The Thomas E. Jones memorial lecture: Changing attitudes toward the treatment of cancer. A personal reminiscence.
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Biomedical subjects
Publications and source records attributed to G Crile.
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A host of expensive thyroid tests and operations could be avoided if aspiration biopsy of thyroid nodules were more widely accepted by American physicians. The procedure is both an accurate diagnostic tool and an effective treatment of many thyroid nodules.
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Multicentric microfoci of cancer are often present in patients with cancer of the breast and affect the contralateral breast as well as the originally affected one. despite the high incidence of these microfoci of cancer, the appearance of new clinical cancers is rare. In a period of 610 patient-years of exposure after partial mastectomy for cancer, six new cancers appeared in the contralateral breast and four in the affected one. These findings suggest that after partial mastectomy the danger of the appearance of a new cancer in the affected breast is less than might have been anticipated.
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The ten-year survival of patients at the Cleveland Clinic treated by operations less than radical mastectomy was 45% compared with 43% in identically staged patients of the "National Cancer Registry" treated predominantly by radical mastectomy. The five and ten-year survival rates of patients treated by simple operations was higher than that of a similar group of patients treated by radical operations, but at 15 years there was no difference. The late deaths from cancer in the patients treated conservatively occurred in patients with favorably staged cancers who never had local recurrences and most of whom had no involvement of nodes. The incidence of local recurrence was no higher after simple operations than after the radical procedure. The ten-year incidences of local recurrence and of death from cancer were the same after partial mastectomy as after total mastectomy. It is pointed out that differences in staging the cancers and in reporting the survival rates invalidate comparisons of results from different institutions. The figures presented suggest that conservative operations and radical operations give the same survival rates at ten and at 15 years.
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Between January 1963 and December 1967, 59 renal transplant recipients underwent thymectomy with or without splenectomy as an adjuvant to standard immunosuppression. All thymectomies were performed transcervically. By internal comparison long-term renal allograft survival was better in recipients who had thymectomy, when compared to those who did not. There were no significant surgical complications associated with transcervical thymectomy and the completeness of thymectomy was judged satisfactory. The role of thymectomy as an adjuvant operation in human renal transplant recipients should be re-examined.
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