Search PubMed⌕ Search

Biomedical subjects

W J Temple

Publications and source records attributed to W J Temple.

At least 55 records · Page 3Linked to original sources
PubMed1990

Surgical palliation for recurrent rectal cancers ulcerating in the perineum.

This report describes a unique palliative approach of radical surgical debridement for uncontrollable, recurrent pelvic tumors ulcerating through the perineum. All conservative treatment attempts with radiotherapy and chemotherapy had failed. Seven patients have been treated with resection of the tumor including a portion of the sacrum to obtain all but the deep margins clear of tumor. Coverage was obtained with myocutaneous flaps. All patients were significantly relieved of pain, requiring little or no subsequent analgesics. Three patients returned to work and the remainder led a relatively comfortable existence at home until their demise. At the time of death, four patients had no visible perineal disease. When conservative attempts at chemotherapy and radiotherapy have failed in this situation, the authors believe that palliative surgery prolongs both quantity and, more importantly, quality of life.

Adenocarcinoma↗
PubMed1990

Combination regional therapy for extremity sarcoma. A tricenter study.

Patients with extremity sarcomas were treated with a neoadjuvant therapy protocol that had originated within the Southeastern Cancer Study Group. Major objectives were to determine tolerance of therapy and its effects on tumor control and survival. After undergoing biopsy, patients received intra-arterial infusion with doxorubicin hydrochloride (Adriamycin) (30 mg every 24 hours) for 3 days and were allocated by institution to receive irradiation of 30 or 35 Gy in 10 fractions or 46 Gy in 23 to 25 fractions. Surgery was done within 7 to 10 days or 30 days pending irradiation dose. Postoperative chemotherapy was given to 31 patients. There were 60 patients, 29 women and 31 men with a median age of 48 years, with 53 soft-tissue tumors and 7 malignant bone tumors. Stages (American Joint Committee on Cancer) included stage IB, 2 patients; stages IIA and IIB, 9 patients; stage IIIA, IIIB, or IIIC, 39 patients; and stages IVA or IVB, 10 patients. Limb salvage surgery was done in 57 patients, including radical resection in 23 with large extensive tumors, wide local excision in 30, excision with narrow margins in 7, primary amputation in 3, and delayed amputation in 2 because of wound complications. There was one local recurrence in the 57 patients who had limb salvage surgery. Disease-free and overall survival at 48 months were 47% and 56%, respectively. We conclude that combined therapy for extremity sarcomas in a multicenter setting resulted in excellent local control, good function, and reasonable long-term survival in patients having limb salvage surgery.

Adolescent↗
PubMed1989

Ocular melanoma in Alberta: a 38 year review pointing to the importance of tumor size and tumor histology as predictors of survival.

A large number of cases of ocular melanoma have been entered in The Provincial Cancer Registry of Alberta over the past 40 years. This study was undertaken in order to describe further the natural history of this disease and derive management recommendations for use at the provincial level. A retrospective chart review was carried out on all cases of ocular melanoma registered through The Alberta Provincial Cancer Registry between 1949 and 1987. Two hundred fifty-one cases were identified: 143 were males and 108 were females. The mean age of the patients at diagnosis was 60. The majority of the melanomas arose from the choroid of the eye (82%) with the remainder arising from the iris, conjunctiva and ciliary body, respectively. According to the Callender classification for ocular melanomas, the majority of the melanomas were of the spindle cell type (53%), the others being either mixed cell (23%), epithelioid (8%), or fascicular (1%). Survival rates differed depending on the cell type. Spindle cell tumors demonstrated a mean survival time of 5.2 years; epithelioid tumors 4.8 years and the mixed cell tumors appeared to be the most aggressive with a mean survival time of 2.7 years after diagnosis. The majority of deaths from ocular melanoma occurred within 5 years of diagnosis, although 14% of patients in this review presented with metastases more than 10 years after diagnosis. Some of the cases of ocular melanoma could be classified pathologically as small, medium, or large. Patients with large ocular melanomas had a 5 year survival rate of 33% compared to 70% and 66% for patients with small and medium sized tumors. Of note, 43% of patients with large ocular melanomas who were dead from their disease within 5 years of diagnosis were also found to have mixed cell tumors. These findings call for a longer follow-up period for ocular melanomas and point to the importance of cell type and tumor size as predictors of survival and as guides in planning prophylactic therapeutic interventions.

Alberta↗
PubMed1989

Natural history of in situ breast cancer in a defined population.

The entire experience of in situ breast cancer in Alberta from 1953 to 1984 was examined. Of 243 patients coded, 226 were available for review by a panel of three pathologists. In 149 cases the diagnosis of in situ disease was confirmed. One hundred and eight patients had 109 ductal carcinomas in situ, 38 patients had lobular carcinomas in situ, with 3 patients having both. A multitude of treatments was used, ranging from local excision to radical mastectomy. Survival at a mean of 6 years follow-up was equal in all groups, with only two patients with a confirmed diagnosis of ductal carcinoma in situ dying from clinically suspected systemic disease. In patients treated by local excision, ipsilateral cancers were seen in 12% of ductal carcinoma in situ patients who had local excision and 13% of patients with lobular carcinoma in situ. Contralateral metachronous invasive cancers were seen in 6% of ductal carcinoma in situ patients and 3% of lobular carcinoma in situ patients. No lymph node involvement was seen in any of these patients, either with prophylactic dissection or in follow-up. The conclusion reached was that both in situ lesions are similar in their clinical course. Lymph node dissection is not necessary. Pathologic review is critical for accurate studies, with a change in diagnosis of 36% of diagnoses. Treatment does not appear to affect prognosis. The most appropriate treatment needs to be determined in prospective randomized trials.

Adult↗
PubMed1989

Predicting the outcome of exploratory laparotomy in ICU patients with sepsis or organ failure.

Critically ill patients with sepsis and/or organ failure are difficult to assess. They are often comatose or on steroids and many nonspecific findings such as fever, positive blood cultures, or septic shock which may suggest intra-abdominal sepsis are far from diagnostic. To determine whether decision making regarding the use of laparotomy in these patients could be improved upon, we reviewed our experience with consecutive intensive care unit patients who had laparotomy and we related laparotomy outcome to clinical signs and symptoms. Seventy-three per cent of the 100 laparotomies reviewed were positive for intra-abdominal sepsis. A discriminant function analysis revealed that eight factors in combination predicted laparotomy outcome. However, the overall accuracy of the discriminant function prediction (76.8%) offered little improvement over the policy in place for performing laparotomies in this group of patients at the participating hospitals during the time period of our investigation.

Adolescent↗
PubMed1989

A biomechanical study of suture pullout in linea alba.

The relationship of suture bite size, suture diameter, and fascial thickness to strength of wound closure was studied in cadaveric linea alba. All soft tissue was removed from the fascia of 12 abdominal walls that were cut into 346 test sections. A single suture loop was placed in each section, simulating laparotomy closure with interrupted technique. Suture bite size (0.3, 0.6, 0.9, 1.2, 1.5, and 1.8 cm) and gauge (00, 0, 1, and 2) were randomly assigned. The force and energy required to pull out suture loops were measured. Mean linea alba thickness was greater above the linea semicircularis than below (1.19 vs 0.77 mm; p less than 0.001). Similarly, mean pullout force was greater above the linea semicircularis (58.2 vs 31.6 N; p less than 0.001). Regression analysis found that fascial thickness and bite size accounted for 68% of observed variability in pullout force. Suture diameter was unrelated to pullout force. Optimum security was obtained with bites of at least 1.2 to 1.5 cm.

Abdominal Muscles↗
PubMed1989

Neoadjuvant treatment in conservative surgery of peripheral sarcomas.

Twenty-five patients with soft-tissue and bony sarcomas of the head and neck and limbs were treated by local neoadjuvant therapy. It consisted of 90 mg of Adriamycin infused intra-arterially over 3 days into a vessel feeding the involved area and 30 Gy of radiotherapy given over 10 days; this was followed by a complete resection of the sarcoma 4 to 6 weeks later. All the tumors were associated with a high risk of local recurrence; eight were locally recurrent and the remainder were stage II to stage IV tumours. Serious local complications were seen in 4% of the patients. This rate compares well with other higher dose neoadjuvant regimens (35 Gy over 10 days), which are associated with a 35% local complication rate. Follow-up at a mean of 30 months demonstrated no local recurrence. All limbs were spared. Long-term morbidity was negligible. No effect on systemic control is suggested; only 63% of the patients were free of systemic disease. This report substantiates other similar experiences supporting neoadjuvant therapy followed by resection as the treatment of choice for local control of sarcomas.

Bone Neoplasms↗
PubMed1988

Guidelines for the surgical management of soft-tissue sarcoma. Report of the Canadian Sarcoma Group.

The Canadian Sarcoma Group was formed in 1985 by interested surgeons, oncologists and pathologists. In the evaluation of new protocols, standard surgical guidelines have been developed which incorporate the concepts of multimodality therapy, particularly radiotherapy and chemotherapy. Also defined are the procedures performed: biopsy, marginal resection, wide local excision, radical resection and the principles to be considered when doing a diagnostic biopsy and a curative resection, particularly with limb salvage in mind. To optimize local control of the disease, centres treating sarcomas should have access to computed tomography, radionuclide scanning, to radiation and medical oncologists, and members of other surgical specialties. This team approach increases survival by 10% and also provides the best circumstances in which to study adjuvant therapy. Surgical guidelines are also essential in order to compare the results of different clinical trials.

Biopsy↗
PubMed1988

Punch biopsy for diagnosis of pigmented skin lesions.

Melanoma is a potentially fatal cancer with a relatively high incidence, but it can be cured if the lesions are removed at an early stage. Punch biopsy is a cosmetically acceptable, rapid method for removing small pigmented lesions to allow definitive pathologic diagnosis. The technique, which usually requires only a small amount of local anesthetic and no sutures, can be performed by a busy physician at the time the suspicious lesion is discovered.

Biopsy↗
PubMed1986

Cervical thymoma.

A 45-year-old woman presented with a five-year history of neck swelling and occasional difficulty in swallowing. The clinical impression was of a thyroid nodule, and fine-needle aspiration biopsy cytology revealed a monotonous lymphoid population, raising the suspicion of Hashimoto's thyroiditis. At surgery, the mass was identified at the level of the cricoid cartilage, displacing the right lobe of the thyroid gland superiorly and extending posteriorly to the prevertebral fascia. Although a frozen-section diagnosis of malignant lymphoma had been suggested at the time of surgery, permanent sections favored a diagnosis of thymoma. Surface marker studies showed the majority of cells to be of thymic T-cell phenotype, and ultrastructural examination demonstrated a dual population of lymphoid and epithelial cells, thus confirming the presence of thymoma. Cervical thymomas are extremely rare and this case report illustrates the difficulties in diagnosis; we speculate that cervical thymoma may be an underdiagnosed entity.

Female↗
PubMed1985

Preservation of the intercostobrachial nerve during axillary dissection for breast cancer.

Preservation of the intercostobrachial nerve during axillary dissection in 50 patients with stage I breast cancer resulted in a significant improvement in sensory function compared with the standard dissection in which the nerve is routinely sacrificed. No local recurrence was found during the 3 to 5 year follow-up period. This modification is worthwhile in patients with axillas that are clinically negative for cancer.

Afferent Pathways↗
PubMed1985

Surgical management of the patient at high risk for breast cancer.

The most controversial aspect of breast disease centres around the management of patients who have either a strong family history of breast cancer or a biopsy diagnosis of lobular carcinoma in situ or ductal carcinoma in situ. The current alternatives for patients who have two or more relatives with breast cancer consist of close follow-up or prophylactic total mastectomies and reconstruction. Invasive breast cancer in patients with lobular carcinoma in situ may occur in either breast and may be as high as 30% at 20 to 30 years. In these women it is reasonable to do a wide excision of the lobular carcinoma; in those without a family history, close follow-up is adequate. Intraductal cancer treated by biopsy only is associated with a 40% risk of cancer in the ipsilateral breast. Therefore, the usual management is total mastectomy. However, the information to support this therapy over a segmental resection has limited scientific validity. Because the cosmetic appearance after total mastectomy and reconstruction is not as good as that of the normal breast, this procedure must be employed cautiously and only with the total support of the patient and her husband or close family. Subcutaneous mastectomy for prophylaxis leaves behind macroscopic glandular tissue and, therefore, is not considered by many to be optimal management. A total mastectomy, preserving the skin and resecting all macroscopic breast tissue and nipple, is the treatment of choice if the procedure is deemed appropriate.

Adult↗
PubMed1984

Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease.

The treatment of a patient for multiple recurrent pilonidal disease failed all forms of conventional therapy. After re-excision, a gluteus maximus myocutaneous flap, measuring 15 X 15 cm and based on the superior gluteal artery, was swung to cover the defect. Complete relief from severe pain was obtained immediately. No recurrence is noted after two and one-half years of follow-up.

Adult↗
PubMed1984

The effects of syngeneic soluble tumor membrane extract on concomitant spleen cell immunity and spontaneous metastases.

The effects of a soluble tumor KCl extract, containing membrane antigen on spontaneous metastases and spleen cell immunity were studied in a syngeneic C57BL/6J murine sarcoma model. The extract was shown to be antigenically distinct from normal tissue by tumor immunization rejection experiments. Tumor soluble extract (SE) was administered daily during the growth of a murine sarcoma. The afferent and efferent arc of immunity were monitored by proliferative index (PI) and in vitro cytotoxicity of spleen cells, as well as the incidence of metastases. PI was significantly activated in the group receiving sarcoma SE as compared to the two control groups receiving muscle SE or saline P less than 0.05. However, in vitro cytotoxicity was significantly depressed on Days 7 and 14 (P less than 0.05) of tumor growth in the mice receiving sarcoma SE. The incidence of metastases was significantly increased to 70% in the sarcoma SE group as compared to the incidence in the control groups of 50% P less than 0.05. This data supports the hypothesis that release of soluble antigen membrane components by growing tumor facilitates the growth of metastases in this model.

Animals↗