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Biomedical subjects

A S Ketcham

Publications and source records attributed to A S Ketcham.

At least 73 records · Page 4Linked to original sources
PubMed1976

The value of the liver scan in preoperative screening of patients with malignancies.

This study analyzes the value of the liver scan as a preoperative screening procedure for occult liver metastases in patients with melanoma, sarcoma, head and neck carcinoma, and pelvic carcinoma. The records of 566 consecutive patients admitted to the Surgery Branch of the National Cancer Institute between 1969 and 1974 were reviewed and 323 patients were found acceptable for inclusion in the study. In these patients, although the liver scan had an overall accuracy of 95%, the scan identified only 50% of the patients with occult metastases to the liver and did not siginificantly add to the yield of the other screening procedures. It was useful as an adjuvant to an abnormal routine workup to confirm and localize metastases to the liver. Scans with only non specific abnormalities were of little help. Liver metastases were not identified in any patients with sarcoma, head and neck cancer, or clinically localized carcinoma of the cervix. Therefore, the liver scan was determimed to be an unnecessary part of their screening workup. Patients with recurrent or advanced carcinoma of the cervix and advanced melanoma were found to have an increased incidence of liver metastases. There was a 10% incidence of occult metastases to liver in patients with melanoma and the incidence increased with advancing clinical stage of disease. Even in this high-risk group of patients the screening liver scan did not significantly add information to that gained by history, physical examination, and blood work.

Head and Neck Neoplasms↗
PubMed1976

The optimal level of anticoagulation for decreasing experimental metastases.

Anticoagulation with warfarin is effective in decreasing experimental metastases, presumably by preventing the fibrin coagulum demonstrated to be necessary for the lodging of tumor cells. To determine the optimal level of anticoagulation for maximal antimetastatic effect, two similar experiments were completed with a methylcholanthrene-induced sarcoma in C57Bl mice. Footpad tumors were produced by tumor cell injection and the mice were divided into four equal groups: control, and groups on 1, 2, and 3 mg. per liter of warfarin, respectively. Control and anticoagulated mice were amputated at the same interval. Three weeks after amputation, all were killed and their metastases were quantitated. Prothrombin times ranged from 10 seconds in the control to 30 seconds in the 3 mg. per liter group. In Experiment 1, there was a significant reduction of pulmonary metastases at all levels of anticoagulation. The controls showed a mean number of 7.7 metastases per mouse, as compared to 2.9 (p less than 0.002) at 1 mg. per liter, 2.1 (p less than 0.0035) at 2 mg. per liter, and 0.7 (p less than 0.002) at 3 mg. per liter. In Experiment 2, the significant effect was found only at the 3 mg. per liter dose, with those mice having 2.3 metastases per mouse as compared with 5.5 in the controls (p less than 0.0001). We conclude that full anticoagulation in the range of 2.5 to 3 times normal is required for a maximal antimetastatic effect.

Animals↗
PubMed1976

Surgical management of parathyroid disease.

One hundred fifty patients who had operation for hyperparathyroidism at the National Institutes of Health are reviewed. The series is composed of several groups of patients, including 18 with normocalcemic hyperparathyroidism, 13 with hyperparathyroidism associated with MEA II, and 24 patients with a history of previous parathyroid operation. Selective venous catherization and radioimmunoassay of parathormone was carried out in 81 patients and was interpreted as being localizing in 65 cases. Following operation, six patients remained hypercalcemic. There were nine instances of permanent hypocalcemia and four cases in which permanent recurrent nerve injuries were experienced. The operative management of these patients is outlined in detail, stressing an approach which includes the surgeon, the internist and the pathologist. Based upon pathological evidence, the importance of identifying by frozen section four glands is emphasized.

Adenoma↗
PubMed1975

Intrathyroidal parathyroid adenoma or hyperplasia. An occasionally overlooked cause of surgical failure in primary hyperparathyroidism.

In six surgically proved intrathyroidal parathyroid tumors, neither thyroid scan nor gross appearance of the thyroid at surgery allowed reliable detection of parathyroid glands wholly within the thyroid. Preoperative selective catheterization of thyroid veins with radioimmunoassay for parathyroid hormone facilitated successful removal of hyperfunctioning intrathyroidal parathyroid tissue in all five cases in which it was performed.

Adenoma↗
PubMed1975

Nitrogen-sparing intravenous fluids in postoperative patients.

Improved nitrogen sparing was demonstrated in 20 patients undergoing either head-and-neck operations or abdominal explorations, who were randomized to receive intravenously either 3 per cent amino acids or 5 per cent dextrose. Infusions were started immediately after operation and continued for a minimum of six days. In patients receiving amino acids, as compared with those receiving dextrose, mean cumulative six-day nitrogen losses were significantly lower (42 plus or minus 5 g [S.E.M.] and 74 plus or minus 7 g, respectively--P smaller 0.005), as were serum glucose and insulin levels, but beta-hydroxybutyrate, acetoacetate and blood urea nitrogen were significantly elevated. No adverse effects of the amino acid solution were observed. The presumed mechanism for improved nitrogen sparing is a decrease in serum glucose and insulin levels, allowing greater endogenous fat mobilization and utilization, thus sparing lean body mass.

Acetoacetates↗
PubMed1975

Techniques for inhibiting tumor metastases.

Of the four major biological mechanisms of cancer spread, hematogenous dissemination is perhaps the most significant, as it usually heralds a fatal outcome for the patient. Recent experimental approaches have shown ways of altering the metastatic process and even totally inhibiting it in some animal models. It appears that these models may be applicable to certain human cancers. To prevent hematogenous metastasis formation the process must be inhibited at any one of four levels: 1) growth of the primary; 2) invasion of vessel walls; 3) release of viable tumor cells; or 4) entrapment and growth in distant organs. Judicious handling of the primary can decrease metastasis by minimizing the shedding of tumor cells. New experimental agents prevent the release of tumor cells from the primary by normalizing the blood vessels of the tumor. Warfarin, heparin, and fibrinolytic agents inhibit the entrapment of circulating tumor cells, presumably by their effect on coagulative mechanisms. A better understanding of the benefits of combined approaches to cancer using chemotherapy, irradiation, and immunotherapy, alone and as adjuncts to surgery, offers new opportunity to study methods of controlling metastatic disease.

Animals↗
PubMed1975

Long-term spontaneous regression of malignant melanoma with visceral metastases. Report of a case with immunologic profile.

A case of a 58-year-old woman with viscerally metastatic malignant melanoma is presented 12 years after spontaneous and complete regression of disease. Diagnosis of primary and metastatic lesions was confirmed by review of tissue sections. The presence and subsequent absence of visceral metastases were documented by open liver biopsies. Sections of metastatic lesions revealed extensive necrosis of tumor and infiltration of lymphocytes and plasma cells. Skin testing showed a strongly positive delayed hypersensitivity response to dinitrochlorobenzene (DNCB), to a standard battery of bacterial and fungal antigens, and to two of four preparations of allogeneic melanoma antigens. Values for cell- and serum-mediated cytotoxicity against melanoma cells and the response of the patient's lymphocytes to phytohemagglutinin were slightly above the normal range. A review of the literature reveals 13 other cases of long-term spontaneous regression of melanoma. None of these, however, had biopsy evidence of visceral disease. In each of the 13 cases, regression was associated with an event that might be inferred to have altered the patient's hormonal or immune status. This patient also provides evidence of a complete, spontaneous, and long-term remission of metastatic disease associated with the spontaneous development of host immunity.

Autoantigens↗
PubMed1975

Induction of pulmonary metastases in both immune and nonimmune mice. Effect of the removal of a transplanted primary tumor.

In mice bearing a benzypyrene-induced fibrosarcoma tumor, the survival was determined of intravenously injected tumor cells at various intervals after previous immunization of experimental animals by induction and subsequent excision of a transplanted primary tumor in the soft tissues of the leg. Seven days after induction of a transplanted primary tumor, I.V. tumor cells produced fewer pulmonary metastases in immunized mice than in nonimmunized mice. When tumor cells were inoculated I.V. immediately following amputation of the transplanted primary tumor, the number of pulmonary metastases in the immunized and nonimmunized animals were similar; however, 6 hours, 7 days and 14 days after primary tumor excision, I.V. inoculated tumor cells produced a higher incidence of lung metastases in the immunized than in the nonimmunized mice. This increased survival of I.V. tumor cells following excision of the transplanted primary tumor may have relevance to the development of metastases after eradication of certain primary tumors in humans.

Amputation, Surgical↗
PubMed1975

Pelvic neoplasms causing pain.

The following is a discussion of dyspareunia and its role as an aid to diagnosing pelvic neoplasms. The great majority of cases of dysparenia are psychosomatic in origin, and in a large proportion of the remaining cases, painful coitus is an indicator of benign problems. Nevertheless, painful coitus is a symptom which requires careful pelvic examination to rule out the possibility of pelvic neoplasm and to discover treatable causes of dyspareunia.

Dyspareunia↗
PubMed1975

Fibrous dysplasia of the sphenoid sinus in an adolescent male.

Fibrous dysplasia involving the sphenoid sinus and the entire left sphenoid bone, manifested clinically by left proptosis and frontal headaches, was diagnosed in a 13-year-old black male. The case is unusual since it is only the third reported instance of fibrous dysplasia of the sphenoid sinus, and because the disease became clinically apparent at the onset of puberty in the patient. Since previous reporters have suggested that fibrous dysplasia remains stable or progresses slightly after the onset of puberty, the patient was not treated with radical surgery, but instead was observed closely. At this point, one year following admission, the patient's proptosis has disappeared and his symptoms are markedly improved.

Adolescent↗
PubMed1975

Ovarian cancer presenting as umbilical hernia.

Six patients are reported whose presenting symptom was umbilical herniation. Upon exploration of the umbilicus with the intent to repair the hernia, ovarian cancer and malignant ascites were encountered in each individual. Cancer at the umbilicus, both metastatic and primary, is briefly discussed. The apperance of an acquired umbilical hernia in an otherwise asymptomatic patient should raise the suspicion of intraabdominal malignancy.

Adult↗
PubMed1975

Metastasis of metastases.

Metastasis of metastases was demonstrated experimentally. Mice whose primary tumors were amputated after the development of pulmonary metastases were placed into parabiosis with normal syngeneic partners. Metastases were demonstrated in the nontumor-bearing partners despite their development of passive immunity. Immunizing the nontumor-bearing partner prior to joining into parabiosis was not protective against the formation of metastasis.

Adenocarcinoma↗
PubMed1975

Reoperative parathyroid surgery.

Reoperative parathyroid surgery is associated with a high mortality and morbidity. Morbidity consists of uncorrected hypercalcemia, hypoparathyroidism, and recurrent nerve injury. Initial operative failure is most frequently a result of not identifying four parathyroid glands. On reoperation, parathyroid glands are most often found in the neck and are usually hyperplastic. It is recommended that before attempting rexploration for parathyroid disease, all the patient's records especially the operative note and the previous pathology material should be reviewed. Preoperative localization by selective venous catheterization is of great use in the management of this type of patient.

Adenoma↗
PubMed1975

High dose methotrexate as a preoperative adjuvant in the treatment of epidermoid carcinoma of the head and neck. A feasibility study and clinical trial.

Thirty patients with operable epidermoid carcinoma of the head and neck were treated with intravenous high dose methotrexate and leucovorin rescue prior to resection. Their clinical courses were compared with those of thirty randomly selected patients matched for tumors site and clinical stage who were treated by surgery alone. No medical or surgical complications associated with methotrexate were encountered. An objective decrease in tumor size (primary lesion or nodal metastases) was noted prior to resection in twenty-three patients (77 per cent). The number of recurrences in the two groups was similar. However, these was a significantly greater disease-free interval in the methotrexate-treated patients (p less than 0.05). No significant differences in survival have been noted to date between the two groups. In view of the absence of complications, the regressions in tumor size, and the increase in postoperative disease-free interval in this trial, evaluation as preoperative adjuvants of higher doses of methotrexate and of other chemotherapeutic agents in combination with methotrexate appears warranted.

Carcinoma, Squamous Cell↗