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S Ariyan

Publications and source records attributed to S Ariyan.

At least 37 records · Page 2Linked to original sources
PubMed1996

Prolonged survival in patients with advanced melanoma treated with neoadjuvant chemotherapy followed by resection.

Patients with metastatic melanoma (AJCC stage IV) generally have a very poor prognosis (median survival, 6-8 months). Combination chemotherapy is often the treatment of choice. Despite the higher response rates of a number of new combination regimens, the median duration of response ranges from 6 to 9 months, with no significant survival advantage. To evaluate whether surgical resection of residual metastases after chemotherapy can improve survival, we conducted a retrospective analysis of all patients enrolled on various chemotherapy protocols for metastatic melanoma at Yale between March 1987 and March 1993. We identified 16 patients who underwent surgical resection of residual disease after receiving one to four cycles of combination chemotherapy. Sites of metastases included regional and distant lymph nodes, skin, subcutaneous tissue, lung, and liver. No patients had brain or bone metastases at the initiation of therapy and performance status (PS) was 0.1. Follow-up for these 16 patients ranges from 14 to 62 months (median, 35 months) from the start of chemotherapy. All 16 patients had either complete responses (CR = 3) or partial responses (PR = 7), or stable disease (SD = 6) after chemotherapy. Eleven patients are currently alive; 10 remain free of disease. A comparison group (control) of 14 patients was identified from the same retrospective analysis using similar clinical characteristics such as sites of metastases, PS, and cycles of chemotherapy. No patients underwent surgical resection either because of patient refusal or concomitant medical problems. None had evidence of disease progression (CR = 3, PR = 2, SD = 9) at the completion of chemotherapy. However, duration of survival in this group from the start of chemotherapy ranged from 4 to 45 months (median, 11.5 months). Twelve patients have died and 2 are currently alive, 1 of which has recurrent disease. Based on the comparison of these two groups, this report suggests that patients treated with neoadjuvant chemotherapy may benefit from surgical resection of residual metastases, and this approach should be studied further.

Adult↗
PubMed1996

General principles of reconstruction following cancer surgery.

The evolution and development of the fields of surgery, radiation therapy, and chemotherapy have led to the collaboration of these specialties in the management of cancer patients. The multidisciplinary approach to the treatment of cancer has led to better cure rates for the patients with the least risk for disabilities.

Combined Modality Therapy↗
PubMed1996

Reconstructive surgery in melanoma patients.

The treatment of malignant melanoma should include a wide resection, the extent of which should be based on the tumor thickness of the primary site as well as the anatomic site of the location of the tumor. The various methods of reconstruction of these donor sites may include primary closure, split-thickness skin grafting, full-thickness skin grafting, or a number of local flaps. Each of these techniques is selected based on the size and extent of the wound necessitated by the wide excision. The concept that needs to be kept in mind is that the surgical treatment for a melanoma should be as wide as is indicated based on the depth of invasion, which is an indication for the potential of local recurrence. The areas should be treated most often with flaps to allow for early ambulation, decreased disability and cost of hospitalization, and improved functional and cosmetic results in the long term for the patient. It is my personal belief that with further experience in the use of these various flaps, surgeons will be able to provide secure wide surgical excisions of many sizes with greater confidence, because these areas can be resurfaced without disability. In this fashion, the extent of the surgical excision no longer should be a compromise for fear of difficulty in closing or resurfacing the wounds.

Humans↗
PubMed1995

The association between melanoma, lymphoma, and other primary neoplasms.

BACKGROUND AND OBJECTIVE: Reports of multiple primary tumors are not new. However, we have noted a disproportionate number of patients with melanoma in whom lymphoma develops and wanted to define the incidence of this association. DESIGN: All 664 patients with melanoma treated at Yale-New Haven Hospital, Conn, during the 5-year period from 1986 to 1991 were reviewed. The incidence of all the associated malignant neoplasms among our patients with melanoma was compared with the incidence that would be expected in the normal population adjusted for age, race, and sex. RESULTS: Among the 664 patients, 54 (8.1%) had one or more additional malignant neoplasms. Of the 10 different malignant tumor types recorded, lymphomas were the most prevalent. This incidence of lymphoma among the melanoma patients was 12 of 664, resulting in an incidence of 548 per 100,000 population, 16 times higher (P < .0125) than the expected incidence (34 per 100,000) when adjusted for age, sex, and race. CONCLUSIONS: The incidence of a second malignant neoplasm in our patients with melanoma was 8.1%. Lymphoma was a particularly common type of second malignancy, showing an incidence more than 16-fold higher than that expected in the normal population. It is particularly important, from a clinical point of view, to be aware of this when clinically palpable lymph nodes develop in areas not normally the site of regional lymphatic drainage of the primary melanoma.

Adolescent↗
PubMed1995

Multiple primary melanomas: data and significance.

Cancer statistic reports show that the incidence of melanoma has increased each decade. It is now estimated that approximately 5 percent of the patients with primary cutaneous melanoma will develop another primary melanoma in their lifetime. This report describes the information gathered from 27 patients at the Yale Melanoma Unit who have developed 59 individual primary melanomas; 22 of the patients developed a second primary melanoma, and 5 patients each developed three primary melanomas. In 8 patients (30 percent), the second primary melanoma was diagnosed within 1 month of the first malignancy and was considered synchronous. The remaining 24 melanomas in the 19 patients presented subsequently: 4 (17 percent) within the first year, 7 (29 percent) during the second year, and 13 (54 percent) beyond the second year of the first diagnosis. Although the thickness of the initial melanoma ranged from 0.2 to 6.0 mm, all subsequent melanomas were either in situ or less than 1.0 mm in thickness. This study shows that patients who developed more than one melanoma invariably had thin subsequent lesions. The implications of the multiple melanomas are not a poorer prognosis, but rather that the patients' prognosis is the same as that of the original, or thickest, melanoma.

Adult↗
PubMed1995

Management of carotid artery rupture by monitored endovascular therapeutic occlusion (1988-1994).

The reported mortality (40%) and neurologic morbidity (25%) rates for carotid rupture remain unacceptably high. This study was conducted to assess the impact of endovascular detachable balloon occlusion and the changing characteristics of carotid rupture in head and neck surgery. Between January 1, 1988, and June 30, 1994, 18 carotid ruptures were identified in 15 patients. Etiologic factors included radical surgery, radiation therapy, wound complications, and recurrent or persistent carcinoma. In 15 of 18 instances of carotid rupture, patients survived without major neurologic sequelae. After the introduction of endovascular techniques in 1991, the 12 patients whose hemorrhage was definitively managed through permanent balloon occlusion survived without significant neurologic sequelae. Endovascular occlusion techniques in the monitored patient may significantly improve the outcome after carotid rupture.

Aged↗
PubMed1995

Tomographic studies of human jaws to assess potentials for preserving the blood supply in rim mandibulectomies.

Rim mandibulectomy, resecting the aveolar segment of the mandible while preserving the inferior cortical arch, has been shown to be a biologically and surgically sound procedure. In order to study the surgical anatomy of the mandible and determine the reproducibility of the anatomic markers and neurovascular supply, we studied serial tomographic cuts of 50 living human mandibles (21 males, 29 females; ages 17 to 87). The dentition was complete in 13, partial in 30, and edentulous in 7. The review showed that the location of anatomic structures was symmetrical in all these adult patients regardless of age, sex, or extent of dentition. (The only significant difference was in the height of the alveolus, which was decreased in edentulous patients.) The data show that in performing a rim mandibulectomy, the blood supply may be preserved in most patients if at least 11 mm of vertical height is preserved of the inferior cortex of the body of the mandible.

Adolescent↗
PubMed1995

Skeletal muscle for cardiac assist.

Although current efforts at cardiomyoplasty have not produced the anticipated clear-cut benefits in cardiac function, replicable improvements in subjective function have resulted. Efforts at optimizing conditioning protocols, skeletal muscle strength, and timing of skeletal muscle assist devices should provide further improvements in cardiomyoplasty. Further work with alternative ways of configuring skeletal muscle for cardiac assist is extremely promising. SMVs, in particular, offer potential to augment cardiac function directly or indirectly powering pumps. Work in all these areas is in early stages, but the future is bright.

Animals↗
PubMed1994

Latency of skeletal muscle contraction after pulse train stimulation: an important factor in correct timing of skeletal muscle cardiac assist devices.

Various configurations of conditioned skeletal muscle are under investigation for cardiac assistance in patients with end-stage cardiac failure. Optimal timing of conditioned skeletal muscle contraction is essential for effective cardiac augmentation. However, unlike mechanical methods of assistance, skeletal muscle requires time to develop peak tension. We measured "time to 50% peak tension" and "time to 90% peak tension" using an electrical strain gauge in 12 canine latissimus dorsi muscles (6 untrained controls and 6 trained with 3 months of electrical stimulation at 25 Hz with a 15% duty cycle). The "time to 50% relaxation" and the "time to 90% relaxation" after discontinuation of the stimulus were also measured. Conditioned skeletal muscle required significantly more time to develop peak tension than unconditioned skeletal muscle. Relaxation was also significantly prolonged in conditioned muscle. Notably, conditioned lattisimus needed, on average, 0.35 sec to develop peak tension and 0.20 sec for 90% relaxation. Thus, 0.55 sec of each muscle contraction/relaxation cycle was devoted to development of peak tension and subsequent relaxation. At normal canine heart rates of approximately 120 beats per minute (0.50 sec per cardiac cycle), conditioned skeletal muscle may take up to 70% of each cardiac cycle (0.35 sec) to develop 90% of peak tension. The recognition of this phenomenon in conditioned skeletal muscle is important for effective contraction timing of both human and animal skeletal muscle assist devices. Development of proper conditioning regimens for such devices may benefit from identification of those training parameters which produce a minimal "time to peak tension."

Animals↗
PubMed1994

Treatment considerations in postmastectomy reconstruction: their relative importance and relationship to patient satisfaction.

Although studies concerning motivation for and satisfaction with breast reconstruction after mastectomy have proliferated, little information is available concerning the relative importance of motivating factors and satisfaction with treatment choice in nonreconstructed and reconstructed mastectomy patients. We studied this by questioning 144 women in four groups: mastectomy patients who had reconstruction; mastectomy patients who did not have reconstruction; and two control groups composed of women who had not had any cancer or who had undergone hysterectomy for uterine cancer. This study was conducted just before the reports of alleged risks of silicone to the patients and reflects the opinions of patients without such bias. This study shows that, although women who opted for reconstruction reported greater concern about appearance than women who did not have reconstruction, both groups described concerns about surgical discomfort and possible complications. Also, women's concerns about appearance did not seem to fall solely into public (others' evaluations) or private (patients' own evaluation) domains. Rather, personal attitudes about appearance may affect interpersonal experiences. Finally, concerns about the possibility of recurrence may reduce patient satisfaction for some women who have reconstruction, so postsurgical education regarding cancer risk may be needed. Reconstructed and nonreconstructed mastectomy patients do not appear to differ in postoperative behaviors promoting personal health. This information, analyzed before the silicone controversy, may serve as a baseline for future research on the impact of the silicone crisis on women's perceptions regarding reconstruction.

Adult↗
PubMed1994

Tetracycline fluorescence incident photometry: a new technique to quantitate bone formation.

We describe a technique for measuring new bone formation by tetracycline fluorescence incident photometry (TFIP) based on the affinity of tetracycline for newly calcified bone. Unlike traditional fluorescent labeling techniques, which measure appositional bone growth, TFIP measures the total amount of newly labeled bone by quantitating the amount of fluorescent light emitted by tetracycline bound to new bone in response to ultraviolet light excitation. TFIP offers a technically simple and accurate technique for quantitative comparison of new bone formation. It may have broad applications in experimental as well as clinical situation.

Animals↗
PubMed1994

The effect of periosteal preservation on osteogenesis in a canine rib autograft model: tetracycline fluorescence incident photometry.

In the first portion of this study, we describe a new technique, tetracycline fluorescence incident photometry (TFIP) for quantifying new bone formation. In this portion, we use routine histology, Microfil vascular injection, and tetracycline incidence fluorescence (TFIP) to determine the effect of periosteal preservation on bone formation in canine rib autografts. We found that periosteal preservation significantly enhanced new bone formation in both cortical and trabecular bone (83-70% of control) when compared with autografts without the periosteum (76-60% of control) (p < 0.05). In addition, periosteal preservation favorably influenced graft revascularization. We found that the periosteum of the transferred rib autografts was made up of 3 distinct layers: (1) the inner (cambial) layer of osteogenic cells, (2) the middle (fibrous) layer of osteogenic reserve cells, and (3) the outer vascular network of arterioles and venules, which communicate with the trabecular vessels internally. This outer vascular network has not been previously described in transferred bone grafts and is responsible for early graft revascularization.

Animals↗