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Biomedical subjects

R A Abrams

Publications and source records attributed to R A Abrams.

140 records · Page 8Linked to original sources
PubMedDate not supplied

Should pancreaticoduodenectomy be performed in octogenarians?

As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%) distal bile duct adenocarcinoma (n = 5; 11%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma; (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 454; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.

Adenocarcinoma↗
PubMedDate not supplied

The effects of eye and limb movements on working memory.

Three experiments examined the role of eye and limb movements in the maintenance of information in spatial working memory. In Experiment 1, reflexive saccades interfered with memory span for spatial locations but did not interfere with memory span for letters. In Experiment 2, three different types of eye movements (reflexive saccades, pro-saccades, and anti-saccades) interfered with working memory to the same extent. In all three cases, spatial working memory was much more affected than verbal working memory. The results of these two experiments suggest that eye movements interfere with spatial working memory primarily by disrupting processes localised in the visuospatial sketchpad. In Experiment 3, limb movements performed while maintaining fixation produced as much interference with spatial working memory as reflexive saccades. These results suggest that the interference produced by eye movements is not the result of their visual consequences. Rather, all spatially directed movements appear to have similar effects on visuospatial working memory.

Extremities↗
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Musculoskeletal consequences of near-drowning in children.

Nearly drowned children sustaining cardiac or respiratory arrest or altered neurologic status developed anoxic encephalopathy (30%), died in the ensuing days (36%), or were discharged neurologically normal (34%). In encephalopathic children, spasticity was more malignant than in children with other causes of spasticity. The most common musculoskeletal problem was contracture, especially equinus, hip adductor, hamstring, and quadriceps. Hip subluxation or dislocation occurred in 34% as early as 1 month after injury. Scoliosis developed in 18%, with some requiring bracing and surgery. Thirty-one percent ambulated, and the rest were quadriplegic. Independent sitting or better function by discharge was a predictor of ambulation potential. Of the quadriplegics, 66% were dependent sitters.

Child↗
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Attitudes of older versus younger adults toward dentistry and dentists.

A total of 416 adults were interviewed by telephone to gauge their attitudes toward dentistry and dentists. Attitudes of those age 55 and older were compared with those younger than age 55. It was found that 72% of those 55 and older had not visited a dentist in the previous 2 years because they felt it was not necessary; 38.5% of respondents younger than 55 gave this reason. Only 15% of those 55 and older reported that high costs kept them away from the dentist.

Age Factors↗
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Recurrent pancreatic adenocarcinoma: spiral CT evaluation following the Whipple procedure.

Computed tomographic (CT) examination of patients who have undergone pancreaticoduodenectomy (Whipple procedure) for pancreatic adenocarcinoma is complex. The radiologist's assessment of the three surgically created anastomoses, as well as of subtle abnormalities that are the earliest signs of recurrent disease, is substantially aided by the volume acquisition capability of spiral CT and use of overlapping reconstruction intervals. Normal postoperative findings on spiral CT scans include ill-defined increased attenuation in the fat of the pancreatic bed and surrounding the superior mesenteric artery and pneumobilia. The most frequent sites of tumor recurrence are local disease in the pancreatic bed and metastases in the liver; concurrent local and liver disease may also be the initial manifestation of recurrent pancreatic adenocarcinoma. CA 19-9 is a tumor-associated antigen whose level is frequently elevated in patients with recurrent pancreatic cancer, and correlation of CT findings and the serum CA 19-9 level is helpful in differentiating between recurrent disease and postoperative changes. Correlation of CT appearances with clinical parameters, such as the type and position of surgically created anastomoses and knowledge of the radiation port in those patients receiving adjuvant radiation therapy, aids interpretation and helps one avoid false-positive diagnoses in the setting of complex anatomic and persistent postoperative changes inherent in this patient population.

Adenocarcinoma↗
PubMedDate not supplied

Spiral CT of colon cancer: imaging features and role in management.

Colorectal cancer is a common malignancy that results in significant morbidity and mortality. Abdominal computed tomography (CT) is valuable in planning surgery for colon cancer because it can demonstrate regional extension of tumor as well as adenopathy and distant metastases. At CT, colorectal cancer typically appears as a discrete soft-tissue mass that narrows the colonic lumen. Colorectal cancer can also manifest as focal colonic wall thickening and luminal narrowing. Complications of primary colonic malignancies such as obstruction, perforation, and fistula can be readily visualized with CT. At CT, local extension of tumor appears as an extracolic mass or simply as thickening and infiltration of pericolic fat. Extracolic spread is also suggested by loss of fat planes between the colon and adjacent organs. The liver is the predominant organ to be involved with metastases from colorectal cancer. At CT, hepatic metastases usually appear as hypoattenuating masses, which are best visualized during the portal venous phase of liver enhancement. Other common sites of metastases from colon cancer include the lungs, adrenal glands, and bones. Use of CT is critical for identifying recurrences, evaluating anatomic relationships, documenting "normal" postoperative anatomy, and confirming the absence of new lesions during and after therapy.

Adipose Tissue↗
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Salivary testing to reduce sugar consumption in school children.

A total of 423 elementary and middle school children participated in a project to see if it would be possible to reduce their sugar consumption. Children tested their salivary lactobacillus colony count and buffering capacity in their health/science class, and they used this information to measure their caries risk. Because the lactobacillus colony count is a good indicator of a person's recent sugar consumption, any change in sugar consumption will produce a change in the lactobacillus colony count. Children's saliva was tested four times, and an intensive dietary counseling program was provided in the classroom. Results showed that lactobacillus counts went down, and the children reduced their sugar consumption.

Adolescent↗
PubMedDate not supplied

The clinical use of multimodality therapy in the management of cancer.

The essential challenge in managing malignant disease with intent of cure is to eradicate the last malignant cell without imposing unacceptable burdens regarding toxicity, functional loss, or damaged cosmesis. In this review we examine the strengths and limitations of surgery, radiotherapy, and systemic chemotherapy when used as single modalities and the unique features of each that allow their advantageous combination. Finally, we consider newer developments in the antineoplastic armamentarium which may soon contribute to the challenges of achieving cure with acceptable sequelae.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Survival results among patients with alpha-fetoprotein-positive, unresectable hepatocellular carcinoma: analysis of three sequential treatments of the RTOG and Johns Hopkins Oncology Center.

PURPOSE: To analyze the observed therapeutic impact of the post-induction components of three treatment programs utilized sequentially between 1983 and 1991 for patients with unresectable alpha-fetoprotein-positive hepatoma. METHODS: Over a 7.5-year period, three treatment regimens were sequentially utilized: (1) RTOG 83-19, (2) a Johns Hopkins Oncology Center Institutional Pilot Program, and (3) RTOG 88-23. Each treatment program began with an induction phase of external-beam hepatic irradiation (2100 cGy/7 fractions), with concurrent doses of intravenous chemotherapy intended to be radiosensitizing. After induction, patients received cycles of one of the following: (1) intravenous doxorubicin and 5-fluorouracil (5-FU) with or without 131I-polyclonal antiferritin (RTOG 83-19); (2) intrahepatic artery cisplatin (Hopkins Institutional Pilot); or (3) intrahepatic artery cisplatin with or without 131I-polyclonal antiferritin (RTOG 88-23). Analysis of survival results was performed with multivariate and Cox regression methods. RESULTS: The addition of intravenous 131I-polyclonal antiferritin to post-induction cycles of either intravenous doxorubicin and 5-FU or intrahepatic artery cisplatin did not enhance survival. Intrahepatic artery cisplatin treatment yielded median survival duration of 9.1 months and survival at 12 and 24 months of 37% and 9%, respectively. These results were significantly superior to those resulting from use of intravenous doxorubicin and 5-FU (P = 0.0001; median survival duration 3.6 months; 12- and 24-month survival results 17% and 4%, respectively). A significant survival difference for the cisplatin regimen remained even when patients were stratified by previously identified prognostic factors and the results were appropriately adjusted. CONCLUSION: Patients with unresectable alpha-fetoprotein-positive hepatocellular carcinoma experienced improved survival and decreased toxicity when managed with post-induction cycles of intra-arterial cisplatin as compared with intravenous doxorubicin and 5-FU. Intravenous 131I-polyclonal antiferritin did not improve survival when added to either post-induction regimen but dramatically increased hematologic toxicities.

Antineoplastic Agents↗