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Biomedical subjects

F L Greene

Publications and source records attributed to F L Greene.

At least 55 records · Page 3Linked to original sources
PubMed1996

Wound recurrence following laparoscopic colon cancer resection. Results of the American Society of Colon and Rectal Surgeons Laparoscopic Registry.

INTRODUCTION: Multiple case reports have suggested that laparoscopic resection of colon cancer may alter the pattern or incidence of cancer recurrence. All reports lack a significant denominator to evaluate the incidence of surgical wound recurrence. We hypothesized that wound recurrence incidence is not increased by laparoscopic resection of colon cancer. METHODS: A prospective registry was initiated under the auspices of The American Society of colon and Rectal Surgeons, American College of Surgeons, and Society of American Gastrointestinal Endoscopic Surgeons in 1992. Patients having laparoscopic colon resection were voluntarily entered and followed until June 1995. Recurrences were evaluated by the primary surgeon and reported to the registry. RESULTS: A total of 504 patients treated for cancer were identified in the registry. A minimum follow-up of one year was obtained for 480 of 493 evaluable patients (97.4 percent). Wound recurrence was identified in five patients (1.1 percent). Recurrence status was unknown in 18 patients (3.8 percent). CONCLUSION: Wound recurrence rates appear to be low. Although length of follow-up is limited, patterns of recurrence from previous studies suggest that 80 percent of recurrences should have occurred within one year. Given the limitations of a Phase II study, the hypothesis that recurrence rate is low is supported. However, prospective randomized trials are needed to establish if any difference in wound recurrence rates after laparoscopic or open resection of colorectal cancer exists.

Colectomy↗
PubMed1996

Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program.

SUMMARY BACKGROUND DATA: Partial gastrectomy for benign peptic ulcer disease is associated with an increased risk of adenocarcinoma of the gastric remnant, especially in patients who are at least 15 years' postgastrectomy. Increasing evidence of mucosal dysplasia is noted on random gastric biopsy and may serve as a histologic marker in the identification of early cancer of the gastric stump. METHODS: From an initial group of 233 patients who underwent gastrectomy for benign peptic ulcer disease between 1960 and 1975, 163 patients began yearly flexible gastroscopy and random mucosal biopsy. Routine histologic studies identified either normal or dysplastic epithelium as well as adenocarcinoma. An average of eight biopsies were taken per endoscopic study. All endoscopic studies were performed by surgical residents under the supervision of one surgical attending. RESULTS: From July 1980 to June 1995, 145 patients completed annual gastroscopy and random biopsy. A total of 2287 endoscopic studies were performed. Fifteen patients were found to have severe dysplasia. Nine (60%) had associated microscopic evidence of adenocarcinoma. Four additional patients had macroscopic adenocarcinoma on endoscopic examination. All 13 patients with cancer were asymptomatic. Six patients continue surveillance who display moderate-to-severe dysplasia alone. The 13 patients with carcinoma underwent completion gastrectomy (R2 nodal dissection) with no evidence of cancer found beyond the gastric wall. These patients averaged 29 years since their original partial gastrectomy. OBJECTIVE: A prospective screening program for gastric remnant cancer was begun to assess the ability to discover early neoplastic changes on random biopsy and to make treatment decisions regarding the efficacy of completion gastrectomy after discovery of carcinoma. CONCLUSIONS: Aggressive annual screening using flexible endoscopy and multiple random biopsy may discover cancer in the gastric remnant and can lead to completion curative gastrectomy in asymptomatic people. Patients who are at least 20 years postpartial gastrectomy for benign disease should be considered for annual endoscopic surveillance.

Adenocarcinoma↗
PubMed1995

Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography.

Although pneumoperitoneum has been well tolerated in a predominantly healthy population, there is concern that an increased intraperitoneal pressure may be poorly tolerated in patients with marginal cardiopulmonary function. The purpose of this study was to demonstrate noninvasively the hemodynamic effects of carbon dioxide pneumoperitoneum utilizing biplane transesophageal echocardiography. Fourteen otherwise-healthy patients undergoing nonemergent laparoscopic cholecystectomy were studied using bi-plane transesophageal echocardiography under a standardized anesthetic protocol utilizing isoflurane, fentanyl, and vecuronium bromide. End-tidal CO2, oxygen saturation, cardiac rhythm, temperature, and blood pressure were monitored noninvasively. Minute ventilatory volume was adjusted as needed to keep end-tidal CO2 less than 38 mmHg. Data were recorded at baseline, following abdominal insufflation to 15 mmHg with CO2, with head-up tilt of 20 degrees, following exsufflation, and with the patient level. Significance was determined using a paired Student t-test. Insufflation to 15 mmHg decreased cardiac index (C.I.) by 3% (3.34 to 3.23 l/min/m2) while both heart rate (HR) and mean arterial pressure (MAP) increased (by 7% and 16%), respectively, and stroke volume index decreased by 10% (from 51.6 to 46.6 ml/beat/m2). Head-up tilt of 20 degrees further decreased CI to 2.98 l/min/m2 (-11%) and SVI to 40.3 ml/beat/m2 (-22%) while HR increased by a total of 14% and MAP by 19%. As laparoscopic techniques are applied to a broader population, the impact of small but significant decrements in cardiac function become increasingly important. This study demonstrates that the combination of CO2 pneumoperitoneum and the reverse Trendelenburg position does adversely effect cardiac output.

Adolescent↗
PubMed1995

Discovery of early gastric remnant carcinoma. Results of a 14-year endoscopic screening program.

Partial gastrectomy for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma, particularly in patients who are 15-20 years postresection. Using a planned protocol of routine endoscopic surveillance with biopsy, 163 patients who were at least 10 years postgastrectomy for benign ulcer disease have undergone screening flexible esophagogastroduodenoscopy (EGD) between July 1980 and August 1994. The completed study group consists of 153 patients who have been examined at least yearly over the 14-year period of surveillance. Routine biopsies from various areas of the gastric remnant have been interpreted for dysplasia or early gastric adenocarcinoma. Patients who evidenced significant dysplasia or adenocarcinoma were offered complete gastrectomy during the study. Results of this ongoing 14-year screening program revealed severe dysplasia of the gastric remnant in 13 patients (8.4%) with eventual findings of adenocarcinoma in seven of this group (54%). These seven patients underwent total gastrectomy with findings of limited disease. Six patients continue to be followed with evidence of dysplasia. During this 14-year screening program, seven patients undergoing completion gastrectomy for early gastric remnant adenocarcinoma continue to be well and free of disease. This aggressive screening program supports the concept that neoplastic change in the gastric remnant is a function of time from the initial gastric resection. Patients identified with early gastric remnant carcinoma benefit by completion gastrectomy. In addition, patients harboring dysplasia in the gastric remnant should continue to be followed in an aggressive screening protocol utilizing random biopsy.

Adenocarcinoma↗
PubMed1995

Laparoscopic Bowel Surgery Registry. Preliminary results.

UNLABELLED: Laparoscopic surgery has evolved rapidly since 1989. The American Society of Colon and Rectal Surgeons, the Society of American Gastrointestinal Endoscopic Surgeons, and the American College of Surgeons Commission on Cancer jointly sponsored a registry to identify as early as possible the patterns of practice and acute complications of laparoscopic colectomy. METHODS: Cases were voluntarily registered by community and academic surgeons. Information was entered in the EPI-5 database. RESULTS: One thousand fifty-six cases were contributed by 118 surgeons; 763 patients were completed laparoscopically. The most common indication for surgery was cancer in 453 patients. The right colon (n = 364) and sigmoid (n = 294) were most frequently resected. Respondents felt adequate cancer resections were performed. Although several unique complications were noted, intraoperative complications were similar in type and frequency to open cases. CONCLUSION: Laparoscopic colorectal surgery can be performed with acceptable complications. It remains unclear if this approach is adequate for long-term management of colon and rectal cancer.

Colectomy↗
PubMed1995

Predictors of Pap smear screening in socioeconomically disadvantaged elderly women.

OBJECTIVE: The objective for this study was to identify predictors for participation in Pap smear screening in a socioeconomically disadvantaged older population. DESIGN AND SAMPLE: A cross-sectional survey design was used to examine data from 238 southern women 50 years of age and older who were recruited from 24 randomly selected congregate meal sites of the Council on Aging. MEASUREMENTS: The 45-item questionnaire covered demographics, Pap smear screening history, and colorectal cancer screening history. RESULTS: Among this older, very low income population, women who had never had Pap smears (17.2%) were significantly more likely to have no phone or to be unable to use a phone (adjusted odds ratio (aOR) = 4.1; 95% confidence interval (CI) 1.6-10.6), to have annual incomes of less than $5,800 (aOR = 3.1; 95% CI 1.1-9.0), to be widowed (aOR = 2.8; 95% CI 1.1-7.3), to have no family history of cancer (aOR = 3.3, 95% CI 1.3-10.0), to report having never had a rectal examination (aOR = 5.4, 95% CI 1.8-16.0), and not to have participated in a free fecal occult blood testing program (aOR = 5.0, 95% CI 2.0-10.0). CONCLUSIONS: These data, unique in including very low income (< $10,000) and older women (65 and over), found that income and access to a phone were strongly correlated with cervical cancer screening participation. Women who lacked external incentives for screening (being widowed and not having a family history of cancer) were less likely to obtain screening. This study's finding that "not having a phone" was a strong predictor for nonparticipation in cervical cancer screening has implications for national telephone-derived estimates of cervical cancer screening.

Age Factors↗
PubMed1995

Role of esophagogastroscopy in application and follow-up of high-dose-rate brachytherapy (HDRB) for treatment of esophageal carcinoma.

Flexible esophagogastroscopy (EG) and external beam radiotherapy (EBR) have become important means of diagnosing and treating both squamous and adenocarcinoma of the esophagus and gastroesophageal (GE) junction. Recently, new technology, termed high-dose-rate brachytherapy (HDRB), utilizing the placement of radioisotopes in the esophagus by endoscopic techniques has been introduced. This report describes the endoscopic application of the brachytherapy afterloading catheters and the additional role of EG in the posttreatment assessment of these patients. Twenty-four patients (21 esophageal, 3 GE junction) were treated using HDRB delivered by afterloading catheter techniques utilizing flexible EG. Radiation dosages ranged from 5 Gy (500 rads) to 8 Gy (800 rads) delivered to the tumor bed over an average of three applications. All patients were followed to assess swallowing ability, endoscopic evidence of tumor reduction, and complications resulting from intraluminal radiation therapy. Fifteen patients had reduction in intraluminal tumor based on endoscopic evaluation. Seven had partial or complete relief of dysphagia. Nine patients required gastrostomy tube placement for alimentation before or after therapy. Four patients had complications of perforation (1), fistula (1), or bleeding (2) after HDRB. Overall survival ranged from 2 to 27 months (mean = 8.9 months) after the first HDRB treatment. EG proved to be an efficient and safe technique for the introduction of intraluminal esophageal radiation therapy.

Adenocarcinoma↗
PubMed1992

Laparoscopy in malignant disease.

The use of laparoscopy in patients with malignant disease is particularly helpful diagnostically and will often impact on future therapy. The indications and complications of this technique in combination with other diagnostic and therapeutic modalities in patients with malignant disease are evaluated and the accuracy of results are compared to laparotomy procedures. Future trends in laparoscopic surgery also are discussed.

Abdominal Neoplasms↗
PubMed1992

The effect of breast clinic participation on the education of third-year medical students.

Traditional methods of teaching concepts of breast disease to medical students have included didactic lectures, patient interviews and examinations in the hospital, and patient-directed rounds with housestaff and attendings. From 1980 to 1987, third-year students at the University of South Carolina School of Medicine participated in these educational experiences and were tested at the conclusion of the eight-week surgical core rotation, utilizing written and oral examinations. Beginning in July 1987, students began participating in a defined weekly Diagnostic Breast Clinic which included in-depth instruction in patient examination techniques, mammographic interpretation, and treatment planning. Results of oral and written examinations, specifically regarding knowledge of breast cancer, were compared between the early and later periods. Significantly improved performance was noted in students exposed to a defined breast clinic experience and strongly supports the integration of specific cancer clinic experiences in undergraduate medical education.

Breast Diseases↗