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Biomedical subjects

M A Steves

Publications and source records attributed to M A Steves.

8 recordsLinked to original sources
PubMed1993

Evaluation of computed tomography in patients with peritoneal carcinomatosis.

BACKGROUND: Radiologic tests to determine the size and location of cancer on peritoneal surfaces are needed for patient management and for clinical research activity. METHODS: Computed tomography (CT) of the abdomen and pelvis were obtained on 45 patients with a diagnosis of peritoneal carcinomatosis before implementation of a complete exploratory laparotomy with biopsy or resection of all tissues suspicious of malignancy. CT findings and surgical findings were recorded and the data analyzed by dividing the abdomen into 9 regions or into 15 anatomic sites. RESULTS: In an overall patient analysis, the sensitivity was 79%. In the nine different abdominal regions, sensitivity was greater than 80% in the right flank, left flank, and right lower and left lower abdominal regions. Sensitivity was lowest in the pelvis (60%). Negative predictive value in the pelvis was 20%. The volume of tumor present within an abdominal region or anatomic site greatly influenced the sensitivity. A sensitivity of only 28% was recorded when tumor nodules were less than 0.5 cm in thickness. This increased to 90% when nodule thickness was greater than 5 cm. CONCLUSIONS: CT is not a reliable diagnostic test for low volume tumor on peritoneal surfaces, and the greatest inaccuracies were recorded in the pelvis. Its diagnostic value increased as tumor volume increased.

Abdomen↗
PubMed1993

A cytoreductive approach to treatment of multiple liver metastases.

Modest benefits and extensive costs have occurred as a result of hepatic artery chemotherapy with fluorodeoxyuridine (FUDR). As a consequence, pump or port infusions of chemotherapy through the hepatic artery are rarely used today. A new cytoreductive approach to the treatment of multiple liver metastases isolated to the liver has been introduced. Induction chemotherapy is used to achieve a response or stabilize disease in the liver. Patients are then selected for surgery, at which time a complete response is achieved through the judicious use of a variety of cytoreductive techniques. In a limited number of patients treated to date the median survival greatly exceeds that reported for intraarterial chemotherapy alone. As experience accumulates, protocols are being modified to decrease the morbidity and maximize the number of complete responders.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy.

BACKGROUND: Peritoneal carcinomatosis has been regarded as a uniformly lethal clinical entity. Recently, dose-intensive treatments combining cytoreductive surgery and intraperitoneal chemotherapy have resulted in long-term survival in selected patients. METHODS: This article reports the morbidity and mortality associated with this new treatment strategy in 45 consecutive treatments of 43 patients with peritoneal carcinomatosis treated during an 18-month interval. RESULTS: The duration of median postoperative ileus was 21 days, and increased age of the patient and extent of cytoreduction caused an increased incidence of ileus. Twenty-one complications occurred in 17 patients (37.7%). Complications related to enteric function included fistula (n = 4), bile leak (n = 1), pancreatitis (n = 1), and anastomotic disruption (n = 1). There were two early and two late episodes of postoperative bleeding requiring reoperation. Six patients had pneumonia and one had deep vein thrombosis. There were no deaths. Six of the seven complications related to enteric function occurred in patients who had undergone induction intraperitoneal chemotherapy before cytoreductive surgery plus early postoperative intraperitoneal chemotherapy. CONCLUSIONS: As a result of these findings, induction intraperitoneal chemotherapy is only recommended for patients with low-volume intraabdominal cancer. In most patients surgical removal of peritoneal carcinomatosis before intraperitoneal chemotherapy is recommended. Because of the significant morbidity related to treatment of peritoneal carcinomatosis, careful patient selection and favorable long-term results of treatment are required.

Adult↗
PubMed1992

Preoperative radiological evaluation of the liver by computerized tomographic portography in patients with hepatic tumors.

The main objective of preoperative imaging studies is to define as accurately as possible the number, size, location, and relationship of tumor masses in the liver to pertinent portal and hepatic venous vasculature. Computerized tomographic portography images hepatic veins and segmental portal vein branches and identifies the anatomical location of tumor nodules with excellent sensitivity and a low false-positive rate. The intraoperative correlation of computerized tomographic portography on 30 patients in the last 20 months at this institution shows a sensitivity of 88 per cent with a low rate of false-positivity. The ability to detect metastatic lesions in the liver by computerized tomographic portography diminishes when the lesions are noted to be less than 1 cm. The authors conclude that the preoperative interpretation of the computerized tomographic portogram provides valuable information not previously available to the surgeon operating on the liver.

Adult↗
PubMedDate not supplied

Fluoroscopically guided peritoneal catheter placement for intraperitoneal chemotherapy.

PURPOSE: Surgical placement of intraperitoneal catheters for intraperitoneal chemotherapy is associated with bowel perforation, peritonitis, and catheter occlusion. The authors evaluated the safety and efficacy of fluoroscopically guided placement of temporary intraperitoneal catheters for chemotherapy. PATIENTS AND METHODS: Two hundred one intraperitoneal catheter placements were attempted in 88 patients with peritoneal carcinomatosis or sarcomatosis. The peritoneum was punctured with 22-gauge needles and exchange was made with use of Seldinger technique and liberal injections of contrast material at each step for 8.3- or 8.5-F multiple-side-hole catheters. Placement sites included all four quadrants and the midline. Computed tomographic (CT) peritoneography was performed prior to chemotherapy. RESULTS: One hundred ninety (94.5%) of 201 attempted catheter insertions were technically successful. Results of CT peritoneography were available in 175 cases and showed free distribution of peritoneal contrast material in 39% (n = 69), partial loculation in 38% (n = 67), and extensive loculation in 22% (n = 39). Catheters remained in place for a median of 5 days (range, 2-6 days). Significant complications occurred in 11 procedures (5.5%). There were seven unintended bowel intubations; all were treated conservatively except one that required surgical repair. One other patient developed necrotizing fasciitis requiring surgical débridement. Three other patients (1.5%) developed mild peritonitis responsive to antibiotics. Technical success, complications, and peritoneal distribution of contrast material did not correlate with the site of catheter placement. CONCLUSION: Percutaneous catheter placement with use of small-gauge needles for initial puncture is safe and efficacious in patients requiring short-term peritoneal access for chemotherapy.

Adult↗