James P. Fidler

Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas.

Papillary carcinoma is the most common type of thyroid malignancy. It has been recently shown that these tumors commonly have one of three genetic alterations: BRAF point mutations, RET/PTC rearrangements, or RAS point mutations. In this study, we analyze the relationship between these alterations and the microscopic features of papillary carcinomas, their clinical features, and prognostic characteristics. Ninety-seven papillary carcinomas were studied; in all cases, frozen tissue was available for nucleic acid extraction. Of 96 unselected cases, 42% were positive for BRAF, 18% for RET/PTC, and 15% for RAS mutations. Morphologic features were evaluated in detail in 61 cases and 6 characteristic nuclear features and 3 additional microscopic features were assessed quantitatively. At least 4 nuclear features were found in each tumor, with nuclear pseudoinclusions being the least frequent finding in all mutation groups. BRAF mutations were associated with older patient age, typical papillary appearance or the tall cell variant, a higher rate of extrathyroidal extension, and more advanced tumor stage at presentation. RET/PTC rearrangements presented at younger age and had predominantly typical papillary histology, frequent psammoma bodies, and a high rate of lymph node metastases. Tumors with RAS mutations were exclusively the follicular variant of papillary carcinoma and correlated with significantly less prominent nuclear features and low rate of lymph node metastases. These findings demonstrate that BRAF, RET/PTC, and RAS mutations are associated with distinct microscopic, clinical, and biologic features of thyroid papillary carcinomas.

Carbon dioxide laser excision of acute burns with immediate autografting

Abstract 1. 1. A series of 13 patients underwent 15 operations for primary burn excision with the CO2 laser. No mortality was experienced. 2. 2. Burn wounds excised with a knife lost on an average 3.8 cc of blood for every 1 cc lost with a laser. 3. 3. The laser required 1.6 min of operating time for every 1 min required to excise a similar area of eschar with a cold knife. 4. 4. Skin grafts take and survive as well on laser excised sites as on cold knife prepared sites. 5. 5. Early results from excision with the laser are most encouraging and efforts with this modality of treatment are being expanded.

Current Experience With Renal Transplantation in Older Patients

Older patients (greater than 50 years old) are generally considered to be at high risk in renal transplantation, particularly those receiving cadaveric kidneys. The outcome in 53 older patients (mean age, 54 years; range, 50 to 64 years) receiving transplants between January 1, 1980 and December 31, 1986 and followed through June 30, 1987 were analyzed. Before 1984, immunosuppression consisted of azathioprine and prednisone (AP); thereafter, triple therapy (TT)--low-dose cyclosporine, azathioprine, and prednisone--was used. The overall 1-, 3-, and 5-year actuarial patient survival was 87%, 84%, and 84%, respectively. Survival for living related donor (LRD) transplant recipients was 100%, 92%, and 92%; survival for cadaveric (CAD) transplant recipients was 81%, 81%, and 81%. The overall graft survival was 74%, 66%, and 66% at 1, 3, and 5 years, respectively; graft survival was 88%, 81%, and 81% for LRD transplant recipients and 68%, 58%, and 58%, for CAD recipients. The patient and graft survival rates were better in the TT group than in the AP group. Eight patients died after transplantation; six within the first year. The causes of patient death were infection (50%), cardiac (25%), and malignancy (25%). Rejection (56%) and patient death (38%) accounted for most of the grafts lost. Patient and graft survival rates in diabetic patients were not significantly different from survival rates in nondiabetic patients. Results in recipients of ten secondary and one tertiary transplant were poor, with only four of 11 grafts functioning at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser wound healing compared with other surgical modalities

Abstract In this study the measured rate of healing of identical excisional wounds produced by the carbon dioxide laser and three other surgical modalities, viz.: conventional scalpel blade, electrosurgical (Bovie) unit, and plasma torch are compared. Differences in the gross and microscopic findings are discussed and partially explained. These studies would indicate that portable and easily controllable lasers have the potentiality of becoming a new type of practical surgical-knife and haemostatic instrument.

Squamous Cell Carcinoma of the Ureterovesical Junction after Renal Transplantation

A case of squamous cell carcinoma of the bladder occurring at the ureterovesical junction in a renal transplant recipient is presented. References are made to ureteral obstruction in transplanted kidneys, the broader field of squamous cell carcinoma of the bladder in non-transplanted patients and the relationship of malignancy to transplantation. We anticipate that an ever increasing number of these unusual cases will be forthcoming in the urological literature as renal transplantation develops.

Vaginal reconstruction after total pelvic exenteration using a modification of the Williams' procedure.

Abstract The complete rehabilitation of women who have been subjected to ultraradical pelvic surgery should include the reconstruction of a functional vagina. The creation of a vaginal pouch as described by Williams for patients with congenital absence of the vagina or vaginal stenosis may be considered in some of these patients. The principle of his operative procedure can be applied to anatomic conditions in which the vagina and vulva have been resected utilizing perineal tissue structures and skin grafts. This is demonstrated in two patients with different postoperative perineal defects.

Early laser excision of thermal burns in the white rat and miniature pig

Abstract To find a technique which will permit a quick bloodless primary excision of an acute burn, through hyperaemic tissues, experiments have been conducted in the laser excision of thermal burns of the white rat and the miniature pig. The animals were burned, excised by carbon dioxide laser, argon laser, cold-knife scalpel or Bovie electric scalpel, and grafted. Burns were successfully excised with minimal blood loss using the lasers, but there was no significant difference in haematocrit, WBC, total protein or weight values between the laser-excised rats and those excised by Bovie or cold-knife scalpel. There was little difference between take and survival of grafts in the Bovie, cold-knife and laser series, but there were marked differences between the thermally excised and cold-knife excised burns in the ability of epithelial islands of the burn area to grow out and cover the lost-graft areas. Differences were found in the coverage of burns between the white rat and the miniature pig.

Optical Engineering Aspects of Laser Surgical Instrumentation

At the Laser Laboratory of the Medical Center of the University of Cincinnati for more than 11 years detailed studies have been done with laser surgery in animals and in clinical investigative studies in a large series of patients. It is evident that the optical engineering phase of current laser surgical instrumentation requires considerably more research and development. Reliable high-output lasers, preferably CW, Md-YAG, CO2 are argon are required. Optical engineering requirements include flexibility and efficiency of beam transmission through small, sterilizable precise operating probes capable of incision, coagulation or fulguration. Probes must be adaptable for use with operating microscopes and for laser surgery in body cavities.