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Biomedical subjects

J Fortner

Publications and source records attributed to J Fortner.

At least 19 recordsLinked to original sources
PubMed1999

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.

OBJECTIVE: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease. METHODS: Clinical, pathologic, and outcome data for 1001 consecutive patients undergoing liver resection for metastatic colorectal cancer between July 1985 and October 1998 were examined. These resections included 237 trisegmentectomies, 394 lobectomies, and 370 resections encompassing less than a lobe. The surgical mortality rate was 2.8%. RESULTS: The 5-year survival rate was 37%, and the 10-year survival rate was 22%. Seven factors were found to be significant and independent predictors of poor long-term outcome by multivariate analysis: positive margin (p = 0.004), extrahepatic disease (p = 0.003), node-positive primary (p = 0.02), disease-free interval from primary to metastases <12 months (p = 0.03), number of hepatic tumors >1 (p = 0.0004), largest hepatic tumor >5 cm (p = 0.01), and carcinoembryonic antigen level >200 ng/ml (p = 0.01). When the last five of these criteria were used in a preoperative scoring system, assigning one point for each criterion, the total score was highly predictive of outcome (p < 0.0001). No patient with a score of 5 was a long-term survivor. CONCLUSION: Resection of hepatic colorectal metastases may produce long-term survival and cure. Long-term outcome can be predicted from five criteria that are readily available for all patients considered for resection. Patients with up to two criteria can have a favorable outcome. Patients with three, four, or five criteria should be considered for experimental adjuvant trials. Studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.

Adult↗
PubMed1995

Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma.

BACKGROUND: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. METHODS: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. RESULTS: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in non-cirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P < 0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (< or = 5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). CONCLUSIONS: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.

Adolescent↗
PubMed1994

Repeat hepatic resections for metastatic colorectal cancer.

OBJECTIVE: The authors weighed the risks and benefits of repeat liver resections for colorectal metastatic disease. METHOD: In the 6-year period between January 1985 and June 1991, 499 patients underwent liver resections for colorectal metastases at the Memorial Sloan-Kettering Cancer Center. Of these, 25 patients had repeat surgical resections for isolated recurrent disease to the liver. The clinical data for these patients were reviewed. RESULTS: The median interval between the two resections was 11 months. There were no perioperative deaths, and the complication rate was 28%. Median follow-up after the second liver resection is 19 months, with median survival of 17 months for nonsurvivors. Although the median survival after the second resection is 30 months, 20 of the 25 patients have had recurrences with a median disease-free interval of only 9 months. No characteristic of primary or metastatic disease predicted outcome, including time between presentation of the primary and development of liver metastases, disease-free interval after the first liver resection, and bilobar liver involvement. CONCLUSIONS: Although repeat liver resections can be performed safely and improves survival, the likelihood of cure from such resection therapy is low. This likelihood of further recurrences encourage studies of adjuvant or alternative treatments of this population.

Adult↗
PubMed1990

The use of a prosthetic tissue expander to displace bowel from a brachytherapy implant site.

We describe the use of a prosthetic maneuver to displace bowel from an implant site. The patient presented with a recurrent low grade fibrosarcoma which was grossly excised with positive microscopic margins in the right paravertebral area. For this reason we performed an Iridium-192 implant using afterloading catheters. Because of several dense adhesions, it was not possible to mobilize an omental sling over the implant site. To prevent the small bowel from lying on the catheters, we inserted a prosthetic breast tissue expander. This was expanded with saline and bacitracin solution and placed in the tumor bed overlying the catheters, thereby displacing the small bowel away from the sources. A postoperative CT scan with gastrograffin demonstrated that this procedure was effective. There were no complications. We conclude that such devices are suitable for use under these circumstances and can achieve the objective of decreasing the dose of radiation to the small bowel.

Abdominal Neoplasms↗
PubMed1982

Pharmacokinetics of cisplatin regional hepatic infusions.

Cisplatin (DDP), a potent antineoplastic agent, is usually administered via a peripheral vein. Recently, there has been considerable interest in intraarterial regional infusions of DDP. The pharmacokinetics of DDP when administered by this technique have not been explored in detail. We studied DDP pharmacokinetics in dogs given DDP by infusion and bolus injection in the hepatic artery (H.A.), portal vein (portal V), and peripheral vein (P.V.). Blood and biliary platinum concentrations ([Pt]) were assayed by flameless atomic absorption spectrophotometry. During an infusion into the H.S., peak [Pt] in the vessel were markedly higher (mean value 19 micrograms/ml) than those found, simultaneously, in the portal V or superior vena cava. Following a bolus injection of DDP into the H.A., higher H.A. [Pt] were also seen, but [Pt] rapidly (within 5-10 minutes) equilibrated in all sites sampled. During the H.A. infusion, most [Pt] was in its free (active) form. Bile and hepatic tissue were also sampled. Hepatic artery infusions of DDP give high drug concentrations in the perfusing blood, while systemic [Pt] are much lower. During the infusion, the majority of DDP is in its active (unbound) state.

Animals↗
PubMed1981

Acinar cell cystadenocarcinoma of human pancreas.

A 7000 g cystic tumor replacing the body and tail of the pancreas was resected in a 64-year-old man. Numerous peritoneal implants confirmed its malignant nature. Light microscopy of both the primary tumor and the implants revealed distinctive cytoplasmic eosinophilia and apical granules. Ultrastructural examination demonstrated numerous zymogen granules and abundant, rough endoplasmic reticulum, which confirmed that the tumor was composed of acinar cells. No mucinous or serous differentiation was detected. We have not found report of a similar tumor.

Carcinoma↗
PubMed1981

Scapulectomy for soft tissue sarcoma.

Between 1961 and 1978, 19 patients with primary soft tissue sarcomas were treated by resection of part or all of the scapula and musculoaponeurotic attachments. Recurrence-free survival was from 2 to 18 years (mean 10.7 years) in all six patients with a histologically low-grade fibrosarcoma and from 2.5 to 9 years (mean 4.9 years) in three of six patients with high-grade tumours. In all 12 patients the margin of resection was satisfactory. In contrast, only two of seven patients with high-grade sarcomas and gross or microscopically involved resection margins were alive 1 year after operation. Long-term salvage or cure of soft tissue sarcomas at this or other sites depends upon the histologic grade of the tumour and the feasibility of an adequately wide monobloc excision. Adjunctive measures to diminish the likelihood of local recurrence and to avoid amputation in marginal situations include intraoperative brachytherapy (with iodine-125 or iridium-192) and supplemental external radiotherapy. Recent experience with intensive multiple-agent chemotherapy indicates an appreciable reduction in the occurrence of systemic metastases from tumours with this potential.

Adult↗
PubMed1977

Cryptosporidium in snakes with hypertrophic gastritis.

Fourteen captive snakes of three genera and four species had severe chronic hypertrophic gastritis. Persistent postprandial regurgitation and firm midbody swelling were the most common clinical signs. Fecal smears had many roughly spherical organisms confirmed by ultrastructural study to be oocysts of Cryptosporidium. Pathologic changes included hypertrophy of gastric mucosa and atrophy of granular cells. There were cystic changes in gastric glands and focal mucosal necrosis. Many Cryptosporidium lined microvillar surfaces. All developmental forms were identified by ultrastructure. Characteristic oocysts were found in abundance.

Animals↗