Annals of surgical oncology
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Before 1983 we routinely used subxiphoid drainage for the management of pericardial effusions. Pericardial-pleural window through a left anterior thoracotomy was used in selected patients. Due to frustration over the rate of recurrent pericardial effusions with subxiphoid drainage alone and concern over the higher morbidity with thoracotomy, the creation of a 3-cm pericardial-peritoneal window in the fused portion of the pericardium and diaphragm overlying the left lobe of the liver was added to subxiphoid drainage in 1983. ⋯ Pericardial-peritoneal window is a simple, safe, and effective procedure and applicable to most patients with malignant and noninfectious benign pericardial effusion, including those with tamponade.
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Clinical Trial
Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.
Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low. ⋯ Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.
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Randomized Controlled Trial Clinical Trial
Effect of systemic insulin on protein kinetics in postoperative cancer patients.
Cancer cachexia is a significant cause of postoperative morbidity and mortality in patients with tumors of the upper gastrointestinal tract. Standard parenteral nutrition (TPN) has failed to alter this. The anabolic effect of insulin has been well documented, and its positive effect on protein economy in cancer patients has been recently demonstrated. This study examines the effect of high-dose insulin and parenteral nutrition on protein kinetics in postoperative cancer patients. ⋯ High-dose insulin in conjunction with hypercaloric parenteral nutrition causes improved skeletal muscle protein synthesis, skeletal muscle protein net balance, and whole-body protein net balance compared with standard TPN in postoperative cancer patients.
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The finding of lobular carcinoma in situ (LCIS) in the breast has generally prompted treatment with unilateral or bilateral mastectomy. Most experts now feel that LCIS simply identifies a woman who is at high risk to develop future breast cancer and requires only close clinical and mammographic follow-up. This approach has been recommended at our institution for > 15 years. This study defines the natural history of a population of women with LCIS who were treated by observation alone. ⋯ Four of 51 women treated with observation alone after diagnosis of LCIS developed breast cancer. All were detected by screening at an early stage. LCIS appeared to be an incidental finding on biopsy of mammographic abnormalities. The policy of observation alone for the finding of LCIS spares women mastectomy. Furthermore, cancers that develop in follow-up are likely to be detected at an early stage and be amenable to curative therapy. Observation alone is appropriate treatment for women with LCIS.