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Biomedical subjects

F L Greene

Publications and source records attributed to F L Greene.

At least 73 records · Page 4Linked to original sources
PubMed1990

Neoplastic changes in the stomach after gastrectomy.

Partial gastric resection for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma, particularly 15 to 20 years after resection. These remnant carcinomas are particularly virulent with little hope of resection or cure once symptoms occur. Using a planned protocol of routine endoscopic surveillance with biopsy, the goal was to identify early markers of neoplasia, that is, dysplasia, and a diagnosis of adenocarcinoma of the gastric remnant, while both resection and cure were possible. Between July 1980 and August 1988, yearly flexible gastroscopic examination and random biopsy have been performed on 163 patients at least ten years after gastrectomy for benign ulcer disease. All biopsy results were interpreted for findings of dysplasia and early gastric adenocarcinoma. Results of this ongoing screening program revealed dysplasia of the gastric remnant in nine patients with eventual findings of adenocarcinoma in four of this group. These patients underwent total gastrectomy with findings of limited disease. Five patients with mucosal dysplasia continue to be observed at six month intervals. Three additional gastric carcinomas were found on initial gastroscopic screening, while one patient had adenocarcinoma diagnosed during a third yearly gastroscopic examination. These eight asymptomatic patients with adenocarcinoma in the gastric remnant had a postgastrectomy interval which ranged from 15 to 29 years (mean of 26.5 years). The results of this study support the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection. Findings of dysplasia on random biopsy indicate a greater likelihood of development of carcinoma of the gastric remnant and identify a subset of patients requiring aggressive endoscopic surveillance.

Adenocarcinoma↗
PubMed1990

The effect of preoperative endoscopy on recurrence and survival following surgery for colorectal carcinoma.

Numerous studies have elucidated the benefits of endoscopy before surgery for carcinoma of the colon and rectum. In patients with known colon cancer, the incidence of synchronous colon cancers is 1.5 to 7.6 per cent and synchronous colon polyps is 25 to 40 per cent. Standard barium contrast studies are inferior to endoscopic examination in detecting these synchronous lesions. Endoscopy has been shown to alter the planned surgical procedure in 11 to 13 per cent of patients with colorectal cancer. Nevertheless, some authors avoid preoperative endoscopy because of concern that neoplastic cells may be seeded throughout the colon during the examination. They fear that manipulation of the tumor may promote hematogenous or lymphatic spread. Our study seeks to demonstrate whether this concern is valid by comparing rates of local recurrence, distant metastases, and survival between patients who have undergone preoperative endoscopy with those who have not.

Adult↗
PubMed1989

Failure of preoperative staging to assess unresectability in M0 bronchogenic carcinoma.

Despite extensive preoperative staging, unresectability of a bronchogenic carcinoma may not be known until an exploratory thoracotomy is done. Failures in anatomic staging occur because of inability to detect local extent of hilar lesions and inability to detect small deposits of metastatic disease. At the University of South Carolina, nine of 75 patients who underwent thoracotomies were found to be unresectable. Using an extensive staging protocol, the "back out" thoracotomy rate can be reduced to a minimum whereas no patient is denied a chance for surgical cure.

Carcinoma, Bronchogenic↗
PubMed1989

Gastroscopic screening of the post-gastrectomy stomach. Relationship of dysplasia to remnant cancer.

In July 1980, an aggressive screening program for benign disease of the stomach in 163 patients at risk for carcinomatous change of the gastric remnant was instituted. All patients were at least ten years post-gastrectomy. Three gastric remnant cancers were identified during esophago-gastroduodenostomy (EGD) on 45 patients undergoing only one screening endoscopic examination during the study. One hundred and eighteen additional patients underwent two or more screening gastroscopic studies between July 1980 and July 1985. Of this group, seven patients (5.8%) had gastric biopsies showing mild to moderate dysplasia in the gastric remnant. During the period July 1985 to July 1987, these seven patients underwent two to four additional gastroscopic examinations that revealed carcinoma of the gastric remnant in two patients (28%) with progression of the dysplastic changes in three of these seven patients (42%). The post-gastrectomy interval in these seven patients ranged from 10 to 27 years with a mean of 21.5 years. This study supports the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection. EGD and biopsy are important in identifying dysplastic changes which may be harbingers of invasive carcinoma of the gastric remnant. Aggressive endoscopic screening is recommended for patients with dysplasia in order to identify gastric remnant cancer while potentially curable.

Adenocarcinoma↗
PubMed1989

The status of gastrointestinal endoscopy by surgeons in the Veterans Administration Healthcare System. A survey.

Between January and December 1987, a survey was sent to all Chiefs of Surgery in the Veterans Administration Healthcare System to assess current practices of surgical endoscopy. Results of this survey have shown a significant involvement in flexible gastrointestinal endoscopic procedures by most surgical services, especially those affiliated with major resident teaching programs. Total number of procedures performed, based on the projections of numbers of cases as reported, indicate that approximately 60,000 gastrointestinal endoscopic procedures are currently performed by surgeons each year in the Veterans Administration system in order to assess the greater than 90,000 gastrointestinal operations performed. Results of the survey also indicate that Chiefs of Surgery in the VA system enjoy a wide range of support by Gastrointestinal (GI) Medical Services in the VA, but generally this support is adequate. Part-time and full-time surgeons in the VA need to increase overall Continuing Education activities in endoscopy as well as increase the number of surgeons affiliated with organizations interested in endoscopic care.

Digestive System Surgical Procedures↗
PubMed1988

Cryptococcosis of the colon resembling Crohn's disease in a patient with the hyperimmunoglobulinemia E-recurrent infection (Job's) syndrome.

A 29-yr-old woman presenting with granulomatous colitis and a chronic perirectal abscess was found to have localized cryptococcosis associated with the hyperimmunoglobulinemia E-recurrent infection (Job's) syndrome. Similarity to previous cases of esophageal cryptococcosis and ileocecal histoplasmosis suggests an association between the hyperimmunoglobulinemia E-recurrent infection syndrome and localized fungal infections of the alimentary tract. To our knowledge, this is the first well-documented case of cryptococcosis confined to the colon and perirectal tissues.

Adult↗
PubMed1988

Nipple discharge: surgical significance.

Nipple discharge is an important clinical entity ranking second only to a lump as the most common complaint among 7,588 patients having breast surgery (560/7,588, or 7.4%). In the office and clinic it is even more common, since many patients can be treated medically and do not require an operation. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Nipple discharge can be milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), or bloody (sanguineous). Watery, serous, serosanguineous, and sanguineous discharges are surgically significant; while they are most often caused by intraductal papillomas or fibrocystic disease, they can be due to cancer or a precancerous mastopathy. Among 503 patients operated on for one of these types of discharge, 67 (13.3%) had cancer, and 36 (7.2%) had a precancerous mastopathy. Among the 67 patients with cancer, eight (11.9%) had no palpable mass, 11 (16.4%) had negative cytologic findings, and seven (10.4%) had a negative mammogram. The incidence of associated cancers increases when the discharge is, in order of increasing frequency, serous, serosanguineous, sanguineous, or watery, when it is accompanied by a lump, when it is unilateral and from a single duct, when there are positive cytologic or mammographic findings, and when the patient is more than 50 years of age. Milky discharge caused by galactorrhea is treated medically except when caused by a pituitary adenoma. Multicolored sticky discharge due to duct ectasia is also treated medically except in advanced cases. Purulent discharge caused by an abscess requires drainage and a biopsy of the abscess wall. Except in women less than 30 years of age of in those anxious to have children, we advise a complete central duct excision for patients with surgically significant types of discharge. If done carefully, this procedure can yield good cosmetic results.

Adult↗
PubMed1988

Comparison of a totally implantable access device for chemotherapy (Port-A-Cath) and long-term percutaneous catheterization (Broviac).

Because of the difficulty in maintaining vascular access in patients receiving aggressive parenteral chemotherapy, a growing number of patients have had implantation of either percutaneous or subcutaneous devices allowing permanent intravenous access. In our study, between July 1980 and July 1985, 110 patients had placement of a Broviac catheter, while 100 patients had placement of a subcutaneous device via a subclavian venous approach. Both groups of patients were identical regarding age, primary malignancy, chemotherapy, and nutritional status. Catheter-related sepsis occurred in 15% and thrombotic occlusion in 22% of those patients with Broviac catheters, compared with 3% and 1%, respectively, in patients having subcutaneous reservoirs. Although the initial cost of the subcutaneous reservoir is greater, overall cost of maintenance of the percutaneous catheter far exceeds that of the reservoir because of the need for daily catheter care and heparin flushing of the Broviac device, which is unnecessary for the subcutaneous port. Our experience favors the use of the subcutaneous reservoir in patients receiving prolonged chemotherapy.

Antineoplastic Agents↗
PubMed1988

Gestational breast cancer: a ten-year experience.

During the period 1973 to 1983, eight pregnant women were treated for breast cancer at Richland Memorial Hospital. These patients were compared with 36 nonpregnant premenopausal women with breast cancer treated at the same institution. Pregnant patients averaged two years older than the nonpregnant patients. Five of eight pregnant patients had stage I breast cancer, which compared favorably with the nonpregnant group. Seven patients carried their pregnancy to term. Seven of eight patients in the gestational group are alive after four to 14 years, an 87.5% survival, with an average follow-up of 90 months. These data indicate no major differences in survival between pregnant and nonpregnant women with similar stages of breast cancer.

Adult↗
PubMed1987

Early detection of gastric remnant carcinoma. The role of gastroscopic screening.

Partial gastrectomy for benign ulcer disease has been associated with carcinoma in the gastric remnant. To detect formation of this cancer in patients having undergone this operation, we initiated a screening protocol using barium contrast studies, flexible gastroscopy, and biopsy. Patients were selected from a group of 233 patients who had undergone partial gastrectomy for benign disease between 1960 and 1975. In this group, operations for duodenal ulcer had been performed in 156 patients (83 Billroth I and 73 Billroth II reconstructions) and subtotal gastrectomy in 77 patients with gastric ulcer (17 Billroth I and 60 Billroth II reconstructions). From July 1980 to July 1985, 163 patients underwent gastroscopy and biopsy with a median postoperative interval of 14.6 years. Through screening, three resectable remnant carcinomas were found. We conclude that routine gastroscopy leads to earlier detection and a higher rate of resectability if gastric remnant carcinoma is found; yearly screening should be performed after a ten-year postresection interval; and gastroscopic biopsy is more accurate than upper gastrointestinal tract barium contrast studies and should be used preferentially to identify gastric remnant carcinoma.

Duodenal Ulcer↗
PubMed1987

Effect of dietary copper on colonic tumor production and aortic integrity in the rat.

Gastrointestinal malignancy has been associated with aortic aneurysmal disease in humans, while metabolic derangement of copper has been incriminated as a possible promotor of aneurysmal development of the aorta. An animal model utilizing the carcinogen 1,2-dimethylhydrazine (DMH) was selected to evaluate levels of dietary copper on both colonic tumor production and morphologic changes in the rat aorta. Six groups, each including 10 Sprague-Dawley rats, received 16 weekly doses (20 mg/kg) of DMH beginning at 4 weeks of age. Groups were maintained on either normal (25 ppm), low (0.6 ppm), or high (100 ppm) copper chow during the entire experimental period. After 25 weeks, all animals were sacrificed to assess colonic tumor production and to perform scanning (SEM) and transmission electron microscopic (TEM) studies of the rat aorta. Results showed a significant increase in colonic tumor production (3.14 +/- 0.39 tumors per centimeter colon) in rats treated with low-copper chow and DMH when compared with rats on normal chow and DMH (0.74 +/- 0.07 tumors per centimeter colon) and animals maintained on high-copper diets and DMH (0.76 +/- 0.08 tumors per centimeter colon). In addition, morphologic study showed disruption of the intima and media in rats maintained on low-copper diet alone, and also on low-copper diet plus DMH. The results of this study showed that DMH and low dietary copper significantly increase (P less than 0.001) the yield of colonic tumors and produce loss of aortic integrity when studied morphologically. Copper levels may be important in the association of neoplasia and aneurysm formation in the clinical setting.

1,2-Dimethylhydrazine↗
PubMed1987

Colorectal cancer in animal models--a review.

Colorectal cancer remains the second leading cause of cancer death in the western hemisphere. During the past several decades information regarding epidemiology, etiology and associated factors regarding colo-rectal cancer in humans has been collected through study of experimental colonic tumors in animal models. Much of this work has been influenced by the use of 1,2-dimethylhydrazine as the inducing carcinogen in susceptible populations of animals, although other specific carcinogens have been used. Through application of this experimental model, knowledge of dietary, immunologic, and bacterial factors has been realized in the etiology of colo-rectal cancer. This review details methodology and results of developing experimental models as they pertain to human colo-rectal cancer.

1,2-Dimethylhydrazine↗
PubMed1986

Splenic salvage techniques in the management of pseudocysts of the spleen.

Nonparasitic splenic pseudocysts are an uncommon late sequela of splenic trauma. These cysts presumably develop from previously unrecognized subcapsular splenic hematomas. Classical therapy for splenic pseudocysts has been splenectomy. However, the recent recognition of the postsplenectomy sepsis syndrome has led to methods of surgical management that salvage the remainder of the spleen.

Adult↗
PubMed1986

Needle-catheter jejunostomy for postoperative nutritional support.

Use of the needle-catheter feeding jejunostomy at Richland Memorial Hospital and the Dorn Veterans Administration Hospital, both clinical teaching institutions of the University of South Carolina School of Medicine, has been evaluated in 114 patients ranging from 20 to 90 years old. The results of this survey span a 36-month period, from Jan 1, 1982 to Jan 1, 1985, in which jejunostomy catheters were inserted via a subserosal approach to provide early postoperative enteral support after elective and emergency surgical procedures. Of the 114 patients who had the catheter inserted, 82 (72%) completed a course of enteral tube feedings without complications, whereas 32 (28%) had either mechanical or metabolic complications leading to temporary or permanent cessation of feeding. One patient had a serious midjejunal volvulus, resulting in extensive jejunal necrosis and subsequent resection, a heretofore unpublished complication of this technique. The median number of days with catheter per patient was 18, with a range of one to 98 days. Only four (3.5%) of the catheters inserted were not used. Nutritional parameters were maintained or improved in all patients reviewed. The results of this study encourage the insertion of a feeding jejunostomy catheter as a complementary surgical procedure in patients expected to have a catabolic postoperative course, and who are therefore in need of aggressive nutritional support.

Adult↗