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Biomedical subjects

J K Martin

Publications and source records attributed to J K Martin.

At least 55 records · Page 3Linked to original sources
PubMed1986

An aborted, prospective, randomized trial of sclerotherapy for prolonged drainage after mastectomy.

Annually, approximately 100 of the 400 postmastectomy patients we studied have persisting serous drainage. Sclerotherapy with the use of tetracycline has been advocated to decrease serous drainage and the formation of seromas. Reports in the literature suggest that the use of tetracycline for treatment has been efficacious and that it is not painful. We devised a prospective, randomized controlled trial to study the effects of tetracycline on patients with prolonged persisting drainage. Six patients in the control group had the drains left in place until the drainage diminished. One of these patients had a seroma develop after the drains were removed. Eight patients were treated with tetracycline. Four of these patients had seromas develop after the drains were removed. Three of the eight patients had severe reactions of pain when the tetracycline was introduced into the drains. Because of the severe pain associated with sclerotherapy treatment and the lack of demonstrable benefit in those treated, we terminated the study. We did not find tetracycline to be of help in treating patients with prolonged drainage after mastectomy and some of those patients had severe pain develop from the treatment.

Drainage↗
PubMed1986

Surgical considerations after chemotherapy and radiation therapy for inflammatory breast cancer.

Eighteen patients seen between 1974 and 1982 with the clinical diagnosis of inflammatory breast carcinoma underwent modified radical mastectomy after preoperative chemotherapy and radiation therapy. In 17 of the 18 patients (94%), residual carcinoma was detected in either the resected breast or the axillary nodes. All mastectomies were accomplished without major technical difficulty. Seven wound complications, including three infections, occurred. Local recurrence was noted in 29% (five of 17 patients) and distant metastasis was detected in 89% (16 of 18 patients). Only three patients are presently alive without evidence of disease 19, 21, and 21 months since the onset of symptoms. Eleven patients have died, the median survival being 23 months since the development of symptoms, and four are alive with distant metastasis. Modified radical mastectomy can be accomplished in patients with inflammatory breast cancer after preoperative chemotherapy and radiation therapy and may have a role in reducing local tumor burden.

Adult↗
PubMed1985

Residual, recurrent, or unresectable gastrointestinal cancer. Role of radiation in single or combined modality treatment.

When conventional modalities of external beam irradiation and chemotherapy +/- resection are used in the treatment of locally advanced gastrointestinal malignancies, although useful palliation can be achieved in many patients, cure and long-term survival is infrequent. Aggressive combined modality approaches have recently encorporated irradiation boost techniques with intraoperative electrons or intraoperative or transcatheter brachytherapy. Both local control and long-term survival appear to be improved when compared with results achieved with conventional treatment. Randomized trials are needed to determine if the observed differences are real or due to differences in case selection.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Carcinoma of the breast associated with pregnancy.

Sixty-three pregnant patients were treated for primary carcinoma of the breast at the Mayo Clinic between 1950 and 1980. These patients had a greater incidence of nodal metastasis and scirrhous histopathologic factors than did non-pregnant patients with a malignant condition of the breast. The five year survival rate of pregnant patients with localized malignant growths of the breast was 80 per cent. Improved survival time was not demonstrated for patients who terminated the pregnancy.

Abortion, Therapeutic↗
PubMed1985

Carcinoid tumors of the gastrointestinal tract: presentation, management, and prognosis.

One hundred fifty-four patients with gastrointestinal carcinoid tumors were surgically treated at our institution between 1972 and 1982. The most frequent primary sites were the ileum (43%), rectum (30%), appendix (11%), jejunum (6%), stomach (6%), and duodenum (1%). Asymptomatic tumors were discovered incidentally in 93 patients (60%). Symptomatic tumors were common (48%) among the group with ileal carcinoid tumors. Except for endoscopy, preoperative studies were of limited value. The malignant carcinoid syndrome was present in 12 patients (nine with ileal tumors). One hundred forty-seven patients underwent surgical or endoscopic resection of the primary tumor; the overall operative mortality rate was 2.6%. Of significance was the high incidence (18%) of metastasis from ileal primary tumors smaller than 1 cm.

Adolescent↗
PubMed1984

Analysis of failure following curative irradiation of gallbladder and extrahepatic bile duct carcinoma.

Twenty patients with carcinoma of the gallbladder (GB-4 patients) or extrahepatic bile ducts (EHBD-16 patients) received radiation therapy with curative intent between January, 1980 and December, 1982. All 20 received 4500-5000 rad in 180-200 rad fractions to the tumor and regional lymph nodes. A 1000 to 1500 rad external beam boost was delivered in 180-200 rad fractions in 10 patients who received external beam alone or concomitant 5-Fluorouracil (5-FU). Three of the four GB and 5 of the 16 EHBD patients received a transcatheter boost with 192-Iridium (192Ir) to a dose of 2000-2500 rad calculated at a 0.5-0.1 cm radius. An additional 2 patients with EHBD lesions received an intraoperative electron (IORT) boost of 1500-2000 rad in one fraction calculated to the 90% isodose. Survival and patterns of failure were analyzed by site and treatment method. All four patients with GB carcinoma are dead of disease at 5 1/2, 6, 9 and 10 months from the date of diagnosis respectively. Three of the four developed diffuse peritoneal carcinomatosis. Five of the 16 patients with EHBD carcinoma are alive with a median follow-up of 18 months (range 6-23 months). Four of the 5 patients received a transcatheter 192Ir or IORT boost and all are without evidence of disease. Four of 9 patients who had a subtotal resection with transection of tumor, dilatation of the bile ducts with probes or curettement of the bile ducts developed either diffuse peritoneal carcinomatosis (3 patients) or a recurrence in the surgical scar (2 patients). Local failure was documented in 3 of the nine patients treated with external beam alone +/- 5-FU, and has been documented in one of the seven patients who received an IORT or transcatheter 192Ir boost. Further experience is necessary to determine whether this aggressive treatment will result in long-term disease-free survival in these patients.

Adult↗
PubMed1984

Surgical management of acute pancreatitis.

Acute pancreatitis is a formidable problem that infrequently necessitates surgical intervention. Indications for operation may be divided into four main categories: (1) uncertain diagnosis, (2) deteriorating condition, (3) biliary pancreatitis, and (4) pancreatic abscess. One of the most important contributions concerning acute pancreatitis has been the development of predictive criteria that allow quantitation of the severity of disease and precise comparison of various reported series. During a 2-year period, 222 patients with acute pancreatitis were seen at our institution, and 62 of these patients (28%) underwent operation. Biliary pancreatitis accounted for 63% of our cases. The overall mortality of 24% was directly related to the severity of the pancreatitis. Cholecystectomy, during the same hospital admission, is advised for treatment of biliary pancreatitis.

Abscess↗
PubMed1984

Intraoperative and external beam irradiation with or without resection: Mayo pilot experience.

At our institution, intraoperative radiation therapy (IORT) with an electron beam has been administered as a single boost dose of 1,000 to 2,000 cGy (rad) in combination with 4,500 to 5,000 cGy (rad) of fractionated external beam irradiation. From April 1981 to July 1983, 50 patients received such treatment, and results are analyzed in detail in this article. All patients had locally advanced disease (initially unresectable for cure, residual after resection, or recurrent), and the main disease sites were gastrointestinal (pancreatic, colorectal, and biliary tumors) and soft tissue (sarcomas). Disease-free survival to date has been excellent in our colorectal and biliary subsets of patients. Although local progression has not been a major problem in patients with unresectable pancreatic lesions, failures in the liver and peritoneal cavity have been excessive, and treatment strategies have been altered in an attempt to decrease the frequency of such failures. Although both short-term and long-term morbidity are acceptable, pilot trials with use of radiation-dose modifiers are planned to determine whether the therapeutic ratio of local control to associated complications can be improved even further.

Combined Modality Therapy↗
PubMed1984

Prebiopsy localization of nonpalpable breast lesions.

Invasive localization procedures are indicated preoperatively when breast lesions are nonpalpable. Several techniques are available for locating such lesions. In experience with 343 nonpalpable lesions, 27% of the biopsied lesions were malignant. Calcification was present in 51% of all lesions. A combination needle-hooked wire technique was used. Some problems were encountered, the most frequent being vasovagal reactions. The most serious problem was the failure to remove the located lesion in nine cases.

Adult↗
PubMed1983

Surgical treatment of functioning metastatic carcinoid tumors.

Thirteen patients with functioning carcinoid syndrome and hepatic metastases were surgically treated. Localized hepatic metastases were resected in five patients, and diffuse hepatic metastases were treated with hepatic artery ligation in eight. There were no postoperative deaths, and follow-up ranged from six to 46 months. All patients were symptom-free after operation. In all patients with resection, levels of 5-hydroxyindoleacetic acid (5-HIAA) returned to normal or near normal, whereas in patients who underwent hepatic artery ligation, the average reduction in 5-HIAA level was 76%. Three patients died during the follow-up period--two of metastatic carcinoids and one without evidence of disease. The mean duration of response was 36 months for resection and 4.8 months for hepatic artery ligation. The addition of postoperative intra-arterial chemotherapy and sequential systemic chemotherapy may enhance the response to hepatic artery ligation.

Aged↗
PubMed1983

Hickman catheter implantation in the treatment of acute leukemia.

Between July 1980 and May 1981, 32 permanent indwelling Hickman catheters were implanted in 29 patients. Most of the catheters were placed for treatment of acute leukemia (25 patients) or lymphoma (two patients). Catheters were used for a total of 3,461 patient-days (mean, 108 days). Two patients had infections at the exit site, one seven and the other 11 days after implantation. Four patients had sepsis, but none of those infections appeared to be catheter related. Hickman catheters appear to provide ease of treatment in acute leukemia and are associated with patient satisfaction and an acceptable complication rate.

Acute Disease↗
PubMed1982

Staging laparotomy in Hodgkin's disease: Mayo Clinic experience.

Between 1967 and 1979, 316 patients with Hodgkin's disease underwent staging laparotomy. Histologic examination demonstrated lymphocyte predominance in 40 (12.7%) patients, nodular sclerosis in 178 (56.3%), mixed cellularity in 80 (25.3%), and lymphocyte depletion in seven (2.2%); results in 11 (3.5%) patients were considered unclassifiable. There were no deaths. Major complications occurred in 7.9% and required reoperation in 1.9%. Pathologic stage differed from clinical stage in 111 (35.1%) patients. In 90 (28.5%) patients, the stage advanced; in 21 (6.6%) patients, the stage was reduced; and in five (1.6%) patients, the histologic subtype was changed. Stage changes occurred in 40% of those with lymphocyte predominance, in 27.5% with nodular sclerosis, in 46.3% with mixed cellularity, and in 85.7% with lymphocyte depletion. The reliability of staging laparotomy for the determination of appropriate treatment favors its continued use.

Adolescent↗
PubMed1982

Recurrent and metastatic cystosarcoma phyllodes.

During a 30 year period (1950 to 1980), 42 patients with cystosarcoma phyllodes were seen at the Mayo Clinic. Ten patients (24 percent) had recurrence of metastasis. The malignant or metastatic potential could not be identified or predicted by histologically evaluating tumor contour, stromal atypia, or mitotic activity. Spread was chiefly by a hematogenous route, and no patient with metastasis survived. Five of the 10 patients died from their disease 2 to 7 years after treatment. Simple mastectomy appears to be the surgical treatment of choice.

Abdominal Neoplasms↗
PubMed1982

Synchronous and metachronous carcinoma of the breast.

To determine the incidence of synchronous bilateral breast cancer, 100 women receiving their initial treatment for primary breast cancer prospectively underwent biopsy of the opposite breast. No patient had a clinically detectable abnormality in the contralateral breast, but 2% had unsuspected invasive ductal carcinomas. An additional 5% had premalignant lesions. To determine the incidence of the development of metachronous breast cancer, 153 women who underwent surgical treatment of primary breast cancer between 1955 and 1979 were followed from 2 months to 26 years, with an average of 3.6 years. During that time, 3.9% developed metachronous carcinomas of the contralateral breast.

Adult↗
PubMed1980

Colitis cystica profunda.

Colitis cystica profunda is a benign disease of the colon. Its importance lies in differentiating it from mucus-producing adenocarcinoma. It has rarely been described in the surgical literature. A review of records of patients seen at the Mayo Clinic produced 66 clinical cases of localized colitis cystica profunda, and in 21 patients the diagnosis was confirmed histologically. Follow-up, which was available in all patients, ranged from 2 months to 29 years, with a mean follow-up of more than 8 years. The data suggest that local excision is the preferred initial therapy.

Adolescent↗