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Biomedical subjects

D E Kenady

Publications and source records attributed to D E Kenady.

At least 37 records · Page 2Linked to original sources
PubMed1997

The structured clinical instruction module as a tool for improving students' understanding of breast cancer.

The Structured Clinical Instruction Module (SCIM) is a novel format for teaching clinical skills. A multidisciplinary SCIM was presented to 30 medical students to improve their understanding of breast cancer. The SCIM consisted of 12 10-minute stations, each covering a different aspect of the diagnosis and management of breast cancer (e.g., history, physical examination, treatment options, mammography, cytology, and pathology). The students rotated through the various stations in groups of three. Nine patients and 14 faculty members participated. At the end of the SCIM, students, faculty, and patients rated their level of agreement (on a five-point scale ranging from "Strongly Disagree" to "Strongly Agree") with statements on a multi-item evaluation questionnaire. All ratings were positive. The students agreed most that the small-group format was an effective instructional method (mean, 4.6). Both students and faculty agreed that the SCIM increased students' clinical skills (mean, 4.4 in both evaluations). Faculty expressed a willingness to participate in future such workshops (mean, 4.6). Patients agreed most strongly that they enjoyed the SCIM (mean, 5.0) and that faculty feedback to students was excellent (mean, 5.0). The SCIM was well received by all participants in this pilot project.

Breast Neoplasms↗
PubMed1996

Psychosocial adjustment and quality of life in women with breast cancer and benign breast problems: a controlled comparison.

Comparison of psychosocial adjustment in women with breast cancer (BC) and women with benign breast problems (BBP) has been hampered by a failure to control for age differences between these groups, as well as a failure to assess positive psychosocial adaptation in addition to psychological distress. Age-matched women with breast cancer (n = 80) and benign breast problems (n = 80) completed measures of psychological distress, positive psychosocial adaptation, and general quality of life (QOL). Breast cancer patients had completed primary treatment for breast cancer a mean of 24.6 months prior to participation (range, 6-57 months). Comparison of the BC and BBP groups indicated that the BC group reported (1) poorer physical health and functioning, (2) no differences in psychological distress, and (3) greater positive psychosocial adaptation, such as improved life outlook, enhanced interpersonal relationships, and deeper spiritual and religious satisfaction. Results support the theoretical position that cancer is a transitional event, that is, a traumatic event that alters an individual's assumptive world with the potential to produce long-lasting changes of both a positive as well as negative nature. This underscores the importance of using measures of both psychological distress and positive psychosocial adaptation when assessing psychological adjustment following transitional events such as breast cancer.

Adaptation, Psychological↗
PubMed1996

Diagnosis and management of adrenal tumors.

Tumors of the adrenal gland are not uncommon. Patients with these tumors usually demonstrate symptoms associated with the biochemical substance or hormone produced by the tumor. Tumors of the adrenal cortex, whether benign or malignant, are often associated with excess production of steroids, whereas tumors of the medulla are generally associated with overproduction of catecholamines. With the ubiquitous use of computed tomographic imaging, many asymptomatic adrenal lesions are discovered, presenting a management problem for the clinician. The algorithm for investigating so-called adrenal "incidentalomas" in the current era of cost containment continues to evolve. This review addresses current trends in the clinical evaluation, biochemical testing, and nuclear and radiologic imaging in the diagnostic work-up of these neoplasms. The mainstay of treatment is still surgical extirpation, the only curative modality. However, advances have occurred in adjuvant therapies, perhaps best typified by the neoadjuvant use of 131I-methyl iodobenzylguanidine in the treatment of neuroblastoma.

Adrenal Cortex Neoplasms↗
PubMed1996

Marjolin's ulcer of the foot caused by nonburn trauma.

Marjolin's ulcers are malignancies that arise from previously traumatized, chronically inflamed, or scarred skin. We report a case of squamous cell carcinoma arising in a foot wound 42 years after the time of injury. The historical background, epidemiology, pathophysiology, diagnosis, treatment, and prognosis of Marjolin's ulcer are reviewed. Diagnosis is best accomplished by punch biopsy or excision of suggestive lesions. Wide local excision is required and amputation may be necessary to achieve an adequate margin. Regional lymph node dissection should be done if regional nodes are palpable. Elective lymph node dissection is controversial but should be considered if the tumor is poorly differentiated. Lymph node metastases and high tumor grade indicate a poor prognosis. Clinicians should be diligent in the long-term surveillance of all significant scars or areas of chronic inflammation.

Carcinoma, Squamous Cell↗
PubMed1996

Surgical management of pancreatic carcinoma.

Since 1935, when Whipple originally described the removal of periampullary tumors, both the surgical method and the outcome associated with it have changed extensively. The mortality rates associated with the procedure as performed today have decreased from 20% to less than 5%; the 5-year survival rate after resection of pancreatic cancer has increased from 3.5% to more than 20% in some studies. These improvements are the result of improved perioperative care and the numerous modifications and technical refinements to the procedure itself. The most important determinants of long-term survival, however, relate to the biology of the tumor. Unfortunately, most pancreatic cancers are diagnosed at an advanced stage and are often unresectable. In this setting, any surgical intervention will be purely palliative in nature. Such procedures can reduce the symptoms associated with the disease and can slightly extend survival times. Several nonoperative approaches can also offer significant palliation to patients with inoperable pancreatic cancer.

Ampulla of Vater↗
PubMed1995

Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer.

Diagnosis of life-threatening illness now meets Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria for traumatic stressor exposure for posttraumatic stress disorder (PTSD). Quality of life (QOL) and PTSD-like symptoms were assessed in 55 women posttreatment for breast cancer. PTSD symptom measures included the PTSD Checklist--Civilian Version (PCL-C) and the Impact of Events Scale. QOL was assessed using the 20-item Medical Outcomes Study Questionnaire. PTSD symptomatology was negatively related to QOL, income, and age. Time since treatment, type of cytotoxic treatment, and stage of disease were unrelated to PTSD symptoms. With suggested criteria for the PCL-C, 5% to 10% of the sample would likely meet DSM-IV PTSD criteria. Findings suggest that in survivors of breast cancer, these symptoms might be fairly common, may exceed the base rate of these symptoms in the general population, are associated with reports of poorer QOL, and, therefore, warrant further research and clinical attention.

Adaptation, Psychological↗
PubMed1995

Diagnosis and management of thyroid and parathyroid hyperplasia and neoplasia.

Several causative factors for thyroid cancer have been identified, the most important of which is low-dose ionizing radiation. Although the prognosis for patients with differentiated thyroid cancer is generally good, the literature continues to present new information concerning clinical, pathologic, and molecular factors that allow for identification of high-risk subgroups. Molecular biology techniques now enable clinicians to identify patients with benign disease or a family history of thyroid cancer who will develop a malignancy. Despite these advances in tumor biology, however, controversy continues regarding the surgical procedures that should be performed for the various types of thyroid cancer. Although parathyroid cancer is a very rare but lethal form of neoplasia, benign parathyroid disease is much more common. Recent molecular studies have revealed fascinating differences among the various clinical manifestations of primary hyperparathyroidism.

Humans↗
PubMed1995

Adjuvant therapy of soft-tissue sarcomas.

Combination surgery and radiation therapy is currently the standard of care for primary treatment of soft-tissue sarcomas. The practice of complete muscle group excision has been replaced by that of achieving a 3- to 4-cm circumferential margin or adding either pre- or postoperative radiation to the surgical therapy. The surgeon can limit the margins to preserve the optimum tissue function but at the same time achieve maximum local control. Investigations continue to define the role of brachytherapy. Achieving therapeutic radiation doses while significantly limiting the treatment time has obvious advantages. Failure to irradiate a field wide enough, however, could result in marginal relapses. The demonstration of Brennan et al that the very high complication rate associated with this technique can be limited by delaying the delivery of radiation through the surgically placed catheters until 5 days after a surgical resection has significant implications for further protocols. The role of adjuvant chemotherapy in the multimodal management of patients with soft-tissue sarcomas is still investigational. Although a few of the randomized trials showed definite disease-free and overall survival benefit in those patients receiving adjuvant chemotherapy, most did not. In general, many authors believe that adjuvant chemotherapy for soft-tissue sarcoma cannot be recommended outside the context of a clinical trial.(ABSTRACT TRUNCATED AT 250 WORDS)

Brachytherapy↗
PubMed1995

The ramifications of immediate reconstruction in the management of breast cancer.

A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstruction was performed to determine the effect of reconstruction on the treatment of these patients. The overall complication rate was 50% (25 of 50). Smoking statistically correlated with an increased rate of wound complications (0 = 0.0001). Obese patients had nearly twice as many wound complications; however, this finding was not statistically significant (P = 0.261). Eleven of the 50 patients underwent reconstruction with a prosthesis, with an overall complication rate of 64% (seven of 11) and a 55% (six of 11) rate of prosthesis loss. Thirty-nine of the 50 patients underwent reconstruction with autologous tissue. Forty-six per cent (18 of 39) of the patients in the autologous group developed complications, and eight required emergent reoperation to prevent flap loss. The wound complication rate was significantly lower for bipedicled transverse rectus abdominis muscle (TRAM) flap reconstructions than for other forms of autologous reconstruction (P = 0.040). total operative time (including mastectomy) was 3.11 hours (range, 2-4 hours) for the prosthetic group and 9.4 hours (range, 5-15 hours) for the autologous group. All but two patients undergoing autologous tissue reconstruction required blood transfusions; an average of 2.4 U of blood was transfused per patient (range, 0-7 U). Only two patients in the prosthetic group required a transfusion. The average hospital stay was 5 days (range, 2-7 days) for the prosthetic group and 8.3 days (range, 5-19 days) for the autologous tissue group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Floor of the mouth cancer.

One hundred eighty-three patients with floor of the mouth cancer, of whom 162 were evaluable, were treated between 1962 and 1987. Most patients (139) received treatment with curative intent. Forty-seven received surgery only; 45 received radiotherapy (RT) only; 23 received preoperative RT and surgery; 24 received surgery and postoperative RT. A subset of 30 patients received brachytherapy and external beam RT. Overall survival rates were: surgery only, 90%/68% (2 years/5 years); RT only, 65%/45%; preoperative RT, 65%/43%; and postoperative RT, 78%/41%. Patients receiving surgery generally had lower stage disease and good performance status; RT patients generally had higher stage disease--(64% had stages III and IV disease). Patients receiving RT also had over twice the incidence of deaths from intercurrent disease. These were the contributing factors to the lower survival rate of the patients receiving RT. Disease-free survivals were similar between the groups. In contrast, locoregional control was better for patients receiving RT, particularly in the postoperative RT and brachytherapy groups. Locoregional control rates were: surgery only, 59%/52% (2 years/5 years); RT only, 78%/69%; preoperative RT, 75%/58%; postoperative RT, 80%/74%; and brachytherapy, 96%/89%. This advantage in locoregional control was marked in patients with advanced local disease and was evident at 2 years and beyond. Treatment approaches evolved during the study period toward the use of surgery only in lower stages and combined with RT (usually postoperative) in higher stages.

Adult↗
PubMed1994

Familial paraganglioma.

Extra-adrenal pheochromocytomas and paragangliomas are rare tumors of neural crest origin, most commonly found in the retroperitoneum. Because these tumors are so uncommon, relatively little is known about their natural history. Comparisons between adrenal pheochromocytomas and extra-adrenal pheochromocytomas have appeared in the medical literature. Like pheochromocytomas, paragangliomas may occur as functional or nonfunctional tumors. Furthermore, although the hereditary occurrence of pheochromocytomas is well documented, the familial nature of paragangliomas is unclear. We present the first report of a mother and son with nonfunctional paragangliomas occurring in the same anatomic location and describe their care and treatment.

Adolescent↗
PubMed1994

Diagnosis and management of thyroid malignancies.

Although thyroid nodules occur quite frequently, thyroid carcinoma is a relatively infrequent malignancy. Fine needle aspiration has proven to be the most efficient, most accurate diagnostic procedure in the management of nodular thyroid disease, and it has significantly improved the selection of patients for surgery. Although there is still some controversy, most authors advocate total thyroidectomy for differentiated thyroid carcinoma. This treatment strategy facilitates detection of recurrence with 131I and allows for more effective treatment of recurrent disease. Several novel prognostic markers are being investigated to help identify the most aggressive thyroid malignancies and thus aid in the overall treatment of patients with these tumors.

Biopsy, Needle↗
PubMed1993

Images of estrogen-receptor-positive breast tumors produced by estradiol labeled with iodine I 123 at 16 alpha.

OBJECTIVE: To examine the suitability of estradiol labeled with iodine I 123 at 16 alpha for imaging estrogen-receptor-positive breast carcinoma using imaging instrumentation that is widely available. DESIGN: Single-photon emission computed tomographic imaging survey of 29 women with suspected primary or expected recurrent breast carcinoma. SETTING: University-based referral center. PARTICIPANTS: Twenty-nine women undergoing diagnosis for primary or recurrent breast carcinoma. Selection was voluntary. MAIN OUTCOME MEASURE: Qualitative imaging study designed to provide tomographic data of radioligand retention and descriptive data of imaging results. RESULTS: Single-photon emission computed tomographic imaging using 123I-estradiol at 16 alpha was performed for patients with breast carcinoma. Independent readers, without knowledge of receptor status or proven disease, interpreted the films. Scintigraphic detection was most noteworthy in patients with chest wall tumors and inflammatory breast cancer. Agreement between readers was 98% for true-negative readings and 94% for true-positive readings, but only 60% for false-positive and false-negative film readings. CONCLUSIONS: Our results indicated that areas shown on imaging were also found to have estrogen-receptor activity and that radioligand accumulation can occur with low frequency in some surgically explored tissue. Radioligand imaging with 16 alpha-123I-estradiol can locate estrogen-receptor-positive breast tumors, including some that may be difficult to detect using conventional diagnostic imaging.

Breast Neoplasms↗
PubMed1993

Management of mammographic indeterminate lesions. First place winner of the Conrad Jobst Award in the Gold Medal paper competition.

The positive predictive value of mammography in nonpalpable malignancy, only 20 to 25 per cent, could be improved with better mammographic criteria for lesions not requiring biopsy. The outcomes of 89 patients with indeterminate lesions were reviewed to determine whether these lesions could be managed safely by observation rather than biopsy. Indeterminate lesions were defined as 1) tightly clustered, nonlinear calcifications (> 5 within 1 cm of tissue); 2) dominant, well-circumscribed soft-tissue masses (< or = 1 cm2); or 3) asymmetric density. Lesions not immediately undergoing biopsy were followed with frequent-interval mammography. Twenty-two lesions (26%) underwent immediate biopsy, and 2 of these demonstrated carcinoma in situ with microinvasion. Sixty-seven lesions (74%) were observed (median follow-up, 34 months), and 2 (2.5%) proved to be malignant, for an overall malignancy rate of 4.5 per cent. All malignancies were stage I, and the patients remain alive with no evidence of disease (average follow-up, 24 months). Sixty patients were spared unnecessary biopsy, decreasing potential wire-directed biopsies by 25 per cent. The positive predictive value of mammography increased from 21 to 32 per cent over the period. Indeterminate lesions can be safely followed with frequent ipsilateral mammography, reserving biopsy for lesions that progress. Management schemes such as this one can be used to decrease the number of negative wire-directed biopsies.

Awards and Prizes↗
PubMed1993

Surgical therapy for endocrine tumors of abdominal origin.

Surgery continues to be the primary treatment of endocrine neoplasia. Only occasionally are other therapies appropriate and, in those cases, usually only for palliation. In this review, we address the surgical management of endocrine tumors of the pancreas, the adrenal glands, and the gastrointestinal tract (specifically carcinoid tumors). Endocrine tumors, although rare, often present in quite dramatic fashion but are generally associated with excellent survival rates when treated with appropriate surgical resection.

Abdominal Neoplasms↗