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Biomedical subjects

E Watkins

Publications and source records attributed to E Watkins.

At least 37 records · Page 2Linked to original sources
PubMed1987

Long-term results of resection of renal cell cancer with extension into inferior vena cava.

From July 2, 1971 to April 1, 1985, 47 patients (median age 63 years) with renal cell cancer extending into the renal vein or inferior vena cava were evaluated and treated. Two-thirds of the tumors occurred in men and three-fourths were found in the right kidney. Of the 44 patients operated on 35 had no evidence of preoperative metastatic disease at operation. The patients were divided into ideal, favorable and unfavorable subgroups. The adjusted 5 and 10-year survival rates in the former 2 groups (32 patients) were 68.8 and 60.2 per cent, respectively. In contrast, 12 patients with nodal involvement or metastases had an adjusted median survival time of 1.2 years with no survival extending beyond 4.8 years. We believe that an extended operation for renal cell cancer with involvement of the vena cava is warranted and provides reasonable long-term survival in properly selected patients.

Aged↗
PubMed1987

Evaluation of blood donors with elevated serum alanine aminotransferase levels.

We evaluated 100 asymptomatic blood donors with serum alanine aminotransferase (ALT) levels exceeding 0.83 mu kat/L, for evidence of liver disease or risk factors for non-A, non-B hepatitis and followed serum ALT levels for another 6 months. In 92 donors completing the study, ALT elevations occurred once in 33%, intermittently in 36%, persistently in 28%. Twenty-two donors were obese, 5 had clinical and biochemical evidence of alcoholic liver disease, and 45 drank alcohol regularly; 1 had hemochromatosis, and another, myopathy. In 22 no cause for elevated serum ALT levels was found. The presence or absence of risk of acquiring hepatitis did not correlate with the pattern of ALT elevations or the identification of another cause for the elevated ALT levels. In 92 blood donors with an initially elevated ALT level, two-thirds have intermittent or persistent elevations; most approximately 20% have no apparent cause for the elevations other than possible non-A, non-B hepatitis. These findings may be helpful in counseling and following blood donors with elevated ALT levels.

Adult↗
PubMed1986

Transthoracic versus extrathoracic esophagectomy: mortality, morbidity, and long-term survival.

Extrathoracic esophagectomy for carcinoma is an acceptable substitute for transthoracic resection if it can be shown to have comparable or superior safety and no adverse effect on long-term survival. To test this hypothesis, we employed extrathoracic esophagectomy in 30 consecutive patients with carcinoma of the esophagus from January, 1978, to July, 1984. During this period, 65 comparable patients underwent transthoracic resection through a left thoracotomy for lower esophageal lesions or a right thoracotomy and laparotomy for upper thoracic lesions. Only patients with carcinoma limited to the gastric cardia were excluded from the study. Overall morbidity was higher in the extrathoracic than in the transthoracic group (13 of 30 or 43.3% versus 15 of 65 or 23.1%; p = 0.05), but the differences in hospital mortality (4 of 65 or 6.2% for the transthoracic group versus 4 of 30 or 13.3% for the extrathoracic group) and duration of hospital stay (17.4 +/- 11.7 days for the transthoracic group versus 20.5 +/- 13.4 days for the extrathoracic group) were not statistically significant. Considering all patients who either died or sustained a postoperative complication, we found significant differences favoring transthoracic resection in those subgroups of patients who were able to undergo primary reconstruction at the time of resection (12 of 57 or 21.1% versus 15 of 28 or 53.6%; p = 0.004), those with advanced Stage III lesions (11 of 47 or 23.4% versus 12 of 20 or 60%; p = 0.006), those with tumor of the lower esophagus (8 of 35 or 22.9% versus 6 of 10 or 60%; p = 0.04), and those with tumor that could be resected through a left thoracotomy (2 of 18 or 11.1% versus 17 of 30 or 56.7%; p = 0.002). Actuarial survival curves for all transthoracic and extrathoracic resections and separate analysis for Stage I and Stage III tumors revealed no statistically significant differences between these two techniques.

Aged↗
PubMed1986

Segmental pancreatic autotransplantation with pancreatic ductal occlusion after near total or total pancreatic resection for chronic pancreatitis. Results at 5- to 54-month follow-up evaluation.

Reported are eight patients with idiopathic chronic pancreatitis and two patients with alcoholic pancreatitis who had near total distal pancreatectomy for disabling pain and underwent simultaneous segmental pancreatic autotransplantation of the body and tail of the gland to the femoral area in an attempt to prevent or delay the onset of diabetes. The median follow-up period was 31 months, and follow-up study in nine patients ranged from 24 to 54 months. Patency of the grafts was determined by angiography and selected percutaneous venous assays for insulin. Islet cell function was determined by oral glucose tolerance tests, intravenous (I.V.) glucose tolerance tests, and I.V. glucagon stimulation studies. Segmental autotransplantation was technically successful in eight patients, only one of whom required insulin (at 2 years after grafting). The other seven patients with technically successful grafts have remained insulin independent, including two patients who later underwent pyloric preserving pancreatoduodenectomy for completion pancreatectomy. Variable pain relief was observed in patients who underwent near total pancreatectomy, but pain was unrelieved in those patients who underwent limited distal resection. Patients with idiopathic pancreatitis appear to have better pain relief and preservation of endocrine function than alcoholic patients. Segmental pancreatic autotransplantation prevents or delays the onset of diabetes mellitus and should be considered as an alternative for those patients who require extensive pancreatic resection for chronic pancreatitis.

Adult↗
PubMed1986

Pyloric and gastric preserving pancreatic resection. Experience with 87 patients.

Eighty-seven patients with neoplasm (57 cases), pancreatitis (28 cases), or benign biliary obstruction (2 cases) were treated with pyloric preserving pancreatectomy with two postoperative deaths, neither due to abdominal complications. About 50% of patients had delay in recovery of gastrointestinal function. Six and seven patients had clinically significant biliary and pancreatic fistulas, respectively, with some patients having both. Complications required 16 reoperations. Marginal ulcer was suggested by endoscopy or barium study in five patients, three of whom were successfully managed by a medical regimen. In the other two patients, exploration failed to demonstrate an ulcer or jejunitis. In most patients, long-term gastrointestinal function was judged to be excellent based on weight gain and lack of digestive symptoms. Pyloric function and gastric motility were evaluated by abdominal scanning using indium 111 and technetium 99m. Gastric emptying of liquids and solids was normal. Estimations of enterogastric reflux showed a moderate difference between normal subjects and pancreatectomy patients. Cancer-free survival was comparable to that after the standard Whipple procedure.

Adenocarcinoma↗
PubMed1986

Vascularized versus nonvascularized nerve grafts: an experimental structural comparison.

This study compared the success of nerve regeneration through conventional nonvascularized and vascularized nerve grafts in the sciatic nerve of rats. The number or size of regenerated axons between the two grafts was not significantly different. In addition, the ratio of axonal diameter to total diameter of the nerve, a measurement linearly related to conduction velocity, was not significantly different in the two groups. Thicker myelin sheaths were found around axons in the nonvascularized nerve grafts.

Animals↗
PubMed1986

Target-specific nerve regeneration through a nerve guide in the rat.

Nerve regeneration across a gap in peripheral nerve has been achieved through various nonneural nerve guides in both lower and primate species. This technique can only be useful if the regenerated nerve cable grows specifically to and reinnervates the appropriate distal target. In this study, the proximal peroneal fascicle of rat sciatic nerve was inserted into the proximal limb of a Y-shaped nerve guide. Distal peroneal and tibial fascicles were placed within the two distal limbs of the same Y. The proximal peroneal nerve grew preferentially by a 2:1 ratio to the appropriate distal peroneal fascicle suggesting that target-specific reinnervation is possible through a nerve guide.

Animals↗
PubMed1985

Results of valve reconstruction for mitral regurgitation secondary to mitral valve prolapse.

Mitral valve prolapse (MVP), often the result of myxomatous degeneration of the mitral valve, is the most commonly known pathologic entity leading to pure mitral regurgitation (MR). Reconstruction of the mitral valve rather than replacement is particularly applicable to this pathologic defect, but is not often used in the U.S. Experience with reconstruction of the mitral valve for MR secondary to MVP during the period January 1970 to January 1984 was reviewed. A total of 479 patients with mitral valve disease underwent operation during this period, 82 (17%) of whom had MR secondary to MVP. Thirty-one patients (6%) had valve reconstruction by a technique of leaflet plication and posteromedial anuloplasty. Eleven of these patients had associated cardiac disease requiring correction: 2 requiring aortic valve replacement and 9 requiring coronary artery bypass grafting procedures. One hospital death (3%) and 6 late deaths (19%) occurred, of which only 3 were related to cardiac factors. Major complications included recurrent MR in 5 patients and cerebral embolus in 1 patient. The adjusted 5-year survival rate was 89 +/- 6 (mean +/- standard error of the mean), and the overall survival rate of patients free of cardiac-related complications was 73 +/- 9%. Thus, reconstruction of the mitral valve is a highly effective surgical approach to the management of symptomatic patients with MR secondary to MVP, and its use is favored over replacement in the management of these patients.

Actuarial Analysis↗
PubMed1985

Immunogenicity of hepatitis B vaccine in renal transplant recipients.

To evaluate the immunogenicity of hepatitis B vaccine in renal transplant recipients, we administered three 40-microgram doses of vaccine to 17 patients who had previously undergone transplantation and were on immunosuppressive therapy. Life-table analysis revealed a cumulative antibody response rate of only 17.6% at 12 months, and the three responders had low titers of antibody to hepatitis B surface antigen. There were no serious adverse effects and no episodes of graft rejection in responders or nonresponders. In addition, the ratio of helper/inducer (T4) to suppressor/cytotoxic (T8) T cells in vaccinees bore no relationship to the immunogenicity of the vaccine. These data indicate that hepatitis B vaccine is weakly immunogenic in renal transplant recipients and illustrate the need for vaccination prior to transplantation for maximal protection against hepatitis B virus infection.

Adult↗
PubMed1985

Immunogenicity of hepatitis B vaccine in oncology patients receiving chemotherapy.

We evaluated the immunogenicity and safety of three 40 micrograms doses of hepatitis B vaccine in oncology patients receiving chemotherapy. Of 76 patients screened for entry into the study, 13 (17%) already had been exposed to hepatitis B and were ineligible; 26 chose to join the study. The cumulative life-table response rate during the 12-month observation period was 70.8%; adequate immune response was linked to survival, 73% in survivors completing the study and 9% in nonsurvivors. Adverse effects were minor. We conclude that hepatitis B vaccine is safe and usually effective in inducing immunity in oncology patients younger than 60 years of age who are receiving chemotherapy.

Adult↗
PubMed1985

Overview of the current management of carcinoma of the esophagus and cardia.

Esophagogastrectomy with esophagogastrostomy provides the best palliation for patients with carcinoma of the esophagus and cardia. It affords better palliation, longevity and overall survival than do other forms of therapy either singly or in combination. Treatment span is short, the patient is able to return to a reasonably normal life-style relatively quickly and the debilitating effects of dysphagia are relieved in most patients. Between January 1970 and July 1984 at the Lahey Clinic Medical Center, the overall operability rate was 80.3% and the resectability rate 87.2%. Four of 191 patients who underwent resection died for a hospital death rate of 2.1%. The overall 5-year survival rate was 16.3% and 81.2% of patients had successful palliation of dysphagia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Biliary carcinoma. A review of 109 cases.

One hundred nine patients operated on for bile duct carcinoma were reviewed. Herein, we reported 83 proximal duct tumors, 12 mid-duct tumors, and 14 distal third tumors. Resectability was 10 percent, 33 percent, and 100 percent, respectively, with an operative mortality of 0 percent, 25 percent, and 23 percent. The median survival time and 5 year survival rate for these resected groups were 21 months and 25 percent for proximal duct tumors, 8 months and 0 percent for mid-duct tumors, and 16 months and 20 percent for distal third tumors. Eighty-three patients were treated with strictly palliative procedures with an operative mortality of 19 percent, an adjusted median survival rate of 10.9 months, and a 5 year survival rate of 0. The 2 and 5 year survival rates of patients with well-differentiated tumors were 73 percent and 15 percent, respectively, whereas for patients with poorly differentiated lesions, it was 6 percent and 0. Although most patients require palliative decompressive procedures, resection should be attempted whenever possible. It is expected that nonoperative techniques will have an increased role in the treatment of poor-risk patients or those who have unresectable disease.

Adenocarcinoma↗
PubMed1984

Operation for esophageal achalasia. Results of esophagomyotomy without an antireflux operation.

Between January, 1970, and January, 1984, 113 patients with esophageal achalasia underwent 115 esophagomyotomies at the Lahey Clinic. Twenty-nine patients had been treated on one or more occasions by forceful dilation, and 18 had been operated upon before. Results are based on follow-up studies of 103 patients operated on 1 to 13.5 years ago (average follow-up period, 6.75 years). Six patients were lost to follow-up study, and six were operated upon less than a year ago. The condition of 94 patients (91%) was improved by operation. The improvement rate was 94% for those who underwent a primary operation and 76% for those who underwent reoperation. Only four of the nine poor results were caused by reflux esophagitis, and these patients are satisfactorily managed medically. Multiple regression analysis of risk factors including age, sex, duration of symptoms, severity of disease, length of follow-up, previous operation, and forceful dilations revealed that only previous operation correlated significantly with poor results (p = 0.0004). Preoperative and postoperative manometric assessment of the lower esophageal sphincter was made on some of these patients. The amplitude of lower esophageal sphincter pressure dropped from 32.5 +/- 1.6 (SEM) to 14.5 +/- 1.4 mm Hg, and the length of the lower esophageal sphincter decreased from 3.7 +/- 0.1 to 2.2 +/- 0.1 cm. These differences were highly significant (p = 0.001). After myotomy a short subhiatal remnant of the lower esophageal sphincter remains with pressure within the normal range, which minimizes the risk of postoperative gastroesophageal reflux. Because of the high success rate of limited esophagomyotomy and the low incidence of significant reflux symptoms after its use, we recommend that it be performed without an associated antireflux procedure.

Adolescent↗
PubMed1984

Metastasis control by injection of blood lymphocytes cultured with neuraminidase-treated MT/W 449A rat mammary carcinoma.

Inevitable metastatic disease was partially controlled in Wistar/Furth rats after intraperitoneal injection of blood lymphocytes cultured with neuraminidase-treated tumor cells and phytohemagglutinin after amputation of implanted syngeneic MT/W 449A mammary adenocarcinoma. Control of MT/W 449A metastasis was limited to animals with primary tumors weighing less than 700 mg. An optimal 20-25 X 10(6)-lymphocyte dose gave control in 8 of 18 animals (44%). Metastasis control rate was 50% in animals with small primary tumors (less than 250 mg). All animals in different control groups died of metastatic disease, without significant survival differences among overall groups or tumor weight-stratified subgroups. Intraperitoneal injection of neuraminidase-treated tumor cells alone did not control metastatic disease. Cell-mediated 51Cr-release cytotoxicity indexes of test inocula were significantly predictive of longevity and survival.

Animals↗
PubMed1983

Segmental pancreatic autotransplantation for chronic pancreatitis.

Three patients who underwent 95 percent removal of the pancreas for chronic pancreatitis with autotransplantation of the body and tail of the gland to the femoral area are described. The follow-up periods are 18, 6, and 2 months. Pain lessened in all patients and none required exogenous insulin. Patency of the graft was documented in all patients by angiography, technetium scan, and Doppler studies. Percutaneous selective venous assays of both external iliac veins showed a high insulin concentration in the transplanted side, both early and late in the postoperative period. In one patient the operative insulin levels obtained at the completion of autotransplantation proved to be highest in the external iliac vein on the transplanted side, lowest in the iliac vein on the nontransplanted side, and intermediate in the portal vein. Subsequent biopsies of the autografts showed fibrosis of the gland and atrophy of the acinar tissue with preservation of islet tissue. This technique appears to offer a means of preserving endocrine function in selected patients who require extensive resection for chronic pancreatitis.

Adult↗
PubMed1983

Esophagogastrectomy. A safe, widely applicable, and expeditious form of palliation for patients with carcinoma of the esophagus and cardia.

Of 262 patients with carcinoma of the esophagus or cardia seen at the Lahey Clinic between January 1970 and January 1983, 209 (79.8%) underwent surgical exploration. This report is confined to the 167 operations performed in the division of the senior author. Half of the tumors involved the esophagogastric junction with nearly equal numbers being located in the lower and upper halves of the thoracic esophagus and a relatively small number involving the cervical esophagus. The majority were adenocarcinomas of which 20 developed in a Barrett esophagus. Three of the squamous cell cancers developed in an achalasic esophagus. Of the resected tumors, 94 were classified as Stage III, 18 as Stage II, and 37 as Stage I. Esophagogastrectomy with esophagogastrostomy is the procedure of choice regardless of the level of the lesion. Of the 167 patients, 149 (89.2%) underwent resection with two deaths within 30 days of operation for a hospital mortality rate of 1.3%. There were 22 major complications (14.9%), which prolonged the hospital stay, and 14 minor complications (9.5%). Satisfactory palliation of dysphagia was achieved in 82.7% of the patients. The overall adjusted survival rate at 5 years was 21.7% +/- 7.5% (SEM) with a median survival time of 17.3 months. The 5-year adjusted survival rate according to stage was 43.4% for patients with Stage I lesions, 23.6% for Stage II lesions, and 12.8% for Stage III lesions (p = 0.0004). A multivariate analysis of risk factors involved in survival disclosed that neither age, sex, site of tumor, duration of symptoms, or cell type influenced survival, but stage of the disease had a profound effect. It is concluded that long-term survival of patients with carcinoma of the esophagus or cardia will probably not improve until early diagnosis is possible and that esophagogastrectomy by conventional techniques should be the treatment of choice until other forms of therapy prove superior to it both in terms of palliation and long-term survival.

Adult↗