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Biomedical subjects

J S Spratt

Publications and source records attributed to J S Spratt.

At least 73 records · Page 4Linked to original sources
PubMed1983

Acute carcinoma of the breast.

The timely discovery of curable carcinoma through screening and early treatment is compromised by the existence of acute carcinoma with adverse properties. The existence of an acute carcinoma must be considered in planning and promoting any public health program for the control of carcinoma of the breast. These carcinomas will surface under any contemporarily available screening or detection program through no physician or patient error. These carcinomas have identifiable properties, and their occurrence should not be the basis of a malpractice suit, since their evolution is not presently preventable. The available data on actual doubling times obviously provide truncated distributions, since they contain no data on the faster subsets of carcinomas that surface in the intervals between screenings too quickly to permit measurement of size and calculation of DT (act).

Acute Disease↗
PubMed1983

Tumor growth, doubling times, and the inability of the radiologist to diagnose certain cancers.

In the absence of prevention, the control of breast cancer demands that it be discovered as soon as possible after it reaches threshold size, but before it disseminates. This optimal detection time is known as the "cancer control window." The actual doubling time of a cancer is a major determinant of the length of time available for effective discovery. Data are presented showing the enormous variance possible for this interval, ranging from very short times to extremely long times. With refined mammographic techniques and conscientious, aggressive mammographers, this threshold size continues to shrink and now approaches 2 mm. Many factors, however, continue to influence effective detection in this size range including cancer type, breast parenchymal density, proper applications of examination techniques, and the duration of the cancer control window for different cancers. Our own experience and review of the literature indicate that a certain percentage of cancers will be missed in the symptomatic and screened populations. With some adjustments of technique and interpretation and careful attention to them, many of these overlooked cancers can be recognized. However, data support the presence of a subset of acute breast cancers below threshold size at examination but that can grow to clinically detectable and symptomatic size within weeks to months of the breast evaluation showing no abnormality. These cancers will surface under any contemporarily available screening or detection program through no physician error. Under optimal conditions, this group of cancers can neither be prevented nor recognized and account for the inability of the radiologist to diagnose some breast cancers.

Acute Disease↗
PubMed1982

One-stage pharyngoesophageal and oral mucocutaneous reconstruction with two segments of one musculocutaneous flap.

This report describes a one-stage technique that provides both cover and lining to mucocutaneous defects of the head and neck with either latissimus dorsi or pectoralis major musculocutaneous units that are split into anatomic segments to create two independent flaps from one musculocutaneous unit. In addition, this technique further refines reconstruction of pharyngoesophageal defects. Techniques of simultaneous mandibular reconstruction with vascularized bone carried on these same segmental flaps are also commented on.

Animals↗
PubMed1981

Association between the actual doubling times of primary breast cancer with histopathologic characteristics and Wolfe's parenchymal mammographic patterns.

This study identifies associations between the actual doubling time of primary mammary cancers with histopathologic characteristics and Wolfe's parenchymal mammographic patterns. Seventy microscopic criteria and Wolfe's mammographic parenchymal patterns were coded for 32 primary breast cancers on which actual volume doubling times were calculated from serial mammographic views of tumor nucleus shadows. Circumscribed cancer margin and papillary intraductal growth were associated with slow-growing breast cancers. More anaplastic nuclear grade was associated with faster-growing cancers. No association could be established between doubling time and parenchymal patterns as described by Wolfe.

Breast Neoplasms↗
PubMed1981

Analysis of breast cancer screening in women younger than 50 years.

The five-year screening experience for 10,128 asymptomatic women whose conditions were evaluated at the Louisville Breast Cancer Detection Demonstration Project disclosed 163 breast carcinomas in women aged 35 to 74 years. Thirty-four percent of patients with proved carcinoma were younger than 50 years; 31% with infiltrating carcinoma had axillary metastases at the time of diagnosis. In younger patients, carcinomas disclosed at intervals between scheduled screenings were more commonly metatastic. Minimal breast cancer was more prevalent in the screened population (29%) than the unscreened population (less than 5%), and appeared with similar frequency in screenees of each age category. Screening women younger than 50 years allow earlier diagnosis and treatment of breast cancer in a favorable stage that is comparable with that noted in the older screenees.

Adult↗
PubMed1981

Sacral chordoma: a case study and review.

Chordomas are a low grade, tenacious, but eventually lethal neoplasm for which little improvement in outcome has been reported. A current review of the literature and a case report are provided to support his position. The reported sacral chordoma did respond temporarily to chemotherapy. Its rare occurrence precludes controlled studies of chordoma; therefore, any response merits reporting. The authors observed that hyperthermic chemotherapy was feasible for treating some chordomas but has not yet been reported. It was evaluated for the patient in this report.

Antineoplastic Agents↗
PubMed1981

The primary and secondary prevention of cancer.

Prevention of cancer is now divided into primary and secondary prevention. Primary prevention is that set of interventions that keeps a cancerous process from ever developing and includes health counseling and education, environmental controls. and product safety as examples. Secondary prevention is that set of interventions leading to the discovery and control of cancerous or precancerous processes while localized, i.e., screening, early detection, and effective treatment. Risk is lifelong for all, though it may vary in intensity among different groups. Jointly, primary and secondary prevention must be synthesized into optimum life time strategies that are best understood and evaluated under certain basic concepts of the epidemiology of cancer and operations research. The purpose of this report is to provide a brief review of these concepts applied to primary and secondary prevention of human cancer. Improved understanding of these concepts is essential for planning, implementation, and evaluation of prevention programs.

Health Education↗
PubMed1981

The relationship between the rates of growth of cancers and the intervals between screening examinations necessary for effective discovery.

Data compiled since 1961 on the actual doubling times, DT(act), of human cancers at many sites have repeatedly shown an extreme natural variance, usually lognormal. This variance contributes to extreme variance in the optimum intervals between screening exams, lead time and length bias, and the frequency of cancers surfacing between screens. This variance can be used to estimate the optimum intervals between screens. The DT(act) determine the variance in the cancer control window. The CCW is that segment of time in the life history of a cancer elapsing between the attainment of a threshold size for detection and a size at which a cancer disseminates beyond the region of origin. The CCW cannot exceed 14 net doublings and the median is probably not greater than 9 doublings. A table is provided relating DT(act) to the net number of doublings in the CCW demonstrating how a year between screens will exceed the CCW for most acute cancers. These considerations can then be cross referenced to the observed lognormal frequency distributions of the DT(act) of many common human cancers measured in vivo to estimate the percent of cancers that might be detected effectively with various screening intervals. Doubling time data from the University of Louisville Breast Cancer Detection Demonstration Project and other sources are reported to show the relationship of these concepts to known doubling times.

Humans↗
PubMed1980

Recurrence of breast cancer. Obesity, tumor size, and axillary lymph node metastases.

Substantially different conclusions have been reached by several studies about relationships between mammary cancer and obesity. We studied retrospectively 106 consecutive patients who underwent mastectomy for breast cancer. We found no association between obesity per se and the frequency or time of recurrence. Our sample did reaffirm that recurrence of breast cancer is related to tumor size and nodal status. Obesity was similarly related to tumor size and nodal status. However, we could not confirm prior findings that obese patients with pathologically similar breast tumors had a poor prognosis.

Axilla↗
PubMed1980

The value of no-touch isolation technique for resection of cancer. The eye as a model.

The role of the no-touch technique was examined using retinoblastoma and primary choroidal malignant melanoma of the eye as a model. Choroidal invasion, tumor friability, and tumor vascularity are important factors that render these two tumors susceptible to metastasis secondary to intraorgan pressure increases. Animal studies on no-touch enucleation procedures show that increased intraocular pressure during enucleation decreases survival rates considerably providing the tumor has invaded the choroid but has not yet metastasized. This "critical stage" correlates well with earlier data on the no-touch technique studied in noneye models. In humans, standard enucleations create intraocular pressures measured up to 500 mm Hg. The no-touch technique is applicable to the therapy of retinoblastoma and primary choroidal malignant melanomas, but long-term clinical studies are needed to establish the true benefit.

Animals↗
PubMed1980

Clinical delivery system for intraperitoneal hyperthermic chemotherapy.

A 35-year-old man was treated for pseudomyxoma peritonei by surgery and by thermal infusion and chemotherapy with a machine designed specifically for the treatment of cancers of serosal surfaces. After extensive abdominal resection and closure, the patient's peritoneal cavity was instilled with 2.5 liters of 5% lactated Ringer's solution. He was then attached to hyperthermic perfusion system which elevated the i.p. temperature by warming (to 42 degrees) and recirculating the effusion solution. When the 42 degrees i.p. temperature was attained (after 1.5 hr), chemotherapy was added to the recirculating effusion. A second procedure followed 8 days later. The patient's postoperative course was uneventful except for minor pulmonary atelectasis with bacteremia. Hyperthermic perfusion was tolerated well and was evaluated as safe for intracavitary cancer treatment.

Adult↗
PubMed1980

Hyperthermic peritoneal perfusion system in canines.

The thermal infusion filtration system was designed to manage malignant effusions and treat metastatic cancers of the intracavitary serosa. Hyperthermia, chemotherapy, and cell and debris filtration were administered by a dynamic fluid flow. Preclinical evaluations of surgical procedure, temperature studies, fluid dynamics, and physiology were carried out in 15 dogs (17.2 to 25.4 kg) with peritoneal perfusion at 41 degrees C and 10 liters/hr flow. Results suggest that the dynamics of flow achieves total intracavitary equilibrium in 7 min. The time essential to elevate animal body mass temperature from ambient to 41 degrees varied as a function of mass. The hyperthermia induced expected nonlethal responses in physiology. The system was determined to be safe for clinical procedure.

Animals↗