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Biomedical subjects

N Martini

Publications and source records attributed to N Martini.

At least 91 records · Page 5Linked to original sources
PubMed1989

Resection and debridement of chest-wall tumors and general aspects of reconstruction.

The main criterion for adequate local control of a chest-wall malignancy remains wide excision. With the available techniques of skeletal and soft-tissue reconstruction, even large lesions can be resected with safe margins. The primary purpose is to achieve a curative resection, although a significant number of symptomatic patients can benefit from palliative resection provided by such procedures. A key element in the success in treating chest-wall tumors is a multidisciplinary approach by all participating physicians, namely the thoracic surgeon, the plastic and reconstructive surgeon, the radiotherapist, and the medical oncologist.

Debridement↗
PubMed1989

High-frequency T-DNA-mediated gene tagging in plants.

An insertion element [transferred DNA (T-DNA)], transferred by soil agrobacteria into the nuclear genome of plants, was used for induction of gene fusions in Arabidopsis thaliana, Nicotiana tabacum, and Nicotiana plumbaginifolia. A promoterless aph(3')II (aminoglycoside phosphotransferase II) reporter gene was linked to the right end of the T-DNA and transformed into plants along with a plasmid replicon and a selectable hygromycin-resistance gene. Transcriptional and translational reporter gene fusions were identified by screening for APH(3')II enzyme activity in diverse tissues of transgenic plants. The frequency of gene fusions, estimated by determination of the copy number of T-DNA insertions, showed that on average 30% of T-DNA inserts induced gene fusions in Arabidopsis and Nicotiana. Gene fusions were rescued from plants by transformation of the T-DNA-linked plasmid and flanking plant DNA into Escherichia coli. By dissection of gene fusions and construction of chimeric genes, callus- and root-specific promoters were identified that showed an altered tissue specificity in the presence of a 3'-downstream-located 35S promoter. Transcript mapping of a gene fusion and expression of a non-frame transcriptional fusion of bacterial luciferase luxA and luxB genes demonstrated that dicistronic transcripts are translated in tobacco.

Base Sequence↗
PubMed1989

Superior sulcus tumors: CT and MR imaging.

Thirty-one patients with superior pulmonary sulcus tumors underwent a total of 32 sets of computed tomographic (CT) and magnetic resonance (MR) imaging examinations before receiving therapy. Prospective, independent, and blinded interpretations of the studies were compared with both the surgical findings (15 patients) and the patient's clinical symptoms (17 patients). Thin-section (5-mm) coronal and sagittal MR images proved more accurate than CT scans (.94 accuracy with MR imaging, .63 with CT) in evaluation of tumor invasion through the superior sulcus. The improved accuracy of MR imaging in this region appears almost certainly to be related to the improved display of the anatomy of the superior sulcus on thin-section coronal and sagittal images.

Adenocarcinoma↗
PubMed1988

Blood transfusion and lung cancer recurrence.

Recent reports have suggested that perioperative blood transfusions may adversely affect prognosis after resection of non-small cell lung cancer (NSCLC). To determine the impact of perioperative transfusion on the recurrence-free interval, the status of 352 patients who underwent pulmonary resection for pathologic Stages I and II NSCLC was investigated. Transfused patients were significantly older than untransfused patients (P = 0.0009) but were not significantly different in sex distribution (P = 0.12) or tumor stage (P = 0.09). Recurrence was not significantly different in transfused patients when compared with patients who received no blood (P = 0.23) even when stratified for stage (Stage I, P = 0.58; Stage II, P = 0.14). Furthermore, the number of units transfused was not associated with time to tumor recurrence (P = 0.58). Contrary to other reports, these results do not support the contention that perioperative blood transfusion is significantly associated with decreased recurrence-free survival.

Aged↗
PubMed1988

Primitive neuroectodermal tumors of the chest wall.

Primitive neuroectodermal tumor (PNET) is a rare, highly malignant small-cell neoplasm that most often arises from the chest wall or paravertebral region. A patient is described from whom resection, intensive chemotherapy, and bone marrow transplant were unsuccessful. Eleven patients were treated between 1975 and 1985; there was only one long-term survivor (48 months) despite intensive multidisciplinary treatment. The median survival of 49 published cases was 9 months. Conservative resection minimizing disability, radiotherapy, and intensive chemotherapy remain valid options, but use of experimental agents as part of initial therapy seems justified. The role of autologous marrow transplant remains unclear.

Adult↗
PubMed1988

The current state of intraoperative interstitial brachytherapy in lung cancer.

Low dose-rate intraoperative brachytherapy allows for a more precise tumor localization of the delivered radiation and its easier adaptation to the tumor shape than it is possible with external radiation. As a result a higher dose is usually delivered to the tumor volume and the damage to the normal lung is less. In an attempt to determine the value of lung brachytherapy we provide in this article a complete review of the evolution of brachytherapy in lung cancer at Memorial Sloan-Kettering Cancer Center, an experience which exceeds 1,000 patients. The use of encapsulated sources of I-125, greatly reduced radiation outside the treatment volume and simplified medical and nursing staff radiation protection. Lung brachytherapy in combination with surgery and postoperative external radiation, improved local tumor control in advanced tumors (from 63% to 76%) with no increase in late pulmonary morbidity, but only a modest survival advantage. The results of brachytherapy in patients with early lung cancer who had limited pulmonary reserve, suggest that intraoperative brachytherapy is an effective alternative treatment option. The limited experience with interstitial brachytherapy under fluoroscopic and CT guidance is encouraging, but needs more investigation.

Brachytherapy↗
PubMed1988

Bilobectomy for bronchogenic carcinoma.

During a 12-year period, bilobectomy was performed on 166 patients for the treatment of primary lung carcinoma: 108 patients (65%) underwent right upper and middle lobectomy, while 58 patients (35%) underwent right middle and lower lobectomy. Indications for bilobectomy were tumor extending across a fissure (45%), absent fissure (21%), endobronchial tumor (14%), extrinsic tumor or nodal invasion of bronchus intermedius (10%), and vascular invasion (5%). Thirty-one patients (19%) suffered 41 perioperative complications, and 7 patients (4.2%) died. Upper and middle lobectomies were not associated with a significantly different morbidity (p greater than 0.10) or mortality (p greater than 0.10) when compared with middle and lower lobectomy. The postoperative chest roentgenograms of all patients demonstrated ipsilateral volume loss, and 31 patients were found to have asymptomatic hydropneumothoraces, which cleared during the follow-up period. Late complications occurred in 4 patients (2%) and included two empyemas, one bronchopleural fistula, and one superficial wound infection. These results indicate that bilobectomy is associated with morbidity and mortality that lie between those currently reported for lobectomy and pneumonectomy.

Adenocarcinoma↗
PubMed1988

The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lymph node metastases (N2 M0).

We have defined "clinical N2" disease in non-small cell lung cancer to mean the presence of enlarged metastatic mediastinal nodes evident on plain chest roentgenograms or widening of the carina at bronchoscopy. Forty-one patients with non-small cell carcinoma of the lung and clinical N2 M0 disease presumed operable received 2 to 3 cycles of high-dose cisplatin with vindesine (or vinblastine sulfate) with or without mitomycin-C. Following chemotherapy, 30 patients (73%) had a major radiographic response. Of these patients, 28 had thoracotomy, and 21 (75%) of them had complete resection of the disease, 8 of whom had total sterilization of the tumor proven histologically. An additional 4 patients had limited microscopic foci of residual tumor either in lung or lymph nodes. Survival at 3 years from diagnosis was 34% for all patients, 40% for those who completed the combined treatment (chemotherapy and surgery), and 54% for those who had complete resection with a median follow-up of 44 months and a median survival not yet attained.

Adult↗
PubMed1988

Effect of food on the bioavailability of a slow-release theophylline formulation.

A study was conducted in two groups of healthy volunteers to assess whether the time of administration (10 min before the meal versus 60 min after the meal) influences the pharmacokinetics and absorption kinetics of a slow-release theophylline product (Teonova). In the first group (Group A, n = 10), the drug was given in a paired-sample design as a single dose of 600 mg before and after breakfast with an interval of at least 1 week between the two administrations. In the second group (Group B, n = 10), Teonova was given by the same study design before and after dinner. In all cases, time curves of theophylline plasma levels were determined by collecting serial blood samples 24 h after dosing and analysed pharmacokinetically through model-independent methods. In Group A, curves obtained before and after the meal were fully superimposable, and no difference was found between the pharmacokinetic parameters determined in either condition. The same result was obtained in Group B. Our results indicate that, after single dose, the two different times of administration that we tested were equivalent in pharmacokinetic terms.

Adult↗
PubMed1987

Intraoperative radiotherapy in stage I and II lung cancer.

Lung cancer is the leading cause of cancer deaths in both men and women in the United States. Treatment depends on the type and stage of lung cancer. For stage I and II cancer, surgery is usually the treatment of choice. Radiation therapy is used in patients who are considered poor risks for surgical resection. Intraoperative brachytherapy is an effective alternative to external irradiation in this group of patients. From 1958 to 1984, 55 patients with non-small-cell lung cancer were explored at Memorial Sloan Kettering Cancer Center and found to have surgical stage I or II tumors, which were considered to be unresectable mainly because of severe obstructive pulmonary disease precluding adequate resection. All these patients were treated with intraoperative brachytherapy at the time of the thoracotomy. Forty-four percent of these patients received in addition external irradiation, mainly to the mediastinum. The overall 5-year survival calculated by the Kaplan-Meier Method was 32%, and the local disease-free survival was 63%. Cox regression multivariant analysis demonstrated that there is a distinct subgroup with a better prognosis based on tumor site and patient's age--ie, patients who were younger than 58 years of age and had right-side lesions.

Actuarial Analysis↗
PubMed1987

Pleural mesothelioma.

Pleural mesotheliomas are uncommon tumors. Correct diagnosis of the benign variant is rarely made preoperatively, and resection is the treatment of choice and is curative. Malignant pleural mesotheliomas are locally aggressive and difficult to treat. They may be seen clinically as localized pleural tumors or as diffuse pleural disease with effusion and encasement of the lung and obliteration of the pleural space. The localized forms of malignant mesotheliomas are fibrosarcomatous. Their diagnosis and treatment do not differ from those for soft-part sarcomas seen elsewhere. Wide en-bloc excision is the treatment of choice and can be curative. The diffuse forms of malignant mesotheliomas are mainly epithelial. Treatment is generally unsatisfactory, and long-term survival is rare. Two surgical approaches are currently available: an extrapleural pneumonectomy and a pleurectomy with irradiation. The authors favor the latter approach because of its wider applicability, lower morbidity rate, and better survival advantage. Steps in selecting the best surgical mode of treatment are presented.

Adolescent↗
PubMed1987

Treatment of superior sulcus tumor (Pancoast tumor).

It appears that combined preoperative radiation and surgery continue to offer the best survival results in patients with superior sulcus tumors. Patients with involvement of the brachial plexus, Horner's syndrome, rib invasion, and ipsilateral neck node metastases are still candidates for combined modality therapy, with expectations of survival of about 30 to 40 per cent. However, those presenting with invasion of vertebrae, involvement of subclavian vessels, and mediastinal lymph node metastases do poorly. In this latter group, treatment by high-dose external radiation alone may prove to be as effective as combined modality treatment.

Adult↗
PubMed1987

Methods of skeletal reconstruction following resection of lung carcinoma invading the chest wall.

The 5 per cent of patients with carcinoma of the lung directly invading the chest wall present a challenge for treatment. Complete resection of all tumor, including the chest wall, should be done. Immediate reconstruction to prevent a flail chest ensures a smooth postoperative course. Excellent palliation and a 46 per cent 5-year survival rate can be achieved if there is no spread to mediastinal lymph nodes.

Fascia Lata↗
PubMed1987

Results of surgical treatment of stage III lung cancer invading the mediastinum.

From 1974 to 1984, 225 patients underwent thoracotomy at Memorial Sloan-Kettering Cancer Center for primary non-small cell lung cancer invading only the mediastinum (T3). The perioperative mortality was 2.7 per cent, and the nonfatal complication rate 13 per cent. Forty-nine patients underwent complete resection of all intrathoracic disease, with a median survival of 17 months, 3-year survival of 21 per cent, and 5-year survival of 9 per cent. Thirty-three patients underwent pulmonary resection with simultaneous iodine-125 interstitial implantation or iridium-192 delayed afterloading to areas of unresectable primary or nodal disease, with a median survival of 12 months, 3-year survival of 22 per cent, and 5-year survival of 22 per cent. One hundred and one patients underwent interstitial implantation without resection, with a median survival of 11 months, 3-year survival of 9 per cent, and no 5-year survivors. Forty-two patients had incomplete resection without intraoperative radiation therapy and fared no better than a cohort group of 44 unoperated patients with clinical evidence of mediastinal invasion--both groups had a median survival of 8 months and no 3-year survivors. An aggressive surgical approach with pulmonary resection and/or brachytherapy appears to offer some survival advantage to this group of patients. In particular, 5-year survival rates ranging from 7 to 15 per cent were observed in subsets of intraoperatively treated patients with invasion of pulmonary vein, phrenic nerve, esophagus, or pericardium and in those with clinically occult T3 disease.

Adult↗
PubMed1987

The role of surgery in N2 lung cancer.

Whereas most physicians believe that long-term survival is unlikely when mediastinal lymph node metastases are present, a significant number of these patients do have resectable tumors with encouraging long-term survival results. Data are presented to support this view, and steps identified to guide the physicians in selecting the patients who can benefit from this surgical approach.

Adult↗
PubMed1987

Preoperative and adjuvant chemotherapy in locally advanced non-small cell lung cancer.

The continued favorable results with surgery in early stage lung cancer have led many investigators to use radiation and chemotherapy to reduce the size of unresectable tumors either before or after definitive surgery. Although earlier results with both radiation and chemotherapy have been poor, the newer cisplatin-containing combination chemotherapy regimens have yielded decreased local recurrence rates when used postoperatively following a complete resection and have produced increased complete resection rates when given preoperatively to patients with locally advanced and unresectable non-small cell lung cancer at diagnosis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Intraluminal irradiation in bronchogenic carcinoma.

Endobronchial tumors present a difficult therapeutic problem. Most often these patients have primary lung cancer and present with endobronchial disease following a definitive course of surgery and/or irradiation. The most common methods of treatment include transbronchial excision of tumor or laser coagulation. The improvement obtained from these procedures is usually limited to 2 or 3 months, and repeated treatments become more difficult and less effective. A number of brachytherapy radiation techniques have been developed to deliver localized radiation in higher doses without exceeding surrounding normal tissue tolerance. Intraluminal radiation with brachytherapy techniques consists of implantation of radioactive pellets into the tumor through a rigid or flexible bronchoscope or the use of afterloading removable implants with remote afterloading techniques. These procedures can be combined with laser therapy to obtain effective palliation and long-term tumor control. Initial results appear promising.

Brachytherapy↗