Leonard I. Goldman

Stresses affecting surgical performance and learning: I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes

Abstract Operative performance and cardiac response (heart rate and electrocardiograms) were evaluated in surgical personnel during 33 operations. These were recorded on videotapes for subsequent analysis. Fatigue and operative difficulty were associated with tachycardia in susceptible personnel. Operative performance was impaired during the former with probable impaired learning. Likewise when performance difficulties arose during surgery, the instructor joining the “scrubbed team” provided a more meaningful learning environment than did his sideline advice. This approach appears to offer a method for studying the relationship between stress, surgical performance and the learning of surgical skills.

Immunologic competence of regional lymph nodes in patients with breast cancer

In 24 patients undergoing radical mastectomy, the degree of sensitization to breast cancer was compared between lymphocytes obtained from regional lymph nodes and circulating lymphocytes. Using the direct lymphocyte migration inhibition assay a greater immunologic response was observed in regional lymph node lymphocytes as compared to circulating lymphocytes when challenged with breast cancer antigen in vitro. In the breast cancer group, migration inhibition (M.I.) was 21% ± 3% in the regional lymph node (R.L.N.) lymphocytes, as compared to 7% ± 3% in the peripheral blood (P.B.) lymphocytes (p < .01). In the control group M.I. was −10% ± 2% in the R.L.N. lymphocytes, as compared to −2% ± 3% in the P.B. lymphocytes (p = n.s.) indicating no immunologic response to the breast cancer antigen. A significant delayed hypersensitivity response (M.I. > 20%) was found in 17/24 regional lymph nodes of the radical mastectomy group, as compared to 7/24 in the peripheral blood samples tested in the same group, indicating a superior immune response in the regional lymph node lymphocyte population. These data support the concept that regional lymph nodes in breast cancer patients are immunologically competent, and that the lymphocytes in these nodes are more reactive with a tumor antigen than are the circulating lymphocytes.

Preoperative nuclear scans in patients with melanoma

One hundred forty‐one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow‐up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

Adenocarcinoma of the small bowel complicating Crohn's disease

The seventeenth recorded case of adenocarcinoma of the small bowel complicating Crohns disease is presented. This patient, the youngest reported, was followed in her entirety by the authors since the diagnosis of regional enteritis was established at age 10. the literature is reviewed and a comparison made to small bowel carcinoma not associated with regional enteritis.

Leiomyosarcoma of the colon—A revised prognosis

SummaryExtrarectal leiomyosarcoma of the colon is a pathologic rarity. An unduly optimistic prognosis has been reported. Our experience with a rapidly lethal case prompted this review. Follow-up information was requested from previous reviewers. Only two cases of five-year survival without disease have been documented. Because of these statistics and the early deaths of ten patients, we believe that the optimism previously mentioned is unwarranted.

Penetrating Abdominal Wounds in a Civilian Population

Abstract Our experience with penetrating abdominal wounds have been reviewed. The major cause of death is massive hemorrhage and its sequelae. The management of various organ injuries has been reviewed. Peritoneal sepsis proved to be a rather minor complication in this civilian group. The purpose of this report is to analyze our experience, during a ten year period, with 196 penetrating abdominal wounds. Since 94 per cent of these patients were managed by the house staff, principles concerning this type of trauma are reviewed. We strongly urge that all penetrating abdominal wounds be examined to rule out intraperitoneal injury. The over-all mortality rate was 3.6 per cent with no deaths occurring in forty-one patients in whom exploratory examination revealed no intraperitoneal penetration or injury.

5-Fluorouracil inhibition of experimental peritoneal adhesions.

Abstract Experimental adhesions were produced in rats. 5-Fluorouracil in daily doses of 25 mg./ kg., 37.5 mg./kg., and 50 mg./kg. was administered subcutaneously to three groups of animals and results were compared in controls receiving saline solution. Formation of adhesions was prevented by using the 50 mg./kg. per day dose. Marked toxicity is associated with this dose. Neither inhibition of adhesion formation nor toxicity occurred in the other dose ranges.

Breast biopsy vacucylinder

Summary There is a need for a simple, reliable means for obtaining biopsy specimens of the human breast that are more ample than those obtainable with needle technics. Such tissue specimens are needed for improved diagnosis of cancerous and precancerous lesions as well as for other studies requiring adequate amounts of tissue. We have designed, constructed, and preliminarily tested an instrument for such purposes. The instrument has repeatedly secured tissue specimens 3 or 4 mm in diameter and several centimeters in length from the breast immediately prior to mastectomy. It consists of a cylinder 3 or 4 mm in diameter with a disposable razor-sharp cutting tip and an adapter at the opposite end to which a vacuum tube is applied. Experience with more than twelve cases to date has been without complication.

The effect of distal small bowel bypass and resection on 7,12-dimethylbenz[a]anthracene-produced mammary carcinoma in the rat☆

Abstract Distal ileal bypass or resection performed prior to the intragastric instillation of DMBA in sesame oil to 50–52-day-old female Holtzman rats significantly reduces tumor production. This effect is not present when animals are bypassed after the administration of carcinogen. Tissue levels of DMBA are low in the groups with lowered incidence of tumor and reflect decreased absorption of this agent. Significantly fewer tumors developed with ileal bypass than with ileal resection. The addition of cholic acid reverses this effect. Both serum cholesterol and weight gain are not affected by these procedures.