Journal of the American College of Surgeons
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To delineate the most reasonable approach to patients with traumatic cardiac arrest we studied the experience at our level 1 trauma center. ⋯ Patients with traumatic cardiac arrest with intact neurologic function should receive treatment. Resuscitation should not be attempted in patients who also have severe brain injury or prolonged time of cardiac arrest.
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Neoadjuvant chemotherapy followed by surgery or radiation therapy, or both, has become the treatment of choice for patients with large-sized resectable carcinoma of the breast in whom mastectomy is the conventional option. Since tumor regression before surgery is considered a favorable prognostic factor, there is still controversy regarding the need to perform an axillary dissection after a good response to systemic induction treatment. ⋯ These findings suggest that axillary lymphadenectomy should be considered an important component of the combined modality therapy for patients with large-sized resectable carcinoma of the breast in order to identify subgroups of patients that may benefit from alternative treatments in the adjuvant setting.
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The application of video-endoscopy to general thoracic surgery is radically changing the approach to many benign and malignant diseases of the chest. Since July 1991, we have performed 794 purely thoracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. ⋯ These data underscore the flexibility, safety, efficacy, and potential for cost savings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity and sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Preliminary report of a prospective randomized study of octreotide in the treatment of severe acute pancreatitis.
Experimental and clinical studies on the effect of octreotide in the treatment of patients with acute pancreatitis have presented controversial results. Since January 1992, we have been conducting a prospective randomized study on the clinical effect of octreotide in severe acute pancreatitis, at three hospitals in Israel. ⋯ Although some of the parameters did not reach statistical significance, these preliminary results suggest that octreotide may have a beneficial effect in the treatment of patients with severe acute pancreatitis. This study is scheduled to continue for two more years.
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In the United States of America, the five-year survival rate among patients surviving curative resection for gastric carcinoma will range between 20 and 25 percent. In Japan, early diagnosis and an aggressive surgical approach including planned lymph node dissection has resulted in the five-year survival rate exceeding 50 percent for all patients with newly diagnosed gastric carcinoma. This report is a retrospective review evaluating the effect of extended lymph node dissection (D2) on overall survival in 101 patients with gastric adenocarcinoma who underwent a potentially curative gastric resection from 1975 to 1990 at Roswell Park Cancer Institute. ⋯ Patients treated by extended resection (D2, D2.5) were more likely to survive five years and had prolonged median survival times when compared with patients treated with limited resection (D1, D1.5). For patients with T2-4, N0-1, M0 gastric carcinomas treated with extended resection, their differences reached levels at or approaching statistical significance.