in this malignancy.

Adult↗
PubMed1983

ABO (H) cell surface antigens in benign and malignant parotid neoplasms.

Twenty-two inflammatory, benign, or malignant parotid lesions were studied by means of the specific red cell adherence test (SRCA), a modification of the Coombs' mixed cell agglutination reaction. In 22 normal parotid tissues the acinar structures were devoid of red cell agglutination, but it was present in ductal epithelium. Findings were similar in 2 cases of parotitis, 11 benign mixed tumors, and 1 malignant mixed tumor. All lacked red cell agglutination in areas of neoplastic change. Benign Warthin's tumors (4 cases) demonstrated antigenicity in the columnar epithelial component of the tumor, but lacked red cell agglutination in areas of the lymphoid component. One malignant Warthin's tumor showed agglutination in areas of normal columnar epithelium but not in areas of malignant dedifferentiation. Undifferentiated carcinoma (1 case) and adenoid cystic carcinoma (2 cases) did not possess detectable ABO (H) antigens in neoplastic areas of the gland. The absence of ABO antigens in normal acinar glands supports their suggested myoepithelial or mesenchymal derivation, as the absence of antigen in benign and malignant mixed tumors supports their proposed mesenchymal derivation. Ductular epithelium and the epithelial components of benign Warthin's tumors have ABO (H) antigens, while the loss of antigen in the epithelial portion of the malignant Warthin's tumor is characteristic of epithelial neoplastic dedifferentiation. Loss of antigen in adenoid cystic and undifferentiated carcinomas of the parotid supports the concept that antigen is absent in epithelially derived malignant neoplasms.

ABO Blood-Group System↗
PubMed1983

The extent of primary melanoma excision. A re-evaluation--how wide is wide?

A retrospective review of 118 clinical Stage I melanoma patients, including the re-examination of histologic slides in 57 cases, was performed to define factors important to survival. The majority (76.7%) had excision margins of 30 mm or less (range = 6-85 mm, mean--29.3 mm). The adjusted 5-year survival was 77.3%. Local recurrences within 5 cm of the primary closure scar developed in 3.4%. The recurrences occurred in patients with satellitosis (1), unrecognized subclinical Stage II disease (1), or as the first evidence of disseminated Stage III disease (2). Margins less than 20 mm were associated with an increased risk of dying if the tumor diameter was more than 10 mm (p = 0.0105) or if the depth of invasion was more than 2.0 mm (p = 0.0491). Increasing the margin to 25 mm improved survival. However, no further protection was evident for margins over 30 mm. For smaller and shallower lesions, no optimal margin could be identified. It appears that a 30 mm margin is adequate for large and deep clinical Stage I melanomas, and mortality and local recurrences are due to factors other than the extent of excision.

Adolescent↗
PubMed1982

The significance of the internal mammary lymph nodes in medially located breast cancer.

The efficacy of adjuvant radiotherapy for medial breast cancers in Stage I or II disease was studied with a retrospective clinical analysis. All cases of breast cancer free of axillary node metastases at the time of standard or modified radical mastectomy were included. These were grouped by location and size of the primary tumor. There were 76 medial lesions, including those in the 6:00 or 12:00 axis. Seventeen of these had received postoperative radiation. Lateral tumors included 59. The size was based on the largest linear dimension and grouped less than or equal to 2 cm or greater than 2 cm. At the time of initial recurrence, all areas of metastases were determined. The data suggests that: (1) medial breast cancers have a greater rate of recurrence than lateral ones; (2) adjuvant radiation for medial lesions decreases that recurrence rate to the range of lateral tumors; (3) large lesions may have a greater chance for local recurrence as well as medial lesions of all sizes; and (4) the potential problems with local recurrence may be diminished with adequate radiotherapy as an adjunctive measure. When recurrence does occur, prior radiotherapy seems to delay the appearance of that recurrence.

Breast↗
PubMed1982

Metastatic cancers to the neck from undetermined primary sites: long-term follow-up.

When a patient presents with a mass in the neck, diagnosis by fine needle aspiration cytology is recommended. This allows an accurate diagnosis of malignancy with minimal morbidity. Tissue planes, important in any future definite neck surgery, are not altered, as they would be from an excisional biopsy. Once the diagnosis of metastatic cancer is confirmed, thorough search for the primary tumor must be made. The history, physical examination, and radiographic and laboratory studies must be complete. Finding no origin of tumor, local treatment of the metastases must be done, with the objective being complete eradication of disease. Regular follow-up, with a continual search for the primary malignancy is then recommended. The specifics of this approach and the results of our series are outlined.

Biopsy, Needle↗
PubMed1982

Chondroma of the larynx.

Chondroma of the larynx is rare, but should be suspected in elderly patients with persistent voice changes or recurrent colds when carcinoma has been disproved. We report a patient with chondroma of the larynx. The diagnosis was established following complications associated with anesthesia for an unrelated ailment.

Aged↗
PubMed1982

Primary procedure in carcinoma of the tongue: local resection versus combined local resection and radical neck dissection.

Whether to perform local resection alone (LR) or to combine local resection with ipsilateral radical neck dissection (LR and RND) as primary treatment for carcinoma clinically confined to the tongue is controversial. To compare the outcomes of the two procedures, we reviewed the records of 502 patients treated for carcinoma of the tongue from 1949 to 1974, 128 of whom had no evidence of disease beyond the tongue. Immediate LR and RND was performed in 39; 16 (41%) had recurrences, and 14 (36%) died. On the other hand, 89 patients underwent LR alone; 43 (48%) had recurrences, and 29 (31%) died. All were followed for a minimum of 5 years or until their deaths. There was no statistical difference between the two procedures in recurrence or outcome. The two groups were compared with respect to tumor size according to the TNM classification, and no significant differences in recurrence or survival were apparent. LR alone appears to be adequate primary treatment for patients with no evidence of metastatic disease, provided close postoperative follow-up is observed. LR and RND may result in increased morbidity and certainly in disfigurement, and fails to improve prognosis or survival.

Adult↗
PubMed1980

Surgical management of papillary and follicular carcinoma of the thyroid.

The clinical outcome in 155 patients with papillary or follicular carcinoma of the thyroid gland operated on over a 25-year period demonstrated no difference in survival rates or incidence of recurrent tumor between those treated by total thyroidectomy and those undergoing less than total thyroidectomy. However, the complication rate was statistically significantly higher in those undergoing total thyroidectomy. Partial thyroidectomy with lobectomy on the side of the tumor, resection of the thyroid isthmus, and simple excision of enlarged cervical lymph nodes, if present, appears to be equally effective and safer.

Adenocarcinoma↗
PubMed1979

Adenovirus type 21 bronchopneumonia in infants and young children.

An epidemic of bronchopneumonia in infants and young children, with adenovirus type 21 infection, was observed in Auckland, New Zealand, in 1977. Eighteen children, four to 44 months of age, with clinical and radiologic evidence of bronchopneumonia are described. Several of the children were seriously ill but there were no deaths. When reviewed six to 12 months after diagnosis, six children had clinical signs and 13 had radiologic signs of residual pulmonary disease. There were no detectable pulmonary sequelae in two children. Three children were lost to follow-up and could not be evaluated. Adenovirus type 21 bronchopneumonia is a serious illness and an important cause of chronic bronchopneumopathy in infants and young children.

Adenoviridae Infections↗