Biomedical subjects
Publications and source records attributed to V Velanovich.
Mice with intravesical urothelial tumors (MBT-2) were challenged with E coli inoculated intravesically. Adherence of bacteria measured at 15 min or persistent infection at 24 h was significantly greater in the tumor-bearing bladders than in normal non-tumor-bearing mice. The tumor-bearing portion of the bladder contained significantly more bacteria than the non-tumor-bearing portion.
BACKGROUND: The purpose of this study was to determine whether routine biologic tumor markers can predict lymph node status. The authors attempted to discover whether predictors of axillary lymph node metastasis based on biologic characteristic of primary breast cancers exist. METHODS: Eight hundred and fifty-one patients with invasive breast cancer who underwent surgical treatment, including axillary lymph node dissection, at a tertiary referral center were studied. Univariate and multivariate analysis were performed on prospectively gathered data from a breast cancer registry, including pathology, site of primary lesion in the breast, estrogen and progesterone receptor status, DNA index, S-phase fraction, nuclear grade, and extensive intraductal component. Outcome was determined by (1) the presence of any lymph node metastasis and (2) the presence of 10 or more lymph node metastases. RESULTS: The only independent predictors of lymph node metastasis were primary tumor size and pathology. For predicting 10 or more metastases, only size and ER-negative status were independent predictors. These factors accounted for less than 20% of the regression, implying that more than 80% of lymph node metastases are not explained by the regression model. Lymph node metastases were seen in 8.3% of T1a, 15.3% of T1b, and 30.7% of T1c lesions. CONCLUSIONS: Biologic tumor markers are not reliable predictors of lymph node metastasis, except possibly for T1a lesions, therefore direct pathologic evaluation of lymph node status cannot be abandoned. Efforts to determine lymph node status through other methods such as sentinel lymph node biopsy are warranted.
Staging laparoscopy avoids unnecessary laparotomies in patients with unresectable intra-abdominal malignancies. However, the postoperative oncologic treatment of these patients has not been documented. This study compares rates and timing of postoperative chemotherapy (ChT) and/or radiation therapy (XRT) in patients with unresectable intra-abdominal malignancies initially evaluated by staging laparoscopy (SL) or exploratory laparotomy (EL). The records of patients surgically evaluated for esophageal, gastric, hepatobiliary, and pancreatic cancers or abdominal lymphoma were retrospectively reviewed. Data gathered included type of exploration (SL or EL), resectability, whether postoperative cancer treatment was given (ChT, XRT, or both), and the time from surgery to the beginning of such treatment. This study includes only patients with unresectable malignancies. Twenty-one patients underwent SL and 58 EL. Sixteen of the SL patients (76%) and 25 of the EL patients (43%) received postoperative cancer treatment (P = 0.009). The median number of days from surgery to postoperative cancer treatment was 13 days (range 5 to 41 days) for the SL group and 35 days (range 16 to 89 days) for the EL group (P = 0.0004). We conclude that patients with unresectable intra-abdominal malignancies discovered by SL are more likely to receive postoperative ChT and/or XRT than patients surgically evaluated by EL. Further studies to determine whether this better utilization of postoperative treatment results in better outcomes in these patients are needed.
The Gastroesophageal Reflux Disease-Health-Related Quality-Of-Life (GERD-HRQL) scale was developed to objectively quantify symptom severity. It was compared to a "gold standard" health survey, the SF-36. Forty-three patients treated either medically or surgically for gastroesophageal reflux disease were asked to complete both the GERD-HRQL and the SF-36. They were asked the following: (1) Which questionnaire do you like best? (2) Which questionnaire was easier to understand? (3) Which questionnaire was more reflective of the problems you have with reflux disease? (4) Given the choice, which questionnaire would you rather fill out? Patients were asked to state their overall satisfaction with their present reflux symptom conditions. Multivariate analysis showed that the only significant predictor of patient satisfaction was the total GERD-HRQL score (P <0.00001). There were differences in the SF-36 domains of physical function (88.7 vs. 65.3; P = 0.004) and general health (68 vs. 46.5; P = 0.006). There were no correlations between the total GERD-HRQL scores and the SF-36 domain scores. Fifty-nine percent of patients preferred the GERD-HRQL questionnaire, 62% felt it was easier to understand, 86% felt it was more reflective of their symptoms, and 67% said they would rather use it over the SF-36. The GERD-HRQL better assesses symptom severity for gastroesophageal reflux disease than the generic SF-36
A controversy exists with regard to the relative efficacy of two preparations of silver sulfadiazine (AgSD), Silvadene and Flint's Silver Sulfadiazine Cream. We compared the susceptibility of Staphylococcus aureus and clinical Gram-positive cocci, Gram-negative rods, and mixed floral isolates by the Nathan's agar well diffusion method and found no differences. However, when S aureus-infected rat burn wounds were treated with these antimicrobial creams over a period of ten days, Silvadene significantly lowered bacterial counts, whereas results after treatment with Flint's Silver Sulfadiazine Cream were no different from those of the control group, which received no treatment. These data imply that Silvadene controls S aureus-generated burn wound infections better than the Flint product.
Successful closure of thermal injuries, by either skin graft or delayed wound closure, largely depends on the ability to control the number of bacteria in the wound. The purpose of this study was to investigate the efficacy of two new antimicrobial agents, ticarcillin and clavulanate (Timentin) and amoxicillin and clavulanate (Augmentin), in the infected thermal injury. The therapeutic results were compared with the model treated with the standard topical silver sulfadiazine (Silvadene). Seventy-six Sprague-Dawley rats received a 20% full-thickness thermal injury and were then divided into six treatment groups. Three of the groups were inoculated topically with 10(8) Pseudomonas aeruginosa/ml, and three of the groups received topical inoculation of 10(8) Staphylococcus aureus/ml. The groups inoculated with P. aeruginosa received either intraperitoneal Timentin, topical Silvadene, or placebo treatment. The groups inoculated with S. aureus were treated with either enteral Augmentin, topical Silvadene, or placebo. The animals received 10 days of therapy and underwent tissue biopsies on alternate days. Statistical analysis showed that the level of bacteria in the wounds compared with the control group was significantly (p less than 0.05) decreased for both antibiotics tested as measured by quantitative wound biopsies. These studies demonstrate the efficacy of systemic Timentin and Augmentin in the infected thermal injury.
BACKGROUND: Achalasia is a relatively rare disorder with a variety of treatment options. Although laparoscopic Heller myotomy has become the surgical treatment of choice, little data exist on the overall quality of life of patients undergoing this technique versus standard open approaches. METHODS: We prospectively evaluated all patients surgically treated for achalasia by a single surgeon. Laparoscopic Heller myotomy consisted of a long (> or = 6 cm) esophageal cardiomyotomy extending at least 2 cm onto the gastric cardia, with a concomitant Dor fundoplication. Patients were evaluated preoperatively and postoperatively for symptoms and quality of life using the SF-36, a standardized, generic quality of life instrument. RESULTS: A total of 23 patients were surgically treated: 15 patients had a planned laparoscopic procedure, with 3 conversions; 8 had planned open procedures. Dysphagia resolved in 20 of 21 patients, with 1 patient in the laparoscopic group requiring reoperation due to an inadequate gastric myotomy. Compared with preoperative scores, a statistically significant improvement occurred in the general health domain of the SF-36 (70 to 82, P = 0.04). Compared with that in patients undergoing open surgery, the laparoscopic group had better scores in the domains of physical functioning and bodily pain. CONCLUSIONS: Laparoscopic Heller myotomy has comparable success to open Heller myotomy, and causes less early detriment to quality of life. This should be the primary treatment in all fit surgical patients with achalasia.
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