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1.
Pacing Clin Electrophysiol ; 21(11 Pt 2): 2204-8, 1998 Nov.
Article in English | MEDLINE | ID: mdl-9825319

ABSTRACT

The morphology of intracardiac electrograms (IEGMs) was used for pacemaker patient workload estimation. The body posture also was studied as another characteristic. The IEGMs were obtained and recorded via temporary transcutaneous leads connected to the implanted pacemaker. IEGMs were recorded during exercise and at rest. Recordings at rest were performed in different body positions. The morphology was analyzed visually in order to observe changes due to workload and posture. The recordings were digitized and processed by a computer-simulated neural network. The network was used as an automatic IEGM classifier based on the morphology. Our results show that the morphology of the IEGM may be used as an indicator of patient workload and body posture. The necessary information is found mainly in the ST segment. We conclude that neural networks seem to be useful in an active cardiac device.


Subject(s)
Neural Networks, Computer , Pacemaker, Artificial , Software , Aged , Aged, 80 and over , Algorithms , Cardiac Pacing, Artificial , Computer Simulation , Electrocardiography , Female , Heart Block/therapy , Humans , Male , Middle Aged , Posture , Signal Processing, Computer-Assisted
2.
Int J Radiat Oncol Biol Phys ; 13(1): 5-10, 1987 Jan.
Article in English | MEDLINE | ID: mdl-3804816

ABSTRACT

Beginning in December 1975, at the Massachusetts General Hospital (MGH) patients with rectal carcinomas thought to be at high risk of local recurrence after potentially curative surgical resection, were entered on a treatment protocol of high dose postoperative radiation therapy. Treatment was given with X rays of 10 MeV, generally using a four-field box technique to a dose of 4500 cGy with a boost to 5040 cGy or higher when the small bowel could be excluded from the reduced field. One-hundred sixty-five patients who began their radiation therapy between December 1975 and December 1982 were entered into the study. The median age was 65 years. The median follow-up in the survivors was 56 months, with a minimum follow-up of 17 months. All but 10 patients were followed for more than 2 years. Of the entire group, the actuarial 5-year survival was 53%, with survival of 71% in patients with Stage B-2, 39% in Stage C-2, and 17% in Stage C-3. Local failure was seen in 5/53 patients with Stage B-2 disease and 0/7 of patients with Stage B-3 disease. In patients with positive lymph nodes, local failure occurred in 2/10 (20%) of patients with Stage C-1, 16/77 (21%) of Stage C-2, and 8/15 (53%) of patients with Stage C-3 disease. Compared to previous series of surgery alone, the local failure rate has been decreased by more than one-half in all patients, except those with Stage C-3. Efforts to maximize the radiation doses in all stages should be made to minimize local failure. For Stage C-3, newer strategies such as intraoperative radiation therapy should be employed to decrease the continuing high incidence of failures.


Subject(s)
Rectal Neoplasms/radiotherapy , Aged , Combined Modality Therapy , Follow-Up Studies , Humans , Prognosis , Rectal Neoplasms/surgery
3.
Arch Surg ; 121(4): 421-3, 1986 Apr.
Article in English | MEDLINE | ID: mdl-3954588

ABSTRACT

We treated 29 patients who had primarily unresectable rectal cancer with an aggressive combined surgical and radiotherapeutic approach. Each patient received 5,040 rad of preoperative external beam radiation therapy. Eighteen patients responded adequately to allow resection of all macroscopic tumor; 11 patients underwent resection but had residual cancer in the pelvis. A single bolus of 1,000 to 2,000 rad of intraoperative electron beam radiation was given. Follow-up time ranged from three to 66 months, with a median of 43 months for living patients. The actuarial local control rate at 36 months for the entire group was 87%. In the group of 18 patients who underwent resection, the local control rate was 92%, with a three-year survival rate of 70%. Our results are considerably improved over our prior experience without intraoperative radiation therapy--a 57% local control rate and a 30% three-year survival rate.


Subject(s)
Radiotherapy/methods , Rectal Neoplasms/radiotherapy , Actuarial Analysis , Adult , Aged , Female , Humans , Infections/etiology , Intraoperative Period , Male , Middle Aged , Neoplasm Metastasis , Postoperative Complications/etiology , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery
4.
Surg Gynecol Obstet ; 161(5): 438-44, 1985 Nov.
Article in English | MEDLINE | ID: mdl-3876608

ABSTRACT

It is now evident that injection sclerotherapy is a fast, effective method for controlling the acute variceal bleed. The results of sclerosis for control of acute variceal hemorrhage have been reported by many, including ourselves, and control rates vary from 78.0 to 95.0 per cent. Herein, we report a control rate of 94.7 per cent and a rebleeding rate of 22.0 per cent using a technical variation of sclerosis therapy. Thrombosclerosis is used soon after admission to the emergency room as a first line treatment to control variceal bleeding, often in lieu of the Sengstaken tube. Follow-up injections are scheduled at increasing intervals to achieve definitive control of the varices and are an essential feature of sclerotherapy as a management option.


Subject(s)
Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/therapy , Sclerosing Solutions/therapeutic use , Acute Disease , Adult , Aged , Esophageal and Gastric Varices/pathology , Esophageal and Gastric Varices/therapy , Esophagus/pathology , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Sclerosing Solutions/administration & dosage
5.
Am J Surg ; 149(1): 65-72, 1985 Jan.
Article in English | MEDLINE | ID: mdl-3881057

ABSTRACT

Ultrasonography can detect changes in pancreatic and bile duct sizes after pancreatic stimulation by secretin or morphine and prostigmine. The effects of the two pharmacologic regimens on pancreatic duct dilatation were comparable and correlated with papillary stenosis determined at surgery, but the morphine and prostigmine combination produced more false-positive responses than did secretin. After administration of intravenous secretin (1 unit/kg), the pancreatic duct dilated in 83 percent of 12 symptomatic patients found at surgery to have a stenotic sphincter of Oddi and in 72 percent of 17 symptomatic patients found to have a stenotic accessory papilla associated with the pancreas divisum anomaly. Comparable dilatation occurred in 14 percent of 14 control subjects without suspected ampullary disease and in none of 10 patients with surgically disproved stenosis (p less than 0.001). The morphine and prostigmine combination produced more false-positive results in both the pancreatic duct and bile duct. Concomitant elevation of the serum amylase level and reproduction of pain were found to be of no discriminatory value. In patients whose pancreatic duct dilated preoperatively during secretin stimulation, dilatation did not occur after surgical sphincteroplasty. A positive test result was associated with a 90 percent success rate in preventing recurrent pancreatitis and ameliorating pain. A negative test result was associated with a 29 percent success rate. Ultrasonography of the pancreatic duct with secretin stimulation may provide objective criteria to supplement clinical judgment in selecting patients for sphincteroplasty to treat stenosis of either the sphincter of Oddi or the accessory papilla in pancreas divisum.


Subject(s)
Ampulla of Vater , Pancreas/drug effects , Pancreatic Ducts , Sphincter of Oddi , Ultrasonography , Common Bile Duct/pathology , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/surgery , Dilatation, Pathologic/diagnosis , False Negative Reactions , Humans , Morphine , Neostigmine , Pancreas/abnormalities , Pancreatic Diseases/diagnosis , Pancreatic Diseases/surgery , Pancreatic Ducts/pathology , Secretin , Stimulation, Chemical
7.
Annu Rev Med ; 36: 619-25, 1985.
Article in English | MEDLINE | ID: mdl-3994327

ABSTRACT

Carcinoma of the large bowel arises almost exclusively in neoplastic polyps, which are present in 5-10% of the population over age 40. These polyps may be of three histologic types: (a) tubular adenoma (adenomatous polyp), (b) tubulovillous adenoma (villoglandular polyp), and (c) villous adenoma. The tendency for malignant change is greatest in the villous adenoma (41%) and in tubulovillous (villoglandular polyps--23%). In tubular adenomas (simple adenomatous polyps), the incidence of malignancy is 5% over all. The tendency toward malignant change is determined by histologic type, size, and degree of atypicality of adenoma. Early detection and complete removal of neoplastic polyps of the colon are essential to the prevention of cancer of the large bowel, and this may usually be done in most cases with the colonoscope.


Subject(s)
Colonic Polyps/surgery , Adenoma/pathology , Colonic Polyps/diagnosis , Colonic Polyps/pathology , Follow-Up Studies , Hamartoma/pathology , Humans , Inflammation , Neoplasm Recurrence, Local , Syndrome
8.
Int J Radiat Oncol Biol Phys ; 10(10): 1831-9, 1984 Oct.
Article in English | MEDLINE | ID: mdl-6436198

ABSTRACT

The ability to demonstrate an improvement in therapeutic ratio is critical in assessing new treatment modalities; an evaluation of treatment complications is essential for this purpose. We have studied the severe complications occurring after treatment with intraoperative radiation therapy (IORT) in patients with locally advanced carcinoma of the rectum. Four groups of patients were compared: Group 1 (80 patients) had treatment with surgery alone for mobile and resectable tumors; Group 2 (23 patients) had treatment with high dose preoperative irradiation followed by surgical resection for tumors which were fixed to adjacent structures and initially unresectable for cure; Group 3 (24 patients, primary disease) and Group 4 (17 patients, locally recurrent disease) had locally advanced tumors as in Group 2 but were treated with IORT after preoperative irradiation and attempted surgical resection. All but 3 complications occurred within one year of therapy. Severe complications were seen in 16% of patients in Group 1, 35% in Group 2, 21% in Group 3 and 47% in Group 4 (32% in Groups 3 and 4 combined). There was a statistically insignificant increase (p = .10) in the complication rate in all irradiated patients (locally advanced tumors) compared to surgery alone (clinically mobile tumors). These data indicate no increase in severe complications with the use of IORT. If the ongoing studies continue to show improved local control with the use of IORT, expanded use of this modality may be warranted.


Subject(s)
Radiotherapy, High-Energy/adverse effects , Rectal Neoplasms/radiotherapy , Adult , Aged , Combined Modality Therapy , Electrons , Female , Humans , Intraoperative Period , Male , Middle Aged , Particle Accelerators , Rectal Neoplasms/surgery
9.
Dig Dis Sci ; 29(6): 481-5, 1984 Jun.
Article in English | MEDLINE | ID: mdl-6609803

ABSTRACT

Angiodysplasia is a recently recognized important cause of lower intestinal bleeding in older patients. Although angiography is an established procedure for the diagnosis of angiodysplasia, colonoscopy is being used increasingly for evaluation of lower intestinal bleeding. In order to define the nature of bleeding due to angiodysplasia and the appropriate role of colonoscopy, 80 patients diagnosed by angiography, pathology, or colonoscopy were reviewed. Bleeding attributable to angiodysplasia varied from acute life-threatening hemorrhage to occult blood in stools. Thirteen patients with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. Eighty-nine percent of the lesions were located in the right colon and there was a mean of 1.5 angiodysplastic lesions per patient. The sensitivity of colonoscopy compared to angiography and pathology was 68% overall and 81% when the colon was completely examined and lesions were located in the colon. The predictive value of a positive colonoscopic diagnosis was 90% in this population. Colonoscopy should be employed as an initial study in patients with chronic or mild acute rectal bleeding.


Subject(s)
Colon/blood supply , Colonoscopy , Vascular Diseases/diagnosis , Acute Disease , Aged , Angiography , Dilatation, Pathologic , Evaluation Studies as Topic , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Vascular Diseases/complications , Vascular Diseases/pathology
10.
Surg Clin North Am ; 64(3): 511-28, 1984 Jun.
Article in English | MEDLINE | ID: mdl-6379928

ABSTRACT

The article describes the reintroduction of the use of stapling devices for intestinal suture at Massachusetts General Hospital in 1976, and reviews the results. Tabulated data of a large number of procedures performed are presented in detail and discussed.


Subject(s)
Digestive System Surgical Procedures , Surgical Staplers , Suture Techniques , Boston , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Surgical Staplers/adverse effects , Surgical Wound Dehiscence/etiology
11.
Hepatology ; 4(3): 536-40, 1984.
Article in English | MEDLINE | ID: mdl-6724520

ABSTRACT

We report the case of a 28-year-old woman with a history of oral contraceptive use and the simultaneous occurrence of histologically proven hepatic adenoma and focal nodular hyperplasia. A review of the literature discloses that the simultaneous occurrence of these hepatic lesions is a rare event. Epidemiologic evidence suggests that hepatic adenomas are etiologically related to oral contraceptive use, whereas focal nodular hyperplasia does not seem to be caused by these agents. The finding of the two lesions in the same liver may represent the chance occurrence of two rare diseases.


Subject(s)
Adenoma/complications , Liver Neoplasms/complications , Liver/pathology , Adenoma/chemically induced , Adenoma/pathology , Adult , Angiography , Contraceptives, Oral/adverse effects , Female , Humans , Hyperplasia/complications , Liver Circulation , Liver Neoplasms/chemically induced , Liver Neoplasms/pathology
12.
Int J Radiat Oncol Biol Phys ; 9(11): 1597-606, 1983 Nov.
Article in English | MEDLINE | ID: mdl-6417072

ABSTRACT

While combinations of external beam radiation (XRT) and surgery decrease pelvic recurrence and improve survival in the subgroups with residual disease (postop XRT) or initially unresectable disease (preop XRT), local recurrence is still unacceptably high, and survival could be improved. In view of this, pilot studies were instituted at Massachusetts General Hospital in which 32 patients received the standard previous treatment of external beam irradiation and surgery but in addition had an intraoperative electron beam boost of 1000-1500 rad to the remaining tumor or tumor bed. For the 16 patients who presented with unresectable primary lesions, the addition of intraoperative radiotherapy has resulted in a total absence of local recurrence with a minimum 20 month follow-up, and survival rates are statistically better than for the previous group treated with only external beam irradiation and surgical resection. In the group with residual disease, again there have not been any local recurrences in the 7 patients who received all treatment modalities versus 54% and 26% for the group with gross and microscopic residual treated with only external beam techniques. The remaining 9 patients presented with recurrent unresectable lesions--3 are alive (2 NED) at greater than or equal to 3 years.


Subject(s)
Colonic Neoplasms/radiotherapy , Rectal Neoplasms/radiotherapy , Colonic Neoplasms/surgery , Combined Modality Therapy , Electrons , Humans , Intraoperative Period , Particle Accelerators , Radiotherapy, High-Energy , Rectal Neoplasms/surgery
13.
Cancer ; 52(3): 446-51, 1983 Aug 01.
Article in English | MEDLINE | ID: mdl-6861084

ABSTRACT

A regimen of low-dose preoperative radiation therapy (RT), surgery, and elective postoperative RT for resectable carcinomas of the rectum and rectosigmoid is presented. Initial results in a group of 36 patients is discussed. In four patients clinically silent metastatic disease was discovered. Of 16 patients without indications for postoperative RT, only one died with disease. Indications for postoperative irradiation were found in 15 patients and four relapses (26%) subsequently occurred. Since the surgicopathologic stage of the tumor is the best prognostic predictor for rectal cancer, this regimen allows for the delivery of high-dose adjuvant irradiation only to those at high risk of local recurrence. Thus, this combination selects patients likely to benefit from postoperative RT while preserving the advantages of preoperative RT.


Subject(s)
Rectal Neoplasms/radiotherapy , Sigmoid Neoplasms/radiotherapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Prognosis , Radiotherapy Dosage , Rectal Neoplasms/surgery , Sigmoid Neoplasms/surgery
15.
Am J Surg ; 143(4): 426-31, 1982 Apr.
Article in English | MEDLINE | ID: mdl-6978620

ABSTRACT

Fifty-three patients with upper gastrointestinal bleeding and proven esophageal varices were treated by intravascular injection sclerotherapy of the varices using a mixture of ethanolamine oleate, bovine thrombin and cephalothin. An intraesophageal balloon was used to impede craniad flow during the injection. Except in three patients who failed to stop bleeding from nonvariceal lesions, sclerotherapy was 94 percent successful in controlling bleeding. The mortality rate in sclerotherapy patients with ascites was 25 percent compared with 54 to 75% reported elsewhere. There has been no rebleeding from varices after the third treatment week in patients followed up for up to 14 months.


Subject(s)
Esophageal and Gastric Varices/drug therapy , Ethanolamines/therapeutic use , Oleic Acids/therapeutic use , Sclerosing Solutions/therapeutic use , Ascites/complications , Endoscopy , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/pathology , Esophagogastric Junction/pathology , Female , Gastrointestinal Hemorrhage/mortality , Gastrointestinal Hemorrhage/prevention & control , Humans , Male , Middle Aged , Pilot Projects
16.
J Clin Gastroenterol ; 3(2): 203, 1981 Jun.
Article in English | MEDLINE | ID: mdl-7240701
19.
Arch Surg ; 112(10): 1201-3, 1977 Oct.
Article in English | MEDLINE | ID: mdl-907463

ABSTRACT

Aneurysms of the pancreaticoduodenal arcades, although uncommon, may rupture and produce symptoms similar to those of pancreatic carcinoma. We describe one patient with a ruptured interior pancreaticoduodenal artery aneurysm and a large hematoma in the pancreatic head. He had a three-week history of painless jaundice. Angiography was essential in establishing the diagnosis and defining a vascular road map preoperatively. The surgical management involved resection of the aneurysm and vascular reconstruction.


Subject(s)
Aneurysm/diagnosis , Duodenum/blood supply , Pancreas/blood supply , Pancreatic Neoplasms/diagnosis , Aneurysm/complications , Aneurysm/diagnostic imaging , Aneurysm/surgery , Angiography , Arteries , Cholestasis/etiology , Diagnosis, Differential , Humans , Male , Middle Aged , Rupture, Spontaneous
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