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Biomedical subjects

R E Hermann

Publications and source records attributed to R E Hermann.

At least 55 records · Page 3Linked to original sources
PubMed1985

Results of conservative operations for breast cancer.

The results of conservative operations for breast cancer in 1,593 patients treated at the Cleveland Clinic between 1957 through 1975 are reported. During this period, we individualized our treatment of breast cancer depending on tumor size, location in the breast, and clinical stage of the disease. The following three principal operations were performed: modified radical mastectomy in 592 patients (37%), simple (total) mastectomy in 442 patients (28%), and partial (segmental) mastectomy in 291 patients (18%). Survival results at 5, 10, and 15 years are reported. Factors important in long-term survival included stage of the disease, number of lymph node metastases, delay in therapy, size of the tumor, histologic type, and estrogen receptor status; type of operation was not a significant factor. In this series, partial (segmental) mastectomy without radiation therapy provided five- to 15-year survival rates equal to modified radical mastectomy and simple (total) mastectomy.

Adenocarcinoma, Mucinous↗
PubMed1985

The management of retained and recurrent bile duct stones.

The records of 156 consecutive patients treated for retained and recurrent bile duct stones between 1965 and 1980 were reviewed to compare current management techniques. One hundred sixty-eight procedures were performed in the 156 patients: 36 endoscopic sphincterotomies, 89 common bile duct explorations, and 43 common bile duct explorations with drainage procedure. Mean follow-up was 7.2 years. The overall success rates were 81% for endoscopic sphincterotomy, 80% for common bile duct exploration, and 86% for common bile duct exploration with drainage procedure. Five variables were evaluated in regard to the success of these procedures: (1) the time interval between cholecystectomy and the next procedure on the biliary system, (2) the number of previous biliary procedures or operations performed, (3) the diameter of the common bile duct, (4) the number of stones in the duct and their size, and (5) morbidity and mortality. The time interval and number of previous biliary procedures did not affect the success of any procedure group. Endoscopic sphincterotomy has become our procedure of choice. When common bile duct exploration with drainage procedure is performed and a dilated bile duct or more than five bile duct stones are found, the addition of a drainage procedure provides better long-term results.

Adult↗
PubMed1985

Intraoperative consultation for the liver, biliary system, pancreas, duodenum, and spleen.

The urologist, when operating transabdominally, may unexpectedly encounter a cystic or solid mass in the liver, a dilated gallbladder or a gallbladder containing stones, or a mass in the pancreas, or may inadvertently injure the duodenum or spleen when mobilizing these organs for a nephrectomy or adrenalectomy. Discussed are some of these common liver, biliary, and pancreatic problems and their management, and the methods of management of duodenal and splenic injuries.

Biliary Tract↗
PubMed1984

Combination chemotherapy for metastatic carcinoma of the ampulla of Vater--report of three cases.

Three patients with metastatic carcinoma of the ampulla of Vater received celiac artery infusion of 5-fluorouracil, adriamycin, mitomycin-C, and streptozotocin followed by intravenous administration of the same combination. In two patients with measurable disease, one partial (6.0 months) and one complete response (16.0 + months) occurred. Two out of three patients remain alive at 30.0+ and 21.0+ months. Carcinoma of the ampulla of Vater may be a neoplasm responsive to combination chemotherapy.

Aged↗
PubMed1984

Partial mastectomy without radiation therapy.

Partial mastectomy without radiation therapy has been used at The Cleveland Clinic as a treatment option for selected patients with breast cancer since 1957. Our experience with 322 patients has been reviewed; survival results are equal to or better than the other operative procedures we have employed for the treatment of breast cancer. These results, we believe, relate more to the selection of patients with small tumors and at a more favorable stage of the disease than to the benefit of the operative procedure itself.

Axilla↗
PubMed1984

Biliary proteins. Unique inhibitors of cholesterol crystal nucleation in human gallbladder bile.

The onset time for cholesterol crystal nucleation of supersaturated normal human gallbladder biles is consistently prolonged when compared with biles from patients with cholesterol gallstone disease. Investigation of the factor(s) responsible for the suspended supersaturation (metastability) of normal human biles revealed that model bile solutions of cholesterol saturation index (CSI) and molar lipid composition identical to individual gallbladder bile specimens had much shorter crystal nucleation times, i.e., exhibited decreased metastability. Unsaturated normal biles, after supplementation with lecithin, cholesterol, and sodium taurocholate to a 'standard' supersaturated lipid composition, also demonstrated nucleation times three- to 15-fold longer than the comparable standard model bile. Total lipid extracts of normal biles, however, when similarly supplemented, did not differ in nucleation time from the control model solution. Gallbladder biles were fractionated by gel chromatography and the eluted fractions were pooled into two fractions. The fractions eluting in about the first 25% of the included volume when mixed with the supersaturated standard model bile induced a modest increase in nucleation time of approximately 1.5 times the control value. The fractions eluting in the second 25% of the included volume and which contained all of the bile lipids, were concentrated and supplemented with lipids to the standard composition. The nucleation times of these supplements were 3-10 times longer than the control nucleation times. Delipidated bile protein mixtures, purified by discontinuous sucrose gradient centrifugation, were recombined with purified lipids at the standard composition used previously. The nucleation times of these mixtures were significantly prolonged to the same extent as those associated with the second chromatographic fraction. These observations demonstrate that the delayed onset (inhibition) of cholesterol crystal nucleation observed in normal human gallbladder bile is produced by a factor(s) present in the biliary protein fraction.

Anticholesteremic Agents↗
PubMed1984

The role of hepatic veins in liver operations.

In this report we review the role of the hepatic veins in resective operations of the liver. Emphasis is placed on the distribution of the hepatic veins, their relationship to hepatic arterial and portal venous inflow tracts, and the drainage patterns of hepatic lobules. An extensive review of the older literature has emphasized the necessity to preserve hepatic venous drainage for the various hepatic segments to prevent postoperative liver congestion and injury. Recent experimental and clinical reports have identified the mechanisms through which hepatic vein obstruction can be well tolerated. These mechanisms include interlobar and interlobular collateral development, reversal of blood flow in the portal vein with conversion of the portal vein to an outflow tract, development of extrahepatic collaterals, drainage through the caudate lobe, and increased lymphatic draining to relieve hepatic congestion.

Adolescent↗
PubMed1984

Antiestrogen-cytotoxic chemotherapy and bacillus Calmette-Guerin vaccination in stage II breast cancer: seventy-two-month follow-up.

A prospective, randomized clinical trial of adjuvant treatment of 312 stage II breast cancer patients with use of chemotherapy, antiestrogen therapy, and immunotherapy is reported after 72 months of follow-up. The stratification of patients was based on nodal involvement and estrogen receptor (ER) assay of the primary tumors. Findings at 72 months indicate that antiestrogen therapy (tamoxifen, Nolvadex) added to chemotherapy with cyclophosphamide (Cytoxan), methotrexate, and fluorouracil (5-Fluorouracil) (CMF) resulted in significant delayed recurrence in ER-positive postmenopausal patients, ER-positive patients with four or more positive nodes, and ER-positive patients with tumors greater than 3 cm in diameter. The addition of nonspecific immunotherapy with bacillus Calmette-Guerin had no effect on disease-free survival. ER and progesterone receptor measurements in patients with primary breast cancer provide valuable prognostic information on subsequent recurrence and overall survival and should be documented in future clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Adjuvant endocrine therapy, cytotoxic chemotherapy, and immunotherapy in stage-II breast cancer: five-year results.

Five-year results of a prospective, randomized clinical trial of three treatment regimes--(a) cytoxan, methotrexate, and 5-fluorouracil (CMF); (b) CMF plus the antiestrogen drug, tamoxifen (CMFT); and (c) CMFT plus bacillus Calmette-Guerin (BCG) vaccinations--in 312 women with stage-II breast cancer are reported. Estrogen receptors (ER) were measured in all of the primary tumors. Addition of tamoxifen to CMF therapy significantly decreased the number of recurrences at five years in ER positive patients with four or more positive axillary lymph nodes. Addition of tamoxifen to CMF had no effect on disease-free survival in ER-positive patients with 1-3 positive axillary lymph nodes or in patients with ER-negative tumors. Addition of BCG vaccinations had no discernible effect on disease-free survival. ER measurements in the primary tumor provide important prognostic information regardless of treatment, with ER-positive patients having lower recurrence rates and mortality after five years. ER measurements also have predictive value for response to endocrine therapy. Further follow-up is needed to determine whether tamoxifen is delaying recurrence or preventing it in a subset of these patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Surgical management of portal hypertension and esophageal varices. 10 year experience.

The results of 157 operations performed for portal hypertension and esophageal varices on 148 patients at the Cleveland Clinic in the 10 year period between 1970 and 1980 are reported. One hundred four shunt procedures and 53 ligation procedures were performed. The overall operative mortality rate of 13 percent did not differ significantly from the 11 percent rate reported from this institution in 1971. A comparatively higher rate of recurrent variceal hemorrhage and a lower rate of encephalopathy reflected our increased use of selective shunts and ligation procedures. There was no improvement in overall long-term survival, which was approximately 50 percent. The two most important factors in predicting the results of all operations for esophageal varices continue to be assessment of preoperative liver function and the timing of the operation. The best results were obtained in patients with good liver function who had an elective operation. Our data suggest that the portacaval shunt is associated with a higher incidence of late mortality, largely as a result of liver failure; therefore, our preference now is to perform a distal selective splenorenal shunt procedure whenever possible. If a selective shunt procedure cannot be performed, we advocate either a mesocaval shunt or a ligation procedure, depending on patient risk and the suitability of veins for a shunt procedure.

Esophageal and Gastric Varices↗
PubMed1983

Gastric carcinoma. A ten-year review.

Data on 164 patients treated at the Cleveland Clinic with gastric adenocarcinoma during the ten year period 1970 to 1980 was analyzed. Fiberoptic esophagogastroduodenoscopy was introduced as a routine diagnostic modality during this time and yielded a positive tissue diagnosis in 86% of patients in this series. Laparotomy was performed on 150 patients; 49 patients (30%) were biopsied only, 19 (12%) were bypassed for palliation, and 82 (58%) underwent gastrectomy. Of the latter group, only 45 patients (27%) were resected for cure. The overall operative mortality rate was 6%. All patients were staged according to the International TNM classification (stage I--10%, II--24%, III--12%, and IV--53%). Survival at 5 years was influenced by tumor location and extent of gastric resection but was most significantly related to stage of disease at operation (stage I--65%, II--22%, III--5%, and IV--0%; p less than 0.0001) and to the status of regional nodes (positive--17%, negative--56%; p less than 0.005). Despite the routine use of fiberoptic endoscopy, the majority of gastric cancers were advanced at diagnosis and their prognosis remains discouraging. Improvement of results will require a more aggressive approach to the endoscopic investigation of upper gastrointestinal symptoms and earlier surgical intervention.

Adenocarcinoma↗
PubMed1982

Estrogen receptor status as a prognostic indicator for stage I breast cancer patients.

The prognostic value of estrogen receptor determination was studied for 510 stage I (axillary node negative) breast cancer patients treated by mastectomy alone. Results at 60 months after mastectomy indicate that stage I patients whose tumors lack estrogen receptors fall into a significantly poorer prognostic group for both recurrence and survival than those whose tumors contain estrogen receptors. Within the postmenopausal group, estrogen receptor negative (ER -) patients are recurring more rapidly than estrogen receptor positive (ER +) patients. Within the premenopausal group, ER + patients have a recurrence rate identical to ER - patients, which is apparent only after prolonged follow-up. In contrast to postmenopausal ER + patients, premenopausal ER + patients appear to have no prognostic advantage over the ER - patients, and thus constitute a high risk group for which adjuvant endocrine therapy might prove beneficial.

Breast Neoplasms↗
PubMed1982

Bile duct cysts. Experience with 15 patients.

Fifteen patients, all of whom underwent surgery at this institution from 1955 to 1981, were included in this study. Bile duct cysts were classified into Types I to V to include cysts of the intra- and extra-hepatic bile ducts. The association of this entity with other congenital abnormalities is discussed. Carcinoma of the biliary tree occurred in two cases. The treatment of this condition is surgical. Excision is preferred whenever technically possible; otherwise a bypass procedure is performed. The technique of excision described by Lilly [32,34] is preferred because it is safer, decreasing the risk of injury to the hepatic artery and portal vein. Controversy continues regarding the procedure of choice.

Adolescent↗
PubMed1981

Pseudolymphoma of the stomach.

Pseudolymphoma of the stomach is an unusual condition that is frequently confused with true gastric lymphoma. This has resulted in favorable long-term results in several large series of gastric lymphoma. The distinction between lymphoma and pseudolymphoma may be difficult to make on the basis of frozen sections and, occasionally, on permanent histologic sections. When the diagnosis can be made intraoperatively, a conservative procedure is indicated. When the diagnosis is suspected but cannot be made microscopically, it is suggested that observation for definite evidence of malignancy on follow-up be undertaken before initiating adjuvant therapy. This condition is frequently associated with chronic peptic ulcer disease and is considered benign. It has be proposed that pseudolymphoma, if left untreated, may progress to true lymphoma.

Adult↗
PubMed1981

Recertification in surgery, 1980.

The first recertification process of the American Board of Surgery was completed in 1980. The process consisted of a review of diplomates' credentials, peer review, a requirement for continuing education in surgery, submission of an operative experience list, and a multiple-choice examination. Of the 478 diplomates who completed the process, 471 were recertified. The mean score for participants in the examination was 82.8% correct. The passing score was 67.2% correct. An analysis of examination scores, correlated with biographic and demographic data, showed that the highest scores were achieved by the younger diplomates and those who indicated that their practice was full-time academic.

Adult↗