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R Quinlan

Publications and source records attributed to R Quinlan.

24 records · Page 2Linked to original sources
PubMedDate not supplied

Surgical resection improves survival in the treatment of early gastric lymphomas.

Gastric lymphomas are a relatively rare form of malignancy and controversy about their optimum treatment still exists. To date, there have been no studies directly comparing results of medical therapy alone versus a combination of surgery plus medical therapy. We reviewed our experience in the three teaching hospitals of the University of Massachusetts Medical School to determine the role of surgery in the management of early gastric lymphoma. Statistics were evaluated by means of chi-square, log-rank, and Kaplan-Meier curve analysis where appropriate. Using tumor registry data, 39 patients were treated for early disease at our medical school from 1980 to 1998. Patients treated with surgery plus chemotherapy and radiation had a 90% 5-year survival compared to patients who received chemotherapy and radiation alone (55% 5-year survival; P <0.01). When we compared all patients on an intention-to-treat basis (patients preoperatively thought to have early-stage disease), there was still a significant survival benefit with the addition of surgery to their management. Because this is an uncommon disease, there are no large prospective studies examining treatment. Based on our retrospective experience, surgical resection should be considered an important adjunct in the treatment of gastric lymphomas in early-stage disease.

Adult↗
PubMedDate not supplied

A double-blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine in gynecologic surgery.

BACKGROUND AND OBJECTIVES: Ropivacaine is a long-acting local anesthetic agent with similar potency to that of bupivacaine when administered for epidural anesthesia. Ropivacaine, however, may be less cardiotoxic than bupivacaine. Epidural bupivacaine and ropivacaine have been shown to be equally effective in providing sensory block for lower extremity surgery, but they have not been compared for their ability to produce abdominal wall relaxation. METHODS: Sixty-six American Society of Anesthesiologists I-III women, 18-70 years old undergoing elective gynecologic surgery were studied in a randomized, double-blind manner after giving informed consent in an institutionally approved protocol. Thirty-four patients received a single epidural injection of 20 ml 0.75% bupivacaine at the L2-L3-L4 interspace and 32 patients received 20 ml 0.75% ropivacaine in a similar manner. Sensory block was tested with pinprick; motor block with a modified Bromage scale, rectus abdominis muscle (RAM) test and surgeon satisfaction. Statistical analysis was performed using the SigmaStat for Windows computer software. Parametric data were analyzed with Student's t-test, while nonparametric data was analyzed using the Mann-Whitney rank sum test. RESULTS: Results are expressed as mean +/- SD. Times to maximal sensory block and peak sensory level achieved were similar in both groups. However, time to complete sensory regression was significantly longer with bupivacaine than ropivacaine (458 +/- 77 vs. 404 +/- 62 minutes, P < .03). Bupivacaine lower extremity motor block onset was significantly faster than ropivacaine (9 +/- 3 vs. 12 +/- 3 minutes, P < .0013). Time to maximum lower extremity motor block was significantly shorter with bupivacaine than ropivacaine (28 +/- 12 vs. 40 +/- 15 minutes, P < .0234). Duration of lower extremity motor block was significantly longer with bupivacaine than ropivacaine (371 +/- 97 vs. 310 +/- 65 minutes P < .069). There was no significant difference between the two groups for changes in RAM scores or the time to achieve those changes. Maximum motor block scores using the modified Bromage score and surgeon satisfaction with operating conditions also did not demonstrate a significant difference between the two groups. In one instance (with ropivacaine), anesthesia was judged clinically inadequate despite evidence of bilateral epidural anesthesia. CONCLUSIONS: Both 0.75% ropivacaine and 0.75% bupivacaine provide adequate surgical anesthesia for lower abdominal surgery when administered epidurally. However, lower extremity motor block with ropivacaine is significantly shorter and of slower onset and sensory block shorter at these concentrations.

Abdominal Muscles↗