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Biomedical subjects

M J Lopez

Publications and source records attributed to M J Lopez.

At least 73 records · Page 4Linked to original sources
PubMed1986

The current role of ultraradical surgery in the treatment of pelvic cancer.

Based on the results of experience accumulated in the past 30 years, exenterative pelvic surgery should be a part of the armamentarium of specially prepared oncologic surgeons. It is most frequently indicated for radiation failures in the treatment of carcinoma of the cervix, although it may be justified as primary treatment of selected cases of stage IV lesions without evidence of dissemination outside the pelvis. It is also justified for postirradiation radionecrosis causing sloughing and fistula, provided adequate relief cannot be offered by simple urinary and fecal diversion. For carcinoma of the rectum and pelvic colon, exenteration has a role in the advanced lesions that appear not to have become disseminated outside the pelvis but that involve contiguous viscera. Reoperation for recurrent carcinoma of the rectum is rarely successful, and this dreaded complication is best avoided by a well-planned and adequate standard first operation, or by the early recognition that a more extended operation is necessary. It is to be hoped that adjuvant radiation therapy, either preoperative or postoperative, or both, may be proved effective in preventing recurrence, especially for lesions below the peritoneal reflection, which is the most frequent site of recurrent disease. Finally, ultraradical pelvic surgery has reached its anatomical and pathologic limit. It only remains for the mortality and survival results to be further improved by continued refinements in the technicalities of the operation and in the judgment and selection of patients for it. Multimodal adjunctive therapy has an emerging role, as does selection of patients for functional preservation and reconstruction. The procedures should continue to be done in institutions where special studies are being conducted and where trained and experienced personnel are available with the necessary ancillary services.

Combined Modality Therapy↗
PubMed1986

Iatrogenic duodenocolic fistula.

Benign duodenocolic fistula is a rare, surgically curable, but potentially lethal entity. Etiology, symptomatology, diagnosis and management are discussed. The authors describe the fifth reported case of an iatrogenic cause and review the literature on benign duodenocolic fistula. Early diagnosis and aggressive nutritional and surgical management are necessary to avoid serious morbidity and malnutrition leading eventually to death.

Colonic Diseases↗
PubMed1985

District nurse training: a pilot survey of demand, provision and students.

A pilot survey of district nurse training provision for the period April 1982-March 1983 was carried out to provide a profile of training institutions; their resources (human and physical), courses and students. Information was collected by means of a postal questionnaire sent to the 50 UK training institutions. The survey highlighted differences between district nurse and district enrolled nurse training; variations in entry requirements, size and length of courses, and staffing. It also gave an overview of students' characteristics and provision of training for other professional groups. It proved the feasibility and value of collecting such information, and also provided the basis for a current study (Baseline Data Project), which will produce a package of survey material, and software for analysis to enable the subsequent collection of information.

Adult↗
PubMed1985

Changing patterns in the management of locally advanced breast cancer: a preliminary report.

Over the 8 years from 1976 to 1983, 28 patients with stage IIIB (T4a,b,c, NX-2, M0) and inflammatory breast cancers without evidence of disseminated disease at the time of diagnosis were treated at Ellis Fischel State Cancer Center in Columbia, Mo. This group comprised 4% of all cases of primary breast cancer seen during that period. Radiotherapy was the primary treatment in one half of the group during the first 4 years of the study (group A). Since 1981, locally advanced breast cancer has been treated by multidrug chemotherapy followed primarily by mastectomy (group B). The rate of local control was the same for both groups (78%). However, the median survival for group A was 11 months, only one patient being alive 5 years after diagnosis, whereas in group B, 12 of 14 patients were alive and clinically free of disease 9 to 31 months after diagnosis with a median follow-up of 16.5 months. This preliminary report confirms recent findings, supporting the use of polychemotherapy followed by mastectomy in the management of patients with locally advanced breast cancer.

Adult↗
PubMed1984

Reconstructive surgery for the complications of pelvic irradiation.

Severe damage to the pelvic viscera is a complication of irradiation therapy that, unfortunately, cannot always be avoided. Resulting rectal and rectocolonic strictures, rectovaginal fistulas, and shortening and stenosis of the vagina present very difficult problems that frequently require a colostomy for relief and may permanently impair sexual function. The authors present a new approach to correction of these unfortunate lesions based on the use of proximal nonirradiated colon which serves as a vascular pedicle graft to correct the defect without a complicated and massive resection. Twenty-two such operations have been done with 19 satisfactory to excellent results and two total failures (one death from small bowel complications). All patterns and combinations of irradiation injury have been found amenable to this technique of repair. These have included both web and linear strictures with and without fistulas. In half of the patients, it was possible to make use of normal colon bypassed by a prior colostomy. Normal nonirradiated colon with good blood supply will heal satisfactorily to irradiated colon or rectum, thus making excision of all the irradiated tissue unnecessary. The results of this surgical approach have thus far been gratifying and warrant further trials for these distressing injuries.

Colon↗
PubMed1983

Gastrosplenic fistula following successful chemotherapy for disseminated histiocytic lymphoma.

A case is presented of a patient with diffuse histiocytic lymphoma with splenic involvement who developed a communication between the greater gastric curvature and the splenic parenchyma after successful antineoplastic chemotherapy. This fistula was diagnosed by CT scan and confirmed by upper gastrointestinal barium series and fiberoptic endoscopy. This complication was managed successfully by an enbloc resection of the greater curvature of the stomach, splenectomy, and distal pancreatectomy. Histologic assessment of the stomach and spleen failed to reveal residual tumor. The clinical evolution of this rare complication is discussed and the literature on this subject is reviewed.

Antineoplastic Agents↗
PubMed1983

Controversy in the surgical management of melanoma.

In more than one half of cases of melanoma the disease is not controlled. Treatment of the disease should be based on a clear understanding of its biology and natural history. This paper presents an overview of the controversial issues in the management of primary melanoma and suggests an acceptable approach. The author recommends: (a) excisional biopsy where anatomically feasible for adequate histologic assessment, (b) wide excision of the tumour including the deep fascia, (c) en bloc in-continuity dissection for lesions close to the regional lymph nodes and (d) selective elective lymphadenectomy for clinical stage I melanoma and other groups, based on Clark's level of invasion and Breslow's thickness of the lesion, its location, histologic factors and the patient's medical and socioeconomic background.

Biopsy↗
PubMed1982

Experience with a modified Witzel gastrostomy without gastropexy.

The records of 161 adult patients who underwent a modification of the Witzel gastrostomy without gastropexy at Ellis Fischel State Cancer Hospital, Columbia, Missouri, between 1977 and 1980, are reviewed in detail and form the basis of this report. Six of these patients had gastrostomies on two different occasions. There was no mortality or major complication directly attributed to the procedure in this group of patients. Technical details are examined and considered most important in preventing intraperitoneal or extraperitoneal leak of gastric contents and migration of the catheter, the most commonly found complications of other techniques. Anterior gastropexy is considered unnecessary, thus simplifying the operation and eliminating gastric deformity and other related problems. The liberal indications of this procedure are discussed, and potential areas of technical pitfalls are reviewed. The personal experience of one of the authors (EMB) with 774 gastrostomies during a 15-year period using this technique confirms these conclusions. A random sample of 200 records of these patients were examined for complications of the operation. This study suggests that tube gastrostomy by the technique described is a reliable and safe procedure with wide applicability for patients undergoing major abdominal surgery. The relatively few complications are more than compensated for by the degree to which postoperative comfort and care are facilitated.

Adolescent↗
PubMed1981

Pseudo-obstruction of the colon during pelvic radiotherapy.

Pseudo-obstruction of the colon, or Ogilvie's syndrome, is characterized by an adynamic, dilated, unobstructed colon, the exact cause of which remains obscure. Although several precipitating factors have been described in the literature, we have observed three patients whose pseudo-obstruction of the colon occurred during interstitial and intracavitary pelvic irradiation. Such a cause has not been noted previously. Pseudo-obstruction of the colon can have serious consequences if it is not recognized early and treated vigorously.

Aged↗