bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conservative treatment of breast cancer with the QU.A.RT. technique
Authors: Veronesi Umberto , Zucali Roberto , Del Vecchio Marcella 
Published: May 2005

AbstractData are presented from a randomized, prospective clinical trial comparing the Halsted radical mastectomy with quadrantectomy, axillary node dissection, and breast radiotherapy (QU.A.RT.). From 1973 to 1980, a total of 701 patients with tumors <2 cm and clinically negative axillary nodes were accessed; the mean time on study is 8 years. No significant differences were apparent in local/regional recurrence, relapse‐free survival, or survival. Two percent of the patients in either group developed a local recurrence, and an additional 2% demonstrated a regional treatment failure. Relapse‐free survival at 8 years was 79% in the mastectomy group and 80% in patients treated with the quadrantectomy regimen; the proportion of patients surviving was 82.5% and 85%, respectively. In histologically node‐positive patients, there appeared to be prolonged survival for women treated with quadrantectomy (82% versus 70%), although this difference was not statistically significant. It is concluded that for patients meeting the eligibility criteria of this study, there is no demonstrable disadvantage for the use of quadrantectomy, axillary node dissection, and radiotherapy to the ipsilateral breast.
Limited surgical management for primary breast cancer: A commentary on the NSABP reports
Authors: Fisher Bernard , Wolmark Norman 
Published: May 2005

AbstractThis report presents an overview of findings from 2 interrelated studies carried out during the past 15 years by the National Surgical Adjuvant Breast and Bowel Project to determine the efficacy of alternative local and regional treatments of primary breast cancer. Findings from the first clinical trial, begun in 1971 involving 1,665 women, indicate that after 10 years of follow‐up there are no significant differences in disease‐free survival, distant disease‐free survival, or survival among patients treated by radical mastectomy or total mastectomy with and without radiation. The findings also indicate that radiation of internal mammary nodes in patients with inner quadrant lesions does not improve survival and that results obtained at 5 years accurately predict the outcome through 10 years. The second clinical trial, implemented in 1976 and accruing 1,843 women, demonstrates that after 5 years, treatment by segmental mastectomy (lumpectomy) with or without radiation results in disease‐free, distant disease‐free, and overall survival at least equivalent to, and in certain aspects better than, that achieved after total breast removal. Whereas 92% of those treated with radiation remained free of breast tumor at 5 years, when breast radiation was not employed, 72% (p<0.001) were without tumor reoccurrence. In positive‐node patients, 98% of those radiated remained tumor free, whereas only 64% of those receiving no radiation were free of tumor although both groups received chemotherapy.While the clinical significance of these findings is obvious, their biological importance has received less attention. When considered in conjunction with other laboratory and clinical investigations, they lend no support for the anatomic and mechanistic precepts that have dictated thinking relative to metastasis production and have influenced surgical thinking. Clinical issues have arisen as a consequence of the 2 studies, particularly the second. Should a mastectomy be performed when lumpectomy specimen margins are involved with tumor? How should tumor reoccurrence in the ipsilateral breast following lumpectomy be managed? Can lumpectomy be employed for subareolar tumors or for tumors ≥4 cm? How extensive need radiation therapy be following lumpectomy? We have commented on all of these issues and have presented our current thinking regarding the management of patients in whom they arise.
Lumpectomy and axillary dissection for breast cancer: Surgical, pathological, and radiation considerations
Authors: Fisher Bernard , Wolmark Norman , Fisher Edwin R. , Deutsch Melvin 
Published: May 2005

AbstractRecently, the first results were disclosed from a trial carried out by the National Surgical Adjuvant Breast and Bowel Project (NSABP) to evaluate the efficacy of breast conservation. These observations indicate that lumpectomy and axillary dissection plus radiation can be employed instead of total mastectomy for the treatment of a large proportion of women with primary breast cancer. The present report describes the technique of operation (lumpectomy), how the pathological examination of the resected specimen is carried out, and the manner in which radiation therapy is administered to the operated breast. The methodologies are those utilized in more than 1,200 women who for almost a decade have been participants in the NSABP study. It is emphasized that the outcome of patients exposed to breast preservation relates to the expertise of the surgeon, pathologist, and radiation and medical oncologists. The orchestration of care that will result in a satisfactory cosmesis and control of disease in the breast is more complex than is necessary for carrying out a mastectomy. Above all it is emphasized that, although the Halstedian concept for cancer surgery has been displaced, that change does not provide the imprimatur for haphazard surgery.
Adjuvant chemotherapy for operable breast cancer with positive axillary nodes: A comparison of CMFVP versus L‐PAM
Authors: Rivkin Saul E. , Glucksberg Harold , Foulkes Mary , Osborne C. Kent , Tranum William , Gad‐el‐Mawla Nazli , Constanzi John 
Published: May 2005

AbstractThis 5‐year update of a study by the Southwest Oncology Group continues to show that combination chemotherapy utilizing cyclophosphamide, methotrexate, 5‐fluorouracil, vincristine, and prednisone (CMFVP) is superior to melphalan (L‐PAM) used alone. Adjuvant chemotherapy for patients with operable breast cancer and positive axillary nodes treated with continuous CMFVP confers a significantly longer disease‐free and total survival compared to those treated with intermittent L‐PAM. This significant decrease in recurrence and prolongation of survival are demonstrated for the entire CMFVP group and in the following subgroups: premenopausal, postmenopausal, and women with 4 or more axillary nodes. Women with 1 to 3 axillary nodes have a significantly longer disease‐free interval, but a total survival advantage is not statistically significant.
Eight‐year follow‐up of adjuvant therapy for stage II breast cancer
Authors: Hubay Charles A. , Gordon Nahida H. , Pearson Olof H. , Marshall James S. , McGuire William L. ,   Participating Investigators
Published: May 2005

AbstractThe 8‐year results of a prospective, randomized, clinical trial of 3 treatment regimens in 311 women with stage II breast cancer are reported. Cyclophosphamide, methotrexate, and 5‐fluorouracil (C) were compared with C plus the anti‐estrogen drug tamoxifen citrate (Nolvadex®) (CT) and CT plus Bacillus Calmette‐Guérin vaccinations (CTBCG) as adjuvant therapy postmastectomy. Estrogen receptors (ER) were measured in all primary tumors. The addition of Nolvadex® to chemotherapy significantly decreased the number of recurrences at 8 years. This decrease in recurrence was more pronounced in estrogen receptor‐positive patients as follows: (a) those with ≥ 4 positive lymph nodes; (b) those with tumor diameters ≥ 3 cm; and (c) postmenopausal women.Addition of Nolvadex® to C had no effect on disease‐free survival in patients with ER‐negative tumors. Immunotherapy with BCG vaccinations had no discernible effect on disease‐free survival. Estrogen receptor measurements in the primary tumor provide important prognostic information regardless of treatment. Estrogen receptor‐positive patients have a lower recurrence rate and lower mortality after 8 years. Both estrogen and progesterone receptor measurements have predictive value for response to endocrine therapy and should be determined in all patients with breast cancer.
Adjuvant tamoxifen and chemotherapy in stage II breast cancer: Interim findings from NSABP protocol B‐09
Authors: Wolmark Norman , Fisher Bernard 
Published: May 2005

AbstractData are presented from a prospective clinical trial in which 1,891 patients with histologically confirmed stage II breast cancer were randomized to receive adjuvant therapy consisting of 1‐phenylalanine mustard and 5‐fluorouracil (PF) with and without tamoxifen (T). The findings indicate that the benefit previously noted for the addition of tamoxifen at 2 and 3 years' mean follow‐up is still apparent at 4 years. Although the tamoxifen‐containing regimen prolongs disease‐free survival and survival, this effect is not uniform and is dependent on patient age and tumor receptor content. Only those patients ⩾ 50 years of age demonstrated a benefit from the addition of tamoxifen to chemotherapy. The benefit was influenced by the degree of quantitative tumor receptor content. Patients ⩽ 49 years of age failed to demonstrate a prolongation in disease‐free survival with tamoxifen even when the tumor estrogen receptor content was ⩾100 fmol. Not only was there no benefit attributable to tamoxifen in patients ⩽49 years, if the tumor progesterone receptors were <10 fmol there was a significant diminution in disease‐free survival and survival. The results continue to indicate that the response to PFT therapy is heterogeneous in that only specific patient subsets demonstrate a salutary effect. Whether this phenomenon of heterogeneity is unique to the PFT combination or is an intrinsic biological property of stage II breast cancer remains to be ascertained.
Anti‐estrogen treatment of postmenopausal breast cancer patients with high risk of recurrence: 72 months of life‐table analysis and steroid hormone receptor status
Authors: Rose Carsten , Mouridsen Henning T. , Thorpe Susan M. , Andersen Johan , Blichert‐Toft Mogens , Andersen Knud W. ,   Danish Breast Cancer Cooperative Group
Published: May 2005

AbstractThe role of anti‐estrogen treatment of postmenopausal breast cancer patients with high risk of recurrent disease is evaluated in a nationwide, prospective, randomized trial conducted by the Danish Breast Cancer Group. After total mastectomy and postoperative radiotherapy, 829 patients were randomized to treatment with tamoxifen (RT + TAM) for 1 year and 821 were randomized to no further therapy (RT). The recurrence‐free survival (RFS) after 72 months of life‐table analysis is 44% in the RT + TAM treated group, and 40% in the RT group(p=0.0003). Survival is 51% in both treatment groups(p=0.53). The data have been further analyzed with respect to prognostic factors such as age, degree of anaplasia, tumor size, and positive nodes. The RFS is lower in all subsets of patients treated with RT + TAM, but is only significant in patients 50–59 years of age, with tumors of anaplasia grade I, with tumors less than 5 cm, or with 4 or more positive lymph nodes.Estrogen receptor concentrations were measured in a subset of 291 of these patients. A cut‐off limit of 10 fmol/mg cytosol protein and the use of a Cox proportional hazards model distinguished between patients with long RFS and those with early recurrent disease. Patients with an estrogen receptor content below 100 fmol/mg did not benefit from the endocrine therapy, while those with concentrations above 100 fmol/mg had a significantly longer RFS. Progesterone receptor determinations were performed in 12% of the patients. Progesterone receptor‐positive patients had a lower rate of recurrence when treated with RT + TAM compared to the receptor‐positive patients in the RT group(p=0.017).
The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery
Authors: Sorace Richard A. , Bagley Caroline S. , Lichter Allen S. , Danforth David N. , Wesley Margaret W. , Young Robert C. , Lippman Marc E. 
Published: May 2005

AbstractForty‐three patients with locally advanced breast cancer, 15 with stage IIIA and 28 with stage IIIB, received primary induction chemotherapy, including hormonal synchronization in 38 patients, to a maximum objective clinical response before proceeding to local therapy. Patients achieving a pathological complete response received radiation therapy, while patients with residual disease, partial response (PR), or no change (NC) status received debulking surgery prior to radiation therapy; in all patients, 6 additional months of chemotherapy were administered. Chemotherapy consisted of cyclophosphamide 500 mg/m2 and doxorubicin 30 mg/m2 intravenously day 1; tamoxifen 40 mg/m2 orally days 2–6; premarin 0.625 mg orally every 12 hours 3 times beginning on day 7; methotrexate (mtx) 300 mg/m2 intravenously followed in 1 hour by 5‐fluorouracil 500 mg/m2 intravenously day 8, and leucovorin 10 mg/m2 orally every 6 hours 6 times beginning 24 hours after mtx. Forty‐two patients are evaluable with respect to response, time to progression, and survival. Objective response rate to chemotherapy was 90% with 50% CR, 40% PR, and 10% NC. Median number of cycles of chemotherapy to achieve a CR, PR, or NC was 5, 4, and 4 respectively. Eighteen patients with a CR to chemotherapy were assessed by multiple biopsies (16 patients) or mastectomy (2 patients). Fourteen patients (70%) were proven to be pathological complete responders. Thirty patients have completed combined therapy thus far and all have been rendered disease free. Seven stage IIIB patients have relapsed, 6 of them having inflammatory histological findings. No stage IIIA patients have relapsed. Median survival and time to progression have not been reached for either stage.
Seat belt‐induced trauma to the small bowel
Authors: Christophi C. , McDermott F. T. , McVey I. , Hughes E. S. R. 
Published: May 2005

AbstractThirty‐two patients with seat belt‐induced injuries to the jejunum and ileum are reviewed. These patients are classified into 3 groups according to the nature and mechanism of injury. Group I consists of 4 patients with complete transection of the proximal jejunum caused by deceleration forces. Injuries commonly associated include spleen rupture and perforation of the transverse colon and splenic flexure. Group II consists of 6 patients with infarcted ileum caused by crushing forces. Associated injuries include tears to the cecum, aorta, and inferior vena cava. Group III consists of 22 patients with “blowout” perforations of the jejunum and ileum. These injuries are caused by transmitted forces. There are no associated specific injuries related to this group.
Two techniques of measurement of the delayed hypersensitivity skin test response for the assessment of bacterial host resistance
Authors: Christou Nicolas V. , Boisvert Ginette , Broadhead Mary , Meakins Jonathan L. 
Published: May 2005

AbstractWe evaluated 2 methods for measuring the delayed hypersensitivity skin test response and related the data to clinical outcome in 586 subjects. Individual intradermal injections of 5 recall antigens and a saline control (Candida, mumps, PPD, trichophytin, and Varidase®) were used in one arm. A specially designed device that applied, simultaneously, 7 antigens and a glycerin control (tetanus, diphtheria, strep antigen, old TB,Candida, Trichophytin, andProteus mirabilis) was used at a separate site. Mean diameters of induration were recorded at 24 and 48 hours. Sepsis was defined as a bacteremia or an abscess identified at surgery or autopsy. Regression analysis of the sums of the mean diameters of induration of the first skin test response obtained by each of the 2 methods showed a positive correlation between the individual antigen technique and the multitest technique (n=1508, X=0.29Y+1.6, r2= 0.633,p<0.0001). Anergy to the individual antigen technique (n=155) was associated with a sepsis rate of 34% and a mortality of 38% compared with 7% sepsis and 3% death rates in reactive patients (n=281,p<0.0001). Similarly, anergy (n=281) to the 7 multitest antigens was associated with a 26% sepsis rate and 23% mortality compared to 5% sepsis and 5% mortality in the reactive subjects (n=242,p<0.0001). Despite the different antigens used in the 2 methods, both gave similar correlations between the delayed hypersensitivity skin test response (DTH) skin test score and sepsis—individual antigen technique: sepsis = 33.1 − 7.9*ln(DTH score) r2= −0.89,p<0.001; multitest technique: sepsis = 27.4 − 7.0*ln(DTH score) r2= −0.79,p<0.001. Patient acceptance of both tests was equal. Both techniques of assessing the DTH response demonstrated a close association with bacterial sepsis, and are useful tools for assessing host resistance in surgical patients.
Median sternotomy in reoperations for primary hyperparathyroidism
Authors: Norton Jeffrey A. , Schneider Philip D. , Brennan Murray F. 
Published: May 2005

AbstractThirty‐three patients underwent median sternotomy at reoperation for persistent or recurrent hyperparathyroidism. Radiographic studies correctly localized abnormal tissue to the mediastinum in 21 patients and surgery was successful in 19 of them. In the 12 patients without preoperative localization, surgery was successful in 9. Twenty‐six of 29 patients with a diagnosis of parathyroid adenoma had successful surgery, while only 2 of 4 patients with hyperplasia had successful procedures. In 10 patients the median sternotomy proved unnecessary since the parathyroid abnormality was located at a site reachable through the cervical incision. Abnormal parathyroid glands were found in the thymus (21), posterior to the thymus along the arch (6), within the thyroid (4), and at other ectopic locations. Abnormal parathyroid glands found within the thymus were often smaller than 1 cm in diameter and were detected by the pathologist after dissecting the entire thymus, indicating the need for total thymectomy. The complication rate was 12%, and the mortality rate was 6%.
Lasers in general surgery
Authors: Aronoff B. L. 
Published: May 2005

AbstractLaser technology has wide application in general surgery. The CO2 laser functions as a scalpel sealing small blood vessels in the process of dividing tissues. The YAG laser has been especially useful in the performance of liver resection and the coagulation of large vascular tumors. The utility of lasers in various types of general surgical procedures is discussed.
Clinical applications of the Argon and carbon dioxide lasers in dermatology and plastic surgery
Authors: Maser Morton R. , Apfelberg David B. , Lash Harvey 
Published: May 2005

AbstractSince the 1960's, thousands of skin and soft tissue malformations have been treated with the Argon and carbon dioxide lasers. The Argon laser, emitting blue‐green light, is very useful for treating port wine hemangiomas and other cutaneous vascular abnormalities; it has also been applied to a variety of nonvascular skin lesions. Its mechanism of action is essentially heat coagulation.Carbon dioxide lasers function as hemostatic scalpels by emitting light that is much less selective in its tissue effect. Its role in the resection of hemangiomas and other lesions is discussed.Histopathologic and tissue culture studies have been undertaken to monitor the effects of laser radiation on tissues. No malignant change has been noted. The Argon and carbon dioxide lasers must be used with great care; safety measures and treatment protocols are outlined.
Laser photocoagulation in alimentary bleeding
Authors: Swain C. P. 
Published: May 2005

AbstractLaser therapy is theoretically more advantageous than endoscopic techniques such as diathermy in the treatment of alimentary bleeding primarily because the bleeding point is not directly touched or handled during therapy and the amount of energy dissipated in the surrounding tissue is more easily controlled. Only Argon and Neodymium‐Yttrium Aluminum Garnet (Nd Yag) laser beams can be passed down flexible wave guides suitable for endoscopic use in clinical gastroenterology. The Argon laser has been used by several groups for the treatment of patients with upper gastrointestinal bleeding. Success has been achieved in 80 to 95 percent of patients. Randomized trials comparing laser therapy to other modalities or to conservative, nonendoscopic therapy have in general suggested a greater benefit and lower incidence of rebleeding following laser application. Prospects for the utilization of lasers in patients with gastrointestinal bleeding depend crucially on the correct execution of randomized controlled trials currently in progress.
Current use of lasers in pulmonary disease
Authors: Hetzel M. R. 
Published: May 2005

AbstractThe principal role of lasers in pulmonary medicine is, and will probably remain, in the treatment of unresectable tumors. In its most limited capacity, current research has already demonstrated them to be valuable palliation tools in carefully selected cases, where it can improve the last few months of life of patients for whom conventional treatments are ineffective. At best, high power lasers and dye laser HpD systems may eventually offer cures to some patients unsuitable for surgery because of poor respiratory reserve, when the total tumor mass is endoscopically accessible. It is clear, however, that only a minority of lung cancer patients are suitable for laser therapy, and lasers should only be regarded as a promising addition to the current armamentarium against this depressingly lethal disease; rather than a replacement for currently accepted treatments.
Bile reflux and degree of gastritis after highly selective vagotomy, truncal vagotomy, and partial gastrectomy for duodenal ulcer
Authors: Dewar E. Paxton , Dixon Michael F. , Johnston David 
Published: May 2005

AbstractEnterogastric reflux of bile has been shown to be associated with chronic gastritis. We have investigated preoperative duodenal ulcer patients and patients treated by highly selective vagotomy, Polya partial gastrectomy, truncal vagotomy and pyloroplasty, and truncal vagotomy and gastrojejunostomy to assess the incidence of endoscopically observed bile reflux and gastritis, and to quantitate the degree of reflux of bile acids and histologically proven gastritis. The correlation between observed and proven gastritis was poor when the observed incidence of bile reflux was low (preoperative duodenal ulcer, highly selective vagotomy) but was good when the observed reflux was high (partial gastrectomy, truncal vagotomy, and drainage). Bile acid concentrations in the stomach were significantly lower after highly selective vagotomy than in preoperative patients and those treated by partial gastrectomy and truncal vagotomy and drainage. The antritis and body gastritis found before operation did not improve after highly selective vagotomy, but antritis showed a tendency to worsen after partial gastrectomy and truncal vagotomy and drainage. Body gastritis after highly selective vagotomy was significantly less (P < 0.001) than after partial gastrectomy and less than after truncal vagotomy and gastrojejunostomy and truncal vagotomy and pyloroplasty. The beneficial effects of highly selective vagotomy in the treatment of duodenal ulcer may be enhanced in the long term by reduction of enterogastric reflux and postoperative gastritis.
Thromboembolic complications after renal transplantation: A retrospective analysis
Authors: Arnadottir Margaret , Bergentz Sven‐Erik , Bergqvist David , Husberg Bo , Konrad Peter , Lindholm Torsten 
Published: May 2005

AbstractIn a retrospective study of 125 transplanted patients, 8.8% developed thromboembolism (diagnosed with objective methods) during the first year after transplantation. In one patient pulmonary embolism was the cause of death and in one it was contributory. The thromboembolism developed rather late after transplantation. The side of the transplant did not determine the site of the thrombosis. Juvenile diabetes mellitus was found to be a significant risk factor.