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Biomedical subjects

W L Donegan

Publications and source records attributed to W L Donegan.

At least 37 records · Page 2Linked to original sources
PubMed1987

Screening for recurrent breast cancer--its effectiveness and prognostic value.

Performance of periodic follow-up examinations after mastectomy for breast cancer is standard practice, primarily for early detection and treatment of recurrence. This study was designed to determine whether this routine screening resulted in significant survival benefit for the patient. The medical records of 1,230 women treated for cure of invasive carcinoma of the breast were reviewed, and 248 cases of recurrence were identified for analysis. Only 36% of recurrences were discovered asymptomatically. Asymptomatic recurrence was associated with favorable biologic factors, ie, more frequent estrogen receptor (ER) positivity and initial node negative status, and survival was superior to that of others. This was particularly true for occult local recurrence. However, compliance with a present schedule of examinations did not confer superior survival. It was concluded that (1) routine screening after mastectomy detects few recurrences that are not already symptomatic, and (2) the superior survival associated with discovery of occult recurrence may result from the influences of lead time and length bias.

Breast Neoplasms↗
PubMed1987

Surgical prophylaxis against large bowel tumors in an animal model.

Subtotal removal of high-risk organs is of uncertain value as cancer prophylaxis. This study examined to what extent partial colectomy prevented carcinogen-induced large bowel tumors. Male Fischer 344 rats (N = 98) were given five weekly subcutaneous injections of azoxymethane 7 mg/kg, then treated as follows: group I (controls), the ileocecal junction was divided and reanastomosed without resection; group II, a proximal 1/3 colon resection was performed; and group III, a proximal 2/3 colon resection was performed. After 7 months the rats were sacrificed and colorectal tumors confirmed histologically. Sixty-nine animals survived for analysis. Tumor incidence and average number of tumors per rat were not significantly changed by resection. Surgical prophylaxis was compromised by a high frequency of multiple tumors and by a higher than expected frequency of tumors in the remaining bowel.

Animals↗
PubMed1987

Postmastectomy seromas and wound drainage.

Wound seromas and lymphedema are continuing problems after mastectomy for carcinoma of the breast. This study was done to determine whether or not the volume of postoperative wound drainage was related to the frequency of seromas and lymphedema of the arm. The daily wound drainage and the total hospital drainage (THD) were recorded for 49 consecutive patients who had undergone a mastectomy and the results were correlated with the frequency of seromas and lymphedema. All of the patients had modified mastectomies and no irradiation. All had closed suction drainage and none had flap necrosis or infection. Suction catheters were discontinued three to 15 days after operation at the discretion of the surgeon. THD varied from 227 to 3,607 milliliters and did not correlate with body weight. Twenty-six patients had wound seromas develop requiring drainage for up to seven months, most often with repeated aspirations, but in four instances ultimately with open drainage. THD and 24 hour drainage immediately prior to discontinuing suction catheters correlated directly with the frequency of seroma formation. No patient with less than 20 centimeters of drainage in the 24 hours prior to catheter removal had a seroma. Ipsilateral edema of the arm (more than 3 centimeters difference in circumference) developed in five patients. THD was directly correlated with the frequency of edema of the arm. No patient with less than 500 milliliters of THD had edema develop whereas the frequency rate was 75 per cent with THD of more than 900 milliliters. It was concluded that THD likely reflects the magnitude of lymphatic interruption after mastectomy and, consequently, the likelihood of lymphatic insufficiency and lymphedema. Minimal wound drainage of 24 hours before discontinuing closed drainage catheters minimized seroma formation.

Arm↗
PubMed1986

Establishment of a clinical teaching associates breast examination program for medical students.

A program was designed to instruct medical students on how to obtain a history pertinent to breast abnormalities and to perform a breast examination. The use of clinical teaching associates provides direct student instruction and critiques during the examination. In addition, students are taught how to instruct patients in the breast self-examination and to properly document breast abnormalities. Such a program should be considered for incorporation in all physical diagnosis courses as well as in residency training programs and seminars for practicing physicians.

Breast↗
PubMed1985

National survey of patterns of care for Hodgkin's disease.

Patterns of care for Hodgkin's disease were surveyed through voluntary audits of hospitals with cancer programs approved by the Cancer Commission of the American College of Surgeons. Four hundred seventy-three hospitals reported 6314 patients in the long-term survey (patients diagnosed immediately preceding December 31, 1975), and 611 hospitals identified 3168 new patients in the short-term study (patients diagnosed immediately following January 1, 1981). The latter represent 45% of the estimated annual incidence in the United States. Comparison of the two studies showed changes in the procedures employed in staging, including an increased use of lung and abdominal computed tomography and bilateral bone marrow biopsies. Use of upper mantle plus periaortic node radiotherapy increased, whereas the inverted-Y field decreased. The use of single-agent chemotherapy decreased, and MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) chemotherapy increased. The survival rates varied with age, being better at younger ages and worse in the elderly.

Adolescent↗
PubMed1985

Hepatic artery infusion chemotherapy for colorectal metastases: a personal experience.

A personal experience is reported with hepatic artery infusion (HAI) chemotherapy of 57 patients with metastatic colorectal carcinoma confined to the liver. Fifty-seven percent of the 54 patients who received more than 2 weeks of infusion had objective regressions documented on hepatic scans. The response rate with fluorouracil and mitomycin C (75%) was higher than for fluorouracil alone (52.5%). The median survival of treated patients was 15 months with the longest survivor living 3 years 8 months, and responders had a median survival 3 months longer than nonresponders. Complications included one case of hemolytic uremic syndrome after HAI with mitomycin C. Survival after HAI was 9 months longer than that of comparable historical controls who received no treatment, but survival after HAI with fluorouracil alone was not superior to that of comparable patients treated with intravenous fluorouracil. HAI produces a high frequency of tumor regression, but superior survival has yet to be demonstrated.

Adult↗
PubMed1984

Surgical clinical trials.

Surveys of surgical practice in the United States during the last 2 decades have documented a gradual retreat from the standard radical mastectomy for treatment of early breast cancer. During this time, clinical trials have tested traditional principles of cancer surgery, and permitted conclusions to be made regarding treatment alternatives. Modified mastectomy (total mastectomy plus axillary dissection) has proved equal to radical mastectomy in terms of survival, disease-free survival, and local tumor control in a randomized trial confined to TNM clinical Stage I and II cases. This study showed that routine removal of grossly uninvolved pectoral muscles (and apical axillary nodes) is not necessary in early cases, a result which failed to support the principle of en bloc dissection. Trials addressed to the practice of prophylactic regional node dissections have indicated that node dissections are useful for reducing regional tumor recurrence, for providing prognostic information, and for establishing the need for adjuvant treatment, but they do not improve overall survival. Metastases in lymph nodes appear to be a sign, rather than a source, of tumor dissemination. Furthermore, a recent trial indicates that routine removal of the breast may not be necessary in early cases. High-dose irradiation of the breast (after wide excision of the primary and axillary dissection) in TNM clinical Stage I cases provided local tumor control and survival comparable to that of radical mastectomy. Trials of breast preservation not yet complete address more advanced stages (TNM I and II), and the question of whether irradiation is necessary in all cases. On the basis of completed studies, it appears that TNM clinical State I and II cancers can be appropriately treated with modified mastectomy; Stage I cancers can be treated equally well with irradiation of the breast after quadrantectomy and removal of axillary lymph nodes.

Adult↗
PubMed1984

The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons.

The 1982 survey documented changes in the management of carcinoma of the breast in this country. If one compares the current survey results with the results of the 1978 survey, an inescapable conclusion is that there is a changing understanding of carcinoma of the breast and a willingness to apply new knowledge to clinical practice. These results also show the potential of the hospital Tumor Registry when records are systematically aggregated and data from different points compared. Future applications of this survey procedure and further analyses of these data may be used to document progress in the control of cancer. While useful for these purposes, it should be noted that these data are not intended, nor suited, for assessing the superiority of given treatments. They may not reflect the outcome that would result from a clinical trial. Comparisons made herein often involve patients who differed in many respects other than that on which the comparison was focused. However, within these constraints, the data may be useful for clinicians and scientists interested in the dynamic state of the treatment of carcinoma of the breast in large numbers of hospitals in the United States.

Adult↗
PubMed1984

Management of cutaneous melanoma in the United States.

Melanoma is an especially important malignant disease for surgeons to know about, since it can be cured with surgical treatment if diagnosed at an early stage. In the American College of Surgeons Melanoma Survey of 4,545 melanoma patients diagnosed during 1980, the typical melanoma was relatively thin (less than 1.5 millimeters), not ulcerated (except in 9 per cent) and did not invade into the reticular dermis or beyond (level IV or V). The melanomas were most commonly located on the trunk in men and on the lower extremities in women. Eighty-eight per cent of the patients had no clinical evidence of metastases to regional nodes or to distant sites at the time of initial diagnosis. Only a small proportion (1 per cent) of patients in the survey were black and in most of these patients, their melanoma were located on the feet or hands. The treatment of melanoma was surgical in 92.5 per cent of the patients, with the majority of patients undergoing a wide excision of the melanoma as the initial form of treatment. Only one-fifth of the patients underwent elective regional node dissection for suspected micrometastases, and most of these patients had a tumor thickness exceeding 1.5 millimeters or a lesion invading to the reticular dermis (level III, IV or V). While the Breslow Microstaging Method is now recognized as the most important parameter that predicts the clinical course of the patient, this parameter was reported in only 45 per cent of the patients in the survey. The natural history of melanoma is changing, since the disease is increasing in frequency and becoming more curable. Surgical treatment should be tailored to the biologic aggressiveness of each individual patient's melanoma. This can be estimated by integrating such prognostic factors as the melanoma thickness, the presence or absence of ulceration, the level of invasion, the anatomic site and the gender of the patient.

Adult↗
PubMed1983

Breast tumor incidence in rats after partial mammary resection.

The use of subcutaneous mastectomy in women at high risk for breast cancer is based on the assumption that surgical reduction of the tissue at risk results in a corresponding reduction in risk. To assess the validity of this assumption in an animal model, we subjected 120 female Sprague-Dawley rats to the mammary carcinogen 7,12-dimethylbenz(alpha)anthracene and a 20% fat diet. Two days later, one mammary ridge was excised in half of the animals (mastectomy group), and a midline incision was made without excision of tissue in the other half (control group). Seventy-nine rats survived dosing and operation and were observed for 77 weeks. After 15 weeks, 17 of 39 controls and seven of 40 animals with mastectomies had histologically confirmed neoplastic tumors of the breast. However, after 77 weeks, 32 of 39 controls and 35 of 40 animals in the mastectomy group had neoplastic tumors. The incidence of carcinogen-induced mammary neoplasms in rats progressed with time; whereas surgical reduction of breast tissue was followed by early reduction in neoplasias, the difference was not maintained.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1983

Obesity, estrogen production, and tumor estrogen receptors in women with carcinoma of the breast.

The poor prognosis of obese women with carcinoma of the breast has yet to find a satisfactory explanation. It is suspected that the hormonal milieu of these patients may favor tumor growth. This investigation explored the relationship between obesity, urinary estrogen excretion, and tumor estrogen receptors (ER) in women treated with mastectomy for carcinoma of the breast. The ER levels determined from the primary cancers of 129 women treated with mastectomy were compared with the obesity index (O.I.) of these patients, i.e., weight in pounds/height in inches. In addition, 24-hour total urinary estrogen determinations were performed in 30 postmenopausal women and compared with their O.I. and ER. A weak direct correlation was found between ER and O.I. in postmenopausal women. The urinary estrogens of postmenopausal women were correlated directly with obesity index, but no relationship could be established between urinary estrogens and the ER content of breast cancers. It is concluded that the excess estrogen production of obese women may be responsible for their poor prognosis by promoting tumor growth. The high tumor ER concentrations associated with obesity suggest a high frequency of hormonally sensitive tumors.

Adult↗
PubMed1982

Montgomery's areolar tubercle. A light microscopic study.

Conflicting impressions regarding the anatomy of Montgomery's areolar tubercle exist. Twelve modified radical mastectomy specimens provided 1,536 serial sections of areolar tubercles. In 34 of 35 tubercles (97%), a mammary lactiferous duct was associated with a sebaceous apparatus. This lactiferous duct ascended from deeper mammary parenchyma and entered the sebaceous gland. Histopathologic changes identified included featured of fibrocystic disease, atypical intraductal hyperplasia, and carcinoma in situ. Because the areolar tubercle has two components, a sebaceous gland and a mammary duct arising from deeper breast parenchyma, diseases of the breast may also involve the areola independent of papilla-nipple involvement. Areolar preservation may best be used with the knowledge that diseases underlying the areola may also involve the areola.

Aged↗
PubMed1980

Second cancers after prolonged adjuvant thiotepa for operable carcinoma of the breast.

From 1963--1972, women treated with radical mastectomy for early cancer of the breast were randomly assigned to treatment with thiotepa weekly for one year (N = 90) or no further therapy (N = 77). Fifteen patients subsequently developed second cancers, six in the thiotepa-treated group, and nine in the concurrent control group. These data are compared to the incidence of second primaries in the other prospective randomized trials of adjuvant chemotherapy for breast cancer. To date there is no greater incidence of second primary malignancies in breast cancer patients treated with adjuvant chemotherapy than in those who are treated with surgery alone. The long-term results of the study were reviewed. There was no difference in survival between the thiotepa-treated patients and the control group. However, of 13 negative node patients less than 55 years old who were treated with adjuvant thiotepa, 12 remain alive and free of disease.

Breast Neoplasms↗