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Biomedical subjects

E W Martin

Publications and source records attributed to E W Martin.

At least 163 records · Page 9Linked to original sources
PubMed1966

The D-I-A idea.

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Information Services↗
PubMedDate not supplied

Impact of Radioimmunoguided Surgery.

Radioimmunoguided surgery (RIGS) is a technique employed to locate tumor deposits with the aid of intravenously injected, tumor-specific, radiolabeled monoclonal antibodies and a small gamma detecting device. The gamma detecting probe (GDP) is a small, portable unit which has the capacity to be used intraoperatively to survey the entire peritoneal surface for increased radioactivity indicative of targeted tumor tissue during abdominal exploration for colorectal cancer. Trials in humans have demonstrated the ability of this system to locate clinically nonpalpable tumor deposits in patients undergoing carcinoembryonic antigen second-look laparotomies. This feature may be of value in improving the definition of tumor location and extent as well as allowing a more thorough resection of tumor-bearing tissue to be performed and hopefully improving overall patient survival.

Antibodies, Monoclonal↗
PubMedDate not supplied

Monoclonal antibodies in imaging and therapy of colorectal cancer.

Intraoperative detection of colorectal carcinoma with the Neoprobe gamma detector has been useful in surgical decisionmaking regarding resectability by localizing additional tumor not readily identified by palpation or inspection, and in determining surgical resection margins. Tumor labeling has been achieved in 84% of the patients. Occult tumor has been identified in 18% of evaluable patients and changed operative decisions in 43% of patients. New monoclonal antibodies with radiolabels offer hope for more effective agents for imaging, Radioimmunoguided Surgery and potential therapeutic modalities.

Antibodies, Monoclonal↗
PubMedDate not supplied

Radioimmunoguided surgery for patients with liver metastases secondary to colorectal cancer.

BACKGROUND: Hepatic resection for metastatic colorectal cancer offers a 5-year survival rate of 30%. Selection of patients who are most likely to benefit from excision is challenging. The judgment is made by radiographic techniques preoperatively and by sight and touch and the instinct of the surgeon intraoperatively. Confirmation that all tumor tissue has been excised relies on the appearance and texture of the tissue and is verified by routine histology. The authors' objective was to evaluate (1) the ability of radioimmunoguided surgery (RIGS) to improve the intraoperative detection of metastatic disease, and (2) any change in the operative plan originating from the information gained in patients with colorectal liver metastases. METHODS: Charts and tumor registry data for patients who underwent planned liver resection for colorectal cancer using the RIGS method from January 1985 to December 1993 were reviewed. This group of patients was compared to a similar group that underwent traditional liver resection for metastatic colorectal cancer during the same period. Patients who had the RIGS procedure during the earlier part of the period (1985-1990), were injected with tumor-associated glycoprotein (TAG) antibody B72.3; those in the later period (1990-1993) were injected with the second-generation anti-TAG monoclonal antibody CC49. Both monoclonal antibodies were labeled with sodium iodide I 125. Both traditional and RIGS exploration were used to determine the extent of the malignant process and any change in operative plan. RESULTS: Seventy-four cases of planned liver resection were performed with the RIGS method (group I), and 215 cases were performed with the traditional method (group II). Age and sex distribution were similar in both groups, as were morbidity and mortality, with an overall perioperative mortality of 1%. The distribution and number of metastatic lesions to the liver were the same, although group I included more cases with smaller metastatic lesions and more patients with anatomic resections. No extrahepatic tumor was found in 140 patients (65%) in group II, whereas there were only 21 patients (28%) in group I in whom no extrahepatic disease was detected (P < .001). RIGS exploration identified additional tumor in 12 (16%) of 74 cases: in the gastrohepatic ligament lymph nodes (LN) in five patients, in the celiac axis LN in one patient, and in the periaortic LN in six patients. These discoveries changed the operative plan for all of these patients, avoiding excision in the latter six patients and extending the resection in the other six. CONCLUSIONS: RIGS surgery provides an immediate and more accurate intraoperative staging system of patients with colorectal liver metastases than does traditional exploration by identifying additional metastatic disease, mainly to the lymph nodes, thus changing the plan of resection in a significant number of patients. More studies are needed to evaluate any significant survival advantage of patients who undergo removal of all RIGS-positive tissue.

Adult↗
PubMedDate not supplied

Delirium in patients with cancer at the end of life.

PURPOSE: Delirium is a common and distressing syndrome seen in patients with advanced cancer. Behavioral manifestations of delirium, such as agitation, may result in medical intervention, stress to family caregivers, and inpatient hospice admission. The purpose of this study was to examine the frequency, characteristics, and presumed causes of delirium in patients with advanced cancer. DESCRIPTION OF STUDY: Records of all patients with cancer who were admitted to an inpatient hospice facility in 1995 were reviewed retrospectively (N = 210). Patients were classified as delirious based on the clinical judgment of the admitting physician. RESULTS: Delirium was the third most common reason for admission (20%). Male gender (P = .04) and the presence of a primary or metastatic brain tumor (P = .03) were significant risk factors for delirium, while advanced age and primary or metastatic liver, lung, or bone cancer were not. Resolution of the agitation, the most disruptive symptom of delirium, occurred in 69% of patients before death or discharge. CLINICAL IMPLICATIONS: Delirium is common in hospice patients with cancer and is an important cause of family distress and increased cost of care. The recognition of early clinical signs and predisposing factors should facilitate prompt diagnosis. Appropriate intervention is usually successful in alleviating the most distressing symptoms of delirium.

Adult↗
PubMedDate not supplied

Preoperative 3D rendering of MR imaging in liver metastases.

In 15 patients who were to undergo resection of hepatic metastases, three-dimensional (3D) images of the liver were rendered from axial T2-weighted MR images by a dedicated 3D workstation. This report assesses the utility of these images in preoperative planning and intraoperative guidance. In three patients, the preoperative 3D images convinced the surgeon of resectability. All patients had laparotomies and in 12 patients, in whom the liver lesions were evaluated, there was good to excellent spatial correlation. Intraoperatively, the 3D images aided the surgeon by allowing early detection of unresectability, by showing relationships of lesions to major vessels, and by directing the surgeon to lesions otherwise difficult to find. In two patients, the original MR images failed to show multiple small lesions, thus limiting the usefulness of the 3D images.

Colonic Neoplasms↗
PubMedDate not supplied

Confusion in the terminally ill: recognition and management.

Pain has been managed aggressively by hospice programs. However, other problems, particularly neuropsychiatric problems, such as confusion, can go unrecognized and untreated even in a hospice setting. The resulting disturbing, violent or disruptive behavior will severely detract from the quality of life the patient and family can share together. Dementia and delirium can be diagnosed using a mental status exam. Care-givers can then be informed about the special needs of the patients and prepared for potential problems. Identification of reversible causes for delirium can continue while agitated behavior is managed with behavioral and pharmacologic approaches. Confusion is a common problem in the terminally ill and prompt recognition and management of the potentially disruptive symptom can do a great deal to maximize the quality of the patient's life.

Cognition Disorders↗