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Biomedical subjects

G A Higgins

Publications and source records attributed to G A Higgins.

At least 127 records · Page 7Linked to original sources
PubMed1982

Amygdaloid and basal forebrain direct connections with the nucleus of the solitary tract and the dorsal motor nucleus.

Although the amygdala complex has long been known to exert a profound influence on cardiovascular activity, the neuronal and connectional substrate mediating these influences remains unclear. This paper describes a direct amygdaloid projection to medullary sensory and motor structures involved in cardiovascular regulation, the nucleus of the solitary tract (NTS) and the dorsal motor nucleus (DVN), by the use of autoradiographic anterograde transport and retrograde horseradish peroxidase (HRP) techniques in rabbits. Since all of these structures are highly heterogeneous structurally and functionally, details of the specific areas of the neuronal origin and efferent distribution of the projection were examined in relation to these features and with reference to a cytoarchitecture description of the relevant forebrain regions in the rabbit. Amygdaloid projections to the NTS and DVN, as determined from HRP experiments, arise from an extensive population of neurons concentrated exclusively within the ipsilateral central nucleus and confined to and distributed throughout a large medial subdivision of this nucleus. Projection neurons, however, also distribute without apparent interruption beyond the amygdala dorsomedially into the sublenticular substantia innominata and the lateral part of the bed nucleus of the stria terminalis and thus delineate a single entity of possible anatomical unity across all three structures, extending rostrocaudally within the basal forebrain as a diagonal band. Descending central nucleus connections, based upon autoradiographic experiments, project heavily and extensively to both the NTS and the DVN. Within both nuclei, the projections have a highly specific distribution pattern, appearing to correspond largely to structural subdivisions, including the dorsomedial, medial, ventrolateral, ventral, and commissural NTS, and to cell group "a," a caudally located dorsomedial region, and peripheral regions of the DVN, some of which appear to be involved in cardiovascular regulation. The existence of such an extensive projection system connecting these specific regions is significant evidence in support to its potential for participation in the amygdaloid expression of cardiovascular influences and has important implications for the cellular analysis of the functional role of these influences.

Afferent Pathways↗
PubMed1982

Surgical resection in the management of small cell carcinoma of the lung.

In an attempt to define the role of initial surgical resection in patients with undifferentiated small cell carcinoma of the lung, we reviewed the experience of the Veterans Administration Surgical Oncology Group (VASOG). One hundred forty-eight patients with small cell carcinoma of the lung had undergone a potentially "curative" resection. This represented 4.7% of "curative" resections carried out in four major prospective adjuvant chemotherapy trials. In the early trials (101 patients), 16 patients (15.8%) died within the first 30 postoperative days. These patients have been excluded from the analysis of long-term survival, since in the more recent trials postoperative deaths were excluded prior to randomization. In the 132 patients remaining, the 5 year survival rate by the life-table method was 23.0%. The tumor of each was classified pathologically by the TNM system. Five-year survival rates for each category were as follows: T1 N0 M0 59.9%, T1 N1 M0 31.3%, T2 N0 M0 27.9%, T2 N1 M0 9.0%, and any T3 or N2 3.6%. The effect of postoperative adjuvant chemotherapy was evaluated in each of the trials. No beneficial effect of the adjuvant therapy was noted with a one or two course regimen of either nitrogen mustard or cyclophosphamide, but possible benefit, although not significant, was noted in a prolonged intermittent chemotherapy trial of cyclophosphamide either alone or alternating with methotrexate. In the most recent trial of prolonged intermittent courses of 1-(2-chlorethyl)-3-cyclohexyl-l-nitrosourea (CCNU) and hydroxyurea, a 5 year survival rate of 80.8% was noted in those receiving adjuvant chemotherapy as compared to a 38.1% in the control group. We conclude that resection is definitely indicated in patients with T1 N0 M0 lesions and probably indicated in those with T1 N1 M0 or T2 N0 M0 lesions. Primary surgical resection is contraindicated in patients with any other TNM category.

Antineoplastic Agents↗
PubMed1982

Remote salmonellosis: surgical masquerader.

The salmonella group of bacteria consists of at least 1700 subtypes and causes widespread gastroenteric disease throughout the world, there being approximately two million cases yearly in the United States alone. An uncommon but interesting complication is the hematogenous lodgment of organisms in other sites of the body with resultant localized abscess formation, often months or years later. We present a review of 15 cases seen in our affiliated hospitals over a nine-year period. Remote salmonellosis most often occurs in patients with underlying systemic disease, such as lupus, malignancy, diabetes, and sickle cell disease, or in association with therapy that suppresses host resistance including steroids and cancer chemotherapy. The most frequent sites of involvement are bone marrow, joints, meninges, pleura, and blood vessels, or in an area of locus minoris resistentiae. The latter include scars, hematomas, fracture sites, prosthetic devices, and neoplasms. Our experience would suggest that these infections, which can remote both in location and time from the original gastrointestinal episode, are perhaps more frequent today than is generally realized. Diagnosis is often delayed because of lack of familiarity with this entity. Treatment consist of either drainage or excision of infected tissue often combined with long-term antibiotics.

Abscess↗
PubMed1981

Adjuvant studies in gastric cancer in the United States.

Early optimism for the chemotherapeutic augmentation of standard surgical treatment of gastric cancer has thus far generally not come to pass. First attempts to destroy circulating cancer cells in small metastatic foci by giving drugs at the completion of operation and in the immediate postoperative period were disappointing. Numerous large cooperative groups and individual institutions are now studying drugs and drug combinations in various treatment regimens and have introduced the use of radiotherapy and immunotherapy in an effort to improve long-term survival following surgical resection of gastric cancer. Resurgence of interest in surgical adjuvant studies, and especially recent encouraging results from drug and immunotherapy, generates optimism that the theoretical potential of this approach to cancer control may soon be realized.

Antineoplastic Agents↗
PubMed1980

Late effects of low-dose adjuvant chemotherapy in colorectal cancer.

As part of a systematic program to evaluate the late effects of antineoplastic therapy in randomized clinical trials, patients enrolled in the low-dose thio-TEPA (TSPA) and 5-fluoro-2'-deoxyuridine (FdUrd) adjuvant colorectal cancer protocols of the Veterans Administration (VA) Surgical Oncology Group between 1958 and 1964 were studied. All patients received surgery with curative intent; 470 also received TSPA, 176 received FdUrd, and 867 received surgery only. The unique VA system permitted complete follow-up through 1977, with 10,902 person-years of observation accrued among 1,613 male patients (mean survival = 6.8 yr). Expected mortality and cancer incidence were computed by applying U.S. Mortality Statistics and Connecticut Tumor Registry age-, race-, sex-, and calendar time-specific rates to the person-years of observation. The mortality experience of the 3 groups was similar. Overall, there was a significant excess in total mortality (observed/expected = 1,359/553) attributable mainly to colorectal cancer (584/14), arteriosclerotic heart disease (258/215.9), pneumonia (41/17), gastric and duodenal ulcers (15/4), and cirrhosis (14/6). No excess mortality from noncolorectal cancers was apparent, nor were there significant differences by treatment: TSPA (22/22), FdUrd (9/12), and surgery only (50/42). Among 1,402 white patients, no significant excess of incident noncolorectal cancers were observed among patients treated with TSPA (30/31, FdUrd (14/15), or surgery only (63/58). Seven incident cases of leukemia developed (4.1 expected) among all patients of various groups: TSPA (3/1.3), FdUrd (1/0.6), and surgery only (3/2.2). No excess of new primary cancers was observed among 211 nonwhite patients. An inverse relationship between the occurrence of second primary cancer and age at diagnosis, irrespective of therapy, was suggested. The results demonstrated the feasibility of this approach for assessment of late complications of anticancer therapy and suggested no measurable carcinogenic effect following very low doses of TSPA and FdUrd in a population of this size.

Adult↗
PubMed1979

Necrolytic migratory erythema, presenting as candidiasis, due to a pancreatic glucagonoma.

A 54-year-old male with diabetes, weight loss, glossitis and Candidiasis presented with the typical cutaneous eruption of necrolytic migratory erythema. The suspicion of pancreatic glucagonoma was confirmed by an elevated plasma glucagon level. Surgical removal of the pancreatic alpha cell tumor resulted in a complete disappearance of all symptoms. The importance of the recognition of the skin eruption of necrolytic migratory erythema as a clue to the presence of pancreatic glucagonoma is emphasized.

Candidiasis↗
PubMed1979

Adjuvant radiation therapy in colon cancer.

The overall five year survival of patients with colorectal cancer is excellent compared with other major visceral malignancies. This is attributable to effect surgical treatment, yet the death rate per 100,000 population has improved little in recent decades, stimulating a search for adjuvant treatment modalities until a better understanding of etiology and pathogenesis results in prevention of earlier diagnosis. Combination of the known cancerocidal effect of ionizing radiation and surgical excision has been used sporadically for over six decades, but only recently has this combined modality therapy been studied in a scientific manner. Numerous variables such as source of radiation, total tumor dose, dose-time factors, location of portals of treatment, size and shape of radiation fields, and the radiation-surgery sequence are now being studied. Current information leaves little doubt of the effectiveness of this combined modality therapy in selected patients. Controlled clinical trials must continue in order to obtain more solid data, which hopefully will eventually result in substantially improved survival.

Adenocarcinoma↗
PubMed1978

Special problems in the evaluation of results in adjuvant trials of cancer treatment.

Adjuvant trials in cancer treatment present special problems in statistical analysis. When the primary treatment modality results in a relatively high cure rate and additional methods of treatment are being inserted in an effort to raise the figures to even higher levels, therapeutic benefit can be obscured unless all features of the study are carefully considered. Biologic benefit may easily be masked by the sizable number of patients randomized to receive adjuvant treatment who have no residual tumor and therefore could not possibly benefit therefrom. For example, 50% of patients undergoing "curative" resection for colon cancer survive without evidence of disease beyond the five-year postoperative period; thus at least half the patients randomized to receive adjuvant treatment (chemotherapy, radiotherapy, immunotherapy) will be disease-free at the time of randomization and cannot benefit from adjuvant therapy. New methods of assessment of treatment must be developed; otherwise, substantial therapeutic effectiveness may go undetected.

Colonic Neoplasms↗