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Biomedical subjects

F L Moffat

Publications and source records attributed to F L Moffat.

At least 55 records · Page 3Linked to original sources
PubMed1987

Early discharge after mastectomy. A safe way of diminishing hospital costs.

In order to assess the risks and benefits of early discharge after major breast surgery, the authors analyzed 73 consecutive private patients who underwent operations by four surgeons over a 1-year period. Patient's ages ranged from 34 to 84 years, with a mean of 56.2 years. One patient was excluded from analysis because thoracotomy with a pulmonary resection was performed during the same hospitalization. Thirty-seven patients underwent total mastectomy with complete axillary dissection, 30 underwent segmental mastectomy with complete axillary dissection, and five underwent total mastectomy alone. For each patient the chest wall and axilla were drained by means of one or two Jackson-Pratt (American Heyer Schulte Corp., Goleta, CA) closed suction drains. Prior to discharge, all patients were instructed in the proper technique of drain care and were directed to record the daily drainage. Patients were discharged when they were fully mobile, did not require injectable narcotics, and felt capable of taking care of the drains as outpatients. The length of postoperative stay ranged from 1 to 9 days (mean 2.9), with all but three patients being discharged by the fifth postoperative day. Patient acceptance of early discharge with drains was excellent. Drains were pulled on an outpatient basis, usually within 7 to 10 days after surgery. Complications were observed in twelve patients (18%), consisting of seromas (8 patients), cellulitis (2 patients), and minimal superficial skin necrosis (2 patients). All complications were managed easily on an outpatient basis. We conclude that early discharge with Jackson-Pratt drains remaining in place is safe, well tolerated by patients, and has tremendous potential for substantial cost savings.

Adult↗
PubMed1986

Combination therapy for resectable and unresectable adenocarcinoma of the pancreas.

The current report summarizes our experience with 77 patients with cancer of the pancreas treated over 3.5 years. Patients were not assigned to a definite group of therapy, but through the availability of different drugs and different types of treatment several comparable groups have evolved. All patients have received radiofrequency hyperthermia and chemotherapy, but in addition, some have received selective immune stimulation with one of two low-molecular-weight compounds. The data show that radiofrequency hyperthermia permits the use of a lower dose of chemotherapy, with an apparent response to treatment. This response is enhanced significantly by the addition of selective immune stimulation. A further, more rigorously defined study will be undertaken to confirm this data.

Adenocarcinoma↗
PubMed1985

Radiofrequency hyperthermia as adjuvant therapy following surgical resection of an experimental malignant neoplasm.

Local recurrence after radical surgery is a major problem with many primary solid cancers. The use of radiofrequency hyperthermia (RFHT) as adjuvant therapy to surgery was explored in the Fischer bladder carcinoma (FBCa)/F344 rat tumor system. After subcutaneous innoculation of 34 rats with 10(6) FBCa cells in suspension, RFHT was administered to 17 animals on days 1, 5, 8, and 12. The development of palpable tumors was delayed but not prevented, and tumor growth was retarded in RFHT-treated animals. In another experiment 40 rats were innoculated by subcutaneous trocar injection with a 1 mm3 piece of FBCa. After tumor excision on day 17, adjuvant therapy (untreated control, mitomycin C, RFHT, or RFHT plus mitomycin C) was started on day 20 (10 rats/treatment). The 20 RFHT-treated rats had only 1 incisional recurrence as compared to 9 recurrences in sham-heated rats (P less than 0.005). The authors conclude that RFHT has considerable value as adjuvant therapy to surgery in these tumors. Additional studies of RFHT as adjuvant treatment after surgical excision of tumors are planned.

Animals↗
PubMed1985

Further experience with regional radiofrequency hyperthermia and cytotoxic chemotherapy for unresectable hepatic neoplasia.

The authors report on 178 patients with unresectable hepatic tumors who have been treated with 1 to 25 (median, 6) courses of radiofrequency hyperthermia (RFHT) and chemotherapy. In 137 patients, the hepatic tumors consisted of metastases from colorectal adenocarcinomas. For patients who had no previous therapy and who had colorectal metastases with no extraheptic disease, cumulative survival at 52 weeks' follow-up was 80.5% and partial tumor regression was seen in 78.4%. Among the 69 patients who previously had conventional treatment for their hepatic disease, partial regression was seen in 43.5%. We are no longer monitoring tumor core temperature routinely, as the invasive methods currently in use yield irreproducible results; the risks to the patient cannot be justified in view of the questionable relevance of the data obtained. A prospective randomized study of systemic chemotherapy with or without RFHT in patients with colorectal hepatic metastases is in progress.

Adenocarcinoma↗
PubMed1985

Hyperthermia for cancer: a practical perspective.

A causal relationship between hyperpyrexia and tumor regression was first suggested in 1866, when Busch reported the cure of a histologically diagnosed sarcoma in a middle-aged woman, following a bout of erysipelas. Over the years, interest in the effect of heat on cancer has remained alive, but this interest has increased dramatically in recent years. The literature on this subject is broadly reviewed and the clinical results discussed. It is apparent from clinical studies thus far that it is a relatively simple undertaking to treat superficial neoplasms with hyperthermia. However, the major challenges in clinical thermotherapy pertain to patients with deeply situated tumors. The lack of safe and reliable methods of monitoring temperature in deep tissues is a major impediment to a thorough understanding of thermal dosimetry in clinical hyperthermia, and routine thermal dosimetry in clinical hyperthermia will have to await the development of reliable noninvasive thermometry. As responses have been reported with modest levels of hyperthermia, the need for thermometry is somewhat lessened, given that invasive monitoring is imperfect and somewhat risky when used in deeply seated tumours. The eventual place of thermotherapy in the treatment of malignant tumours in man is as yet unclear and must be rigourously and thoroughly assessed in well-designed, prospective, randomized patient trials.

Animals↗
PubMed1985

Enhanced survival in antibiotic-treated murine fecal peritonitis by administration of copovithane, a selective immunostimulative polymer.

The purpose of this study was to determine the effect of an immunostimulative polymer, Copovithane (Cpv), plus antibiotics (netilmicin and clindamycin) in a murine model of fecal peritonitis. Cpv augments humoral immunity with little effect on T cells and is nontoxic. Cpv 100 mg/kg iv administered at the onset of sepsis increased median survival time (MST) by 40-55% over untreated controls. Four experiments were performed. Cpv in combination with antibiotics when given at the time of onset of sepsis was significantly more effective than antibiotics alone (MST 235 vs 105 hr, P less than 0.05 at 144, 168, 192, 216 hr). In the second and third experiments Cpv alone and with antibiotics was administered 15 hr after the onset of sepsis. Cpv significantly augmented survival over controls in the second experiment (MST 87 vs 60 hr, P less than 0.025 at 96 hr). Cpv plus antibiotics was significantly better than antibiotics alone in the third experiment (MST 111 vs 64 hr, P less than 0.05 at 72 hr, P less than 0.005 at 120 hr). In the final experiment, Cpv did not inhibit growth of 20 bacterial species in agar and liquid media. Cpv significantly enhances survival in murine fecal peritonitis even when administered after the onset of sepsis; furthermore Cpv plus antibiotics in established peritonitis produces longer survival than antibiotics alone. Synthetic immunomodulators such as Cpv could eventually play a significant role in the management of peritoneal infection in humans.

Animals↗
PubMed1985

Reversal of cyclosporine-induced mortality with a synthetic polymeric immunostimulant in a murine model of fecal peritonitis.

We have been investigating the effects of a synthetic immunostimulative polymer known as copovithane (Cpv). This agent appears to enhance humoral immunity in untreated and cyclosporine-immunosuppressed mice and is nontoxic in rodents and man. The purpose of this study was to determine whether cyclosporine (CsA) is deleterious to survival in a murine cecal ligation, puncture, and excision (CLPE) model of fecal peritonitis, and--if so--whether this effect could be ameliorated by Cpv without interfering with skin allograft acceptance. Cpv significantly prolongs survival in the CLPE model; the optimal dose for this effect was found to be 100 mg/kg. CsA was found to have a significant and deleterious effect on survival at several dosage levels when administrated 48 and 24 hr before cecal ligation, and immediately before and 16 hr after cecal ligation. Using a dose of CsA sufficient for skin allograft acceptance and the same schedule of administration outlined above, Cpv 100 mg/kg was administered 48 hr prior to cecal ligation. Mice treated with CsA plus Cpv had significantly longer survival than mice treated with CsA alone; furthermore, the survival of CsA-plus-Cpv-treated animals was not significantly different from that of saline-treated controls. Acceptance and survival of H-2 incompatible skin allografts in mice treated with CsA were not affected by Cpv 100 mg/kg/week. We conclude that CsA-induced mortality in the CLPE model can be abrogated by Cpv without adversely affecting skin allograft survival. It may eventually be possible to reduce the incidence of septic complications in clinical allotransplantation by prophylactically administering Cpv to patients on CsA immunosuppression.

Animals↗
PubMed1985

Pelvic exenteration for advanced primary and recurrent adenocarcinoma.

The authors report on 45 patients who have undergone pelvic exenteration for adenocarcinoma since 1979. Three patients underwent exenteration as the initial treatment for their disease but all others had had previous surgery, radiotherapy or chemotherapy. Operating time and blood loss were lower in previously irradiated patients. There were seven in hospital deaths (15.5%). The number of complications and length of postoperative hospital stay have decreased significantly as experience with pelvic exenteration has been acquired. Symptoms have been controlled in a high proportion of patients. Exenterative surgery is an effective method of treatment in selected patients with pelvic adenocarcinoma but should be undertaken only by experienced surgeons who have access to a wide range of supportive facilities for optimal perioperative management.

Adenocarcinoma↗
PubMed1984

Palliation of advanced head and neck cancer with radiofrequency hyperthermia and cytotoxic chemotherapy.

Fourteen patients with recurrent malignant tumours of the head and neck were treated with radiofrequency hyperthermia and chemotherapy after conventional therapy had failed. After 2 to 11 treatment courses and a follow-up of 30 weeks, the neoplasms in three patients had completely regressed and one had a partial response. Of eight patients who died, two had partial responses initially; a third patient died of complications relating to surgical resection of the tumour after a partial response. Three of five patients whose tumours were unresponsive to methotrexate responded when this drug was given with radiofrequency hyperthermia. There were seven minor skin burns in six patients. Further studies of radiofrequency hyperthermia and chemotherapy for palliation of head and neck cancer are planned.

Adult↗
PubMed1983

Effect of radiofrequency hyperthermia and chemotherapy on primary and secondary hepatic malignancies when used with metronidazole.

Hyperthermia is selectively toxic to neoplastic tissue. Since August 1981, 357 patients with incurable tumors in various body areas have been treated with chemotherapy and radiofrequency hyperthermia (RFHT) with adjuvant metronidazole at this center. Of this group, the cases of 102 patients with hepatic tumors are reported here. Patients received one to ten treatment courses, each course consisting of two to five daily RFHT sessions. Systemic temperature rose 0.6 +/- 0.3 degrees C during treatment, and tumor core temperature (measured by percutaneous transhepatic thermistor) reached 39.5 +/- 1.2 degrees C in 38 monitored patients. Results have been encouraging; in particular, among 15 patients with newly diagnosed colorectal metastases limited to the liver (and as yet untreated for their secondary disease), there has been objective partial tumor regression in 66.7%. Side effects have been few. Skin burns and subcutaneous fat necrosis were seen in 3.9% and 13.7% of patients, respectively. Tumor temperature is difficult to measure reliably and does not correlate with machine power or tumor response. A phase III trial is currently underway to determine the efficacy of RFHT and chemotherapy for patients with hepatic metastases from colorectal adenocarcinoma.

Adult↗
PubMed1983

Gracilis myocutaneous flap for reconstructing perineal defects resulting from radiation and radical surgery.

When high-dose radiotherapy for carcinoma of the rectum, cervix, vagina or vulva fails and subsequent surgical excision by extended abdominoperineal resection or exenteration is performed, healing is often greatly delayed, for many months, and a scarred, deformed perineum results. The introduction of myocutaneous flaps opened up a new field for reconstruction of defects in a number of areas. The authors used a gracilis myocutaneous flap in 15 patients for primary reconstruction following surgical resection for failed radiotherapy of a primary carcinoma (of the rectum in 6, the cervix in 7 and the vulva in 2) and as a secondary procedure in 2 patients, 1 with an unhealed perineum 4 months after irradiation and extended abdominal resection for carcinoma of the rectum, and the other with extensive perineal necrosis following radiotherapy and chemotherapy. The operative technique, which is relatively simple, is described and illustrated. Since all patients had received radiotherapy, the myocutaneous flap was used primarily and successfully to reduce morbidity and healing time. However, even without radiotherapy, the deformity following exenteration is unacceptable and reconstruction by the method described should probably be planned as part of this operation. Not only can primary healing be expected, but the neovagina has a relatively normal appearance with satisfactory sensation and function.

Abdomen↗
PubMed1983

The effect of radiofrequency hyperthermia and chemotherapy upon human neoplasms when used with adjuvant metronidazole.

It appears that metronidazole causes an increase in tumor core temperature above that achieved with RFHT alone, by an as yet undetermined mechanism. Furthermore, radiofrequency hyperthermia, in combination with chemotherapy, can produce objective evidence of tumor repression in 30 to 50 per cent of the patients with metastatic cancer. These results justify proceeding to a randomized prospective trial of RFHT and chemotherapy in specific human neoplasms. Such a study is currently being undertaken at this center.

Adult↗
PubMed1982

Abdominal surgery in patients undergoing long-term peritoneal dialysis.

Nineteen patients undergoing long-term peritoneal dialysis (LTPD) required abdominal operations--11 elective and 8 emergency. The preoperative hemoglobin level was 9.0 +/- 2.6 gm/dl, and the serum albumin was 28.8 +/- 4.9 gm/L. There was one death in the elective group (an inguinal herniorrhaphy) and four deaths in the emergency group (three spontaneous colonic perforations and one strangulated ventral hernia). Wound complications occurred in five patients. To obtain an indication of nutritional status of patients on intermittent LTPD and high-protein diets, 17 in-center patients underwent nutritional assessment, and deficiencies in delayed hypersensitivity skin testing and total lymphocyte counts were prevalent. Wounds require secure, watertight closure to prevent dialysis leakage. In elective abdominal surgery, LTPD should be carried out shortly preoperatively to delay dialysis for a few days after operation and to decrease defective platelet function. Preoperative transfusion for anemia is generally unnecessary. Drains should be avoided or removed before resumption of LTPD. Abdominal wall hernias should be repaired electively. Constipation should be avoided. Marked protein loss accompanies peritonitis. In certain instances, transfer to hemodialysis is indicated.

Abdomen↗
PubMed1978

Pseudotumor cerebri.

Pseudotumor cerebri is a clinical syndrome in which signs and, sometimes, symptoms of raised intracranial pressure are present but in which mental and neurological function are unaffected. Therefore, the diagnosis is reached after mass and other structural causes of raised pressure have been excluded. Many causes of pseudotumor have been suggested, not all of them well documented. Pathogenesis, however, includes cerebral edema, increased cerebral blood volume, and decreased cerebro spinal fluid (CSF) absorption. Except for the risk of vision in a minority of cases, the prognosis is excellent.

Abducens Nerve↗
PubMedDate not supplied

Nonoperative techniques for tissue diagnosis in the management of thyroid nodules and goiters.

As only 10% of thyroid nodules are malignant, the surgical oncologist is faced with the challenge of selecting for thyroidectomy only those patients likely to benefit therapeutically from surgery. Demonstration of nonfunction on scintigraphic thyroid scan increases the yield of cancer only by 15% to 20%. Aspiration cytology and needle biopsy are potent aids in selecting patients for thyroidectomy. In 1,504 patients for whom a benign or malignant cytological diagnosis was made prior to thyroidectomy, the sensitivity of this technique was 92.0%, specificity was 97.3%, and overall diagnostic accuracy 95.7%. Morbidity is minimal. The reliability of these techniques is dependent on proficient specimen procurement and the cytopathologist's expertise and experience. Differentiation of benign from malignant follicular and lymphocytic lesions is not possible with conventional cytology preparations; 28% of such "indeterminant" lesions prove to be cancer at thyroidectomy. Aspiration cytology is a simple, reliable technique for selection of patients with thyroid nodules for surgery.

Biopsy, Needle↗
PubMedDate not supplied

Metastatic proclivities and patterns among APUD cell neoplasms.

Neoplasms of APUD cell origin are quite variable in their metastatic behavior. Whereas pituitary and parathyroid tumors almost never metastasize, all oat cell lung cancers, malignant melanomas, trabecular carcinomas of the skin and medullary thyroid cancers are capable of dissemination. The metastatic proclivity of individual carcinoids, pancreatic and extrapancreatic islet cell tumors, and paragangliomas is much less predictable. In particular, there are no reliable histological markers of risk for lymphatic or hematogenous dissemination. The behavior of many carcinoids, islet cell carcinomas and paragangliomas is relatively indolent, even when metastatic disease is already present. However, unresectable distant metastases, especially liver involvement, connote a poor prognosis. Mortality is more often related to uncontrolled tumor growth and metastasis than to associated endocrinopathies. Curative or debulking surgical resection should be aggressively pursued as recent data show that worthwhile clinical disease-free survival can be realized in at least some patients.

APUD Cells↗
PubMedDate not supplied

Concern about aspects of body image and adjustment to early stage breast cancer.

OBJECTIVE: Several authors have suggested that patients adjust more poorly to breast cancer if they are heavily invested in body image as a source of their sense of self-worth. This prospective study examined this possibility, looking at two aspects of concern about body image as predictors of several indices of adjustment over the first postoperative year. METHODS: At diagnosis (and again a year later) 66 women with early stage breast cancer reported how much they valued a) a sense of body integrity (or intactness) and b) a good physical appearance. The day before surgery, a week afterward, and at 3-month, 6-month, and 12-month follow ups, they reported on their mood. At presurgery and at follow ups they also rated their attractiveness and sexual desirability and reported on frequency of sexual interaction. At follow-ups they also indicated how much their illness and treatment were interfering with social and recreational activities. RESULTS: Initial investment in appearance was related to distress across the postsurgical year. In contrast, investment in appearance made women more resilient against deterioration in their perceptions of attractiveness. Concern about body integrity did not strongly predict emotional distress, but it related to adverse impact on social and recreational activities in the follow-up period, to deterioration in feelings of sexual desirability, and to feelings of alienation from the self (feeling "not like yourself anymore"). CONCLUSIONS: Body image is often thought of in terms of physical appearance, but there is also a body image pertaining to integrity, wholeness, and normal functioning. People who are greatly concerned about either aspect of their body image are vulnerable to poorer psychosocial adjustment when confronting treatment for breast cancer. The poorer adjustment takes a different form, however, depending on the nature of the patient's body-image concern.

Adaptation, Psychological↗