ABSTRACT
BACKGROUND: Pancreatic islet cell tumors are categorized as either functioning or nonfunctioning. Functioning islet cell tumors (FIT) elaborate a variety of hormones, producing dramatic symptoms, while the initial presentation of non-functioning islet cell tumors (NIT) is commonly an abdominal mass or symptom complex related to invasion of adjacent structures. As a result, NIT are purported to present at a later stage, with lower resectability rates, and an overall poorer prognosis, when compared to FIT. In addition, a number of reports have indicated that the incidence of NIT has increased significantly in recent years. PATIENTS AND METHODS: Twenty-eight patients were studied retrospectively. All had islet cell tumors of the pancreas and were seen at the University of Nebraska Medical Center and affiliated Nebraska Methodist Hospital during a 19-year period. RESULTS: There were 9 patients (32%) in the NIT group and 19 (68%) in the FIT group. The mean ages at presentation were 61 years for the NIT and 52 years for the FIT group. In the NIT group, all presented with either abdominal pain (n = 7) or jaundice (n = 2). In contrast, over 90% of the patients with FIT had symptoms referable to the specific hormone elaborated by the tumor. Primary tumor size for NIT was 4.1 +/- 0.7 cm versus 5.0 +/- 0.6 cm for the FIT group. No significant difference was found for NIT versus FIT with respect to the incidence of metastatic disease at presentation (44% versus 53%), resectability rate with curative intent (44% versus 53%), or disease-free survival at 2 years (67% versus 40%). CONCLUSIONS: This series, in contrast to earlier reports, suggests that nonfunctioning islet cell tumors do not present at a more advanced stage, have lower resectability rates, or an overall poorer long-term prognosis when compared to functioning tumors.
Subject(s)
Adenoma, Islet Cell/physiopathology , Pancreatic Neoplasms/physiopathology , Adenoma, Islet Cell/diagnosis , Adenoma, Islet Cell/surgery , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Prognosis , Retrospective StudiesABSTRACT
We retrospectively studied subclavian catheter infection rates involving 481 patients from October 1983 to September 1985. Over this period of time 496 subclavian catheters including 252 single lumen catheters (SLC) and 244 triple lumen catheters (TLC) were inserted. These studies involved all catheters inserted during the 24-month period. The Methodist Hospital IV Team regularly cared for and recorded catheter-related problems. Charts were then retrospectively reviewed and data accumulated. The incidence of catheter tip infections in SLC was 4/248 (1.6%) compared to an incidence of 12/232 (4.9%) for TLC, p = 0.065. There was no significant difference between the incidence of infections at the insertion site of TLCs, 1/243 and SLCs, 1/251. We believe that the increase in catheter-related infections in the TLC is related to the increased utilization afforded by the multiple injection ports.
Subject(s)
Catheterization, Central Venous/adverse effects , Staphylococcal Infections/etiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Catheterization, Central Venous/instrumentation , Catheters, Indwelling/adverse effects , Evaluation Studies as Topic , Female , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Subclavian VeinABSTRACT
The records of 198 women over 80 years of age with breast cancer were reviewed to identify characteristics of breast cancer and to determine the effect of age in management of the disease in elderly women. Twenty percent of the patients were not staged at diagnosis. Axillary lymph node status was undetermined in 40 percent of the patients because operation was limited to lumpectomy or mastectomy (either simple or total). Complications were related to the operative wound. Breast cancer and cardiovascular disease accounted for 115 of 146 deaths and the 5 year survival rate was 35.6 percent. We have concluded that breast cancer in elderly women can be treated with appropriate surgical therapy and should not be limited because of age.
Subject(s)
Adenocarcinoma, Scirrhous/surgery , Adenocarcinoma/surgery , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Adenocarcinoma/mortality , Adenocarcinoma, Scirrhous/mortality , Age Factors , Aged , Breast Neoplasms/mortality , Carcinoma, Intraductal, Noninfiltrating/mortality , Female , Humans , Mastectomy/methods , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
Anatomical variations in the biliary tract are reported with sufficient frequency to be of concern to the operating surgeon. They are often not identified prior to surgery. Drainage of both intrahepatic ducts into the gallbladder was identified in a case as the gallbladder was removed. The common bile duct proximal to the cystic duct was atretic. The problem was treated by a choledochoduodenostomy at the confluence of the hepatic ducts in the gallbladder bed.
