Biomedical subjects
C H Organ
Publications and source records attributed to C H Organ.
Tracheal agenesis.
Tracheal agenesis is a rare cause of respiratory distress in the neonatal period. Temporary survival depends on ventilation through the esophagus. Thirty-eight case reports of tracheal agenesis (including one from this institution) have appeared in the literature. In this paper, we present the case reports of our 2 patients and review the literature. Tracheal agenesis is associated with a wide variety of congenital anomalies, the most frequent being ventricular septal defect. A new classification encompassing seven types of tracheal agenesis is described.
Megacolon in the elderly. Ischemic or inflammatory?
Ischemic colitis has been previously described in three forms: transient, strictured, and gangrenous. A fourth form of presentation in the elderly is characterized by signs of an acute abdomen, massive colonic dilatation, and systemic toxicity. Bloody diarrhea may be seen prior to the onset of dilatation. Ischemia should be considered as an etiologic factor in "colitis" in the elderly patient with segmental dilatation particularly if it follows a "low flow state." The rectum is usually uninvolved. Barium enema may confirm segmental involvement and later demonstrate stricture. Three patients with ischemic megacolon are presented. The diagnosis was suspected preoperatively in only one. In contrast to ulcerative colitis, these patients show a more abrupt onset and run a fulminant course. In patients who recover, there is lower relapse rate than young patients with ulcerative colitis. When resection is indicated, all attempts should be made to spare the rectum. Loop ileostomy and decompressive colostomy offer an excellent temporizing measure to assist the patient through the acute phase of the illness.
Natural history of lymph-node-negative breast cancer.
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The problem of the retained common duct stone.
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CEA: a guide for the clinician.
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Familial indications for prophylactic surgery in breast-cancer-prone families.
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Management of familial breast cancer. I. Biostatistical-genetic aspects and their limitations as derived from a familial breast cancer resource.
Practical guidelines are given to promote decision-making logic by the physician in managing patients seeking consultation (consultands) because they may be at high familial risk for breast cancer and associated malignant neoplasms. The protocol is designed to aid in the assessment of patients who may become candidates for intensified cancer surveillance and/or prophylactic surgery. A resource comprised of 90 extended breast cancer-prone pedigrees provides the basis for these specific recommendations. The resource shows marked tumor heterogeneity among pedigrees, an approximate 50% incidence of breast cancer and associated malignancies among offspring of affected parents, and threefold higher risk for development of mammary carcinoma in the opposite breast of familial patients with unilateral disease than in sporadic patients. In utilizing this protocol, it is crucial that family history be highly accurate from the standpoint of genealogic relationships and pathologic tumor verification so that management recommendations may reflect sound risk factor assessment. Interpretation of familial risk factors should ideally be made by an informed medical-geneticist. All members of the medical team should then be appraised of familial risk and collectively engage in decision making with the consultand. We believe that this approach can foster more effective control of familial breast cancer.
Management of familial breast cancer. II. Case reports, pedigrees, genetic counseling, and team concept.
The lack of therapeutic progress, coupled with limitations in early breast cancer diagnostic surveillance, suggest the need for innovative control programs for this disease. We have provided certian practical criteria for prophylactic subcutaneous mastectomy based on family history, presence of precancerous diseases of the breast, and other breast cancer risk factors, and the attitudes, feelings, and emotional aspects of the patient, all of which temper decisions for the type of cancer surveillance program and/or prophylactic surgery.
The peripheral lymphocyte count as an aid in the clinical staging of lung cancer.
The association between disease staging and peripheral lymphocyte count (PLC) was studied in 178 patients with histologically verified lung cancer. Mean PLC varied inversely with the stage of disease (p less than .01). The mean values were 2821, 2217, and 1594 for Stages I, II and III respectively. Thoretical normal distributions were generated about the mean peripheral lymphocyte count for each stage. Relative frequencies of lung cancer staging based on the PLC are estimated utilizing these curves.
Familial cancer: implications for surgical management of high-risk patients.
Knowledge of familial/genetic information about cancer risk involving at least 100 disorders could be utilized profitably by surgeons in their daily practice. Familial cancer of the breast, ovary, and colon, malignant melanoma, and testicular feminization syndrome, and masculinizing Turner's syndrome are discussed. Biological markers, an area of emerging research interest, have been considered for their cancer control potential. Prophylactic surgical implications for certain familial cancer have been given.
The black surgeon in the twentieth century: a tribute to Samuel L. Kountz, MD.
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To improve the yield of biopsy of the lymph nodes.
The diagnostic yield of 290 biopsies of thee lymph nodes performed between 1970 and 1974 was reviewed. A specific diagnosis was made in 63 per cent. In 10 per cent, the working diagnosis preoperatively was changed because of the biopsy. There was no significant variance in the postive yield obtained at the various biopsy sites. The surprisingly high yield from biopsy of inguinal lymph nodes was ascribed to a greater hesitancy on the part of th surgeon to do a biopsy of the nodes in the groin, unless they were strongly suggestive of disease. The highest yield rates were obtained when Boeck's sarcoidosis was suspected. Excellent yield rates were also obtained when the preoperative diagnosis was lymphoma or metastatic carcinoma. A protocol for handling the specimen was devised to maximize the potential yield of biopsy of the lymph nodes.
Edgar Poth Lecture. A new horizon for surgeons: genetics and cancer control.
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The surgeon, genetics, and cancer control: the Cancer Family Syndrome.
A family manifesting the Cancer Family Syndrome has been evaluated extensively from the medical and genetic standpoint. Findings of excess occurrence of carcinoma of the colon and endometrium, multiple primary cancer, early age of onset, and autosomal dominant mode of genetic transmission mandate a program of increased surveillance and cancer education. Prophylactic surgical implications are provided for certain of these enormously high cancer risk patients.
The importance of nutritional support for the geriatric surgical patient.
An appropriately designed program of nutritional support will allow the geriatric patient to undergo necessary surgical therapy with fewer risks and improved results. The selection of the route of administration and the specific agent(s) will depend on the functional status of the gastrointestinal tract as well as the patient's protein and calorie requirements. Table 6 summarizes our recommendations in the delection process. Our obvious preference is the gastrointestinal tract route if possible. When this optimum method of nutritional management is not available, sequential or concurrent supplemented feedings or intravenous hyperalimentation may be required to achieve adequate protein calorie intake. Regardless of the route chosen, careful monitoring of the geriatric patient's response to nutritional therapy is required. Only through careful planning and execution of nutritional therapy can optimum results be achieved in this group of patients.
Macroamylasemia.
Macroamylasemia, characterized by hyperamylasemia and a normal urinary amylase, has no known specific clinical symptoms. The disparity in serum and urinary amylase levels is due to a macromolecular amylase complex too large for glomerular filtration. This syndrome is presented in a patient with cholecystitis and a partial small bowel obstruction accompanied by persistent pre- and postoperative hyperamylasemia with proven macroamylasemia. The renal amylase clearance to creatinine clearance (CAM/CCR) ratio confirms this hyperamylasemic entity.
An investigative duodenal tube.
A triple lumen balloon tube has been designed to study the neutralization and dilutional factors in the pathogenesis of acid-peptic ulceration. This tube is designed to create an in situ duodenal pouch from which duodenal contents may be retrieved before and after stimulation with 0.1 N hydrochloric acid.