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Biomedical subjects

W Lawrence

Publications and source records attributed to W Lawrence.

At least 145 records · Page 8Linked to original sources
PubMed1978

Chemotherapy as an adjuvant to surgery for colorectal cancer. A follow-up report.

An adjuvant program of fluorouracil for patients undergoing "curative" resection for adenocarcinoma of the colon and rectum was initiated as a randomized clinical trial in January 1968. Patients were randomly assigned to an intraluminal fluorouracil or intraluminal control (saline) group and were so treated at the time of surgical resection if findings at operation indicated that all gross neoplastic disease could be resected. Those patients receiving intraluminal fluorouracil (30 mg/kg) received intravenous fluorouracil (10 mg/kg) on each of the first two postoperative days and five subsequent postoperative courses of oral fluorouracil (90 mg/kg) in each 18-day course over a one-year period. By July 1, 1975, there were 203 patients undergoing curative resection entered into the study. Survival and disease-free data, as of Dec 31, 1976, revealed no benefit from this adjuvant course of fluorouracil. These data support the need for continued randomized clinical trials of new and innovative adjuvant therapy compared with an untreated control group.

Adenocarcinoma↗
PubMed1978

Paratesticular rhabdomyosarcoma in childhood.

The paratesticular region was the primary site in 20 of 289 children (7%) entered on the Intergroup Rhabdomyosarcoma Study. The 20 patients were 1.7- to 19-years-old at diagnosis. Fifteen underwent retroperitoneal node dissection (12) or biopsy (3), and 6/15 (40%) had nodal involvement by tumor. Nineteen of the 20 patients had no gross local or metastatic disease after surgery. All 20 received chemotherapy, and 13 also received radiotherapy. Treatment was effective: 16 of 18 evaluable patients (89%) were free of disease at a median of 23 months from diagnosis (range, 8-43 months). Since the incidence of tumor-involved retroperitoneal nodes is high, a dissection should be performed. If the nodes are free of tumor, retroperitoneal radiotherapy may not be necessary. Reduction of morbidity in patients with paratesticular rhabdomyosarcoma is desirable, because the disease has a good prognosis.

Adolescent↗
PubMed1978

An evaluation of the wire mesh prosthesis in primary reconstruction of the mandible.

A stainless steel wire mesh prosthesis was used as a primary mandibular replacement in 102 patients after resection of malignant neoplasms arising in the head and neck. In sixty-seven patients the prosthesis was considered successful. Failure of the host to tolerate the prosthesis was associated with a history of previous irradiation, extensive resections, and loss of distant skin flaps used for coverage of the prosthesis. We conclude that the wire mesh mandibular prosthesis is an excellent means to accomplish prompt functional and cosmetic reconstruction after mandibular loss and does not preclude the use of a more complex modality of reconstruction if the initial implant is removed.

Humans↗
PubMed1978

Primary reconstruction of the mandible with a wire mesh prosthesis.

A stainless steel wire mesh prosthesis was used as a primary mandibular replacement in 102 patients following resection of malignant neoplasms arising in the head and neck. In 67 patients the prosthesis was considered successful. Failure of the host to tolerate the prostheses was associated with history of previous irradiation, extensive resections, and the loss of distant skin flaps used for coverage of the prosthesis. But the prosthesis is tolerated by the host in 90% of the cases if it is inserted in a non-irradiated bed, covered with local tissues, and the resection is limited to the maxillo-oral complex only.

Follow-Up Studies↗
PubMed1978

Medical adrenalectomy and plasma steroids in advanced breast carcinoma.

Aminoglutethimide and dexamethasone were administered for 3 months to 11 postmenopausal women with advanced breast cancer. During initial in-hospital studies, there was uniform suppression of plasma cortisol (0.23 microgram/100 ml), androstenedione (8.3 ng/ 100 ml), estrone (0.44 ng/100 ml), and estradiol (0.32 ng/100 ml) to concentrations indistinguishable from those after surgical adrenalectomy. Eight of the 11 patients maintained this degree of suppression for 3 months. The other three patients may have taken inadequate amounts of dexamethasone, as evidenced by plasma steroid patterns characteristic of aminoglutethimide alone, that is, partial cortisol suppression (3.6 microgram/100 ml) and markedly increased androstenedione (355 ng/100 ml) with low estrone (0.54 ng/100 ml) and estradiol (0.61 ng/100 ml) concentrations. This apparent block in the aromatization of androstenedione to estrogens may be a feature important to the effectiveness of the regimen in sporadically noncompliant patients. After 3 months of therapy, return of resting plasma cortisol values to normal occurred within 3 to 4 days after cessation of the regimen and pituitary-adrenal responsiveness to surgical stress was demonstrable. This regimen is capable of maintaining an effective, reversible suppression of plasma steroids considered to be relevant to estrogen-dependent breast cancer.

Adrenal Cortex Hormones↗
PubMed1978

Preoperative radiotherapy for stage III carcinoma of the breast.

We have concluded from these observations in this pilot study that preoperative radiation therapy does not play a particularly helpful role in the management of patients who have the clinical finding of borderline operable carcinoma of the breast and it does not improve the survival rate. Patients within this category of locally advanced disease must be considered to have systemic metastatic disease at the time of diagnosis, as has previously been stressed by many. For this reason, any therapy directed to the regional area for local control must be combined with some form of systemic therapy if there is to be any hope for an increase in survival time.

Adult↗
PubMed1977

Freezing and storage of breast cancer tissue for estrogen receptor protein assay: a convenient method.

Sixteen patients underwent biopsy of primary or metastatic breast cancer and had equal portions of the tumors rapidly frozen by either the use of liquid nitrogen or the fluorinated hydrocarbon spray, Cryokwik. The estrogen receptor protein (ERP) assay was then performed on both specimens, utilizing the surcose gradient density method. In general, both methods of freezing gave similar results. Three patients had ERP measured after approximately three to four months of storage at -70 C. After a minimum of 14 weeks' storage, there was no statistically significant loss of activity by either method of preparation. The Cryokwik preparation method makes the accurate measurement of ERP possible for all community hospitals. The tissue may be prepared and stored until a convenient time for transportation to the appropriate laboratory.

Breast Neoplasms↗
PubMed1977

Medical and surgical adrenalectomy in patients with advanced breast carcinoma.

Twenty-four postmenopausal patients with metastatic breast carcinoma were placed on aminoglutethimide and dexamethasone as a form of reversible medical adrenalectomy. Six patients experienced adverse side-effects. Of the 18 remaining patients 50% had a definite subjective or objective response to therapy. Thirteen of these patients underwent subsequent surgical adrenalectomy after a maximum of 3 month's trial of the medical regimen. In every patient the response to therapy was identical with the two modalities of therapy. In those postmenopausal patients with metastatic breast cancer who are felt to have a hormone- dependent tumor by clinical and/or hormonal assay criteria, medical adrenalectomy may eventually be a feasible replacement for surgery in selected cases. As important, perhaps, is the potential value of this medical adrenalectomy as a reliable indicator of the subsequent response to endocrine ablative therapy.

Adrenal Glands↗
PubMed1977

Lymphatic metastasis with childhood rhabdomyosarcoma.

Clinico-pathologic reviews of series of children with rhabdomyosarcoma have yielded conflicting information regarding frequency of lymphatic spread of this disease. The 264 eligible entries in the Intergroup Rhabdomyosarcoma Study (from November 1972 to September 1975) have been categorized by a prospective staging system and pre-treatment characteristics and pathologic findings reviewed. Data accumulated thus far have revealed a higher than expected incidence of lymphatic metastases from extremity (17%) and genito-urinary sites (19%) with a somewhat lower incidence from the orbit (0%), the head and neck region (3%), and trunk (10%). These differences in regard to lymphatic metastases were found to have no relationship to age, sex, tumor size, or histologic type when these factors were simultaneously examined.

Adolescent↗
PubMed1977

Analysis of the cycling and noncycling cell population of human solid tumors.

The size and kinetics of the cell population of six advanced human solid tumors were analyzed following the continuous infusion of H3-TDR for a period of 6 to 21 days. By using the labelling indices of the cells in interphase and mitosis, and the rate of label incorporation, it was found the only 10 to 40% of the tumor cell population was replicating at any given time. Fifty-five percent to 85% of the remaining cell mass eventually entered into cycle at least once. Anywhere from 5% to 40% of the cell population remained arrested in G2 or G0 in individual cases during the period of observation. The significant size of the "resting" cell compartment is undoubtedly one explanation for the relative insensitivity of advanced adult solid tumors to current cell cycle-oriented therapeutic regimens.

Adenocarcinoma↗
PubMed1977

The draping of the surgical field for major head and neck surgery.

Due to the complexities involved in extensive resections and primary reconstruction necessary in the management of head and neck cancer, a standard draping of the sterile surgical field has been adopted to allow the performance of the anticipated surgical plan or alternatives in an orderly fashion, without disrupting the function of other members of the surgical team.

Head↗
PubMed1977

Survival after palliative surgery for advanced intraabdominal cancer.

The clinical course of 300 patients with known intraabdominal neoplasm requiring surgical exploration was analyzed. The most common primary tumor sites were the gastrointestinal tract (60 per cent), female reproductive organs (17 per cent), and urinary tract (6 per cent). Gastrointestinal and extrahepatic biliary obstruction, gastrointestinal bleeding, and peritonitis were the most common indications for surgery. The overall operative mortality was 26 per cent, and the mean survival time was 6.6 months. Small bowel fistulas, intraabdominal abscesses, and cardiopulmonary and renal failure were the leading causes of death. Palliative procedures in patients less than sixty years old with single site of obstruction or with tumor of gastrointestinal origin were associated with a low operative mortality and prolonged survival. On the other hand, surgical intervention in patients more than seventy years old undergoing chemotherapy, with multiple sites of obstruction, peritonitis, or primary tumor originating outside the gastrointestinal tract, was associated with high operative mortality and seldom benefited from palliative intervention. Surgical intervention to relieve a distressing symptom in a patient with advanced neoplasm is a well established procedure, but the risks and benefits of such intervention should be carefully weighed against the expected mortality and the quality of survival.

Abdominal Neoplasms↗