Achievement of Reactor-Relevant Performance in Negative Triangularity Shape in the DIII-D Tokamak.

Plasma discharges with a negative triangularity (δ=-0.4) shape have been created in the DIII-D tokamak with a significant normalized beta (β_{N}=2.7) and confinement characteristic of the high confinement mode (H_{98y2}=1.

Tokamak operation with safety factor q95 < 2 via control of MHD stability.

Magnetic feedback control of the resistive-wall mode has enabled the DIII-D tokamak to access stable operation at safety factor q(95) = 1.9 in divertor plasmas for 150 instability growth times. Magnetohydrodynamic stability sets a hard, disruptive limit on the minimum edge safety factor achievable in a tokamak, or on the maximum plasma current at a given toroidal magnetic field.

Patterns of initial recurrence in completely resected gastric adenocarcinoma.

Objective: To review recurrence patterns in completely resected gastric adenocarcinoma.

Summary Background Data: Despite improvements in the surgical treatment of gastric adenocarcinoma, recurrence rates remain high in patients with advanced stage disease. Understanding the timing and patterns of recurrence is essential to develop effective adjuvant treatment strategies.

The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma.

Background: Efforts to improve surgical outcomes have traditionally focused on improving preoperative patient selection and reducing the risk of postoperative medical complications. Strategies to optimize surgical technique have been less well studied. We sought to assess the relation between complications related to surgical technique and outcomes after esophagogastrectomy for cancer.

Accurate lymph node staging is of greater prognostic importance than subclassification of the T2 category for gastric adenocarcinoma.

Background: Examination of 15 or more lymph nodes is necessary for accurate staging of gastric adenocarcinoma. This study examined whether prognostic discrimination is improved by distinguishing between pT2 tumors limited to the muscularis propria (MP) and those extending to subserosa (SS).

Methods: A single-institution, prospectively maintained database for 1985-2000 was reviewed for patients who had had R0 resection of pT2 gastric carcinoma.

Sustained stabilization of the resistive-wall mode by plasma rotation in the DIII-D tokamak.

Values of the normalized plasma pressure up to twice the free-boundary stability limit predicted by ideal magnetohydrodynamic (MHD) theory have been sustained in the DIII-D tokamak. Long-wavelength modes are stabilized by the resistive wall and rapid plasma toroidal rotation. High rotation speed is maintained by minimization of nonaxisymmetric magnetic fields, overcoming a long-standing impediment [E.

Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.

Background: Two years after undergoing resection of liver metastases from colorectal cancer, about 65 percent of patients are alive and 25 percent are free of detectable disease. We tried to improve these outcomes by treating patients with hepatic arterial infusion of floxuridine plus systemic fluorouracil after liver resection.

Methods: We randomly assigned 156 patients at the time of resection of hepatic metastases from colorectal cancer to receive six cycles of hepatic arterial infusion with floxuridine and dexamethasone plus intravenous fluorouracil, with or without leucovorin, or six weeks of similar systemic therapy alone.

Metastatic breast cancer masquerading as gastrointestinal primary.

Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis.

Liver resection for colorectal metastases.

Purpose: More than 50,000 patients in the United States will present each year with liver metastases from colorectal cancers. The current study was performed to determine if liver resection for colorectal metastases is safe and effective and to evaluate predictors of outcome.

Materials And Methods: Data for 456 consecutive resections performed between July 1985 and December 1991 in a tertiary referral center were analyzed.

Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomized clinical trial.

Unlabelled: Delayed gastric emptying after esophagogastrectomy can pose a significant early postoperative problem. Because erythromycin, which stimulates the gastric antral and duodenal motilin receptor, has been shown to significantly increase gastric emptying in patients with diabetic gastroparesis, we decided to evaluate its effect on gastric emptying after esophagogastrectomy.

Methods: Twenty-four patients (18 men and six women, age range 41 to 79 years, median 66 years) were randomized to receive either erythromycin lactobionate (200 mg in 50 ml normal saline solution intravenously) (n = 13) or placebo (50 ml normal saline solution intravenously (n = 11) 11 days after esophagogastrectomy (with pyloric drainage procedure).

The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy.

Objective: The purpose of this study was to determine if an endosurgical approach that mimics open exploration would improve the accuracy of simple diagnostic laparoscopy. SUMMARY BACKGROUND DATA; Most patients with peripancreatic malignancy are found at exploration to be unable to undergo resection. Laparoscopy has been suggested as a sensitive method for detecting metastatic disease in this group of patients.

Options in the surgical treatment of esophageal carcinoma.

A single accepted approach for esophageal excision and reconstruction has not yet been devised. The authors describe the options in surgical approaches available for esophageal resection when dealing with carcinoma and discuss the extent of esophageal resection and lymph node dissection, the conduit, and routes of reconstruction.

Long term central vascular access through the gonadal vein.

A technique for long term central venous access through the gonadal vein is described. It has been used five times in four patients with consistently satisfactory results.

Arterial hemorrhage after pancreatoduodenectomy. The 'sentinel bleed'.

Experienced centers report reduced operative mortality after pancreatoduodenectomy for cancer, but significant complications continue to occur in as many as 25% of patients. Anastomotic disruption leads to sepsis in the pancreatic bed where major vascular structures have been exposed by regional lymphadenectomy, creating a setting for arterial erosion or ligature slough and massive hemorrhage. Dehiscence of the pancreatojejunostomy is a particular risk.

Upper abdominal cancer surgery in the very elderly.

From January 1981 to December 1987, 59 major upper abdominal operations were performed on 57 patients aged 80 to 90 years at Memorial Sloan-Kettering Cancer Center. Procedures for primary adenocarcinoma of the stomach, distal esophagus, pancreas, or hepatobiliary system were performed with curative intent or for palliation in 34 of 59 patients (58%) and bypass with limited or no resection in 13 of 59 patients (22%) patients. Emergency operations were performed in six (10%) patients for gastric bleeding, perforation, or outlet obstruction.