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Biomedical subjects

B Cady

Publications and source records attributed to B Cady.

At least 109 records · Page 6Linked to original sources
PubMed1987

Surgical approach to generalized lymphadenopathy in homosexual men.

Sixty patients considered at risk for acquired immune deficiency syndrome (AIDS) were referred for evaluation of generalized lymphadenopathy. All patients were seropositive for antibody to human T-lymphotropic virus type III (HTLV-III). Multiple lymph node biopsies from different nodal areas were performed. The results were evaluated in order to see if the diagnostic yield is increased by the performance of multiple lymph node biopsies. In no case was additional diagnostic information provided by performing multiple biopsies. In patients with diffuse lymphadenopathy who are at risk for AIDS, single node excisional biopsy is indicated to rule out opportunistic infection or/and tumor.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Avoidance of transhepatic drainage prior to hepaticojejunostomy for obstruction of the biliary tract.

We retrospectively reviewed the course of 14 consecutive patients with symptomatic hepatic duct bifurcation obstruction of the biliary tract because of unresectable non-Klatskin malignant disease to clarify issues of diagnostic and therapeutic strategy. All patients were symptomatic with pruritus and were expected to survive three months or more. Ten patients underwent percutaneous transhepatic cholangiography preoperatively. In no instance did the study influence operative decision making, and complications included septic shock in two patients. Decompression of the biliary tract in one patient made the duct technically inadequate for internal drainage. The remaining 13 patients underwent surgical drainage of the biliary tree. Ten had peripheral hepaticojejunostomies, which offers the best palliation of symptomatic obstruction of the biliary tract due to unresectable malignant disease at the hepatic duct bifurcation. Percutaneous transhepatic cholangiographic drainage should not be used for diagnostic studies prior to hepaticojejunostomy for malignant obstruction as it interferes with surgical drainage.

Aged↗
PubMed1986

The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy.

The role of radiotherapy in the treatment of isolated local recurrence of breast cancer after mastectomy is controversial. In an attempt to define this role, the results of moderate-dose radiotherapy in 90 such patients were reviewed. The median follow-up time for these patients was 81 months. The actuarial probability of local control after treatment was 42% at 5 years and 35% at 10 years. Freedom from distant failure was 30% at 5 years and only 7% at 10 years. The rate of appearance of distant metastasis was fairly constant at approximately 20% of patients per year. Overall survival was 50% at 5 years and 26% at 10 years. Overall survival and relapse-free survival were both chiefly influenced by the disease-free interval (DFI). Patients who presented with a DFI of greater than or equal to 2 years had a 5-year actuarial overall survival rate of 58% compared to 33% for patients with a DFI of less than 2 years (P = 0.04). Subsequent local failures after radiotherapy were principally seen at the initial site of recurrence, but also at other sites in or at the edge of the radiation fields. These results strongly suggest that patients with apparently isolated local recurrence after mastectomy are incurable by further local treatment. Effective systemic therapy is required to improve the results in these patients. Radiotherapy is a useful palliative procedure in patients with long disease-free intervals. The role of radiotherapy in conjunction with systemic therapy is, as yet, undefined.

Breast Neoplasms↗
PubMed1986

Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy.

Edema of the arm can be a significant complication following treatment of breast cancer. To determine the risk of arm edema and factors associated with this risk in patients treated with primary radiotherapy, we reviewed the records of 475 women with early breast cancer treated between 1968 and 1980. During this period, the use of axillary surgery prior to radiation gradually increased, and all patients received full axillary irradiation until late in the series. Based on the surgeon's report, the extent of axillary surgery was classified as either a sampling, a lower dissection, or a full dissection. Edema of the arm was scored on clinical grounds and ranged from mild hand swelling to an increased arm circumference of 8 cm. At 6 years, the actuarial risk of developing arm edema was 8% for the entire study population. This risk was 13% for 240 patients who had axillary surgery and 4% for 235 patients not undergoing axillary surgery (p = 0.006). For patients undergoing axillary surgery, the risk of arm edema was 37% with full dissection compared to 5% with sampling (p = 0.0003), and 8% with lower dissection (p = 0.03). The risk of arm edema at 6 years was 28% if more than ten nodes were removed, and 9% if one to ten nodes were removed (p = 0.03). However, the extent of axillary dissection was stronger predictor of subsequent edema than was the number of nodes obtained. The role of axillary irradiation could not be evaluated since 91% of patients received axillary irradiation. The use of chemotherapy, the site or size of the primary tumor, clinical nodal status, patient age and weight, type of suture, the use of a drain, and subsequent local or distant failure did not appear to be significant risk factors. We conclude that the combination of full dissection and full axillary irradiation results in an unacceptably high risk of arm edema.

Arm↗
PubMed1986

Society of Gastrointestinal Radiologists Roscoe E. Miller Award. Monitoring hepatic cryosurgery with sonography.

The intraoperative sonographic appearance of frozen hepatic tumors and frozen normal liver was correlated with the histologic appearance of pathologic specimens from six patients. Frozen tissue was visualized as a hyperechoic rim with posterior acoustic shadowing. Normal liver that was frozen and then thawed appeared hypoechoic when compared with normal unfrozen liver. These findings allowed visualization of the extent of freezing in relation to tumor margins. Pathologically, frozen tumors showed definite evidence of necrosis. Normal liver tissue was extremely sensitive to cold and was completely necrotic after freezing. The sonographic appearance of frozen and thawed liver correlated precisely with the gross morphologic and histologic changes seen in the cryolesion. It appears that intraoperative sonography allows accurate monitoring of hepatic cryosurgery.

Carcinoma↗
PubMed1985

Malignancies of the thyroid gland. The Lahey Clinic experience.

The management of patients with thyroid carcinoma remains controversial. Review of the Lahey Clinic's experience with 964 patients treated for thyroid malignancy and followed up for a period of 15 to 40 years assisted in the formulation of our current guidelines for management of this disease.

Adenocarcinoma↗
PubMed1985

The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy.

The extent of the surgical resection necessary for breast cancer patients treated by primary radiation therapy is unknown. A simple gross excision of the tumor provides the best cosmetic result, but a wide local resection may be important to prevent local recurrence in some patients. In order to identify patients who are not adequately treated by gross excision of the tumor and radiation therapy, we performed a retrospective clinical-pathologic review of 221 treated women with infiltrating duct carcinoma. There were 53 cases in which the excision specimen showed a constellation of three pathologic features: prominent intraductal carcinoma in the tumor, intraductal carcinoma in the grossly-normal adjacent tissue, and poorly-differentiated nuclei. These cases had a 37% risk of a local recurrence at 6 years compared to eight per cent for all other cases (p less than 0.0001). In cases with all three features, the use of a supplemental dose of radiation to the primary site did not significantly reduce the risk of a local recurrence. Local recurrence at 6 years was 34% in cases with all three features, who received supplemental local radiation, compared to 49% in cases not receiving a supplemental dose (p = 0.28). Survival was also worse for patients with all three features compared to other cases (69% vs. 90% at 6 years, p = 0.002). These results indicate that patients with all three pathologic features have a high risk of local recurrence following gross excision of the tumor and radiation therapy. If primary radiation therapy is selected for these patients, they should first undergo a re-excision of the tumor site in order to be certain that areas of extensive intraductal carcinoma have been adequately resected. Patients whose tumors do not show all three features are adequately treated by gross excision of the tumor prior to radiation therapy.

Breast↗
PubMed1985

Major hepatic resection for metachronous metastases from colon cancer.

Hepatic resection of metastatic colorectal cancer is being performed with increasing frequency. Reports describe wide variations in survival after resection of solitary of multiple metastases. In 23 consecutive patients having major hepatic resection for metachronous metastases from colorectal cancers, 18 patients had one, two, or three metastases and five had four or more individual metastases; the cure rate of one, two, or three metachronous metastases was comparable to reports of resected solitary simultaneous metastases. The median maximum diameter of metastases in patients both surviving and dead was 7 cm. Features separating surviving from dead patients were resection margins of at least 1 cm and fewer than four metastatic nodules. All patients with four or more hepatic metastases died of disease, 80% with further liver metastases. Only three of 18 (17%) patients with one, two, or three metastases developed further hepatic lesions. This study suggests that the biology of the hepatic metastatic disease is paramount; timing of the hepatic resection is of little importance. Delayed resection of suitable biologic situations does not impair survival opportunities, and early resection of inappropriate biologic situations with more than three hepatic metastases does not improve survival. Therefore, programs of early detection with the use of carcinoembryonic antigen (CEA) screening or "second look" operations will not increase cure rates.

Aged↗
PubMed1985

Further evidence of the validity of risk group definition in differentiated thyroid carcinoma.

Three hundred nine consecutive patients primarily treated at the Lahey Clinic Foundation for differentiated thyroid carcinoma between the years 1961 and 1980 were followed for a median of 13 years and a minimum of 5 years. The recurrence and survival rates of these patients are strikingly different in the low-risk group (men 40 years of age and under and women 50 years and under) compared with the high-risk group (all older patients). Only two patients died and eight others had recurrences but survived in 192 low-risk patients, whereas 18 died and 23 had recurrences in 117 high-risk patients. Thus 20% of patients with recurrence in the low-risk group died but 78% of patients with recurrence in the high-risk group died. Follicular carcinoma and major capsular invasion carries a poor prognosis, but only 22% of low-risk in contrast to 55% of high-risk patients died. The fact that low- and high-risk patients have a separate biology is emphasized by unique sex ratio differences. Low-risk patients have a constant male to female ratio of about 5:1, whereas high-risk patients have progressively increased from 1:3 to a male predominance during the past 5 decades. This study showing unique differences in results by age reemphasizes the concept of basic risk groups in differentiated thyroid cancer. The effect of this basic risk group, as in our previous report, supercedes the effect of pathologic type, extent of local disease, or aspects of therapy and exerts principal control over biologic behavior.

Adenocarcinoma↗
PubMed1984

Lymph node metastases. Indicators, but not governors of survival.

Regional lymph node filter function has traditionally been assumed to be critical in the prevention of the systemic spread of malignant cells shed from the primary cancer. However, in a multitude of clinical studies involving a variety of cancers, prophylactic removal of such regional lymph nodes, with or without metastases, does not improve cure rates compared with the observation of these lymph nodes. Furthermore, laboratory studies indicate that lymph node filter function may not be either complete or effective, and that many lymphatic and lymphaticovenous shunts exists that bypass regional lymph nodes and allow both lymphatic and hematogenous dissemination of malignant cells. These facts emphasize that regional lymph node metastases are indicators, but not governors, of survival in cancer. The timing of the clinical appearance of regional lymph node metastases and their number are, with few exceptions, excellent indicators of the biologic behavior of the primary cancer and the cells that are shed from it. This shedding of cells into the vascular and lymphatic vessels undoubtedly occurs simultaneously in the vast majority of cancers, but the later progressive growth of cells and micrometastases distributed hematogenously to vital organs is the ultimate governor of survival.

Breast Neoplasms↗
PubMed1984

Orthovoltage intraoperative radiotherapy: a new look at an old idea.

A 300 kvp orthovoltage machine has been permanently installed in an operating room for delivering intraoperative radiation therapy (IORT). A historical review of orthovoltage IORT and our present approach are described. The preliminary experience with 38 patients treated with orthovoltage IORT indicates that this technique is feasible, has low acute morbidity, and can be useful for palliation. "Radical" radiation therapy consisting of IORT "boost" treatment combined with external beam was used in 24 patients with primary or recurrent cancer. Local failure in 27 patients treated with IORT +/- external beam radiation therapy was 56%, but varied from 11% (1/9) for patients with resected disease to 78% (14/18) for patients with unresected disease. Complications occurred in nine patients (24%) and have been acceptable. There are 17 patients alive and six are NED, with follow-up of 4-18 months. There appears to be a role for orthovoltage IORT especially when combined with surgical resection for local control of advanced cancer arising in the abdomen where the use of high doses of external radiation therapy are hazardous.

Adolescent↗
PubMed1984

Management problems in coexisting parathyroid crisis and florid thyrotoxicosis.

The etiologic relationship between parathyroid and thyroid disease is controversial and still not well defined. An increased incidence of parathyroid adenomas with thyroid disease has been suggested by some researchers. Other authors are unable to confirm this and maintain that the major factor contributing to the coexistence of parathyroid adenomas and thyroid disease is the prevalence of these conditions, independently, in middle-aged women. Serum parathyroid hormone levels are generally lower in patients with thyrotoxicosis and higher in patients with hypothyroidism. The simultaneous occurrence of thyrotoxicosis and symptomatic hyperparathyroid crisis has been reported previously only once in the American literature. We report a case of a 32-year-old woman with documented uncontrolled Graves' disease (T4 = 20 micrograms/dl [normal = 4.5 to 11.5 micrograms/dl], total T3 = 361 ng/dl [normal = 115 to 190 ng/dl], T3RU = 53% [normal = 35% to 45%]), who developed parathyroid crisis (serum calcium = 15 mg/dl [normal = 9 to 11 mg/dl], N-terminal parathyroid hormone = 121 pg/ml [normal = 11 to 24 pg/ml], C-terminal parathyroid hormone = 9416 pg/ml [normal = 60 to 450 pg/ml]). After a turbulent 10-day period to achieve a euthyroid state with propranolol, propylthiouracil, and a saturated solution of potassium iodide, operation revealed a large parathyroid adenoma (2 by 2 by 3 cm) and a diffusely hyperplastic thyroid gland. Adenoma excision and bilateral subtotal thyroidectomy were performed. This case illustrates management guidelines of a true endocrine emergency in which prompt operation for acute hyperparathyroidism could not be undertaken until a euthyroid state and reduction in serum calcium levels were achieved with aggressive medical management.

Adenoma↗
PubMed1984

Biologic considerations and operative strategy in papillary thyroid carcinoma: arguments against the routine performance of total thyroidectomy.

Reasons cited for the routine performance of total thyroidectomy in patients with papillary thyroid carcinoma include: fear of multicentric neoplastic foci causing local recurrence and death; risk of anaplastic transformation of unresected multifocal microscopic carcinoma; toxicity of high-dose radioactive iodine to ablate normal thyroid remnants; and lack of reliable criteria for grading malignancy and identifying patients at high risk. However, autopsy studies have detected microscopic foci of papillary thyroid cancer as incidental findings in up to 24% of patients dead of other diseases. The prevalence of anaplastic transformation of papillary thyroid carcinoma as determined from reports in the literature is less than 1%. A retrospective investigation of 90 patients with papillary thyroid carcinoma derived from the Swedish National Cancer Registry showed no complications from radioiodine ablation of postoperative thyroid remnants in 45 patients. Retrospective analysis of the DNA content of tumors at the time of the initial operation showed a significant difference between a group of 10 patients who died of recurrent and metastatic papillary thyroid carcinoma and a group of 16 patients alive at least 10 years after operation despite distant metastases or recurrent cancer in the thyroid bed and/or cervical lymph nodes. The risk of permanent hypoparathyroidism is higher in patients after total thyroidectomy without apparent improvement in survival rates when compared with less extensive resections. Therefore it is proposed that the criteria for total thyroidectomy in patients with papillary thyroid carcinoma be limited to: tumors that clinically involve both lobes of the thyroid gland, extracapsular spread of cancer requiring enbloc resection, and reoperations where scarring prevents accurate delineation of the extent of the tumor. By differentiating patients at high risk for death from papillary thyroid carcinoma from patients at low risk, the measurement of DNA content may decrease the need for routine total thyroidectomy.

Adolescent↗