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Biomedical subjects

P H O'Brien

Publications and source records attributed to P H O'Brien.

At least 37 records · Page 2Linked to original sources
PubMed1981

Oophorectomy in women with carcinoma of the colon and rectum.

Carcinoma of the colon and rectum metastasizes readily to the ovaries, and oophorectomy during operation upon the colon and rectum remains an effective surgical technique for precluding subsequent oophorectomy and, thereby, diminishing the morbidity of carcinoma of the colon and rectum in women. This procedure does not significantly affect the survival rate. Carcinoma of the ovary has become the fourth most common lethal cancer in women. Usually, the tumor is diagnosed after the development of ascites, mass and weight loss. The five year survival rate remains about 30 per cent. The incidence of carcinoma of the ovary in women with carcinoma of the colon and rectum is roughly five times the incidence of carcinoma of the ovary, that would be expected by chance. We believe the aforementioned observations strongly expand and reinforce the original proponents of prophylactic oophorectomy performed upon women with carcinoma of the colon and rectum and that, therefore, oophorectomy should be an integral part of operation upon the colon and rectum in women.

Adenocarcinoma↗
PubMed1980

Lobular carcinoma in situ.

Lobular carcinoma in situ remains controversial in nomenclature, histology, and therapy. The original description and therapeutic recommendations remain a significant contribution to better control of breast cancer. We believe the sophistication of mammography, not available at the time of the earliest therapeutic recommendations, provides the clinician with a valuable and accurate new diagnostic tool for this disease. The risk factors from this disease entity have been well outlined by McDivitt [1] and others. We believe the patient should permitted to participate in the therapeutic decision after proper education about the risk factors of cancer in the ipsilateral and contralateral breast. Patients have requested bilateral mastectomies; some of these patients then wanted plastic reconstruction. Many others, however, have no such interest. The properly informed and responsible patient who elects to have close observation, with mammograms every six months, we feel has elected an acceptable clinical strategy for this disease.

Breast Neoplasms↗
PubMed1980

Granular cell myoblastoma.

The experience at this university between 1954 and 1978 included 96 granular cell myoblastomas in 67 patients. The unusual locations of the tumors were the breast, bronchus, vocal cord, stomach and rectus sheath. An extremely rare invasive squamous carcinoma developed from a lesion of the larynx with pseudoepitheliomatous hyperplasia of the overlying dpithelium. Two patients with malignant granular cell myoblastoma have been encountered.

Adolescent↗
PubMed1980

CEA--a concept worth exploring.

We believe patients who have elevated CEA levels before resectioning procedures and who also have documented cancer of the gastrointestinal tract, with a subsequent drop in normal CEA levels postoperatively, should have sequential monthly determinations of colonic embryonal antigens. If there is an increase in levels of concentration, there is at that time justification for surgical intervention. The earlier the detection of elevated colonic embryonic antigen is accomplished, the better are the odds for a successful surgical resection of recurrent disease. The values of the CEA studies define slopes which can identify local recurrence and liver metastasis. For these slope values, it is necessary that the CEA level be drawn regularly. We consider this a promising real clinical advance in that it permits for better utilization of the two significant therapeutic modalities we have for the treatment of cancer of the gastrointestinal tract, namely resectional surgery and radiation therapy. CEA determinations have false positives and limited specificity. It is unfortunate that adult tissues express fetal antigens under conditions wherein there are bursts of cellular activity. This should not diminish the significance of tumor-embryo cross reactivity. This reactivity phenomenon is, in the words of Sir Peter Medawar, "a now well attested empirical fact," and this observation is "profoundly interesting and potentially important." The eventual significance of this fact may well transcend current use of the CEA in the diagnosis of recurrent cancer of the gastrointestinal tract.

Carcinoembryonic Antigen↗
PubMed1979

Clinical study of 81 gastrointestinal carcinoid tumors.

The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals since 1950. An unusual case of a 0.5 cm primary ileal carcinoid with widespread intra-abdominal and hepatic metastases is documented. In this series carcinoids were found (in order of decreasing frequency) in the ileum, appendix, rectum, right colon, duodenum, jejunum, stomach, ampulla of Vater, sigmoid colon, and pancreas. Metastases were found in 17% of the overall group. Two carcinoids presented with intussusception, while one was found within a Meckel's diverticulum. In addition to the small metastatic ileal carcinoid, one patient with a rectal carcinoid measuring 0.4 cm was found to have metastases after low anterior resection. Because all extra-appendiceal gastrointestinal carcinoids are potentially metastatic, it is stressed that regional lymphadenectomy en bloc with primary excision is the treatment of choice wherever feasible. If the lesion is small or has not invaded deeply, local excision with close follow-up may be an acceptable alternative.

Adolescent↗
PubMed1977

Hashimoto's thyroiditis and its relationship to other thyroid diseases.

The experience of the Medical University of South Carolina with Hashimoto's thyroiditis revealed an 8.3 per cent incidence of carcinoma. The most common type of carcinoma was an associated lymphoma. There was an additional 8.3 per cent incidence of a benign adenoma. Needle biopsy as a mechanism for diagnosing Hashimoto's disease, we believe, is inaccurate. A larger aliquot of tissue should be removed for the pathologist if there is a suspicion of an associated tumor. An open biopsy permits the pathologist to make an accurate diagnosis with a minimal amount of morbidity.

Adult↗
PubMed1975

Carcinoma of the esophagus.

Life tables were computed from the Tumor Registry at the Medical University of South Carolina on 486 patients with histologically proven squamous cell carcinoma of the esophagus. The 5-yr follow-up was available in only 394 patients, or 81% of the total sample. For purposes of comparison with published literature, the traditional crude 5-yr survival percentages in the life-table analyses figures are presented. The life-table calculation utilizes all follow-up information available, in that patients observed for less than 5 yr still may contribute to the estimate of the true 5-yr survival rate in contrast to the past when all patients lost to follow-up were presumed to have died. In this method, patients not observed for the full time of the study are assumed to have had the same risk of dying as patients followed to the end of the fifth year experienced in their fifth-year analyses. The group with the most favorable prognosis in this series was that receiving preoperative irradiation. This operation. They were given 4,500 rads of supervoltage X ray over a period of 3 weeks prior to operation. The differences in surgical or radiation techniques employed by various reporters make comparative data difficult, if not impossible, to evaluate. Supervoltage irradiation has proved itself in some hands equal to surgery. A randomized prospective study would seem appropriate to conclude the best means of managing epidermoid carcinoma of the esophagus.

Age Factors↗
PubMed1975

Villous tumors of the rectum: excision by the posterior approach.

Villous tumors of the rectum require complete excision for accurate histologic diagnosis. The posterior rectotomy approach of Kraske is presented and described in detail as an excellent method for use in the surgical managment of these lesions. The technic is simple and postoperative morbidity minimal. The procedure is curative for benign lesions and does not interfere with further radical resection of malignant lesions.

Humans↗