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Biomedical subjects

F L Greene

Publications and source records attributed to F L Greene.

102 records · Page 6Linked to original sources
PubMedDate not supplied

Pneumoperitoneum in the cancer patient: advantages and pitfalls.

The use of pneumoperitoneum to create a working environment for laparoscopic surgery may have both beneficial and detrimental effects in cancer patients. Studies suggest that immune mechanisms are protected when laparoscopic procedures are used and this does not seem to be compromised by the use of gas in the abdomen. Potential pitfalls in the utilization of pneumoperitoneum include the effects of hypothermia, cardiovascular consequences, hypercoagulability with associated deep-venous thrombosis, and the possibility that trocar-site recurrences may be produced by using a pneumoperitoneum. No concrete evidence of either beneficial or detrimental effects from pneumoperitoneum in cancer patients currently exists. Studies utilizing animal models and humans should be supported in this extremely important area.

Animals↗
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Laparoscopic approaches to abdominal malignancy.

The use of laparoscopy for diagnosis and staging of intra-abdominal malignancies is not an exclusive procedure. It is another modality in the armamentarium of caring for the patient. The selection of the appropriate patients is discussed in detail and must include a determination of the long-range plans for intervention. The technical issues include problems of previous abdominal surgery, adhesions, ability to tolerate general endotracheal anesthesia, and ability to properly position the patient for an adequate examination. The endoscopic surgeon must be able to differentiate between the benign and malignant process during endoscopic examination and must be skilled in obtaining appropriate biopsies. In the staging of lymphoma, laparoscopy has virtually replaced the open celiotomy technique. Laparoscopic removal of appropriate lymph nodes is essential. The role of laparoscopy in a second-look operation is discussed as well as contraindications and complications of the procedure.

Abdominal Neoplasms↗
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Colonoscopic polypectomy: indication, technique, and therapeutic implications.

The flexible fibroscopic colonoscope has changed the way we approach colonic disease. The technique of safe, effective colonoscopy is discussed including the indications and contraindications for therapeutic intervention via the colonoscope. The techniques of polypectomy is described, including some tips for methodology gained by the broad experience of the author, and admonition against the possible complications which can be life-threatening. The application for polypectomy in the presence of in-situ or invasive cancer is presented. The possible future development of colonoscopic and laparoscopic techniques are presented. The article concludes with a discussion of the monumental work of the National Polyp Study documenting that patients undergoing polypectomy have a significant reduction in the incidence of colon cancer. Application of the knowledge to the general population requires the identification of at-risk populations.

Colonic Neoplasms↗
PubMedDate not supplied

Laparoscopic management of colorectal cancer.

Laparoscopic treatment of colorectal cancer has emerged as a result of the technical advances that have been made since the introduction of laparoscopic cholecystectomy. The minimal-access approach to treatment of benign disease results in smaller incisions, reduced length of hospital stay, and a faster return to productive life. Laparoscopic approaches to colon cancer must take into consideration the potential effects of the technique on tumor dissemination at the time of the surgical procedure, as well as rates of recurrence and overall survival. Several technical approaches to laparascopic colon resection have now become possible, utilizing either total intra-abdominal maneuvers or laparoscopic-assisted techniques. Margins of resection and lymph node removal with the minimal-access techniques compare favorably with those of open colectomy. Several series now show that early results utilizing laparoscopic resection for colorectal cancer are favorable but that routine implementation of this procedure should await confirmatory outcomes generated by well-done prospective clinical trials.

Colorectal Neoplasms↗
PubMedDate not supplied

Breast cancer statistics: use and misuse.

Statistics can be manipulated, by using various methods of reporting, to support almost any type of regime in breast cancer. The basis for statistical calculations include: the definition of the population of patients treated, the time used for starting calculations, the exact nature of the treatment used and any adjuvant therapy, the prognostic parameters utilized, the importance of long-term follow-ups, adequate number of cases, therapy standardization and pathological reporting, methods of evaluating survival such as observed or crude, relative and no evidence of disease, methods of calculating observed survival rates such as absolute, actuarial or life-table and Kaplan Meier or product limit, statistical evaluation for planned improvement with acceptable Type I and Type II errors, and the use of arithmetic and logarithmic scales in plotting statistics. Purveyors of innovative methods for the treatment of breast cancer aimed at preserving part or all of the breast as cosmetic alternatives to mastectomy, by limited operations with and without primary radiotherapy, have a most appealing argument to a woman with breast cancer. To determine if such procedures are justifiable alternatives to selective mastectomies and reconstructions, detailed, long-term statistical data on large numbers of cases must be available and end-results comparisons of various therapeutic modalities must be made on the basis of comparable statistical data.

Breast Neoplasms↗
PubMedDate not supplied

Laparoscopic evaluation of abdominal malignancy.

Diagnostic laparoscopy, developed in the early 1900s, has become an integral part of evaluation in the management of abdominal malignancy, including hepatocellular carcinoma, metastatic hepatic cancer, and abdominal lymphoma. When compared with computerized tomography and ultrasound, laparoscopic diagnosis is superior, or at least complementary, to conventional imaging. Laparoscopic evaluation and staging of abdominal cancer will become of greater importance because of the increasing role of palliative procedures and multi-modality therapy.

Abdominal Neoplasms↗