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Biomedical subjects

I M Ariel

Publications and source records attributed to I M Ariel.

At least 19 recordsLinked to original sources
PubMed1988

Tumors of the peripheral nervous system.

Most nerve tumors (benign and malignant) do not arise from the nerves per se, but from the supporting cells; tumors arising from the cells of Schwann are termed schwannoma or neurilemmoma-benign or malignant. Surgical extirpation is the most effective treatment for these tumors. Radiation therapy can offer significant palliation and prolongation of life, but no cures have been observed. Benign tumors can be treated by local surgical extirpation; malignant tumors must be radically resected, including major amputation where indicated. Neurofibromatosis (von Recklinghausen's disease) is a genetic error of metabolism with a proclivity to produce multiple neurofibromas and, in about 10% of the patients, malignant neurilemmomas. Of 100 patients with malignant neurilemmomas treated by the author, 74 were considered determinate; among them, the 10-year "cure" rate was 32%. Patients with von Recklinghausen's disease had almost as good a 10-year survival rate as those with solitary malignant schwannoma (30% vs. 39%).

Combined Modality Therapy↗
PubMed1988

Incidence of metastases to lymph nodes from soft-tissue sarcomas.

Lymph node metastases occur in an appreciable number of soft-tissue sarcomas. The histologic subtype plays a most important role. Synovial sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, and angiosarcoma manifest relatively frequently such metastases, whereas fibrosarcoma, liposarcoma, and malignant schwannoma do so very infrequently. With the use of the newer radiologic techniques, it is expected that this feature will be more clearly defined and taken into account in planning the treatment. For histologic subtypes known frequently to manifest metastases to the regional lymph nodes, the latter should be considered for inclusion in the surgical and/or radiation treatment plan, particularly for primary tumors situated close to a nodal basin; and careful follow-up of these nodes should be practiced.

Histiocytoma, Benign Fibrous↗
PubMed1987

Interscapulo-mammothoracic amputation for advanced breast cancer.

The technique for a major amputation for far-advanced breast cancer is described. The indications are those patients who have exhausted all accepted forms of treatment and who have a fixed large and often ulcerated cancer affecting the axilla and usually making the arm useless. Several examples of patients on whom this operation was performed are presented.

Adult↗
PubMed1986

Altered lymphatic circulation at the site of melanoma excision.

Local excision of malignant melanoma promotes both disruption and regeneration of regional lymphatics. These disturbances in local lymphatic drainage favor escape of residual melanoma cells either locally or in transit from more distal sites. Accordingly, a wide tridimensional resection to eradicate all local tumor and circumvent interstitial entrapment and migration of melanoma cells is still advocated. Changes in lymph vessels after excision also demand caution when distal endolymphatic isotopes are administered. Lymph leakage and trapping with overconcentration of the isotope may result in excess local irradiation and skin breakdown.

Ethiodized Oil↗
PubMed1982

Malignant melanoma of the trunk: a retrospective review of 1128 patients.

Of 3,305 patients with malignant melanoma seen at the Park Medical Group, New York, during the period from 1935-1975, there were 1,128 (34%) melanomas of the trunk. There were 646 melanomas of the skin of the chest wall (20% of all melanomas) and 482 melanomas of the abdominal wall (15%). Of 646 patients treated more than ten years ago, 138 were indeterminate as they were seen only in consultation or with evidence of blood-borne disseminated melanoma. Of the determinate 516 patients, 148 are free of evidence of melanoma after ten years, giving an absolute ten-year survival rate of 29%. All patients who died or who were lost to followup were considered to have died from the melanoma. Of 386 patients with melanoma of the thoracic wall, 296 were determinate, of which 88 (30%) have survived the ten-year period. Of the 260 patients with melanoma of the abdominal wall, 220 were determinate and 60 (27%) are alive and well ten years post treatment. Of 340 males, 74 survived the ten-year period (22%), much lower than the 32% ten-year survival of the 148 females. A preceding mole which existed in 254 patients resulted in a ten-year survival rate of 45%, much higher than the 116 patients whose moles arose de novo, of which 27% survived the ten year period. Of fifty patients with superficial melanomas, 34 (68%) survived ten years. The ten-year survival of 386 patients with infiltrating melanomas was 22%. The ten-year survival for patients in Stage I was 59%. Of 262 patients in Stage II, the ten-year survival rate decreased to 14% and for the 60 patients in Stage III, the ten-year survival rate was 7%. The situation was the same for melanomas of the chest wall as well as for the abdominal wall. Elective node dissection was performed in 122 patients with Stage I melanoma and in 42 (34%), microscopic evidence of melanoma was observed. The ten-year survival of patients with positive nodes was 38%. In 62 patients, no elective node dissection was performed and in 26 (42%), clinical evidence of metastases developed later. Of these, six (23%) survived the ten year period after a therapeutic lymph node dissection. We conclude that melanomas over 1 ml in depth (Breslow's classification), or Levels III, IV and V in Clark-Mihm's classification, elective regional lymph node dissection is warranted. Further studies are necessary to determine the exact treatment procedures for the superficial (Level II) melanomas. Level I melanomas should not be included in a report of metastasizing malignant melanoma.

Abdomen↗
PubMed1982

Treatment of asymptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes.

Forty patients with asymptomatic metastatic cancer to the liver discovered at the time of laparotomy were treated by combined intrahepatic arterial chemotherapy and internal irradiation in the form of 90Yttrium microspheres. One group of 25 patients were treated by a catheter inserted at the time of operation and received 100 mCi; of 90Yttrium microspheres and 5-fluorouracil on a continuing basis. They survived an average of 26 mo (varying from 9 to 60 mo). The second series of 15 patients referred after surgery were treated by the percutaneous insertion of the catheter into the hepatic artery and received a bolus of combined chemotherapy consisting of PlatinolTM, Methotrexate, and 5-fluorouracil. They survived an average of 31 mo, which varied from 12 to 60 mo. The dose of 100 mCi of 90Yttrium was well tolerated by the liver. Prospective studies are in progress, limiting the treatment to the internal irradiation to determine its precise role in the overall treatment of metastatic cancer to the liver.

Antineoplastic Agents↗
PubMed1981

Malignant melanoma of the upper extremities.

There were 487 patients treated for malignant melanoma of the upper extremities at the Pack Medical Group in New York City between 1939 and 1967 inclusive, fourth in frequency (14.7%) of total malignant melanomas treated here, being exceeded by malignant melanoma of the trunk (34%), head and neck (23%), and the lower extremities (20%). A 10-year survival rate of 342 determinate patients was 63%. Fourteen percent of the patients who died of melanoma died between the fifth and tenth years, indicating the need to report survival at the 10-year span. Survival was equal for the sexes (61% male and 64% female). The majority of the patients had infiltrating melanomas (Clark's Level 4 and 5) with a survival rate of 62%. Ten patients with superficial spreading melanomas (Clark's Level 2 and 3) and juvenile melanomas enjoyed a 100% 10-year survival. The worst prognosis was for six patients with amelanotic melanoma in that only two of ten survived ten years or longer. The question of elective axillary dissection remains elusive. In 106 patients classified as clinical Stage I, elective axillary dissection was performed in 55 instances, and 26 patients had microscopic evidence of metastases. Their 10-year survival rate was 65%, slightly higher than 16 patients in whom no elective axillary dissection was performed, among whom six later developed evidence of metastases, underwent therapeutic node dissections, and had a 10-year survival of 56%. Radical amputation is occasionally indicated with great palliation and often prolongation of life.

Adolescent↗
PubMed1981

Malignant melanoma of the female genital system: a report of 48 patients and review of the literature.

Malignant melanoma of the female genital tract comprises 3% of all melanomas afflicting females. Melanoma of the vulva is most common, comprising 45 patients treated by the author. Thirty-two percent had metastases to the regional lymph nodes on presentation. Five-year survival is 31.6%. Radical vulvectomy and radical groin dissection is the treatment of choice. Only 80 melanomas of the vagina have been reported, with cures being an extreme rarity. Forty cases of the female urethra reported in the literature and only five survivors have been reported. Melanoma of the uterus is extremely rare, with no cures recorded. Melanoma of the ovary may occur within a teratoma but most frequently is metastatic.

Adolescent↗
PubMed1980

Malignant melanoma of the lower extremity: evaluation of 453 patients.

Four hundred fifty-three patients are evaluated regarding 10-year survival rates. Females comprise 66% and males the remainder (34%). The absolute 10-year survival rate was 55.2% post therapy. Females had a remarkably better survival (64%) than the males (42%). Age did not affect the prognosis. Staging was most important in that 167 patients with Stage I had a 10-year survival of 66%, which dropped for the 263 patients in Stage II (24%), and of the 23 patients classified as Stage III, only one (4%) survived 10 years. Of the 202 patients in clinical Stage I, 102 were subjected to an elective groin dissection which revealed occult metastases to lymph nodes in 35, whose 10-year survival rate was 49%. In 100 patients, no elective groin dissection was performed, and 41 of these developed metastases to inguinal nodes at a later date. The 10-year survival for that group was 32% -- somewhat lower than the 49%. An elective groin dissection is indicated for invasive melanomas. An eleven percent mortality between the fifth and tenth year after therapy indicates that 10-year survival rates should be recorded for melanomas.

Adolescent↗
PubMed1979

Results of treating 1,178 patients with breast cancer by radical mastectomy and postoperative irradiation where metastases to axillary lymph nodes occurred.

A retrospective study of 1,178 females suffering from cancer of the breast and treated by radical mastectomy is presented. All operations were performed by essentially one group of four senior surgeons, each either trained or connected with Memorial Sloan Kettering Hospital in New York and spent practically all of his professional career in the treatment of cancer. The same techniques of surgery were practiced. The same principles of the overall treatment were utilized; namely, if there were no metastases to lymph nodes detected on histologic studies, no radiation therapy was given. If metastases were present in the axillary lymph nodes, each of the patients received postoperative radiation therapy. None received either chemotherapy nor immunotherapy, as primary treatment. The study includes all patients treated between 1930 and 1965 and complete follow-up data were obtained in 94.6% of all patients. Five hundred and ninety-six patients were classified histologically as Stage I (50.6%), 291 as Stage II (24.7%), 74 as Stage III (6.3%), and 217 patients (18.4%) were undetermined. The total number of patients who developed a second primary cancer in the remaining breast was 91 (7.7%), and only 51 patients (4.3%) developed local recurrences in the chest wall or axilla. The mean age of the patients was 51.9 years. The absolute 5-year survival of all patients was 64% and the 10-year survival equaled 54.6%. The 9.4% mortality between the 5- and 10-year survival emphasizes that the 10-year survival figures are a more accurate index of survival. The larger the tumor, usually the poorer the prognosis, except where the tumor was 8 cm or larger where the prognosis was rather good. This indicates some biologic resistance to the tumor, making patients with large tumors candidates for "curative" radical mastectomy. The delay in seeking treatment had minimal effect on the overall survival. Staging had a significant effect and the 5-year survival for the Stage I group was 81.7% which declined to 60.3% at the 10-year period. In the Stage II group, these values were less and averaged 63.7% 5-year survival and 47.2% 10-year survival. The 74 patients wiival at the 10-year period. It is concluded that radical mastectomy plays an important role in curing a significant number of patients with breast cancer. Whether it should be abandoned for more conservative surgery is a matter which further studies will indicate. This study presents a baseline investigation, under a more-or-less standard clinical situation for evaluating the accomplishments of the radical mastectomy.

Adult↗
PubMed1978

Treatment of symptomatic metastatic cancer to the liver from primary colon and rectal cancer by the intraarterial administration of chemotherapy and radioactive isotopes.

Sixty-five patients were referred for treatment with symptoms resulting from metastatic cancer to the liver from the GI tract. Two groups of patients were analyzed. The first group of 40 patients were subjected to a laparotomy and insertion of a catheter into the hepatic artery and a second group had the catheter inserted percutaneously and a bolus of cancer chemotherapeutic agents injected into the catheter. In both groups, chemotherapy in the form of 5-fluorouracil was supplemented by internal irradiation delivered from the intraarterial administration of Yttrium 90 microspheres. Forty percent of the patients who had an indwelling catheter performed at celiotomy manifested an objective response and in 60% a significant subjective improvement occurred. In the 25 patients whose catheter was inserted percutaneously, the response rate was roughly similar, in that 35% demonstrated an objective response and 65% demonstrated a subjective response.

Catheters, Indwelling↗
PubMed1977

Obesity obscuring breast cancer: a case report.

There is normally a layer of fat in the breast between the parenchyma of the breast and the skin. This is frequently thin and does not preclude the palpation of a tumor mass which involves the breast parenchyma. In patients suffering from obesity this fat pad becomes much thicker and obscures any underlying masses arising from the breast parenchyma. A case is reported in which a woman who was markedly obese lost a significant amount of weight and presented a bulge which was found to be carcinoma. This situation, in which fat obscures underlying breast lesion, has been observed in a number of patients. Attention is called to the limited value of physical examination of the breast in markedly obese patients. If any suspicion exists or if the patient is a candidate for cancer from a familial standpoint, mammograms are indicated.

Breast Neoplasms↗
PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗