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Biomedical subjects

T G Frazier

Publications and source records attributed to T G Frazier.

At least 19 recordsLinked to original sources
PubMed1990

Motivational factors for participation in breast cancer screening.

To evaluate motivational factors for participation in a breast cancer screening program and concurrently to examine beliefs regarding carcinoma of the breast held by those participants, we interviewed 135 consecutive women who took part in an American Cancer Society-sponsored breast screening project in an affluent suburb of Philadelphia. Ages were equally distributed between 30 and 69. Interestingly, cost was the greatest priority for patients, regardless of income. Even 50% of those patients reporting incomes in excess of $100,000 were concerned about cost. Additional motivating factors included reassurance if normal, media advertising, physician referral, and family history of breast cancer. Concerns about actually having breast cancer was least important. Additional questions indicated a number of fallacies regarding breast cancer, including relationships to smoking, caffeine, and trauma. We conclude that even in affluent, upper-middle-class populations, problems with education regarding breast cancer exist, and cost remains a primary deterrent to screening. Efforts must be increased to lower the cost of mammography and, at the same time, to improve patient education, perhaps through the appropriate use of the media.

Adult↗
PubMed1989

Implications of accurate pathologic margins in the treatment of primary breast cancer.

Eighty-seven patients who underwent mastectomy or reexcision following a previous segmental resection with pathologic margins evaluated at that time were restudied following their definitive therapy. Of these, 40 (46.0%) had involved margins, 28 (32.2%) had close margins, and 19 (21.8%) had clear margins. Residual tumor was subsequently found in 21 (52.5%) of 40, nine (32.1%) of 28, and five (26.3%) of 19, respectively. Analysis of specimens for quadrant of residual tumor showed 27 (31.0%) of 87 patients in the same quadrant, and 11 (14.7%) of 75 present in a different quadrant. The assessment of microscopic margins may be misleading since 29.8% (14/47) of patients with clear or close margins subsequently had residual tumor, and 47.5% (19/40) of those with involved margins had no residual tumor found. Further studies are essential to define the optimum guidelines for tumor excision at the time of segmental resection.

Adult↗
PubMed1987

Mass screening for colorectal cancer--the Philadelphia experience.

On May 18, 1985, the Philadelphia Division of the American Cancer Society and WCAU-TV entered into a jointly-sponsored colorectal health day to do mass screening throughout the greater Philadelphia area. This was preceded by a week-long series of television awareness programs, and an organization based on having individual hospital coordinators for those hospitals participating. A total of 46 hospitals in Pennsylvania alone participated in this project, and over 16,000 people were screened in a single day. 410 patients had positive stools for occult blood on site, and 359 were positive on take-home 3-packs. Rectal pathology was diagnosed initially in 502 patients. 13 colorectal cancers and 38 polyps have been diagnosed directly as a result of this screen. Total cost to the Cancer Society was $13,300, meaning each diagnosed cancer cost $1,023 and each cancer or polyp cost $266 in actual funds expended for the screen. This overwhelming response by the public to such a mass screening effort indicates the potential for such programs for colorectal cancer, and the techniques employed in planning, implementing, and following up on data retrieval are discussed. This mass screening effort should serve as a model for future projects, and emphasize the importance not only of interrelationships with the media, but also liaison efforts with a network of area hospitals and individual hospital coordinators.

Colorectal Neoplasms↗
PubMed1985

An objective analysis of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast.

In January 1977, the authors developed a protocol to test the advisability and feasibility of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast. Initial concerns included the morbidity of the procedure, the potential for compromise of cure and of adjuvant cancer therapy, and the aesthetic acceptability of immediate reconstruction both to the patient and to the surgeon. All patients were seen preoperatively by both the oncologic surgeon (T.G.F.) and the plastic and reconstructive surgeon, (R.B.N.), and underwent modified radical mastectomy and simultaneous reconstruction. The initial protocol included only those patients with tumors 1 cm or smaller, but over the last 25 cases the protocol has been expanded to include any patient presenting with clinical Stage I carcinoma of the breast. To date, 70 such patients (ages 27-63 years) have undergone immediate simultaneous reconstruction as part of their treatment. Twenty-five patients had evidence of microscopic nodal disease (35.7%). All patients were offered adjuvant therapy, and in no case was therapy delayed beyond 4 weeks postoperatively. Three patients developed complications resulting in loss of implant (4.3%). All patients have been followed at regular intervals, and no patient has been lost to follow-up. In only one patient was there a local recurrence without distant disease. Survival curves are consistent with the stage of the disease. The surgical techniques utilized and the methods of patient selection are discussed. The authors conclude that this is a desirable and viable option in selected patients with primary breast cancer, and that immediate simultaneous reconstruction can be done with an acceptable morbidity and without compromise of cancer therapy.

Adult↗
PubMed1985

A reevaluation of bone scans in breast cancer.

A retrospective analysis of 151 patients with breast cancer over 2 years was performed to assess laboratory values as predictors of metastatic disease demonstrated by technetium-99 bone scan. In 105 patients with normal alkaline phosphatase (AP) and lactate dehydrogenase (LDH) values, only one positive bone scan (0.95%) was obtained. If either the AP or LDH value was abnormal, 15 of 29 scans (51.7%) were positive. If both values were abnormal, six of nine patients (66.7%) had positive bone scans. Of 41 patients with either an elevated AP or LDH, 26 (63.4%) were shown to have metastatic breast disease. In our subgroup of 120 consecutive admissions for primary evaluation and treatment of breast cancer, the 95 patients with normal AP and LDH values had 41 negative bone scans and no evidence of distant metastases in any patient. According to these results, we recommend that breast cancer metastatic screening be done by alkaline phosphatase and LDH determinations, and that isotope scans should be reserved for those patients having normal values or symptoms that suggest metastases.

Aged↗
PubMed1985

The selected use of ultrasound mammography to improve diagnostic accuracy in carcinoma of the breast.

Our initial experience with diagnostic ultrasound mammography (UM) showed it to be of high diagnostic accuracy and improved specificity when compared with x-ray mammography (XRM) in certain categories of patients. To evaluate this modality further, we reviewed our experience with 600 consecutive patients who underwent ultrasound mammography as part of their initial evaluation for breast disease. Five categories of patients were reviewed: I: age 35 or less--129; II: DY or P-2 pattern on XRM--174; III: negative XRM but symptoms requiring additional evaluation--81; IV: high risk remaining breast in patients previously having mastectomy--48; V: refusal of repeat XRM because of pregnancy, lactation, or fear of radiation exposure--168. Fifty-five solid lesions were diagnosed, including 36 carcinomas. Seventeen of these were not diagnosed on x-ray mammography, giving an improved pick-up of carcinoma in this overall group of 2.83%. Of particular interest was that, of the 27 carcinomas that were found in the group having XRM, 8 or 29.6% were missed on that modality alone. Five of these (62.5%) were patients having a DY pattern. All patients have been followed carefully and re-examined at 3-month intervals, with no evidence of a false negative examination. Overall, we feel diagnostic ultrasound mammography is a valuable adjunct to x-ray mammography and recommend its continued use in selected groups of patients where it has a superior diagnostic accuracy over x-ray mammography alone.

Adolescent↗
PubMed1985

A simplified technique for a totally diverting transverse loop colostomy and distal irrigation.

This technique of totally diverting loop colostomy may be performed as an independent procedure or with exploratory laparotomy and surgical treatment on the distal part of the colon. Either a transverse or sigmoid loop colostomy can be used for diversion without the risk of fecal contamination of the peritoneal cavity, particularly when working with unprepared intestine. When distal irrigation is desired to purge the intestine of fecal material, either intraoperatively or as part of a subsequent intestinal preparation, it can easily be accomplished by placing an irrigating catheter distal to the staple line. In addition, the use of a small rubber suspension bar facilitates application of standard colostomy appliances for the stoma.

Colostomy↗
PubMed1983

Immediate reconstruction in the treatment of primary carcinoma of the breast.

Forty-five consecutive patients who underwent immediate reconstruction at the time of a modified radical mastectomy are presented. Results and complications are discussed, and the follow-up rate has been 100 per cent. Our data show that, from both the carcinoma and reconstructive standpoints, the major concerns appear to be minimal with this approach, and that it is, in fact, a most viable option in patients who have early stage carcinoma of the breast. We continue to offer this option to selected patients and believe it is, indeed, a rational alternative for the treatment of primary carcinoma of the breast.

Adult↗
PubMed1980

Hypomagnesemia: higher risk using total parenteral nutrition in the treatment of patients with malignancies.

The syndrome of hypomagnesemia in patients receiving total parenteral nutrition (TPN) is well known. To determine particular high-risk groups for the development of this syndrome, 26 consecutive patients on TPN were initially evaluated for serum magnesium (Mg) and followed at regular intervals. Seventeen had a diagnosis of solid tumor or hematologic malignancy (CA); nine had inflammatory bowel disease and/or small bowel fistulae (ID). All met the standard criteria for being malnourished--anergy, low serum albumin, and recent weight loss. During TPN, all patients received an average of 24 mEq of magnesium sulfate per day, and all had satisfactory anabolic response in terms of weight gain and increase in serum albumin. Ten patients had at least one magnesium determination below the lower limits of normal, and four of these developed symptoms of tremor which responded to increased amounts of magnesium in their TPN. Eight of these ten (80%) had a diagnosis of CA, and four of four (100%) of those requiring additional magnesium to alleviate symptoms had CA. None of the patients with ID developed symptomatic hypomagnesemia. We conclude that patients with solid tumor malignancy are more likely to develop hypomagnesemia, possibly because of the increased requirements for magnesium in lymphocytolysis of tumor cells., and they must be carefully monitored to prevent this complication.

Adolescent↗
PubMed1979

Comparative value of aspiration cytology in the diagnostic evaluation of breast masses.

For 38 consecutive patients presenting with breast masses we compared accuracy of diagnosis, before biopsy, of the techniques of clinical examination, bilateral xeromammography, and aspiration cytology with a 10-cc syringe and a 22-gauge needle. Of the 38 patients, nine had carcinoma and 29 had benign breast disease. The overall diagnostic accuracy showed a perfect correlation between aspiration cytology and subsequent biopsy for carcinoma in this group. Clinical impression made the correct diagnosis in 89.5% of the cases and bilateral xeromammography produced the correct diagnosis in 84.9%. Both clinical impression and mammography were incorrect in diagnosing 33.3% of the malignancies. The technique of cytologic aspiration is a simple, accurate, and effective adjunct to the early diagnosis and treatment of carcinoma of the breast, and this should become a part of the initial evaluation of the patient who presents with a breast mass.

Adult↗
PubMed1978

Torsion of normal uterine adnexa in childhood: case report.

A case of torsion of a normal right ovary and tube in an 8-year-old child is presented. True infarction of the adnexa can be prevented only by considering this diagnosis early in the course of right lower quadrant pain. It is recommended that a routine exploration of the pelvis be carried out in any patient explored for acute appendicitis in whom that diagnosis cannot be made at the operating table.

Adnexal Diseases↗
PubMed1977

Intravenous hyperalimentation as an adjunct to colon interposition for carcinoma of the esophagus.

Ten consecutive malnourished patients with undifferentiated squamous cell carcinoma of the esophagus underwent operation for colon interposition. They received intravenous hyperalimentation preoperatively and/or postoperatively for an average time of 21.5 days and had an average weight gain of 6.5 lb. There was no significant gastrointestinal morbidity, but one patient succumbed to aspiration pneumonia. All ten patients had postoperative gastrografin swallow radiography which showed no leaks in either anastomosis. With proper use of intravenous hyperalimentation, morbidity and mortality following colon interposition in the malnourished patient for either palliative or curative bypass can be decreased to acceptable levels.

Aged↗
PubMed1977

Prognosis and treatment in minimal breast cancer.

Of 176 patients with minimal breast cancer, 138 had intraductal carcinoma in situ, 21 minimally invasive carcinoma, and 17 lobular carcinoma in situ. Various modalities of treatment were used including radical, modified radical, and simple mastectomy with and without radiation therapy. Long-term postoperative follow-up was available in all but five patients and ranged from one year to twenty-one years. Actuarial analysis projected a twenty year survival of 93.2 per cent for the entire group. Analysis of survival figures based on each of the several treatment modalities showed no definite advantage of one form of treatment over another. The data suggest that minimal breast cancer is a prognostically favorable diagnosis, provided invasive carcinoma is not present or does not develop in the opposite breast. It is also indicated that breast cancer is potentially a bilateral disease and that follow-up and treatment of the opposite breast must be of major concern in the care of these patients.

Adult↗
PubMed1975

Trans-thoracic venous bullet embolism.

Bullet emboli from peripheral wounds occur with sufficient frequency that they must be considered in every case of missile injury not accompanied by an exit wound. A case is presented which demonstrated a venous migration of such a bullet from the axillary vein into the femoral vein through the heart, presumably by gravity.

Adult↗