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Biomedical subjects

P McCormack

Publications and source records attributed to P McCormack.

At least 55 records · Page 3Linked to original sources
PubMed1991

An analysis of the accuracy of prediction of intraocular implant power in the myopic patient.

A series of 90 eyes of 88 myopic patients who underwent extracapsular cataract surgery with intraocular lens implants (IOLs) between 1984 and 1989 were analysed in a retrospective study. The axial length as obtained by ultrasonic A scan and keratometry readings were applied to the SRK1 and modified SRK (SRK2) formulae and the result compared with the actual post-operative state achieved.

Cataract Extraction↗
PubMed1991

Current surgical approach to non-small-cell lung cancer.

Surgery is the best treatment for stage I lung cancer. While most physicians concur, they disagree as to the volume of lung needing to be resected to achieve the best survival results. The author and her colleagues at Memorial Sloan-Kettering feel that a lobectomy should be performed in all cases unless the pulmonary function precludes excision of this volume of lung tissue. In resections of less than a lobectomy for a primary tumor, the recurrence rate is high and usually precludes a salvage lobectomy. The author discusses surgical treatment of other stages of lung cancer as well.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

Adjuvant brachytherapy for treatment of chest wall sarcomas.

Thirty patients treated with surgical resection and brachytherapy for chest wall sarcoma at Memorial Sloan-Kettering Cancer Center from 1980 through 1987 were reviewed. Patients selected to receive adjuvant irradiation were those for whom there was doubt as to the completeness of surgical resection. Overall 5-year survival and locoregional control after brachytherapy were 65% and 54%, respectively. Locoregional control was similar for tumors treated at initial diagnosis (12 patients), at the time of recurrence (13 patients), or for tumors that were metastatic to the chest wall (five patients). Six patients with tumors larger than 10 cm in maximum dimension had a locoregional recurrence rate of 69% versus a recurrence rate of 39% for 18 patients with smaller tumors (p = 0.27). Fifty-four percent of high-grade tumors recurred locoregionally versus 28% of low-grade tumors (p = 0.37). Bone invasion or the presence of positive resection margins was not clearly associated with a higher locoregional failure rate. Only one patient (1/28; 7%) was known to have had recurrence within the irradiated area. Eight patients (8/28; 37%) had recurrence adjacent to the implanted area, and the precise failure site could not be determined for the remaining two patients. Because of the relatively high risk of regional versus in-field recurrence, patients with chest wall sarcoma who receive adjuvant treatment should be treated primarily with external-beam irradiation to allow more generous coverage of the tumor bed. Brachytherapy could be used as a tumor bed "boost" treatment. In patients undergoing resection of recurrent tumor in a previously irradiated site, adjuvant brachytherapy, without external-beam irradiation, should be considered to reduce the risk of extensive soft tissue necrosis.

Adolescent↗
PubMed1990

Surgical resection of pulmonary metastases.

Since the first pulmonary resection for metastatic carcinoma to lung in 1939, this procedure can now be offered to any patient who fills the following criteria: has a controlled primary, resectable lung lesion, has no better treatment method available, and is a good surgical risk. With the increased incidence of this procedure, more and more attention is being directed to the predictors of survival to determine which patients will obtain the best benefit. Disease-free interval, tumor doubling time, and number of lesions are discussed with the effect each has on survival. This paper covers our experience from 1965 to 1985 of 415 patients who underwent resection for primary carcinomas with metastases to lung. The overall mortality rate is 2%, morbidity rate under 10%, and survival rate best for testicular (51%), and head and neck primaries (47%). This procedure has a proven efficacy for increasing survival rates in properly selected patients.

Humans↗
PubMed1990

Elder abuse.

Elder abuse is an under-recognised cause of morbidity in the elderly. The frail elderly with multiple physical and psychiatric problems living with a relative who may also have a physical or psychiatric problem are particularly at risk. Although increased awareness of the problem and a high index of suspicion are necessary factors to diagnose the condition, clinical pointers towards diagnosis are available. Treatment for both victim and "carer" should be on the basis of multi-disciplinary assessment, and may result in admission of the elderly patient to an extended-care facility.

Aged↗
PubMed1988

Isolated systolic hypertension: data from the European Working Party on High Blood Pressure in the Elderly.

The European Working Party on High Blood Pressure in the Elderly study (EWPHE) was a placebo-controlled, double-blind, inter-patient assessment of diuretic treatment in hypertensive patients aged 60 years or more. Of the 840 patients included in the study 247 had isolated systolic hypertension (systolic blood pressure greater than or equal to 160 and diastolic blood pressure less than or equal to 95 mmHg). In those (n = 120) randomized to active treatment (diazide-hydrochlorothiazide with triamterene +/- methyldopa) blood pressure after 3 years was, on average, 19/8 mmHg lower than in the placebo group (n = 119) and after 5 years the difference was 9/7 mmHg. Data on mortality and morbidity were insufficient for firm conclusions to be drawn. The data are presented here only to communicate the trends observed and to provide information that may be useful in the design of future trials. The trends observed for cardiac mortality, terminating non-fatal events (including severe heart failure) and combined fatal and non-fatal cardiovascular events follow a similar pattern to that observed in the trial overall, in that active treatment appeared to confer benefit. However, in the case of isolated systolic hypertension none of these differences between active and placebo treatment achieved statistical significance. We conclude that, given the epidemiological data incriminating systolic hypertension as a risk factor and the data presented here, a rigorous assessment of the value of treating isolated systolic hypertension is justified.

Aged↗
PubMed1986

A comparison of pulmonary function tests for postthoracotomy pain using cryoanalgesia and transcutaneous nerve stimulation.

The beneficial effects of transcutaneous nerve stimulation (TNS) and cryoanalgesia for post-thoracotomy pain were compared against each other and against a control group through pulmonary function testing in the immediate and delayed postoperative period. Patients receiving cryoanalgesia did not perform well in the first 24 hours after operation. However, by the fifth postoperative day, they did as well as or even better than the TNS patients. Both cryoanalgesia and TNS were significantly effective in the management of postoperative pain as compared with controls.

Electric Stimulation Therapy↗
PubMed1985

Adenocarcinoma of the esophagus and gastroesophageal junction. Prognostic factors and results of therapy.

Adenocarcinomas of the esophagus and gastroesophageal junction (AE and GE) are uncommon neoplasms with a poor prognosis. AE or GE are usually analyzed as part of the larger group of carcinomas in patients with either epidermoid carcinoma of the esophagus or with gastric cancer. The prognostic variables and outcome of therapy for patients with AE and GE alone have not been well described. The records of 131 patients treated at Memorial Hospital during the period 1978 to 1982 were reviewed. The majority underwent surgery as their primary therapy. Clinical staging was found to be highly inaccurate, with almost all patients having Stage III disease at surgery. Operative mortality was 7.1%. Adjuvant chemotherapy did not appear to influence survival. Treatment of advanced disease with either conventional or investigational agents yielded modest objective response rates. Prognostic variables for those presenting with locoregional disease who were candidates for potentially curative surgery were analyzed. Only the presence or absence of weight loss and location of the primary tumor (AE versus GE) were significant variables. A model for predicting survival was employed.

Actuarial Analysis↗
PubMed1985

Surgical treatment of spinal cord compression in patients with lung cancer.

We analyzed the clinical features, radiological findings, and results of surgical treatment in a series of 25 patients with lung cancer and invasion of the spine. In 12 of the 25 (40%) patients, involvement of the spine was present at the time of initial presentation of malignancy. Computed tomography revealed the presence of a large paravertebral soft tissue mass with destruction of adjacent ribs in the majority. The surgical approach consisted of an anterolateral exposure through a formal thoracotomy in 22 patients and a thoracoabdominal flank approach in the 3 patients with lumbar lesions. All gross tumor was resected from the involved paravertebral tissues, vertebral body, and epidural space. Immediate stabilization of the spine was then achieved with methyl methacrylate. Local brachytherapy (iridium-192 implants) was used in 19 patients. After treatment, 87% were ambulatory, and 67% maintained ambulation for more than 6 months. Our data suggest that compression of the spinal cord in many patients with lung cancer results from direct extension of tumor through the chest wall. Because the majority of such patients often have localized disease involving the spine, aggressive surgical treatment is indicated.

Adenocarcinoma↗
PubMed1985

Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization.

The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.

Adolescent↗
PubMed1985

Comparative merits of conventional, computed tomographic, and magnetic resonance imaging in assessing mediastinal involvement in surgically confirmed lung carcinoma.

Thirty-four patients with operable malignant tumors of the lung had computed tomography and magnetic resonance imaging of the chest in addition to regular chest roentgenograms and bronchoscopy. The purpose of the study was to assess the extent of tumor involvement in the hilum and the mediastinum by direct invasion and by regional lymph node metastasis. At thoracotomy, 23 tumors were completely resected and 11 were treated by interstitial implantation of radioisotopes. In addition, a mediastinal lymph node dissection or sampling was performed to correlate nodal involvement with the preoperative studies. The tumor was peripheral in 21 patients and central in 13. Histologically, 18 tumors were adenocarcinomas, 14 epidermoid cancers, and two atypical carcinoids. Preoperatively, 18 tumors were classified as N0 disease, nine as N1, and seven as N2. Pathologically, 11 were N0, eight N1, and 15 N2. Plain chest roentgenograms correlated poorly with the nodal findings at operation. Both magnetic resonance and computed tomographic imaging were highly accurate in assessing the hilum and the presence of mediastinal adenopathy, with a sensitivity rate of 87%. Except for identifying contact with the mediastinum, neither method correlated well with mediastinal invasion when present (sensitivity rate 55% for computed tomography and 64% for magnetic resonance) and neither method could differentiate hyperplastic from metastatic nodes. Hence, no advantage of magnetic resonance over computed tomographic scanning was noted in assessing tumor involvement of the mediastinum by direct invasion or by regional lymph node metastasis.

Adult↗
PubMed1982

Combination chemotherapy of esophageal carcinoma using cisplatin, vindesine, and bleomycin.

Sixty-one patients with epidermoid carcinoma of the esophagus have been treated with a three drug combination of cisplatin, vindesine, and bleomycin. Of 53 patients currently evaluable for response, 29 (55%) have had partial remissions: 7/16 with metastatic, and 22/37 with local-regional disease. The median duration of response in metastatic patients is eight months. Of 28 patients treated preoperatively, 23 (82%) had resectable disease. The major toxicities seen were nephrotoxicity and myelosuppression. Cisplatin, vindesine and bleomycin is an effective combination in the treatment of esophageal carcinoma. Effects on long-term survival cannot yet be evaluated.

Acute Kidney Injury↗
PubMed1981

Combined modality therapy of esophageal carcinoma.

One hundred ten patients with epidermoid carcinoma of the esophagus were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC) with combined modality techniques involving preoperative irradiation (RT) and surgery, and with preoperative chemotherapy (CT), surgery, and irradiation. For the 76 patients receiving preoperative RT during the period 1965-1976, the overall resectability rate was 54% with an operative mortality of 12%; long-term survivors (greater than 3 years) were few (7%). For 34 patients receiving preoperative CT with cisplatin and bleomycin, major objective tumor regression (greater than 50%) was seen by day 18 in 20%, with an additional 44% having smaller but definite improvement in the barium esophagram and in swallowing function. Of those receiving preoperative CT, 76% had resectable lesions, with an operative mortality of 11%. The median follow-up for this group is 24 months; of the 30 patients followed for at least 12 months, 20% are alive without evidence of disease. Although the resection rate following preoperative chemotherapy seems to be higher, thus allowing better palliation, neither preoperative radiation nor chemotherapy with cisplatin and bleomycin have had a major impact on long-term survival.

Adult↗
PubMed1981

New trends in skeletal reconstruction after resection of chest wall tumors.

Involvement of the chest wall in malignant tumors, either primary or resulting from contiguous or metastatic spread, occurs in less than 5% of thoracic malignancies. From 1963 through 1978, 155 patients had chest wall resection in continuity with the tumor. Eighty-five tumors were carcinomas, and 70 were sarcomas. Since 1973 reconstruction of chest wall defects in 12 patients has included the use of a composite of Marlex mesh and methyl methacrylate. It provides an excellent replacement both physiologically and esthetically. Such a reconstructed chest wall has obviated the need for postoperative respiratory support. The overall mortality was 4.5% (7 out of 155). The 5-year survival in this varied group of patients is 20%. We believe excellent palliation can be achieved even in patients who are not potentially curable.

Adolescent↗