Urinary catabolites of ribonucleic acid as cancer markers: a preliminary report of their use in patients with lung cancer

Rats with aflatoxin-B1-induced hepatomas and dimethylnitrosamine-induced nephroblastomas excreted greater than normal amounts of urinary modified nucleosides and bases, catabolites of ribonucleic acid (RNA). Although both neoplasms caused increased excretions of the same catabolites, their quantitative profiles differed, suggesting that it may be possible to distinguish between tumors. Rats with transplanted tumors (e.g., hepatomas and osteogenic sarcomas) did not excrete elevated levels of urinary RNA catabolites until approximately 20 days after transplantation despite rapid growth of the tumor for the first 15 days. These data suggest that the source of the elevated levels of these excretory products may be the host's tissue RNA. Preliminary studies in human beings with lung cancer showed marked elevation of one or more urinary RNA catabolites. Resection of the diseased tissue in 2 patients caused a drop in levels. The measurement of urinary RNA catabolites may be useful in the diagnosis, prognosis, and evaluation of therapy in patients with lung cancer.     

Repeat Mediastinoscopy

Although it has been maintained that a repeat mediastinoscopy results in high morbidity and mortality, it was considered an essential staging procedure in this group of 12 patients. The results of repeat mediastinoscopy were negative in 10 patients and positive in 2. On the basis of negative findings, 6 patients underwent thoracotomy. Five of them had a possible curative resection, and the remaining patient had an unresectable invasive carcinoma. An unnecessary thoracotomy was avoided in 2 patients with positive mediastinal nodes. For various reasons, thoracotomy was not indicated in the other 4 patients.In the evaluation of a patient with a new or recurrent pulmonary lesion, repeat mediastinoscopy can be performed safely. When findings are negative, it would appear to increase the likelihood of a curative resection, whereas when findings are positive, an unnecessary thoracotomy can be avoided.     

A circumferentially elastic arterial prosthesis: three-year studies of a Dacron-Spandex graft in the dog

A circumferentially elastic, compliant arterial prosthesis has been developed consisting of a Dacron-polyether urethane (Spandex) weave. The prosthesis can acutely alter its cross section area after implantation in response to changes in flow and pressure. It shows favorable host incorporation and healing properties when studied after 3 years in the dog thoracic aorta and does not dilate significantly over that time. There is some suggestion that its initially elastic properties, present during the early days after implantation, make it more compliant during this healing period and more adaptable to the actual flow conditions present at the time of its insertion.     

A decade of experience with laparoscopic ventral hernia repairs

Background

Few studies have evaluated surgical outcomes in long-term follow-up for patients undergoing Laparoscopic Ventral Hernia Repair (LVHR).

Can parathyroid hyperplasia be predicted preoperatively?

Introduction

The purpose of this study was to determine if there are clinical features that raise suspicion for parathyroid hyperplasia.

Diffuse,Mixed Malignant Pleural Mesothelioma

Forty-six patients with diffuse, mixed malignant pleural mesothelioma were treated between January, 1970, and May, 1979. All had a history of exposure to asbestos. The diagnosis was established by thoracentesis in 3 patients, thoracoscopy in 28, thoracotomy in 5, and minithoracotomy in 9. Mediastinoscopy was performed in 31 patients and bronchoscopy in 32. Mediastinoscopy was positive in only 1 patient, and in no patient was bronchoscopy positive.Ten patients received no definitive therapy and survived an average of 9.1 months (1 lived for 16 months). Thirty-one patients received chemotherapy and survived an average of 9.6 months, the 2 longest survivors each lived for 24 months. Five patients appeared to have early disease and therefore underwent thoracotomy. In only 2 of these patients did resection of all gross disease appear possible. One patient with incomplete removal is still alive after 9 months. The other 4 are all dead, having survived an average of only 6.75 months.We believe that pleural mesothelioma should be considered an unresectable neoplasm because of its multicentric origin and its diffusely invasive nature, and that attempts at partial or complete resection are not indicated. Until prospective, controlled studies demonstrate otherwise, patients with diffuse, mixed malignant mesothelioma should have the most benign surgical procedure necessary to establish a diagnosis.     

The appropriateness of 30-day mortality as a quality metric in colorectal cancer surgery

Background

Our study compares 30-day vs. 90-day mortality following colorectal cancer surgery (CRS), and examines hospital performance ranking based on this assessment.

Surgical clerkship or medical clerkship first: Does it make a difference?

Introduction

This study compares NBME surgical clerkship scores of students who completed their medicine clerkship before their surgical clerkship with the performance of those who had not previously completed their medical clerkship.

Locally advanced pancreas cancer: Staging and goals of therapy

Background

Patients with locally advanced pancreatic cancer have historically been considered inoperable. The purpose of this report was to determine resectability rates for patients with locally advanced pancreatic cancer based on our recently described definitions of type A and type B locally advanced pancreatic cancer.

Effect of intra-operative single dose of dexamethasone for control of post-operative nausea and vomiting on the control of glucose levels in diabetic patients

Background

Dexamethasone adds a unique challenge to glycemic control, and it may complicate patient care if there is an association between intra-operative dexamethasone and blood glucose levels.

Noncovalent bonding of penicillin and cefazolin to dacron

Dacron grafts treated with the surfactant, benzalkonium chloride or TDMAC bind significant quantities of penicillin-14C or cefazolin-14C. The treated grafts showed strong antibacterial activity which indicated that bound radioactivity corresponds to the reversible adsorption of biologically active molecules. Bound penicillin-14C or cefazolin-14C slowly dissociates when the grafts are placed in a surgically prepared muscle pouch in the rat. This slow release of antibiotic produces therapeutic levels of antibiotic in the adjacent tissue. Binding can also be achieved by in situ irrigation of surfactant treated grafts with antibiotic or by injection of the antibiotic.