Edward W. Humphrey

Preoperative radiation and surgery for cancer of the rectum: veterans administration surgical oncology group trial II

In a prospective randomized trial, 361 male patients with histologically proven adenocarcinoma of the rectum, judged preoperatively to require abdominoperineal resection (APR), were treated by surgery alone or were given 3,150 rads of preoperative radiotherapy. Surgical resection was done on 320 patients, 262 having “curative” APR. Only moderate symptoms from radiotherapy were noted and postoperative complications and 30‐day mortality were similar in both groups. Five‐year survival for curative APR was the same in both groups (50% for both treated and control patients). The incidence of positive lymph nodes in the resected specimens was 35% in treated and 41% in controls. In the first preoperative radiotherapy trial conducted by the group, 5‐year survival in patients undergoing “curative” APR was 47% in treated versus 34% in control groups. Additionally, the difference in positive lymph nodes in the resected specimens was substantially greater in the first trial (26% in treated versus 44% in controls). Cancer 58:352–359, 1986.

Preoperative Irradiation of Operable Adenocarinoma of the Rectum and Rectosigmoid Colon

Preoperative irradiation in a moderate dose schedule (2,000–3,000 rads∕two weeks) followed promptly by surgery has had a favorable effect, when matched with controls, on the survival of male patients with operable and resectable adenocarcinoma of the rectum, particularly when the lesion is low-lying and requires an abdominoperineal resection. There is a significant reduction in the finding of positive lymph nodes in the treated group (27%) compared with the controls (40%). With 700 men already in the study, life table survivals at five years are documented at 40.4% for irradiated patients who undergo abdominoperineal resection vs. 27.5% for the control group. This favorable effect appears dose-related.

Adjuvant Therapy for Large Bowel Cancer: Update of Veterans Administration Surgical Oncology Group Trials

The results of eight clinical trials are reported. In two trials radiotherapy was the adjuvant modality, five used chemotherapy, and one used a combination of chemotherapy and nonspecific immunotherapy. There is evidence of a modest but definite survival benefit from both adjuvant chemotherapy and radiotherapy.

The production of malignant tumors of the lung and pleura in dogs from intratracheal asbestos instillation and cigarette smoking

Nine dogs were given yearly intratracheal instillations of crocidolite asbestos for periods up to three years. The maximum dose totalled 66 mg/kg. In addition, seven of these dogs smoked nine cigarettes per day, five days per week for six years. A malignant pleural and/or peritoneal mesothelioma developed in six of these dogs, and adenocarcinoma of the lung developed in four, one of which had areas of squamous differentiation. The first animal died of a malignant tumor six years after the onset of exposure, and the last animal died eight years after the onset.

Temporal trends in survival after surgical resection of localized non-small cell lung cancer

To test whether modern preoperative staging modalities and perioperative care improve survival after resection of localized non-small cell lung cancer (NSCLC), we retrospectively reviewed outcomes of 454 patients with NSCLC resected from 1947 through 1969 (designated pre-1970 cases), and 540 patients with cancers resected from 1981 through 1994 (designated post-1980 cases). Mean ages, histological subtypes, surgical stages, and types of surgical procedures differed significantly between the two groups. Compared with pre-1970 cases, post-1980 cases were older, had more adenocarcinoma and less squamous cell carcinoma, and had lesser proportions of advanced stage disease. Postoperative (day 30) mortality was significantly higher for resections of localized (stages 1 and 2) NSCLC prior to 1970. For patients surviving at least 30 days after surgery, subsequent survival after resection of localized NSCLC differed minimally between pre-1970 and post-1980 groups. We conclude that perioperative mortality after resection of localized NSCLC improved, but subsequent postoperative survival for these patients did not significantly improve over the 45-year period studied.

Giant duodenal ulcer

Abstract Benign giant duodenal ulcer appears to be a unique type of generalized peptic ulcer disease. Massive hemorrhage, perforation, and obstruction are frequent complications. The disorder is best diagnosed endoscopically and treated with one of the standard acid-reducing procedures.

Tuberculosis and Carcinoma of the Lung

A comparison has been made between 43 patients with lung cancer and tuberculosis and the total group of 1,164 patients with cancer of the lung. The quantitative clinical characteristics of the two groups studied were not different. However, when various symptoms are evaluated in light of the therapy, age, and time course, a number of useful clinical signs of a coexistent malignancy can be identified. If a patient over 50 has acid-fast bacilli in the sputum, this should not be accepted as a reason to diminish the suspicion of a coexistent malignancy. The patient with tuberculosis of the lung has only a slightly higher likelihood of having restrictive or obstructive lung disease which would contraindicate exploration and resection. Otherwise in this series, effective operative management of lung cancer in the tuberculosis patients resulted in proportionately as many cures with no more risk than in the usual patients with lung cancer.

Stapling techniques in esophageal replacement.

Either the stomach or the colon can be used to restore deglutition after esophagectomy. The use of the EEA and other stapling devices has increased both the safety and the speed with which these procedures can be done. This article illustrates techniques for the utilization of staplers to perform such operations.

Right upper lobectomy

The description that follows depicts a right upper lobemL, 2111u c”llaequallLIy bllt: I,,“SL difficult is the determination of whether or not the

Factors influencing the measurement of pulmonary extravascular water

Abstract The change in pulmonary extravascular water calculated from indicator-dilution curves recorded by 125 RISA and 131 iodoantipyrene was compared to the weighed lung water in five groups of dogs. Four of these groups were kept hypotensive for 2 hr by hemorrhage, then reinfused with blood. They then received isoproteranol, methylprednisolone, phenoxybenzamine, or no drug. A fifth group was anesthetized for 4 hr, but kept normotensive. Hypotension, or prolonged anesthesia caused a recruitment of pulmonary capillaries in spite of a decreased cardiac output. This recruitment was decreased by isoproteranol or methylprednisolone and was unaffected by phenoxybenzamine. The recovery of RISA decreased during the course of all experiments. This decrease may be due to segmental areas of venous obstruction. Only in the group of animals receiving phenoxybenzamine after hypotension were the typical changes of congestive atelectasis seen.