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Biomedical subjects

M Burt

Publications and source records attributed to M Burt.

At least 73 records · Page 4Linked to original sources
PubMed1994

Esophageal carcinoma. The unusual variants.

The clinical behavior and response to therapy of rare histologic variants of esophageal carcinoma are unclear. To evaluate the results of therapy in this group the records of 29 patients treated between 1949 and 1991 with primary rare histologic variants of esophageal carcinoma were retrospectively reviewed. This group represented 1.2% of 2454 cases of esophageal carcinoma treated between 1949 and 1991 and included mucoepidermoid (n = 14), small-cell (n = 12), adenoid cystic (n = 2), and carcinosarcoma (n = 1) carcinomas. Treatment for localized disease consisted of esophagectomy in five of seven patients with mucoepidermoid carcinoma, two of six patients with small-cell carcinoma, two of two patients with adenoid cystic carcinoma, and one of one patient with carcinosarcoma. Patients with stage IV mucoepidermoid carcinoma were treated predominately with radiation therapy (5/7). The majority of small cell carcinomas were treated with multiagent chemotherapy (10/12). The 1- and 3-year disease-specific survivals were 54% and 9% for mucoepidermoid carcinoma (median survival, 5 months) and 16% and 0% for small-cell carcinoma (median survival, 7 months), respectively. Patients with stage III mucoepidermoid carcinoma (median survival, 20.5 months) compared with those with stage III small-cell carcinoma (median survival, 6.2 months) had a significantly longer duration of survival (p < 0.05). Distant disease was present in 86% of patients in whom recurrence developed after esophagectomy Esophagectomy is standard therapy for localized carcinomas of the esophagus. Small-cell carcinoma appears to be a more aggressive variant of carcinoma and is most commonly treated with chemotherapy.

Adult↗
PubMed1994

Primary malignant tumors of the chest wall. The Memorial Sloan-Kettering Cancer Center experience.

Primary malignant tumors of the chest wall are relatively uncommon. During the 40-year period from 1949 to 1989, 418 primary malignant tumors of the chest wall were evaluated at Memorial Sloan-Kettering Cancer Center. Because the treatment depends on the histology of these tumors, the five different types of tumors are discussed separately in the article. The results from Memorial Sloan-Kettering during the 40-year period are stressed, with comparisons to other studies included when appropriate.

Adolescent↗
PubMed1994

Isolated single lung perfusion with doxorubicin is effective in eradicating soft tissue sarcoma lung metastases in a rat model.

The only effective therapy for patients with metastatic soft tissue sarcoma in the lung is surgical resection, with a 5-year survival of approximately 25%. Because systemic chemotherapy has not significantly affected survival in these patients, we began to investigate locoregional chemotherapy. We have previously shown that isolated single lung perfusion with doxorubicin in the rat results in higher lung tissue levels and lower systemic toxicity than does high-dose intravenous therapy. In the present study, we examined the safety of isolated lung perfusion with doxorubicin and its efficacy in the treatment of experimental pulmonary metastases from soft tissue sarcoma. In experiment 1, 15 F344 rats were randomized into three groups (n = 5): group I had isolated left lung perfusion with doxorubicin 320 micrograms/ml in saline solution; group II had left isolated lung perfusion with doxorubicin 480 micrograms/ml and group III with doxorubicin 640 micrograms/ml. All perfusions with doxorubicin were at 0.5 ml/min for 10 minutes followed by perfusion of saline solution for 5 minutes. On day 21, all animals underwent right (contralateral) pneumonectomy and were observed for over 10 days. In experiment 2, two groups of F344 rats were injected intravenously with 10(7) viable methylcholanthrene-induced sarcoma cells on day 0. On day 7, group I (n = 12) had left isolated lung perfusion with saline solution only and group II (n = 15) had isolated lung perfusion with doxorubicin 320 micrograms/ml. On day 21, all animals were killed, and their lungs were stained for metastases. Routine histologic sections from three animals from group II were examined. In experiment 1, 80% of the animals in group I survived contralateral pneumonectomy. There were no survivors in groups II and III. In experiment 2, three animals died after isolated lung perfusion (one from group I and two from group II), and one animal (group I) was excluded because of mediastinal tumor. All animals in both groups had massive tumor replacement of the right (untreated) lung. Group I animals had massive tumor replacement of the left (treated) lung, whereas animals in group II had eradication of metastases in nine of ten cases; no microscopic evidence of tumor was detected in all three animals evaluated for microscopic disease. Isolated lung perfusion with doxorubicin 320 micrograms/ml is safe and effective in eradicating experimental pulmonary sarcoma metastases in this model.

Animals↗
PubMed1994

Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer. Impact of magnetic resonance imaging.

UNLABELLED: We designed a prospective study to evaluate the accuracy of magnetic resonance imaging in distinguishing a benign from a malignant adrenal mass in patients with otherwise operable non-small-cell lung cancer. METHODS: Potentially operable non-small-cell lung cancer was prospectively staged. If a unilateral adrenal mass was found by computed tomographic scanning, respiratory compensated and cardiac gated thin section magnetic resonance imaging of the adrenal glands was done. One radiologist interpreted the magnetic resonance imaging scan blinded and, on the basis of the relative signal strengths of the T1- and T2-weighted images, judged whether the adrenal mass was benign or malignant. The patients then underwent a percutaneous needle biopsy of the adrenal mass, if technically feasible. If the result of the needle biopsy was nondiagnostic or if the biopsy was not feasible, an adrenalectomy through a posterior approach was performed. RESULTS: Twenty-seven patients with a unilateral adrenal mass entered the study-11 men and 16 women whose ages ranged from 42 to 75 years (median 58 years). Four patients had epidermoid and 23 adenocarcinoma of the lung. The clinical locoregional stage was I in 9, II in 1, IIIA in 16, and IIIB in 1. Twenty-five completed the magnetic resonance imaging procedure. Five adrenal masses (19%) were metastatic non-small-cell lung cancer (adenocarcinoma = 4, epidermoid = 1); 22 masses (81%) were benign (adenoma = 20, hyperplasia = 2). There were no significant differences in age, sex, histologic type, or locoregional stage between those with a benign versus a malignant mass. However, the malignant masses were significantly larger (3.8 +/- 1.9 cm; range 2.5 to 7.1; median 3.1) than the benign masses (2.0 +/- 0.4 cm, range 1.2 to 2.8; median 2.0) (p < 0.001). Among those having magnetic resonance imaging (n = 25), the technique correctly predicted a malignant mass in the four patients with a histologically confirmed metastasis from non-small-cell lung cancer. However, among the 21 histologically benign masses, the magnetic resonance imaging was interpreted as benign in 5, malignant in 14, and indeterminate in 2. Therefore, although the false-negative rate was 0%, the false-positive rate was 67%. CONCLUSION: Most adrenal masses in patients with otherwise operable non-small-cell lung cancer are benign. Currently available magnetic resonance imaging methods cannot replace biopsy.

Adrenal Gland Diseases↗
PubMed1993

Growth hormone administration preserves lean body mass in sarcoma-bearing rats treated with doxorubicin.

Cachexia and malnutrition play a significant role in the morbidity associated with antineoplastic chemotherapy regimens. Conventional nutritional support during cancer therapy has shown little benefit in terms of reducing morbidity and mortality. We examined the anabolic properties of growth hormone (GH) that preserve normal body composition in sarcoma-bearing animals treated with doxorubicin. On day 0, 40 male Fischer 344 rats were inoculated with 10(6) methylcholanthrene-induced sarcoma cells s.c. in the left flank. On day 9, animals were randomized into 3 groups: control (CTL, n = 13); doxorubicin (DOX, n = 13); and doxorubicin plus GH (DOX-GH, n = 14). Two CTL animals were excluded due to tumor invasion into the peritoneal cavity. From day 9 to day 23, the DOX-GH group received daily s.c. recombinant rat GH injection (1 mg/kg). On day 13, DOX and DOX-GH groups received 7 mg/kg of DOX i.v. while the CTL group received sham i.v. sterile saline injection. Body weight and tumor dimensions were measured daily. On day 23, all animals were weighed and sacrificed. Tumors were resected and weighed. Body composition analysis was performed. Plasma GH levels were measured by radioimmunoassay and insulin growth factor 1 levels were measured by chondrocyte proliferation bioassay. The DOX-GH group had a significantly higher mean body weight, carcass weight, total fat free body mass, insulin growth factor 1, and GH plasma levels as compared to the DOX group. No difference in total food intake was observed between the DOX and DOX-GH groups. There was no difference in final tumor weight and tumor growth rate between DOX and DOX-GH groups. Exogenous growth hormone can attenuate weight loss and preserve host body composition in tumor-bearing rats treated with doxorubicin without stimulating tumor growth.

Animals↗
PubMed1993

Normal human mesothelial cells and mesothelioma cell lines express insulin-like growth factor I and associated molecules.

Insulin-like growth factor (IGF) I has important growth regulatory functions in normal growth and development. IGF-I is also a mitogen for a number of cancer cell lines; however, its autocrine effect has not been well established. In this study, the expression of IGF-I, its receptor, and its major serum-binding protein were examined in 5 normal human mesothelial (NHM) cell samples and 11 pleural mesothelioma cell lines. All NHM cells and mesothelioma cell lines expressed IGF-I, IGF-binding protein 3 (IGFBP-3), and IGF-I receptor mRNA by either Northern blot or reverse transcription polymerase chain reaction analysis. IGF-I (0.136 +/- 0.024 ng/ml, mean +/- SEM) and IGFBP-3 (18.5 +/- 3.2 ng/ml) proteins were readily detected in the conditioned medium of mesothelioma cell lines but were not greater than corresponding measurements in that of NHM cells (IGF-I, 0.120 +/- 0.080 ng/ml; IGFBP-3, 15.9 +/- 1.3 ng/ml). Exogenous recombinant IGF-I stimulated cell proliferation of NHM cells, demonstrating the presence of a functional IGF-I receptor. Our results suggest that IGF-I may function as an autocrine growth stimulus in normal proliferating mesothelial cells, which may contribute to their malignant transformation.

Carrier Proteins↗
PubMed1993

Pulmonary metastases from adrenal cortical carcinoma: results of resection.

Adrenal cortical carcinoma is uncommon. There is little controversy concerning treatment of the primary tumor. However, data concerning the treatment of pulmonary metastases are sparse. In order to assess the results of therapy, we reviewed our 14-year experience. Records of 24 patients admitted to our institution from 1973 to 1991 with the diagnosis of adrenal cortical carcinoma and pulmonary metastases were reviewed. Ten patients underwent pulmonary resection, 12 received chemotherapy, and 2 no therapy. In the pulmonary resection group, treatment consisted of wedge resection in 8 patients and lobectomy in 2. For the 10 patients undergoing resection of their pulmonary metastases, the 5-year survival was 71% (median not reached at 5 years). This was significantly longer than those not resected, with no one alive at 3 years (median survival 11 months). Our data suggest that those patients who are able to have their pulmonary metastases resected survive significantly longer than those who do not.

Adolescent↗
PubMed1993

Esophagogastrectomy: reoperation for complications.

From 1961 to 1991, a total of 1,452 esophagectomies were performed for esophageal cancer at Memorial Sloan-Kettering Cancer Center. Of these patients, 40 (2.7%) developed complications requiring a second operation during the same hospitalization. The majority of the carcinomas were located in the midesophagus or the gastroesophageal junction. The pathologic diagnosis was squamous cell carcinoma in two-thirds of the patients. Few comorbid factors could be identified. Twenty-nine patients (72%) had a standard Ivor-Lewis resection, 5 (12%) had a transhiatal resection, 5 (12%) had a transabdominal approach, and 1 (3%) had a cervical approach only. Complications requiring reoperation were the following: respiratory failure in 13 patients, anastomotic leak in 6, bowel obstruction in 5, major bleeding in 4, wound dehiscence in 4, tracheo-esophageal fistula in 3, feeding tube malposition in 2, empyema in 1, chyle leak in 1, a positive margin in 1. Twelve of these same patients had a persistent or second complication and required a third operation. Among the 40 patients in this study, the mortality was 40%.

Adenocarcinoma↗
PubMed1993

Cerebral metastases in pleural mesothelioma: case report and review of the literature.

A case of malignant mesothelioma metastatic to the brain is described. A 52-year old woman, with no known exposure to asbestos, presented with a biphasic mesothelioma of the left parietal pleura. Following resection, the thorax was irradiated with 4000 cGy, and all symptoms subsided. Three months later, a left temporal lobe tumor was diagnosed and subsequently resected. Despite neurological improvement, she died 10 days post-operatively from constrictive pericardial disease. The authors have reviewed the 54 reported cases of brain metastases from mesothelioma and have noted that the histologic appearance of brain metastases from mesothelioma may be similar to glioblastoma multiforme. Because brain metastasis from mesothelioma is rare, procedures to clarify the nature of the tumor should be performed.

Brain Neoplasms↗
PubMed1993

Transcutaneous cardiac pacing during thoracic surgery. Feasibility and hemodynamic evaluation by transesophageal echocardiography.

BACKGROUND: Occasionally, emergency perioperative pacing is necessary. Transcutaneous cardiac pacing is noninvasive, safe, and readily available. Its feasibility and hemodynamic effects during thoracic surgery and one-lung ventilation have not been established. METHODS: Twenty anesthetized patients (aged 25-70 yr) without cardiac disease undergoing elective pulmonary resection (right n = 10, left n = 10) were studied in normal sinus rhythm and during transcutaneous cardiac pacing. Patients were paced in supine and lateral decubitus positions (with closed and opened chest) at the minimal current necessary to produce ventricular capture. Invasive arterial monitoring permitted calculation of mean arterial pressure, and transesophageal echocardiography was used to assess atrial and ventricular wall motion and the evaluation of transmitral flow. Twelve patients underwent Doppler analysis of pulmonary venous flow. RESULTS: Pacing was achieved in all patients, with a mean threshold of 86.9 +/- 20.6 mA for the right thoracotomy group, and 106.7 +/- 16.2 mA for the left thoracotomy group. The mean paced heart rates for the right and left thoracotomy groups were 101.6 +/- 18.2 and 105.4 +/- 11.5 beats/min, respectively. During pacing, all patients sustained reversible transient decrements in mean arterial pressure (9-19%) from baseline, the loss of AV synchrony, and the development of paradoxical ventricular septal wall motion. No patient had significant mitral regurgitation during sinus or paced rhythms. Decreased systolic pulmonary venous flow velocity and abnormal systolic flow reversal were seen during pacing in 11 of the 12 patients studied. CONCLUSIONS: Transcutaneous cardiac pacing is effective in patients undergoing thoracotomy and one-lung ventilation. Its use in patients in normal sinus rhythm induces reversible decrements in mean arterial pressure because of the effects of altered atrioventricular association, ventricular wall motion, and pulmonary venous return.

Adult↗
PubMed1993

Isolated single lung perfusion in the rat: an experimental model.

To evaluate isolated single lung perfusion with chemotherapy in a rat lung metastasis model, we developed a model of in vivo isolated single lung perfusion. Twenty male rats were anesthetized with pentobarbital sodium (50 mg/kg) and intubated endotracheally. A left thoracotomy was performed with an operating microscope (x16 magnification), the left pulmonary artery was cannulated, and a left pulmonary venotomy was performed. Isolated left lung perfusion was performed for 10 min at 0.5 ml/min with heparinized whole blood (n = 10) or 0.9% normal saline (n = 10). Pulmonary vein effluent was collected by suction. Nineteen of the 20 (95%) animals survived isolated left single lung perfusion. Twenty-one days after isolated left lung perfusion right pneumonectomy was performed. Fifteen of the 19 animals (78%) survived right pneumonectomy. Postoperatively, animals that survived surgery recovered preoperative body weight. In vivo isolated single lung perfusion in rats is feasible with low mortality and morbidity and may be useful in the study of isolated perfusion with chemotherapy and in diverse physiological and pharmacological experiments.

Anesthesia↗
PubMed1993

Parathyroid carcinoma: diagnosis and clinical history.

BACKGROUND: Parathyroid carcinoma is often over-diagnosed based on histologic appearance alone. We limited the definition of the disease to patients with recurrence, metastases, or frank capsular invasion on histologic examination. METHODS: With these criteria, fourteen cases of parathyroid carcinoma seen at our institution from 1955 to the present were identified. RESULTS: All patients presented with hypercalcemia, and all deaths were due to hypercalcemia. Two patients have been free of disease after initial operation for 31 and 180 months. Six other patients had a prolonged course with a median survival more than 80 months. Two of these patients have undergone one reexcision each for local recurrence, and four have undergone multiple resections for local recurrence or metastases. These reoperations usually resulted in satisfactory, albeit temporary, control of hypercalcemia. Finally, six patients died of disease after an aggressive course, with a short median survival (47 months). Four of these patients were seen in the 1950s before an aggressive approach to metastatic disease was adopted. CONCLUSIONS: The types of clinical courses observed in this study may be more reflective of the varied biologic features of parathyroid carcinoma and the approach to recurrence than of the initial operations. For patients with recurrent or distant disease, an operation appears to prolong survival and palliate the symptoms of hypercalcemia.

Adult↗
PubMed1993

NR-LU-10 monoclonal antibody scanning. A helpful new adjunct to computed tomography in evaluating non-small-cell lung cancer.

UNLABELLED: Computed tomographic scanning has improved the noninvasive staging of lung cancer but has the deficiency of not distinguishing benign from malignant lesions. This prospective trial evaluated the usefulness of a new radiolabeled monoclonal antibody, NR-LU-10, as an adjunct to computed tomography by assessing its clinical applicability and accuracy in detecting malignancy in primary lung tumors and mediastinal nodes. NR-LU-10 is a technetium 99m-labeled Fab fragment of a murine immunoglobulin G2b monoclonal antibody that recognizes a 40 kD glycoprotein expressed in lung and other epithelial cancers. METHODS: (1) Patients with potentially resectable non-small-cell lung cancer were eligible; (2) all patients had computed tomographic scans of the chest; (3) whole body and single photon emission computed tomographic imaging were performed 14 to 17 hours after intravenous infusion of 20 to 30 mCi of NR-LU-10; (4) subsequent mediastinoscopy or thoracotomy with complete mediastinal nodal mapping provided pathologic correlation. RESULTS: Twenty-four patients were entered, 14 men and 10 women. No allergic reactions or other adverse effects were seen. Interference from a prior ventilation-perfusion scan precluded adequate imaging in 1 patient, but high-quality images were obtained in the other 23 patients. The 22 primary malignant tumors all had uptake and there was no uptake in 1 lung nodule found to be benign. In 21 patients who had surgical correlation of mediastinal nodal involvement, NR-LU-10 was false-positive in 5 and false-negative in 1; results of computed tomography were false-positive in 6 and false-negative in 1. In this preliminary study, NR-LU-10 antibody scanning was safe and easily performed, it produced high-quality images of the lung and mediastinum, and it was accurate in detecting primary non-small-cell lung cancers. Further evaluation of its value in staging the mediastinum is needed, in particular, its role as an adjunct to computed tomography to help distinguish benign from malignant lesions.

Antibodies, Monoclonal↗
PubMed1993

Medical tumors of the chest wall. Solitary plasmacytoma and Ewing's sarcoma.

UNLABELLED: Primary solitary plasmacytoma and Ewing's sarcoma of the chest wall are relatively uncommon tumors, and data concerning treatment and results are sparse. To assess the results of therapy we reviewed our 40-year experience. METHODS: Records of 24 patients with solitary plasmacytoma and 62 with Ewing's sarcoma arising in the chest wall who were admitted to our institution from 1949 to 1989 were reviewed. RESULTS: In the group with plasmacytoma (n = 24), ages ranged from 35 to 75 years (median 59 years); male/female ratio was 2.4:1. The presenting complaint was pain or mass or both in 92% (22/24). Primary therapy was local only in 5 (resection in 3, radiotherapy in 2), chemotherapy in 16 (resection in 5, radiotherapy in 10, and chemotherapy alone in 1); 3 patients did not receive therapy. Multiple myeloma developed subsequently in 75% (18/24). Overall 5-year survival was 38% (median 56 months). Age, sex, site of primary tumor, and local therapy did not significantly impact on survival. Ages in the patients who had Ewing's sarcoma (n = 62) ranged from 2 to 39 years (median 16 years); male/female ratio was 1.6:1. Presenting complaint was pain or mass or both in 98% (61/62). Primary therapy was local in 17 (resection in 7, radiotherapy in 7, resection plus radiotherapy in 3) and chemotherapy in 45 (plus resection in 29, resection and radiotherapy in 10, and radiation therapy alone in 3). Overall 5-year survival was 48% (median 57 months). Age, sex, and site of primary tumor did not significantly impact on survival. Patients in whom distant metastases developed (n = 48) had a significantly decreased survival (5 year, 28%) compared with those who did not have metastases (n = 14; 5 year, 100%). CONCLUSION: Plasmacytoma of the chest wall, even if solitary at presentation, should be considered a systemic disease, and therapy should be directed as such. For Ewing's sarcoma, although resection or radiotherapy may offer local control, because of the prevalence of distant metastases (77%), systemic therapy should be considered an integral part of treatment.

Actuarial Analysis↗
PubMed1992

Primary bony and cartilaginous sarcomas of chest wall: results of therapy.

Primary bony and cartilaginous sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. To assess the results of therapy, we reviewed our 40-year experience. Records of 38 patients with osteosarcoma and 88 with chondrosarcoma arising in chest wall admitted to Memorial Sloan-Kettering Cancer Center from 1949 to 1989 were reviewed. The 88 patients with chondrosarcoma ranged in age from 5 to 86 years (median age, 49 years); the male/female ratio was 1.3:1. Presenting complaint was mass, pain, or both in 93%. Primary therapy was resection (n = 84), radiation therapy (n = 3), or chemotherapy (n = 1). Overall 5-year survival was 64%. Significant adverse prognostic factors included metastases at initial presentation (n = 9), metastases at any time during the course of disease (n = 23), age greater than 50 years (n = 42), incomplete or no resection (n = 13), and local recurrence (n = 24). Sex, grade, and tumor size were not prognostic factors. The 38 patients with osteosarcoma ranged in age from 11 to 78 years (median age, 42 years); the male/female ratio was 1.5:1. Presenting complaint was mass, pain, or both in 95%. Primary therapy included resection (n = 31; alone in 13, with radiation therapy in 3, with chemotherapy in 15), radiation therapy (n = 3), radiation therapy and chemotherapy (n = 2), chemotherapy (n = 1), or no treatment (n = 1). Overall 5-year survival was 15%. Significant adverse prognostic factors included presence of synchronous metastases (n = 13) and metastases at any time during the course of disease (n = 26).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Resection of hepatic and pulmonary metastases from colorectal cancer.

Resection of hepatic metastases of colorectal origin has gained wide acceptance, but when patients have synchronous or metachronous pulmonary metastases, they are often considered incurable and are offered systemic therapy only. We performed a retrospective review of the patients at Memorial Sloan-Kettering Cancer Center who underwent resection of both hepatic and pulmonary metastases of colorectal origin between 1970 and 1990. Ten patients were identified who met the above criteria. Median survival after hepatic and pulmonary resections were 34 and 18 months, respectively. Actuarial 1-, 3- and 5-year survivals are 89%, 78% and 52%, respectively. With a median of 18 months after second operation, three patients have no evidence of disease (NED), four are alive with disease (AWD) and three are dead of disease (DOD). In the absence of effective chemotherapy, selected patients with hepatic and pulmonary metastases of colorectal origin should be considered for resection as it offers the only possibility for long-term survival.

Actuarial Analysis↗