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Biomedical subjects

T W Shields

Publications and source records attributed to T W Shields.

At least 55 records · Page 3Linked to original sources
PubMed1979

Pseudosarcoma of the esophagus. Three new cases and review of the literature.

Three newly found patients with an esophageal pseudosarcoma are described. The features of this unusual polypoid tumor are reviewed based on these three patients and 21 additional reported patients. The origin of the sarcomatous element as a metaplastic reaction to the underlying carcinoma is discussed. The exuberant growth may present with obstructive symptoms earlier than the usual carcinoma of the esophagus, permitting curative surgical resection in some patients.

Aged↗
PubMed1977

Carcinoma obstructing the left side of the colon.

The clinical course, operative treatment, and results of 129 patients with carcinoma obstructing the left side of the colon were reviewed. There were 64 cases of incomplete obstruction, all secondary to primary adenocarcinoma of the colon. Sixty-five patients had complete obstruction; 37 of these had primary adenocarcinoma of the colon, and the rest, cancer from other primary sites, largely the genitourinary tract. The operations involving colostomy only or colostomy as part of a staged resection resulted in high operative mortality and low long-term survival, in addition to a high rate of postoperative sepsis. Results of operations involving primary resection of obstructing tumor were superior in all the above factors studied.

Adenocarcinoma↗
PubMed1977

Adjuvant cancer chemotherapy after resection of carcinoma of the lung.

A prospective randomized trial was conducted by the Veterans Administration Surgical Adjuvant Group in an attempt to discern the value of prolonged intermittent courses of adjuvant cancer chemotherapy after a successful curative resection of a carcinoma of the lung in men. Four hundred and seventeen patients were randomized into three groups; 132 patients received cyclophosphamide (Cytoxan), regimen A; 142 patients received cyclophosphamide alternating with methotrexate, regimen b; and 143 patients received no additional therapy, the controls. The patients in the two treatment groups received an average of 7.1 drug courses. No drug mortality was noted, but toxic symptoms of varying severity were seen after 43.6% of the drug courses. Five-year survival in the two treatment groups was 24.9% (regiment A) and 25.7% (regimen B), respectively, and 23.5% in the control group. No treatment benefit was associated with adjuvant chemotherapy in this trial.

Adult↗
PubMed1977

Postresection stage grouping in carcinoma of the lung.

The postsurgical treatment classification and staging system for carcinoma of the lung has been evaluated in a series of 403 patients admitted to a completed prospective randomized adjuvant cancer chemotherapy trial conducted by the Veterans Administration Surgical Adjuvant Group. The proposed T, N and M classification suggested by the American Joint Committee for Cancer Staging and End Results Reporting is supported. However, the stage groupings as suggested by the Committee fails to separate adequately the various prognostic groups. This appears to be better accomplished by the stage grouping modification suggested by the Radiation Therapy Oncology Group. In the latter schema, the five year survival rate of patients with postsurgical treatment Stage I disease is 40.9 per cent; Stage II, 26.2 per cent, and Stage III, 10.5 per cent. In the Joint Committee classification, these survival rates are 30.8 per cent, 25.5 per cent and 10.5 per cent, respectively. In addition, 18 patients with undifferentiated small cell carcinoma were also evaluated. The long term survival of three of sixe patients with small peripheral lesions without metastatic lymph node involvement supports the opinion that resection of these specific lesions continues to be the treatment of choice.

Adenocarcinoma↗
PubMed1976

The incidence of solitary pulmonary metastasis from carcinoma of the large intestine.

Two hundred and two consecutive patients who underwent resection of an adenocarcinoma of the colon or rectum from January 1958 to December 1972 were evaluated for the development of a metastatic tumor in the lungs. In the 185 patients who survived the 30 day postoperative period, 30 malignant pulmonary lesions were subsequently recognized. Six of these were a solitary lesion and 24 were multiple lesions. Three of these malignant lesions were proved to be other than metastatic disease. Metastatic adenocarcinoma from the colon or rectum was proved to be present in 27 patients, an incidence of 14.5 per cent. Only four of these lesions were solitary, 14.8 per cent of the metastatic pulmonary lesions. The solitary metastatic tumors represented an incidence of 2.1 per cent in this patient population, but long term tumor-free survival was possible with appropriate pulmonary resection of the metastatic disease. It is suggested that periodic roentgenographic examination of the chest, every four to six months, be an integral part of the postoperative follow-up study carried out on these patients.

Adenocarcinoma↗
PubMed1975

The solitary pulmonary nodule. Ten-year follow-up of veterans administration-armed forces cooperative study.

Over a five-year span 1,134 patients with asymptomatic solitary pulmonary nodules were entered into a cooperative study. Of the 392 lesions found to be primary bronchogenic carcinoma, 67 patients were living and under observation ten years following operation. In the study, 32% of lesions were primary bronchogenic carcinoma, the incidence being 51% in patients above the age of 50 years. "Curative" resection was possible in 309 patients (78.9%) with a five-year observed survival of 38.5% and a ten-year observed survival of 20.1%. Factors that influenced long-term survival were size of lesion, age at operation, and interval between the last normal and the first abnormal x-ray film. Histologic cell type and extent of resection were not found to influence long-term survival.

Age Factors↗
PubMed1975

Relationship of cell type and lymph node metastasis to survival after resection of bronchial carcinoma.

In the completed adjuvant chemotherapy lung trials conducted by the Veterans Administration Surgical Group, the cell type was recorded in 2,341 of 2,349 curative resections; extent of lymph node involvement was known in all cases. Nodes were normal in 1,231 patients. Five- and ten-year survival computed by the life-table method was 33.7% and 20.4%, respectively. These rates were significantly greater than the 16.2% and 8.8% recorded in 1,118 patients whose nodes showed metastases. Among patients whose cell type was known, five-year survival in 484 with hilar node involvement was 17.4% and was not significantly different from 20.1% in 364 patients in whom only lobar nodes were involved. The survival was 8.9% in 268 patients with cancer in the mediastinal nodes; this was significantly worse than either of the aforementioned groups. A five-year survival of 26.8% in 1,482 patients with squamous cell carcinoma was greater than the 24.3% in 359 with adenocarcinoma and 22.4% in 500 with undifferentiated cell types, but the differences were not significant. Variations between these groups remained nonsignificant when nodes were normal and were of only borderline significance, at the 5% level, when they showed metastasis. When a curative resection has been accomplished, cell-type as classified in this study has little bearing on long-term survival, whereas the presence of node metastasis as well as its location is of the utmost importance.

Adenocarcinoma↗