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Biomedical subjects

A Sardi

Publications and source records attributed to A Sardi.

At least 37 records · Page 2Linked to original sources
PubMed1996

Management of primary and metastatic tumors to the liver.

Primary and metastatic liver tumors continue to be a significant health problem in the United States. Hepatic resection or, in selected cases, transplantation are the only curative therapies for patients with resectable disease confined to the liver. Careful preoperative selection is crucial to avoid unnecessary surgical explorations that considerably reduce the quality of the short remaining life of patients with unresectable tumors. The surgeon needs to understand the role of imaging techniques in the evaluation of hepatic tumors for better selection of the patients who are candidates for an aggressive surgical approach. Several other therapeutic options are available for patients with unresectable disease. Until further research delineates the specific interactions among environmental factors, hepatic injury, hepatic regeneration, host factors, and molecular mechanisms of malignant transformation that can lead to specific preventive and treatment interventions, control of this disease will continue to rely on modifications of currently available treatment modalities.

Combined Modality Therapy↗
PubMed1996

Use of gamma detecting probe and isosulphan blue to localize sentinel node in patients with malignant melanoma.

Elective lymph node dissection for patients with malignant melanoma remains controversial. Sentinel lymph node sampling has been recommended to select patients who will benefit from lymphadenectomy. Vital blue dye and a gamma detecting probe have been used to identify the sentinel node. Two patients are described in whom microscopic disease was identified in the sentinel node as the sole focus of metastasis. The ability to excise the sentinel node provides accurate pathologic and staging information, is cost effective, and minimizes the morbidity associated with a routinely performed lymphadenectomy.

Adult↗
PubMed1994

Total pelvic exenteration with or without sacral resection in patients with recurrent colorectal cancer.

Pelvic recurrence from colorectal cancer produces significant morbidity. Radiation can help palliate the pain produced by this recurrence. Frequently patients with recurrent colorectal cancer will progress to a constant unrelenting pain and obstructive uropathy with sacral and bladder involvement. These patients can be candidates for an aggressive surgical resection with the hope of significant palliation and prolonged survival. From October 1988 to December 1991, six patients had total pelvic exenteration at our institution. Of these six patients, two had en bloc sacral resection at levels S1-S2 and one at S2-S3. Two patients had residual disease at the time of primary surgery, and in the other four patients, recurrence occurred 7 to 48 months after primary resection. One patient died with disease at 7 months, and five patients are alive at 9, 25, 25, 37, and 37 months since the pelvic resection; four have no evidence of disease. The present Karnofsky performance status is 80% or greater in all patients. There were no operative deaths. Of the five living patients, the survival from diagnosis of the primary lesion is 25 to 97 months. Total pelvic exenteration and abdomino-sacral exenteration can produce significant palliation and prolong survival in a selected group of patients with pelvic recurrence from colorectal cancer.

Aged↗
PubMed1994

Laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura.

Laparoscopy has changed our approach to various surgical problems. The technique described herein, depicted in a patient with idiopathic thrombocytopenic purpura, is safe and allows the patient to return to normal activity sooner than with open splenectomy. Laparoscopy should be considered in patients who require splenectomy for benign disease.

Adult↗
PubMed1994

Laparoscopic adrenalectomy in patients with primary aldosteronism.

Advances in laparoscopic surgery have changed our approach to many surgical problems. We describe a technique of laparoscopic adrenalectomy in patients with primary aldosteronism using an anterior transabdominal approach. The left adrenal gland was approached through the root of the transverse mesocolon, the right adrenal gland through the subhepatic space. The patients were discharged within 24 to 48 h with normal blood pressure after discontinuation of antihypertensive medication. This technique is safe and allows the patient to return to normal activity sooner than with conventional surgery.

Adrenalectomy↗
PubMed1993

Spontaneous rupture of splenic hamartoma.

Hamartoma of the spleen is a rare benign tumor. Only one spontaneously ruptured splenic hamartoma has been reported that presented with an acute surgical abdomen. A second case of a ruptured hamartoma of the spleen is illustrated; however, this case is unique in that it presented as a nonsurgical abdomen. This case stresses the importance of serial physical examinations of the patient and appropriate diagnostic studies in correctly determining the diagnosis when preliminary findings are inconclusive. Surgeons should include splenic hamartomas in the differential diagnoses of splenic defects seen on radiologic studies or splenic masses palpated during abdominal exploration.

Female↗
PubMed1993

Is breast preservation possible in women with large, locally advanced breast cancers?

Breast conservation therapy is an accepted treatment option for early stage breast carcinoma, but is rarely considered appropriate for locally advanced nonmetastatic lesions. Mastectomy specimens of 46/50 patients treated at the Ochsner Clinic and the Mallinckrodt Institute of Radiology with neoadjuvant chemotherapy prior to mastectomy +/- irradiation were evaluated by a single pathologist to assess tumor response to chemotherapy. Forty percent of this group would potentially have been eligible for breast conservation therapy, using a residual tumor size of < or = 4 cm with negative surgical margins as the criteria. Patients most likely to qualify for breast conservation therapy were those with T3N0-1 lesions (67%). Least likely were patients with skin involvement at diagnosis 4/33 (12%). Tumors with an extensive intraductal component at biopsy often had residual islands of intraductal carcinoma occupying the original tumor volume, even when the invasive component was absent or much reduced. A prospective trial will be required to determine whether or not acceptable local control rates can be obtained after breast conservation therapy for that subset of patients with a favorable response to induction chemotherapy.

Adult↗
PubMed1992

Transhiatal and transthoracic esophagectomy: a comparative study.

From January 1981 to December 1990, 55 consecutive patients underwent esophageal resection by either the transhiatal (THE, 26 patients) or transthoracic (TTE, 29 patients) approach. Patient age, tumor size, and tumor stage were similar in the two groups. THE patients had a significantly worse mean preoperative American Society of Anesthesiologists (ASA) risk class assigned by the anesthesiologist. Patients who underwent THE had a significantly lower operative mortality and rate of cardiopulmonary complications, significantly shorter intensive care unit and hospital length of stay, and a significantly better postoperative survival when operative deaths are included in the analysis. Operative deaths in the TTE group were concentrated among patients > 65 years of age (4 of 9 died), in an ASA risk class > or = III (3 of 7 died) or with moderate or severe cardiac or pulmonary impairment preoperatively (4 of 6 died).

Aged↗
PubMed1992

Renal metastases from papillary thyroid carcinoma.

Papillary thyroid carcinoma is the most common type of thyroid cancer. It is estimated that 4% to 20% of patients with papillary carcinoma will develop distant metastases during the course of their disease, most commonly to lung and bones. We describe the rare occurrence of metastatic papillary carcinoma of the thyroid to the kidney in a living patient that was successfully treated with a right radical nephrectomy and 131I with complete disappearance of all metastatic disease.

Carcinoma, Papillary↗
PubMed1992

Immunoperoxidase confirmation of ultrasonically guided fine needle aspirates in patients with recurrent hyperparathyroidism.

Fine needle aspiration (FNA) biopsy in conjunction with ultrasonic definition of nonpalpable masses in the neck region is being used more frequently. Currently available preoperative localization tests have failed, in many instances, to delineate adequately the location of missed adenomas of the parathyroid gland. We describe herein the use of ultrasonically guided FNA of parathyroid tissue with immunoperoxidase confirmation for precise localization of the diseased gland. Three patients with persistent hypercalcemia after exploration of the neck were referred to Ochsner Clinic, New Orleans. In two of these patients, a parathyroid adenoma had been removed, while in one patient no adenoma was found. All patients had elevated calcium (range 10.9 to 11.6 milligrams per deciliter), low phosphorous and elevated parathyroid levels. Preoperative ultrasonography to localize the suspected parathyroid glands was performed, with FNA and immunohistochemical confirmation. Smears confirmed adequate cellular material. Alcohol fixed, Papanicolaou stained and air dried, Wright's and Giemsa stained smears were evaluated for the presence of parathyroid cells by conventional cytologic examination. The Papanicolaou-stained slides were then decolorized in 1 percent hydrochloric acid in 70 percent ethanol. After decolorization, the smears were stained for parathyroid hormone (PTH) in an avidin-biotin complex (ABC) system, using a commercially available ABC kit (Vector Laboratories Inc.). The primary antibody is a polyclonal antiserum generated in rabbits against a synthetic human PTH. Negative controls were obtained from normal thyroid glands. In all three patients, the diseased gland was localized by ultrasound with cytologic and immunohistochemical confirmation, one on the right side and two on the left side. At surgical excision, the adenomas weighed 0.8 and 0.75 gram and the carcinoma, 0.75 gram. In two, intraoperative identification of the diseased gland was aided by ultrasound directed methylene blue injection into the adenoma. During a follow-up evaluation of eight to 24 months, serum calcium had remained normal in two patients, and one patient had become hypocalcemic and required calcium supplements. The preoperative localization allowed a direct surgical approach to the side in question in all patients. Ultrasonically guided FNA in an immunoperoxidase system can be a valuable preoperative localization technique for patients with recurrent hyperparathyroidism, thus avoiding extensive exploration of the neck with the subsequent complications.

Adenoma↗
PubMed1991

Radioimmunoguided surgery using iodine 125 B72.3 in patients with colorectal cancer.

Preliminary data using B72.3 murine monoclonal antibody labeled with iodine 125 suggested that both clinically apparent as well as occult sites of colorectal cancer could be identified intraoperatively using a hand-held gamma detecting probe. We report the preliminary data of a multicenter trial of this approach in patients with primary or recurrent colorectal cancer. One hundred four patients with primary, suspected, or known recurrent colorectal cancer received an intravenous infusion of 1 mg of B72.3 monoclonal antibody radiolabeled with 7.4 x 10 Bq of iodine 125. Twenty-six patients with primary colorectal cancer and 72 patients with recurrent colorectal cancer were examined. Using the gamma detecting probe, 78% of the patients had localization of the antibody in their tumor; this included 75% of primary tumor sites and 63% of all recurrent tumor sites; 9.2% of all tumor sites identified represented occult sites detected only with the gamma detecting probe. The overall sensitivity was 77% and a predictive value of a positive detection was 78%. A total of 30 occult sites in 26 patients were identified. In patients with recurrent cancer, the antibody study provided unique data that precluded resection in 10 patients, and in another eight patients it extended the potentially curative procedure.

Antibodies, Monoclonal↗
PubMed1991

Prognostic value of DNA flow cytometry in paragangliomas of the carotid body.

A carotid body tumor is a paraganglioma of the carotid bifurcation. Histologic appearance does not correlate with the malignant potential of the lesion, and thus a reliable prognostic marker for these tumors is lacking. To determine whether flow cytometric analysis of paraffin block specimens by DNA index and synthetic phase fraction (SPF) would be of prognostic value, a retrospective chart review of 14 patients with carotid body tumors was performed. Three of 14 tumors were aneuploid and were the only tumors with SPF greater than 15%. One of 3 patients (33%) with an aneuploid tumor (SPF = 22%) developed a local recurrence; no patient with a diploid tumor developed a recurrence. Two of 3 (67%) patients with aneuploid tumors (SPF = 18%) but only 1 of 11 (9%) with a diploid tumor were symptomatic preoperatively (P = 0.03). DNA index and SPF may help select a subgroup of patients with more aggressive tumors who are at increased risk for recurrence and therefore require closer follow-up.

Adult↗
PubMed1991

Lobular carcinoma in situ within a fibroadenoma.

The entity of lobular carcinoma in situ within a fibroadenoma is being increasingly recognized. Clinical examination, mammography, and fine-needle aspiration are the cornerstones in managing breast masses. A patient is presented with three lumps in the left breast. Although the workup was completely negative, pathological examination revealed lobular carcinoma in situ within one of the fibroadenomas.

Adenofibroma↗
PubMed1991

Changing trends in thyroid surgery. 38 years' experience.

Although fine needle aspiration (FNA) of thyroid masses has been performed since the 1950s, only recently has it become a common method of diagnosing thyroid malignancy. To assess the trends in thyroid surgery during the last 38 years at this institution, a retrospective study of the total number of cases during 2-year periods of each decade were reviewed, yielding 509 cases. Results showed that the total number of cases and the type of surgical procedure remained stable until recent years when FNA was more commonly used. For the 1987-1988 period, the total number of cases decreased (from an average of 112 per period in 1950-1981 to 60 in 1987-1988), but the percentage of cases with carcinoma was markedly increased (from 6.3% in 1950-51 to 46.7% in 1987-88). The percentage of total thyroidectomies performed increased due to a preoperative pathological diagnosis afforded by FNA. A decrease in surgical complications was also seen (from an average of 4.5% per period in 1950-1981 to 1.6% in 1987-1988). FNA has been shown to reduce the number of patients requiring surgery, increase the percentage of carcinoma in operative cases, increase the number of total thyroidectomies, and increase the percentage of preoperative pathologic diagnoses.

Adenocarcinoma↗