Biomedical subjects

B F Rush

Publications and source records attributed to B F Rush.

At least 55 records · Page 3Linked to original sources

PubMed1987

Lung cancer in patients with head and neck cancer. Incidence and long-term survival.

Of the 3,907 cases of primary head and neck or lung cancer diagnosed between 1961 and 1984, 94 patients were identified with a history of cancer at both sites. The total incidence of lung cancer in our head and neck cancer patients was 5.4 percent. Of the 94 patients, 73 had both cancers diagnosed at our institution. These 73 patients were further analyzed. Squamous cell carcinoma accounted for 63 percent of the lung cancers. Twenty of the lung cancers were synchronous and 47 were metachronous after head and neck cancer. Of the synchronous lung cancers, 50 percent were postoperative stage I, whereas only 11 percent of the metachronous cancers were postoperative stage I. The lung cancer survival rate was significantly better for the synchronous cancer group at 5 years (34 percent) than for the metachronous cancer group (5 percent). The better survival rate was evidently due to the greater proportion of early-stage lung lesions. The relatively large number of advanced-stage lung lesions in the metachronous cancer group suggests that aggressive screening of head and neck cancer patients for lung cancer may detect more metachronous lung cancers at an earlier stage and thus improve the survival rate of these patients.

Follow-Up Studies↗

PubMed1987

The effect of temperature on survival in hemorrhagic shock.

Hypothermia is a frequent complication of severe hemorrhagic shock and can complicate the treatment of trauma patients. The authors have investigated the effect of external warming on a treated model of hemorrhagic shock in rats. Their data show that externally heating the animal during the shock period decreases the animal's ability to withstand shock and increases intrashock and postshock mortality when compared to nonheated controls. The authors have also shown that nonheated animals that can retain body heat by passive retention can withstand increased shock time and have an increased postshock survival.

Animals↗

PubMed1987

Unified approach for nonmalignant esophageal lesions using right colon and terminal ileum. A 30-year experience.

Over the past 30 years, the authors reconstructed the esophagus with the right colon in 85 patients who had congenital and benign disease. The first individual operated upon in 1955 was asymptomatic. Nine patients had congenital tracheoesophageal fistula with atresia, four esophageal varices, 31 advanced obliterative esophagitis, and 23 corrosive destruction. In seven patients, severe esophagitis followed esophagogastrectomy, four had unsuccessful operations for achalasia, and seven had colon bypass following esophageal perforation. Eleven early nonfatal complications occurred. Remote nonfatal complications were seen in six patients. Three early deaths followed dehiscence of an intrathoracic esophago-colon anastomosis, and one patient died from peritonitis (4%). Four individuals died over the study period, and five patients were lost to follow-up. The late results in 72 patients show that 61 (84%) believe they have a satisfactory result, nine (13%) individuals are symptomatic, and two patients (4%) are classified as failures. Early complications have been minimized by employing preoperative intestinal angiograms and anastomotic stapling techniques, and by using the Doppler intraoperatively to prognosticate colon blood flow. Significant observations have been: Anastomosis in the neck is preferable; the transplanted colon dilates from loss of motor activity but is functionally adequate; an isoperistaltic segment is preferable, but antiperistaltic segments can be used; and colonic mucosa is relatively resistant to acid-peptic digestion.

Adolescent↗

PubMed1986

Cancer of the tonsil. Improved survival with combination therapy.

One hundred seventy-four cases of squamous cell cancer of the tonsil (SCCT) were reviewed. Radiation therapy (RT) alone was used in 81 patients, surgery alone (S) in 19 patients, preoperative RT + S in 49 patients, and chemotherapy [( C] methotrexate plus bleomycin plus cisplatin) in 25 patients. The 5-year survival was 83% in Stage I (n = 21), 72% in Stage II (n = 19), 23% in Stage III (n = 34), and 15% in Stage IV (n = 100). RT and S were equally effective in Stages I and II. In Stage III, the 5-year survival for RT + S was 31% versus 11% for RT alone; and in Stage IV, the respective 3- and 5-year survivals for RT + S were 24% and 15% versus 6% and 0%, respectively, for RT alone. There was an 84% response rate to C, and the patients who completed C + RT + S had 3- and 5-year survival rates of 41.7% and 32%, respectively. Our results indicate that RT + S appears to offer better survival in Stage III and IV SCCT. The high response rate in early survival data seen with C + RT + S suggests a promising role for this approach.

Aged↗

PubMed1986

Relation of thickness of floor of mouth stage I and II cancers to regional metastasis.

We have reviewed the clinical course and histologic findings in 84 patients with stage I and II squamous carcinoma of the mouth floor. We concluded that lesion thickness may offer a useful method for predicting the probability of cervical metastasis in node negative (N0) patients. Moreover, surface area of the lesion did not correlate with subsequent nodal disease, whereas thickness did. Elective node dissection appears to be strongly indicated in any patient with a N0 lesion measuring more than 1.5 mm in thickness.

Adult↗

PubMed1986

Evaluation of polylactic acid-carbon mesh for repair of ventral herniorrhaphy.

Large ventral hernias are a difficult surgical problem. Previous attempts to repair large defects in the abdominal wall with prostheses have been associated with recurrences and infection. A filamentous polylactic acid-carbon tissue mesh is a possible alternative prosthesis. We evaluated and compared polylactic acid-carbon mesh and Marlex mesh in repairing a large defect of the abdominal wall in a rat model. The polylactic acid-carbon mesh led to as strong a repair as Marlex mesh for the same time periods postoperatively; furthermore, no infection was noted with the former, whereas a 5.3 percent incidence of infection was noted with Marlex mesh. One mesh disruption was also noted with Marlex mesh. Polylactic acid-carbon mesh was found to have a more marked fibrotic response and a lesser inflammatory response. Polylactic acid-carbon mesh, therefore, appears to be more biocompatible, with more fibrosis, less inflammatory reaction, and equal strength to Marlex mesh. It is therefore a more appropriate synthetic material for a large ventral herniorrhaphy.

Abdominal Muscles↗

PubMed1986

A nonheparinized muscle model for studies of ischemia-reperfusion injury.

An understanding of the basic metabolic, functional, and histologic features of skeletal muscle injury secondary to ischemia and reperfusion has thus far been hampered by the lack of an adequate animal model. We have developed an in vivo isolated skeletal muscle preparation amenable to ischemia-reperfusion studies and the investigation of therapeutic modalities. The model is autoperfused and, most importantly, nonheparinized. The use of a nonheparinized model is essential following the work of Hardaway, recently confirmed by Fry, showing that alterations of flow in the shock state occur when heparin is used, invalidating other models as true replicas of clinical situations. The gracilis muscle in the canine hindlimb and its contralateral control are isolated on their neurovascular pedicles after detachment of fascial boundaries and meticulous ligation of all collateral vascular supply. Prolonged arterial occlusion can be accomplished by clamping proximal and distal to the point of origin of the gracilis artery from the superficial femoral artery. In a similar fashion, occlusion above and below the gracilis vein is effected intermittently to collect venous efluent during reperfusion. Preliminary studies of 100 muscle preparations subjected to 3 or 15 hr of ischemia, followed by 2 hr of reperfusion, demonstrate depression of oxygen utilization of 5% of control values during early reperfusion with improvement to 30% of control values over 2 hr. Contractility, abolished during ischemia, returns to 20% of control values after 2 hr of reperfusion.

Animals↗

PubMed1986

Is ethanol the unknown toxin in smoke inhalation injury?

Of the 12,000 fire-related deaths occurring annually in the United States, it is estimated that 60 to 80 per cent are due to smoke inhalation. Plastic and synthetic materials which have been introduced in home construction and furnishings produce a more toxic smoke when burned. Efforts to identify a "supertoxin" in this smoke have been unsuccessful to date. An alternative approach is to examine why victims are unable to escape, and become exposed to smoke for lethal periods of time. The authors examined the circumstances of death in 39 fire victims (27 adults, 12 children) over a 25-month period. Detailed examination of the fire scene, autopsy studies, and toxicologic analysis were carried out. Position of the victim, and escape efforts were noted. Carbon monoxide was elevated in all victims, with "lethal" levels (= greater than 50%) in 21/39 victims. Cyanide was detected in 24/29 victims, but none had lethal (3 mg/L) levels present. Ethanol was detected in 21/26 adults (80%) and 0/12 children (0%). 18/26 adult victims had ethanol levels above the statutory level of intoxication (10 mg%). Victims found in bed (no escape attempt) had a mean blood ethanol level of 268 mg%, compared with a mean level of 88 mg% in those victims found near an exit (P = .006). Ethanol intoxication significantly impairs the ability to escape from fire and smoke and is a contributory factor in smoke-related mortality.

Adult↗

PubMed1986

Management of squamous cell carcinoma of unknown origin in cervical lymph nodes.

Forty-three patients with the diagnosis of metastatic squamous cell carcinoma from unknown primary to the cervical lymph nodes were treated in EOVAMC between 1962-1982. Six of these patients were N1, 19 N2, and 18 N3. Five-year survival was 41 per cent for N1, 15 per cent for N2, and 6 per cent for N3 nodes. There was no significant difference in the treatment failure of those patients treated with unimodality versus multimodality. A subsequent primary was detected in the head and neck in 23 per cent of these patients (10/43), and eight of these patients had received previous radiotherapy. The most common site for these subsequent primaries was hypopharynx. Nine of the 43 patients developed distant metastasis with no correlation to stage of disease or treatment modality. These data show that the survival of these patients correlates with the stage of nodal disease, and that radiotherapy did not decrease the subsequent appearance of the primary lesions.

Adult↗

PubMed1986

Biochemical and morphologic changes in hepatocytes from the shock injured liver.

It has been proposed that the isolated hepatocyte is an excellent model for the study of cellular changes during and after hemorrhagic shock. To investigate this proposition the biochemical and morphologic changes in the isolated hepatocyte of shock injured rats were documented. Use of the isolated hepatocyte allows direct measurement of intracellular biochemical changes which we find corroborates the results of basic shock studies done on rats using liver slices, perfused liver or specimens taken at biopsy. Morphologic changes in the shocked liver of the rat are noted using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). The results are correlated with the biochemical changes. SEM of the isolated hepatocyte reveals marked swelling immediately after shock with some scattered blebs. The cells show some recovery at two hours with near complete normality restored at 24 hours. TEM of tissue and isolated cells reveal vacuolization and mitochondrial changes in the early post shock period with return to normality at 24 hours after shock. The shock injured hepatocyte is a reasonably faithful representative of the events which have taken place in the liver from which it is isolated. It can be used as a model for treatment in vivo or as a device for comparison of the effects of different environments in vivo or in vitro.

Adenine Nucleotides↗

PubMed1985

Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx.

Twelve patients with advanced locoregional (Stage III and IV) squamous cell carcinoma of the oral cavity and oropharynx underwent treatment with cisplatin, vinblastine, bleomycin, and 5-fluorouracil, given by intra-arterial infusion, as primary adjuvant therapy, in preparation for radiation therapy and surgery. Responses were observed during or immediately after infusion therapy in 8 of 12 (67%) of patients (1 complete response, 7 partial responses). Infusion chemotherapy was followed by radiation therapy alone in five patients and by radiation and surgery in six patients. The protocol was initiated in August 1981, and six patients are now free of their primary cancer, at 21 to 36 months, whereas six have died with disease. Arterial infusion of a combination of effective antineoplastic agents is a promising method for the preparation of selected patients for radiation therapy and surgery, as it is less likely to produce serious systemic toxicity and it requires a shorter period than systemic neoadjuvant chemotherapy.

Aged↗

PubMed1985

Trends in the management of breast cancer.

Responses of general surgeons to a questionnaire on breast cancer were analyzed to determine the current trends in the management of this disease. A 21-item questionnaire was mailed to members of the New Jersey Chapter of the American College of Surgeons in 1982 and the responses, received on noncoded, anonymous answer sheets, were analyzed for frequency distribution. These responses were compared to previously recorded responses to the same questions for 1971 and 1977. Seventy-six percent of the respondents in 1982 performed needle aspirations often or always, compared to 36% in 1971 and 80% in 1977. The use of routine mammography has increased from 16% in 1971 and 20% in 1977 to 38% in 1982. Modified radical mastectomy is now the most common type of procedure employed in the management of stage I breast cancer, with 89% of respondents in favor of this approach compared to 15% in 1971 and 60% in 1977. Fifty-nine percent of the respondents are not opposed to breast reconstruction following mastectomy versus 14% in 1971 and 49% in 1977. For patients with axillary nodes, chemotherapy with multiple agents was recommended by 76% of general surgeons in 1982, compared to 58% in 1977. These results indicate a continuing trend towards increasing use of needle aspiration and routine mammography for diagnosis and for employment of chemotherapy with multiple agents in the adjuvant treatment of patients with positive axillary nodes. Furthermore, modified radical mastectomy is the operation of choice for stage I cancer of the breast for increasing numbers of surgeons.

Breast Neoplasms↗

PubMed1985

A prospective evaluation of 5-fluorouracil plus cisplatin in advanced squamous-cell cancer of the head and neck.

Recent studies have shown improved efficacy of chemotherapy in patients with advanced squamous-cell cancer of the head and neck. Our purpose was to evaluate prospectively the activity of cisplatin plus 5-fluorouracil (5FU) in 37 patients with advanced stage IV squamous-cell cancer of the head and neck. There were two groups. Group 1 consisted of 19 previously untreated patients with either T4 or N3 disease. They received 100 mg/m2 cisplatin (days 1 and 28) and 120-hour infusion of 1,000 mg/m2/24 hours 5FU (days 1 to 5 and 28 to 32). They subsequently were offered preoperative radiotherapy (RT) and surgery. Group 2 consisted of 18 previously treated patients. They received 5FU and cisplatin in the same dosage every 28 days for either recurrent or metastatic disease. It was found that in group 1 there was an 84% response rate (five complete responses (CR) and 11 partial responses (PR) ). Three of those with PR achieved a CR after RT. Seven patients have had RT plus surgery and are disease free at 8 to 27 month follow-up. Six patients (one CR, five PR) refused surgery and progressed within 4 months. In group 2 there was an 11% response rate after two cycles (two PR), three patients had a minimal response (MR, less than 50% response) and received a mean of four cycles of treatment. Three patients with stable disease received a mean of four cycles of chemotherapy until progression. Two of 11 patients who had received previous chemotherapy plus RT showed an MR; nine of these patients had shown a response to their previous chemotherapy. Only one of 14 patients who had RT plus chemotherapy had a PR, and three had MR. Of five patients who had previous surgery, only one had a PR. All five had received chemotherapy as well. It was concluded that 5FU plus cisplatin is an effective combination in previously untreated patients. In previously treated patients with recurrent disease, there is a substantially lower response rate.

Aged↗

PubMed1985

Changing attitudes toward management of cancer of the colon and rectum.

Changes in the attitudes of surgeons toward the management of cancer of the colon and rectum over a 5-year period were assessed by analysis of responses of general surgeons to a 21-item questionnaire on colon cancer from 1978 and 1983. Comparisons of the responses revealed that the use of routine preoperative liver scans has decreased from 57 to 45 per cent. Transanal resection of villous adenoma of the rectum is used more often (44% in 1983 versus 34% in 1978). For obstructing carcinoma of the colon, a two-stage procedure is used more often, with 46 per cent of the respondents in favor of this approach in 1983 compared with 29 per cent in 1978. The use of staplers for colon anastomoses following resection has also increased with 44 per cent surgeons in 1983 using this technique always or frequently compared with 21 per cent in 1978. Following anterior resection, 66 per cent of respondents in 1983 seldom or never use a transverse colostomy (54% in 1978). The number of surgeons closing the perineal wound over suction drains following an abdominoperineal resection has increased from 46 per cent (1978) to 63 per cent in 1983. Sphincter-saving procedures for carcinoma of the rectum are used by a large number of surgeons in 1983 (29% versus 9% in 1978). An increase is noted in the use of preoperative radiation therapy for selected cases of rectal cancer (53% in 1978 to 68% in 1983).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed1985

Reoperation for sepsis.

A retrospective study of 50 patients undergoing reoperation for sepsis was performed to evaluate the ability of commonly available clinical and laboratory tests to predict the findings at reoperation and the outcome after operation. The influence of multiple organ failure on these parameters was also studied. No laboratory finding helped to predict operative findings. Computed tomographic scanning (80% accurate) was the most helpful radiographic procedure. A low total lymphocyte count and a high serum creatinine level both predicted a fatal outcome. No single organ failure or combination predicted a positive reexploration. Infection was found in 75 per cent of patients with multiple organ failure and 79 per cent of patients who did not have this syndrome. Patients having three-organ failure did have a significantly higher mortality. The mortality of a negative reexploration was 18.2 per cent, slightly lower than the 28.2 per cent mortality of patients with a positive exploration. No patient without organ failure died. The authors conclude that laboratory tests are not helpful in predicting the presence of infection on reexploration, that the decision to reoperate is one based primarily on clinical judgment, and that if reoperation is performed before the development of organ failure, the risk associated with a negative exploration is worth taking.

Adult↗

PubMed1984

The incidence of metastases after multimodal therapy for cancer of the head and neck.

Combined therapeutic regimens integrating chemotherapy, radiation therapy, and surgery are reported to be effective in treating advanced squamous cell carcinomas of the head and neck. The current study evaluates 58 consecutive patients with advanced (T4, N3) head and neck cancers. Forty patients (multimodal group) were treated with 2 courses of chemotherapy (cisplatin 2 mg/kg; methotrexate 280-560 mg/m2 with leucovorin rescue; bleomycin 30 mu X 3) followed by radiation therapy and surgery. Eighteen patients (combined group) were treated with preoperative radiation therapy followed by surgery. In the multimodal group there were 27 (67.5%) partial responses and nine (22.5%) complete responses, for an overall response rate of 90%. Response rates by site of primary lesion were: oral cavity, 11 of 11; oropharynx, 13 of 17; hypopharynx, 5 of 5; and larynx 7 of 7. Distant metastases (skin, lung, bone, central nervous system [CNS]) appeared in 16 patients (40%) (P less than 0.05 versus combined) at a median time of 8.5 months after diagnosis, 15 in patients having a partial (11) or complete (4) response. Thirteen patients (33%) developed distant metastases within 1 year of diagnosis (P less than 0.05 versus combined). In 11 of these patients, the primary lesion and neck disease were resectable. Two thoracotomies were performed for solitary pulmonary metastases; one was resected for cure. Fifteen patients (38%) underwent curative resection; 11 (73%) were alive at 1 year, and ten (67%) were free of disease. Overall survival was 20 of 40 (50%) at 1 year. In the combined group, there were 14 partial responses (78%) and no complete responses. Early distant metastases appeared in two patients (12.5%), at 2 and 6 months after diagnosis. Seven patients (38%) underwent curative resection; six of seven (86%) were alive at 1 year, four of seven (57%) were disease-free. Six of 16 patients at risk (37.5%) survived 1 year. After combined therapy, six of ten patients (60%) with responses to therapy survived 1 year versus 12 of 20 responders (57%) without distant metastases in the multimodal group. It is concluded that multimodal therapy for advanced head and neck cancer results in a higher response rate than with conventional combined therapy. The incidence of early and postoperative distant metastases was increased after the multimodal regimen. At 1 year there were no differences in survival between the combined and multimodal groups for responders without early metastases. Further observation is needed to determine the net long-term effects of this regimen. A prospective randomized comparison of combined and multimodal therapy for advanced lesions is indicated.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1984

Primary non-Hodgkin's lymphoma of the duodenum. Case report and literature review.

A case of primary non-Hodgkin's lymphoma of the duodenum is presented. A review of the English literature documented 95 cases, and the presenting signs, symptoms, and radiographic findings have been abstracted. Attention is also drawn to the treatment of 27 cases, 11 of which (41%) survived for 2 or more years. Ten of the 11 long-term survivors were treated with radiotherapy with or without resection, whereas only one long-term survivor was treated by surgery alone.

Adolescent↗

PubMed1984

Scheduling of combination chemotherapy for a murine melanoma, with the subrenal capsular assay.

The effect of varying schedules for administration of two drugs, dimethyl triazeno imidazole carboxamide (DTIC) and methylcyclohexyl chloroethyl nitrosourea (MeCCNU), was studied using the Harding-Passey Mouse melanoma in the subrenal capsular assay. The results of the assay indicate that the responses of the tumor varied depending on the schedule of administration. The best response, with a mean decrease in dimensions of 3.0 ocular micrometer units (+/- 1.12 SD), was noted with administration of DTIC on day 1 after tumor implantation, followed by MeCCNU on day 2. These results are similar to previously reported data in CD2F1 mice bearing intraperitoneal Harding-Passey melanoma and suggest that the subrenal capsular assay may be of use in determining the best combinations and schedules of administration for treatment of tumors.

Animals↗