Journal of surgical oncology
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Review Case Reports
Massive intraoperative atelectasis secondary to untreated mediastinal Hodgkin's disease: report of the hazard and review of the literature.
Mediastinal adenopathy in Hodgkin's disease has been known to cause relative airway compromise, particularly in the more vulnerable left mainstem bronchus. This has been infrequently reported to occur during general anesthesia and to cause respiratory embarrassment, representing a significant hazard. The possibility of its occurrence should be recognized. Preoperative evaluation of the airway by chest films and tomography, followed by radiation therapy in those patients at risk, is recommended to minimize the chances of respiratory complications during general anesthesia.
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Comparative Study
The effect of prior adjuvant chemotherapy on survival in metastatic breast cancer.
Some adjuvantly treated patients develop recurrent breast cancer and little is known about the effect of prior adjuvant chemotherapy on subsequent response rates to systemic therapy or on overall survival. We describe our retrospective comparison of 179 patients who received doxorubicin containing adjuvant chemotherapy and developed recurrent breast cancer on University of Arizona Cancer Center clinical trials with 202 non-adjuvantly treated patients entered onto clinical protocols for recurrent or metastatic breast cancer during the same period. ⋯ In patients having recurrent or metastatic breast cancer, a history of prior adjuvant chemotherapy appears to identify a subgroup who will have a higher incidence of CNS involvement, a lower response rate to chemotherapy and a shorter survival with metastatic disease. These findings may help explain the failure of improved relapse free survival seen in many adjuvant chemotherapy trials to result in improved overall survival.
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Eight patients with obstructing carcinoma of the left colon underwent emergency subtotal colectomy and ileosigmoidostomy or ileoproctostomy. Based on the results obtained by us and those reported in the literature, it is our opinion that emergency subtotal colectomy with primary ileocolonic anastomosis should be considered as the procedure of choice for patients with obstructing carcinoma of the left colon.
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Patients with the Acquired Immunodeficiency Syndrome (AIDS) are known to be at increased risk for developing malignancy; however, the spectrum that these malignancies encompass has not been fully defined. An unusual case of a 32 year old homosexual male with AIDS who developed two spontaneous small bowel perforations is presented. The diagnosis of primary histiocytic lymphoma of the small intestine was established only after his second operation.
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Eighty consecutive cancer patients with severe pain, uncontrolled by conventional narcotic analgesics, received a 2-mg test dose of morphine epidurally. Thirty-four of them had significant pain relief and were thus selected to receive continuous treatment. This consisted of 2-6 mg of morphine administered every 8-24 hours through an indwelling epidural catheter. ⋯ Complications were minimal. No sepsis, hypotension, or respiratory depression occurred. It is recommended that cancer patients with intractable pain will be selected for continuous epidural analgesia by evaluating their response to a test dose of epidural morphine.