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Biomedical subjects

E L Felix

Publications and source records attributed to E L Felix.

36 records · Page 2Linked to original sources
PubMed1980

The use of a moldable plastic splint to minimize early postoperative thrombosis of an internal arteriovenous fistula in the high-risk renal dialysis patient.

An inexpensive moldable plastic wrist splint was developed to protect the site of an internal arteriovenous fistula from accidental thrombosis in the early postoperative period. This splint, or fistula guard, is easily constructed and has been successfully used in a series of 11 high-risk patients without reported discomfort by the wearer.

Arteriovenous Shunt, Surgical↗
PubMed1978

Lung tomography in cancer patients. Full-lung tomograms in screening for pulmonary metastases.

In a retrospective study of the cases of 415 patients with various malignant neoplasms, full-lung tomography and conventional chest roentgenography were compared for accuracy in the detection of pulmonary metastases. Sufficient information was available on 410 patients to permit confirmation as to whether pulmonary metastases were present at the time of screening chest roentgenographic and tomographic examinations. On screening by routine chest roentgenography, metastases were detected in 36 patients, 66.7% of the total with confirmed metastatic disease. Screening by full-lung tomography identified metastases in 51 (94.4%). Fifteen patients with normal chest roentgenograms had metastatic lesions on tomograms. Metastases were detected in 8.8% by chest roentgenograms and in 12.4% by tomograms in a population of cancer patients with a 13.2% incidence of pathologically confirmed metastatic lesions.

Adolescent↗
PubMed1978

Severe complications of intralesional BCG therapy in an unsensitized patient. Case report and clinical implications.

Since the introduction of BCG intralesional immunotherapy for melanoma, severe complications, including death, have been reported after treatment in hypersensitized individuals. This is a case report of BCG dissemination with ulceration, skin necrosis, lymphadenitis, and abscess formation following the first intralesional injection of a minimal dose of BCG in a PPD-negative patient. The case demonstrates that severe complications can occur in patients who are not hypersensitized, anergic, or debilitated or who have been treated multiple times. This patient's complication further suggests that migration of BCG after intralesional therapy may play a role in the regression of uninjected nodules seen in some patients.

BCG Vaccine↗
PubMed1978

Intralesional treatment of recurrent metastatic cutaneous malignant melanoma: a randomized prospective study of intralesional Bacillus Calmette-Guerin versus intralesional dinitrochlorobenzene.

Eighteen patients with multiple recurrences of malignant melanoma without evident distant spread were randomly assigned to treatment with either intralesional Bacillus Calmette-Guerin (BCG) or intralesional dinitrochlorobenzene (DNCB). Both agents were able to destroy approximately 90% of the injected intradermal nodules. Intradermal disease was more easily obliterated than subcutaneous disease with intralesional treatment with either agent, and local control of satellitosis with elimination of all clinically evident tumor was achieved in the patients who had intradermal without subcutaneous satellitosis, regardless of whether the patient was receiving BCG or DNCB. The clinical courses of the treated patients were essentially the same. Although PHA reactivity was depressed, the patients in both groups were responsive to recall and melanoma skin test antigens, demonstrated leukocyte migration inhibition with melanoma antigen and were generally within normal limits when assayed for 29 degrees C E rosettes. Our study demonstrated a dramatic difference in toxicity between the two intralesional agents without a similar difference in therapeutic efficacy or immune testing.

Adult↗
PubMed1978

Excretory urography in evaluation of the surgical cancer patient.

Excretory urography was performed routinely in 504 patients with sarcoma, melanoma, pelvic, head and neck, or other localized tumors over a 5-year period. There were benign abnormalities in 14.4% of the patients examined, tumor associated abnormalities in 10.7%, and 1.4% false positives. The diagnosis of a benign lesion did not change cancer therapy in any patient. Findings on excretory urography were valuable in the management of patients with pelvic and intra-abdominal tumors. In these patients ureteral obstruction was always caused by tumor. There was a high rate of false positively in non-abdominal tumors. No second primary tumors were found.

Abdominal Neoplasms↗
PubMed1977

Barium enema, proctosigmoidoscopy and upper gastrointestinal series in the preoperative evaluation of the cancer patient.

Charts of 566 patients admitted to the Surgery Branch, National Cancer Institute over a five year period were reviewed. Routine upper gastrointestinal series was performed in 453 patients; barium enemas in 490; and proctosigmoidoscopies in 342. Upper gastrointestinal series detected no metastases or second primary malignancies but delineated the extent of large intra-abdominal tumors. Barium enema and proctosigmoidoscopy together revealed three unsuspected primary colonic tumors (1.2% in patients over 50 years of age). Sigmoidoscopy and examination of the stool for occult blood would have detected the same patients. Barium enema may be limited to surgical cancer patients in whom the extent of local tumor invasion is to be defined and to older patients in whom colonic tumors are suspected. Neither UGIS nor barium enema appear to be of value as a routine preoperative screening test in surgical cancer patients.

Adolescent↗
PubMed1977

Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma.

Review of a 19 year experience in melanoma patients undergoinglymphadenectomy at the National Cancer Institute revealedthat the preoperative assessment of the status of theregional lymph nodes was accurate 91% of the time when thesurgeon felt the nodes were clinically positive, and accurate79% of the time when the nodes were judged clinically negative. The 10-year survival in patients with one to three histologicallypositive nodes or no positive nodes was 50-55%, compared to a25% 8-year survival in patients with four or more histologicallypositive nodes. Stepwise multivariate evaluation of prognosticfactors indicated that the most important factor for predictingprognosis is the number of nodes histologically involved. Nodepalpability was the second most important factor because of itshigh correlation with number of nodes histologically involved. Site of melanoma was the third most important factor, aspatients with extremity (upper or lower) melanoma had a bettersurvival (P = 0.002) than patients with axial melanoma (trunkor head and neck). Five years following lymphadenectomythere appeared to be substantial differences in survivalaccording to differences in the level of invasion of the primarylesion, however, these differences were not nearly aspronounced 10 years following node dissection.B The division of melanoma thicknesses into <1.50 mm and>1.50 mm provided some prognostic discrimination at fiveyears but again the differences were not pronounced 10 yearsfollowing node dissection. The thickness measurements wereeasier to determine than the level of invasion, and more reproduceableon resubmission to the same pathologist. Fourpatients with melanoma less than 0.76 mm had subsequentmetastases, but these may represent inadequate sampling of theprimary melanoma both in our series and in the four similarpatients previously reported with such thin metastasizingmelanomas.

Female↗
PubMed1976

Diagnostic scalene node biopsy in the preoperative evaluation of the surgical cancer patient: Five-year experience with 108 cases and literature review.

Records were reviewed of 108 consecutive patients with a variety of surgically approachable malignancies undergoing scalene node biopsy as part of a preoperative staging evaluation. Metastases to the scalene nodes were detected in 12 patients (11.1%). In six patients the scalene nodes were clinically suspicious before biopsy, but in six with nonpalpable nodes the scalene metastases were occult clinically. Four of the patients with clinically benign, but pathologically positive, scalene biopsies were found among the group of 62 patients with epidermoid carcinoma of the cervix. It was concluded that routine scalene biopsies are justified in the properative evaluation of cancer patients only if the nodes are clinically suspicious, except for in patients with advanced pelvic cancers, in whom the incidence of completely occult scalene metastases is 6% or more.

Biopsy↗
PubMed1976

The value of the liver scan in preoperative screening of patients with malignancies.

This study analyzes the value of the liver scan as a preoperative screening procedure for occult liver metastases in patients with melanoma, sarcoma, head and neck carcinoma, and pelvic carcinoma. The records of 566 consecutive patients admitted to the Surgery Branch of the National Cancer Institute between 1969 and 1974 were reviewed and 323 patients were found acceptable for inclusion in the study. In these patients, although the liver scan had an overall accuracy of 95%, the scan identified only 50% of the patients with occult metastases to the liver and did not siginificantly add to the yield of the other screening procedures. It was useful as an adjuvant to an abnormal routine workup to confirm and localize metastases to the liver. Scans with only non specific abnormalities were of little help. Liver metastases were not identified in any patients with sarcoma, head and neck cancer, or clinically localized carcinoma of the cervix. Therefore, the liver scan was determimed to be an unnecessary part of their screening workup. Patients with recurrent or advanced carcinoma of the cervix and advanced melanoma were found to have an increased incidence of liver metastases. There was a 10% incidence of occult metastases to liver in patients with melanoma and the incidence increased with advancing clinical stage of disease. Even in this high-risk group of patients the screening liver scan did not significantly add information to that gained by history, physical examination, and blood work.

Head and Neck Neoplasms↗
PubMed1976

Adult intussusception; case report of recurrent intussusception and review of the literature.

An unusual case of lymphoma is presented in which small bowel intussusception due to a lymphomatous nodule caused an acute abdomen, requiring small bowel resection. Four weeks later a second intussusception caused intestinal obstruction, necessitating a second laparotomy and bowel resection. The high incidence of malignant tumor in adult cases leads us to recommend primary resection without manual reduction in all but rectosigmoid and selected small bowel cases.

Adult↗
PubMed1976

Effects of murine tumors on delayed hypersensitivity to dinitrochlorobenzene. I. Description of anergy caused by transplanted tumors.

In the murine model presented for tumor-associated immune suppression, normal BALB/c mice displayed significant foodpad swelling when sensitized on the flank with 2 mg dinitrochlorobenzene (DNCB) dissolved in dimethyl sulfoxide and challenged in a footpad with 0.05 mg DNCB 10 days later. This reaction in challenged footpads seemed to be a classic delayed hypersensitivity reaction, since it took 24 hours to develop and included an extensive mononuclear infiltrate. The reaction was transmissible from sensitized to normal mice by the transfer of lymphoid cells but not to serum. When sensitized 10 days after tumor inoculation, mice bearing either an allogeneic melanoma or a syngeneic lymphoma or fibrosarcoma did not demonstrate delayed hypersensitivity to DNCB.

Animals↗
PubMed1975

Inhibition of leukocyte migration by tumor-associated antigens in soluble extracts of human malignant melanoma.

Direct leukocyte migration inhibition (LMI) assays were performed to investigate whether cell-mediated immune reactions could be detected in response to tumor-associated antigens of human melanoma. The antigens were 3 M KCl-soluble extracts of different fresh melanomas, other cancers, and benign nevus tissue. A total of 48 of the 79 (61%) blood samples from melanoma patients (64 patients) reacted with extracts of melanoma tissue. Since the subjects were usually tested with two or three extracts, 57/134 (42%) tests with melanoma patients' leukocytes were inhibited by KCl extracts of melanoma tissue, whereas only 3/50 (6%) tests with leukocytes of normal donors and 4/27 (15%) with patients having other cancers gave positive results. No positive reactions were obtained when 13 melanoma patients were tested with a 3 M KCl extract of benign nevus tissue. Likewise, only 2/26 (8%) positive tests were obtained from melanoma patients tested with extracts of other cancers. Individuals in all stages of disease had similar incidences of positive reactions to the soluble melanoma extracts, except for patients with stage-1 disease who exhibited a somewhat higher incidence of reactivity. The highest incidence of reactivity was observed in patients before surgical resection of the tumor, and somewhat decreased reactivity was seen 0-14 days post surgery. The results indicate that the direct LMI assay may be used to measure cell immune reactivity against melanoma-associated antigens. Since many of the positive results were obtained with allogeneic extracts, the results also indicate that different melanomas possess common antigens.

Adult↗
PubMed1975

Staging laparotomy in the treatment of metastatic melanoma of the lower extremities.

Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).

Adolescent↗
PubMed1975

The use of bone and brain scans as screening procedures in patients with malignant lesions.

A retrospective study to determine the value of bone and brain scans was performed in preoperative patients with melanoma, sarcoma, cancer of the head and neck and carcinoma of the pelvis. No occult metastases were identified in 170 patients in whom brain scan was performed. On late follow-up data, eight patients had neurologic symptoms develop and had brain metastases identified on scan. Of 223 bone scans performed, only one distant metastatic lesion was identified. It is, therefore, suggested that, in these types of patients, bone and brain scans be reserved for those with symptoms referable to the neurologic or skeletal systems.

Bone Neoplasms↗