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Biomedical subjects

A S Ketcham

Publications and source records attributed to A S Ketcham.

At least 19 recordsLinked to original sources
PubMed1992

Axillary node dissection for early breast cancer: some is good, but all is better.

Optimal management of the axillary lymphatics in breast cancer patients remains a contentious subject. Axillary recurrence, while infrequent, may have very significant clinical consequences in the affected patient. Axillary sampling, partial and total axillary lymphadenectomy, radiotherapy, and surgery plus radiotherapy are discussed with attention to efficacy in prevention of axillary recurrence, accuracy of nodal staging, and morbidity. The incidence of axillary recurrence decreases and accuracy of staging increases with the number of lymph nodes resected. There is little difference in incidence of morbidity between partial and total axillary lymphadenectomy. Radiotherapy is not as effective as lymphadenectomy for regional disease control and, when administered following a surgical staging procedure, increases the risk of lymphedema of the ipsilateral upper extremity and, in patients undergoing breast-conserving surgery, the ipsilateral breast. We believe that total axillary lymphadenectomy provides optimal regional disease control and axillary staging with morbidity comparable to that of partial lymphadenectomy.

Axilla↗
PubMed1992

Sacral resection for control of pelvic tumors.

A surgical approach for treating patients with resected, recurrent, posterior pelvic visceral tumors involving the sacrum is detailed. Of 11 patients, 9 had rectal cancers, 1 had chordoma, and 1 had cancer of the cervix. Five total pelvic exenterations and five posterior exenterations were performed en bloc with involved sacrum. One patient had a sacral resection only. Surgical mortality was 9%, and the average hospital stay was 1 month. Mean disease-free survival was 1 year, and mean survival was 3 years. Absolute cure rate was 18% with a complete 5-year follow-up. This experience confirms the value of this procedure in selected patients.

Bone Neoplasms↗
PubMed1992

Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery.

PURPOSE: Procedure (mastectomy v lumpectomy) and choice of procedure were examined as predictors of adjustment to breast cancer in a prospective study of the experiences of the first year after surgery. PATIENTS AND METHODS: Breast cancer patients were interviewed the day before surgery, 10 days after surgery, and at the 3-month, 6-month, and 12-month follow-ups. Patients included 24 women who received mastectomy on strong recommendation, 24 who chose mastectomy for other reasons, and 15 who chose lumpectomy. Subjective well-being was assessed in terms of mood disturbance, perceived quality of life, life satisfaction, marital satisfaction, perceptions of social support, and self-rated adjustment. RESULTS: Surgical groups differed in well-being in only one respect: lumpectomy patients reported a higher-quality sex life at 6 and 12 months postsurgery than mastectomy patients. Choice of surgical procedure predicted higher levels of life satisfaction at 3 months. CONCLUSION: The lack of difference between surgical groups in areas other than sexual adjustment replicates previous findings, but extends them by (1) using a fully prospective design, (2) providing data on the period surrounding the surgery (as well as later periods), and (3) examining a broader range of indices of well-being than usual.

Adaptation, Psychological↗
PubMed1991

Total axillary lymphadenectomy in the management of breast cancer.

The optimal extent of axillary dissection in patients with breast cancer remains unclear. We report 278 total axillary lymphadenectomies (levels I, II, and III and Rotter's [interpectoral] nodes) that were performed in 264 closely followed up private patients. There have been no axillary recurrences to date (mean follow-up, 50 months). If only level I and II nodes had been removed, the false-negative staging error would have been only 2.6%. However, 29 (31.5%) of 92 pathological node-positive axillae contained apical and/or Rotter's metastases. The incidence of complications was comparable with that reported for partial lymphadenectomy. Arm lymphedema developed in 6% of nonirradiated patients; postoperative radiotherapy and gross nodal disease were significant risk factors for lymphedema. Total axillary lymphadenectomy largely prevents axillary, recurrence, eliminates the small staging error inherent in partial lymphadenectomy, and has acceptable morbidity, provided radiotherapy to the regional nodal areas is avoided.

Adult↗
PubMed1990

Surgical palliation for recurrent rectal cancers ulcerating in the perineum.

This report describes a unique palliative approach of radical surgical debridement for uncontrollable, recurrent pelvic tumors ulcerating through the perineum. All conservative treatment attempts with radiotherapy and chemotherapy had failed. Seven patients have been treated with resection of the tumor including a portion of the sacrum to obtain all but the deep margins clear of tumor. Coverage was obtained with myocutaneous flaps. All patients were significantly relieved of pain, requiring little or no subsequent analgesics. Three patients returned to work and the remainder led a relatively comfortable existence at home until their demise. At the time of death, four patients had no visible perineal disease. When conservative attempts at chemotherapy and radiotherapy have failed in this situation, the authors believe that palliative surgery prolongs both quantity and, more importantly, quality of life.

Adenocarcinoma↗
PubMed1990

Vexed surgeons, perplexed patients, and breast cancers which may not be cancer.

In situ cancer of the breast is being diagnosed with increasing frequency due to the widespread use of mammography and heightened awareness of these lesions among pathologists. Treatment of these preinvasive cancers is controversial in light of recent data supporting breast-conserving therapy for small invasive cancers. Therapy for in situ breast cancer is discussed with attention to known risk factors for recurrence and breast cancer-related mortality. The controversies surrounding treatment of ductal and lobular carcinoma in situ compel the conscientious oncologist to seek fully informed consent and to respect the individual patient's feelings about cosmesis and breast cancer risk. Hopefully, prospective randomized studies such as the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-17 trial will relieve the oncology community of much of its confusion about the natural history and optimal therapy for these diseases.

Breast Neoplasms↗
PubMed1990

Segmental mastectomy without radiotherapy for T1 and small T2 breast carcinomas.

We describe 111 patients with invasive breast cancer treated by segmental mastectomy at the University of Miami (Fla) since 1975. Postoperative adjuvant radiotherapy was recommended as optional rather than mandatory to 64 of these patients based on small (2.5 cm or less) primary tumor size, adequate resection margins, no lymphatic or vascular invasion within the segmental mastectomy specimen, and minimal associated in situ cancer. Fifty-one of these patients elected to forego postoperative adjuvant radiotherapy. At 72 months median follow-up, relapse occurred in the ipsilateral breast in three patients who elected to forego postoperative adjuvant radiotherapy (6% by Kaplan-Meier analysis). Retrospective pathologic review revealed that tumor grade may also be important in determining whether postoperative adjuvant radiotherapy is necessary following segmental mastectomy. These data suggest that postoperative adjuvant radiotherapy may not be required in every patient treated by segmental mastectomy. Further studies to define which patients can be spared the inconvenience, expense, and potential morbidity of postoperative adjuvant radiotherapy are warranted.

Adenocarcinoma↗
PubMed1988

Breast cancer: management of the opposite breast.

Women who have or had cancer in one breast are at especially high risk for developing cancer in the contralateral breast. Other risk factors for second primary breast tumors include age, the use of radiation in treating the index cancer, and pathological characteristics of the original cancer. Management approaches range from close clinical and mammographic surveillance only to immediate prophylactic contralateral mastectomy. Routine and selective biopsy of the opposite breast at the time of treatment of the initial cancer have their proponents. The authors discuss these methods and the effect of a second cancer on overall prognosis.

Adenocarcinoma↗
PubMed1987

Breast carcinoma post-augmentation mammaplasty: therapy with limited surgery and radiation.

Due to the recent surgical and technical developments in aesthetic surgery and occasional dissatisfaction of women with their external contour, augmentation mammaplasty has become a common occurrence in the surgical practice of the aesthetic surgeon. Breast carcinomas, incidentally associated with augmentation mammaplasty, have been sporadically reported in the literature and have all been treated with a mastectomy when resection was possible. We present a case of breast carcinoma occurring 5 years after augmentation mammaplasty performed with silicone-gel-filled implants. Therapy of this carcinoma was achieved through a segmental mastectomy followed by postoperative radiation. The patient remains well 15 months postoperatively. A large number of breast implants are performed each year and the likelihood of a higher incidence of incidental breast carcinomas seen with implants is certainly possible as these patients become older; thought should be given to the notion that possibly not all of these cases need to be managed with radical surgery.

Adult↗
PubMed1987

Early discharge after mastectomy. A safe way of diminishing hospital costs.

In order to assess the risks and benefits of early discharge after major breast surgery, the authors analyzed 73 consecutive private patients who underwent operations by four surgeons over a 1-year period. Patient's ages ranged from 34 to 84 years, with a mean of 56.2 years. One patient was excluded from analysis because thoracotomy with a pulmonary resection was performed during the same hospitalization. Thirty-seven patients underwent total mastectomy with complete axillary dissection, 30 underwent segmental mastectomy with complete axillary dissection, and five underwent total mastectomy alone. For each patient the chest wall and axilla were drained by means of one or two Jackson-Pratt (American Heyer Schulte Corp., Goleta, CA) closed suction drains. Prior to discharge, all patients were instructed in the proper technique of drain care and were directed to record the daily drainage. Patients were discharged when they were fully mobile, did not require injectable narcotics, and felt capable of taking care of the drains as outpatients. The length of postoperative stay ranged from 1 to 9 days (mean 2.9), with all but three patients being discharged by the fifth postoperative day. Patient acceptance of early discharge with drains was excellent. Drains were pulled on an outpatient basis, usually within 7 to 10 days after surgery. Complications were observed in twelve patients (18%), consisting of seromas (8 patients), cellulitis (2 patients), and minimal superficial skin necrosis (2 patients). All complications were managed easily on an outpatient basis. We conclude that early discharge with Jackson-Pratt drains remaining in place is safe, well tolerated by patients, and has tremendous potential for substantial cost savings.

Adult↗
PubMed1986

Pure squamous cell carcinoma of the breast.

Pathological curiosities have always fascinated the surgical community, and management of breast cancer by the physician has, at times, revealed such rarities. A recent case of squamous cell carcinoma in a clear fluid breast cyst has prompted a review of our experience with this rare pathology, and allowed us to make the following statements: We propose that squamous cell carcinoma of the breast arises from ductal metaplasia. When the T.N.M. system is applied to the squamous cell lesion, the apparent poor prognosis that it is believed to carry may not be so apparent. If no other primaries are identified after extensive metastatic work-up, surgical therapy consisting of total mastectomy with complete axillary dissection, is very effective in local control of tumor progress. Nodal status will indicate the need for additional modalities of therapy.

Breast Neoplasms↗
PubMed1986

Squamous cell carcinoma of the rectum: a multimodality approach.

A 60-year-old homosexual male with a diagnosis of squamous cell carcinoma of the rectum, arising 7 cm from the dentate line, was treated with a rectal preserving multimodality approach consisting of excisional biopsy and chemotherapy with 5-fluorouracil (5-FU) and mitomycin-C with concomitant administration of radiation therapy to the tumor and pelvic nodal bearing areas. The patient has remained disease-free with full preservation of anorectal function on follow-up at 2 years. This approach to a difficult and unusual problem is recommended as a first line of therapy rather than surgical resection if it is deemed that the patient can tolerate a combination of chemo and radiation therapy and the patient will be able to participate in a long-term follow-up.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Infrared light scanning of the breast.

Transillumination and Infrared Light Scanning (I.L.S.) of the breast were evaluated in a high referral breast clinic over a 15-month period. Seven hundred (700) patients were examined and blindly transilluminated; 101 were biopsied, all had mammography. The study was conducted in two phases: Phase I evaluated transillumination without I.L.S. This included 22 biopsied patients out of 101, with eight carcinomas identified histologically, demonstrating 87 per cent sensitivity and 64 per cent specificity for transillumination, versus 87 per cent and 71 per cent for mammography, and 87 per cent and 57 per cent for examination. Phase II evaluated simple transillumination combined with I.L.S. This included 79 biopsied patients out of 101 with 26 carcinomas identified histologically, demonstrating 96 per cent sensitivity and 74 per cent specificity for transillumination combined with I.L.S. compared to 85 per cent and 72 per cent for mammography and 81 per cent and 73 per cent for examination. Of the 26 Phase II carcinomas identified, two were not felt by examination, and two were neither felt nor read correctly by mammography. I.L.S. of the breast has proven effective in the hands of trained personnel and should be used with routine breast examination or mammography to increase yield of breast pathology.

Adult↗
PubMed1985

Hartmann's pouch carcinoma.

Since 1921, when Henry Hartmann first described his procedure for rectal carcinoma, multiple modifications of the original technique have been proposed. However, the basic principle of a rectal pouch has always been retained. Two cases of carcinoma developing in such a pouch are described; both occurred years after creation of the pouch. One was managed by local resection through a transsacral approach; the other required an abdominoperineal resection. Consideration must be given to careful examination and sigmoidoscopy of these pouches as they tend to be forgotten by the physicians due to their hidden location.

Adenocarcinoma↗
PubMed1985

Hyperthermia for cancer: a practical perspective.

A causal relationship between hyperpyrexia and tumor regression was first suggested in 1866, when Busch reported the cure of a histologically diagnosed sarcoma in a middle-aged woman, following a bout of erysipelas. Over the years, interest in the effect of heat on cancer has remained alive, but this interest has increased dramatically in recent years. The literature on this subject is broadly reviewed and the clinical results discussed. It is apparent from clinical studies thus far that it is a relatively simple undertaking to treat superficial neoplasms with hyperthermia. However, the major challenges in clinical thermotherapy pertain to patients with deeply situated tumors. The lack of safe and reliable methods of monitoring temperature in deep tissues is a major impediment to a thorough understanding of thermal dosimetry in clinical hyperthermia, and routine thermal dosimetry in clinical hyperthermia will have to await the development of reliable noninvasive thermometry. As responses have been reported with modest levels of hyperthermia, the need for thermometry is somewhat lessened, given that invasive monitoring is imperfect and somewhat risky when used in deeply seated tumours. The eventual place of thermotherapy in the treatment of malignant tumours in man is as yet unclear and must be rigourously and thoroughly assessed in well-designed, prospective, randomized patient trials.

Animals↗