An aid in the construction of a stapled anterior rectal anastomosis.
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Humans↗
Biomedical subjects
A Mittelman
Publications and source records attributed to A Mittelman.
Abdominal exploration for suspected recurrent carcinoma of the colon and rectum based upon elevated carcinoembryonic antigen alone or in combination with other diagnostic methods.
Thirty-six patients underwent abdominal exploration due to elevated carcinoembryonic antigen (CEA) levels after a curative resection for carcinoma of the colon and rectum. Three groups were evaluated. In group 1, CEA elevation alone was the indication for the exploration in 13 asymptomatic patients. In group 2, 13 other asymptomatic patients underwent exploration because of elevated CEA levels in combination with other findings. In group 3, ten patients were symptomatic with an elevated CEA level at the time of exploration. Five patients from groups 1 and 2 underwent a curative resection for recurrent tumor (14 per cent). Three of these patients are still alive more than five years after exploration. Nine patients had negative findings at exploration for tumor recurrence (25 per cent false-positive results). Six of these patients are alive while three have died of metastatic disease. Twenty-two of the 36 patients (61 per cent) had unresectable disease at the time of exploration. Four of these patients underwent some form of surgical palliative procedure. Considering the five patients who underwent a curative resection with the latter four patients, this results in 25 per cent of the patients benefitting from surgical exploration.
Adult↗
Mixed juvenile-adenomatous polyp of the rectum in an elderly patient.
Large bowel polyps with mixed histologic patterns are rare. Recommendations for their management must be based on the component most propense to develop into a malignancy.
Aged↗
Phase I clinical trial of fludarabine phosphate (F-ara-AMP).
F-Ara-AMP (fludarabine phosphate) is an adenosine analogue that is resistant to deamination; it is a more potent cytotoxic compound than ara-A in experimental tumor systems. F-Ara-AMP was given by continuous IV infusion over 5 days once every 4 weeks to 27 evaluable adult patients with advanced cancer. The median Karnofsky performance status was 70% (range 50%-90%), and the median age was 58 years (range 41-74). In addition to adequate blood counts, a creatinine clearance of at least 60 ml/min was required. The initial dose level was 35 mg/m2/day. Dose-limiting myelosuppression was seen in the first patient. Subsequent patients were treated at lower doses. Myelosuppression was the only major toxicity. Leukopenia was generally more prominent than thrombocytopenia, but 2 patients experienced prolonged thrombocytopenia which prevented further therapy. Nausea was minimal, and neither renal nor neurologic toxicity was encountered. In patients with good renal function a dose of 25 mg/m2/day can be safely administered. However, because of apparent cumulative myelosuppressive effects a lower dose is more appropriate for patients who have had extensive prior chemotherapy or radiotherapy.
Adult↗
Phase II study of combination bleomycin, vincristine and high-dose methotrexate (BOM) with leucovorin rescue in advanced squamous cell carcinoma of the anal canal.
Fifteen patients with advanced squamous cell carcinoma of the anal canal were treated with a combination of bleomycin, vincristine, and high-dose methotrexate (BOM) with leucovorin rescue. Three out of twelve patients with measurable disease had objective responses of 1, 2, and 5 months. Five of the fifteen patients had severe or life-threatening complications as a result of this treatment regimen. The narrow therapeutic index of the BOM therapy makes it a less than ideal drug combination for the treatment of advanced squamous cell carcinoma of the anal canal.
Aged↗
Induction of remission in acute promyelocytic leukemia with mitoxantrone.
Two patients with acute promyelocytic leukemia in first relapse received mitoxantrone 12 mg/m2/day for 5 days. Both patients received IV heparin with replacement of platelets and coagulation factors for control of disseminated intravascular coagulopathy. Both have achieved a complete remission after one course of treatment. We conclude that mitoxantrone is active in patients with acute promyelocytic leukemia and that these patients should also be included in the planned prospective randomized trials comparing daunorubicin and mitoxantrone in combination with cytarabine in previously untreated patients with acute nonlymphoblastic leukemia.
Adult↗
Isolated metachronous metastases to soft tissues of the buttock from a colonic adenocarcinoma.
The more common patterns of dissemination and recurrence of colonic cancer are known and well-documented. In contrast, extravisceral, distant soft tissue metastases are comparatively rare. Therefore, these metastases are not subject to meaningful generalizations, with the exception that they are often associated with widespread metastatic disease. This report describes the first case of carcinoma of the colon metastatic to the skeletal muscle of the contralateral buttock and the sciatic nerve without concurrent evidence of pelvic or distant metastases. Curative resection was not possible because of involvement of the proximal sciatic nerve.
Adenocarcinoma↗
Subcutaneous metastases without visceral metastases from an adenocarcinoma of the rectum.
Skin metastasis from colorectal carcinoma without evidence of visceral metastases is exceedingly rare. However, it must be considered whenever a new skin growth appears in a patient with a history of carcinoma. A diagnostic biopsy is mandatory as the appearance of these metastases is not distinctive.
Adenocarcinoma↗
Surgical resection of pulmonary metastases from colorectal adenocarcinoma.
From 1962 to 1982, 27 patients with pulmonary metastases as the only site of recurrent colorectal carcinoma underwent pulmonary resection at Roswell Park Memorial Institute. Only five of these patients had symptomatic pulmonary lesions. No postoperative mortality occurred. The median survival after pulmonary resection was 27 months. Five patients are alive presently without recurrent colorectal cancer and two patients are alive with recurrent pulmonary metastases. Patients with solitary lesions had a better survival than patients with multiple lesions. The major sites of recurrence following thoracotomy were the lungs and liver.
Adenocarcinoma↗
Metastasis to the parotid gland from colorectal adenocarcinoma.
This manuscript presents only the fifth reported case in the literature of colorectal carcinoma with metastasis to the parotid gland. A 66-year-old white woman, referred to Roswell Park Memorial Institute, presented with a left parotid mass and a past history of undergoing right hemicolectomy for an adenocarcinoma of the ascending colon with synchronous liver metastases. The clinical presentation and treatment of the patient are discussed with a review of the literature.
Adenocarcinoma↗
Analysis of T cell subsets in different clinical subgroups of patients with the acquired immune deficiency syndrome. Comparison with the "classic" form of Kaposi's sarcoma.
Ninety patients were grouped according to three different forms of acquired immune deficiency syndrome (AIDS): Kaposi's sarcoma "recent outbreak" type (38), reactive lymphadenopathy (27), and opportunistic infections (17), and a fourth group of patients with "classic" Kaposi's sarcoma (8). All patients with "classic" Kaposi's sarcoma were previously treated with electron-beam irradiation. These four groups were compared with 40 normal control subjects. Peripheral blood mononuclear cells isolated by density separation were reacted with a panel of mouse monoclonal antibodies that recognizes all peripheral blood T cells (OKT3-positive), helper (OKT4-positive), and suppressor (OKT8-positive) T cell subsets. The OKT4/OKT8 ratio was used to define the balance between these two subsets. All three groups with AIDS with or without Kaposi's sarcoma showed a decrease in the OKT4/OKT8 ratio. The group with "classic" Kaposi's sarcoma showed individual T cell subset values that were also abnormal. These findings confirm the previously reported imbalance of T cell subsets in patients with AIDS and Kaposi's sarcoma, which is also evident in patients with treated "classic" Kaposi's sarcoma.
Acquired Immunodeficiency Syndrome↗
Ileal conduits for recurrent unresectable colorectal adenocarcinoma.
In a retrospective 4 year study, 19 patients with unresectable recurrent pelvic tumor secondary to colorectal adenocarcinoma underwent urinary diversion. An ileal conduit was performed for palliative purposes at the time of exploration. None of the 19 patients had evidence of distant metastases. Survival after the ileal conduit ranged from 2 to 26 months (median 13 months). This survival rate did not vary significantly according to sex or whether hydronephrosis resolved after urinary diversion. Postoperative complications developed in three patients. Two of these complications were ureterointestinal anastomotic leaks and the third was development of an enterocutaneous fistula. The quality of life was rated as good by 75 percent of the patients and fair by 18 percent, with all patients relieved of painful obstructive uropathy. Eighteen of 19 patients were able to resume useful and productive lives.
Adenocarcinoma↗
Pelvic and perineal recurrences after abdominoperineal resection for adenocarcinoma of the rectum.
Pelvic and perineal recurrences were evaluated in 48 patients who underwent abdominoperineal resection at Roswell Park Memorial Institute for adenocarcinoma of the rectum. The duration of follow-up of these patients was at least 5 years or until death. There were 26 male and 22 female patients with a median age of 60 years. In 40 patients, the abdominoperineal resection was considered to be curative and in the remaining 8 patients, palliative abdominoperineal resection was performed. Only 2 of the 48 patients had a pelvic recurrence and in none of these patients was this recurrence the first site of relapse. One of the 48 patients had a local perineal recurrence; however, this was treated successfully with surgery. This represents a total of three pelvic or perineal recurrences in 48 patients, for a recurrence rate of 6 percent.
Abdomen↗
Hepatic resection for isolated metastasis from colorectal carcinoma.
Surgical results were analyzed in 36 patients who had undergone hepatic resection for metastases from colorectal carcinoma. Survival was not altered by the type of surgical resection nor in the presence of solitary compared with multiple lesions. No difference in survival from the time of liver resection was noted in patients staged as Dukes' B and Dukes' C (metachronous liver metastasis) in comparison to patients who presented with synchronous liver metastases. Overall median survival was 22 months with no 5 year survivors to date. There is a tendency for recurrence to occur in extrahepatic sites, which emphasizes the need for an effective chemotherapeutic agent.
Actuarial Analysis↗
Phase-I clinical trial of sodium cyanate in patients with advanced colorectal carcinoma.
Sodium cyanate, a drug that selectively suppresses amino acid incorporation for protein synthesis in tumor tissue, was given to patients with advanced colorectal carcinoma who had failed to conventional therapy, with the purpose of assessing a maximum tolerable oral dose. At 35 mg/kg p.o. daily, the drug had to be stopped in approximately half (4) of the patients because of gastrointestinal toxicity (nausea, vomiting) and neurologic toxicity (hallucinations, disorientation). However, in 5 other patients, at the same dose, the drug was well tolerated for up to 147 days and for a total cumulative dose of 308 g. In this group of patients, sodium cyanate was stopped because of evidence of tumor progression. No hematologic toxicity was observed. We observed no therapeutic effects. We therefore recommend a starting dose of 30 mg/kg p.o. if a phase-II study is considered.
Adult↗
Treatment of acute leukemia with amsacrine and high-dose cytarabine.
We varied the number of doses of high-dose cytarabine (3 g/m2) given to patients with acute leukemia in relapse who were receiving therapeutic doses of amsacrine (600 mg/m2/course). Twelve patients received 13 courses of therapy. Two of six patients with acute nonlymphocytic leukemia and one of three with acute lymphoblastic leukemia achieved remission. Dose-limiting toxicity (diarrhea) was seen in patients receiving more than five daily doses of high-dose cytarabine. We conclude that therapeutic doses of amsacrine can be combined safely with five daily doses of high-dose cytarabine and that a formal study is now required to assess the efficacy of this regimen.
Acute Disease↗
Isolation and characterization of a novel nucleoside, 7-beta-D-ribofuranosylhypoxanthine, from the urine of a chronic myelogenous leukemia patient.
A novel nucleoside, in the amount of 400 micrograms, was isolated from a 24-h collection of urine of a chronic myelogenous leukemia patient. On the basis of ultraviolet, nuclear magnetic resonance, and mass spectrometry and chromatography, its structure was established to be 7-beta-D-ribofuranosylhypoxanthine. The ultraviolet and mass spectral data and the thin layer chromatographic mobilities of the natural material were identical to those of a synthetic sample. High performance liquid chromatographic retention times and the coinjection high performance liquid chromatography of the natural material with the synthetic samples of the alpha and beta-anomers of 7-ribofuranosylhypoxanthines further confirmed the identity of the isolated material as 7-beta-D-ribofuranosylhypoxanthine.
Adult↗