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REPORT THAT EARLY TEST WAS URGED STIRS DEBATE ON REAGAN TREATMENT [Newspaper Article]

Altman, Lawrence K
The physician who said the medical team had called for prompt action last March is Dr. Walter W. Karney, a Navy captain and the internist at Bethesda Naval Medical Center who coordinated the President's annual physical examinations in 1984 and 1985. He said Dr. Edward Cattau, a gastroenterologist who was a member of the examining team, had ''strongly urged'' last March that Mr. [Reagan] be given a colonoscopy ''as soon as possible.'' Mr. [Larry Speakes] said members of Mr. Reagan's medical team had been ''totally forthcoming'' in giving public accounts ''in greater detail, I would say, than any previous Presidential illness.'' Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, who also participated in the operation, said the medical steps that Mr. Reagan's doctors had taken and that led to the operation had been ''flawless.'' He has said it is ''almost impossible'' to know what biological changes may have occurred since March, when the decision was made not to do an immediate colonoscopy
PROQUEST:953982941
ISSN: 0362-4331
CID: 82210

Doctor Says Prompt Test of Reagan Was Urged in March [Newspaper Article]

Altman, Lawrence K
He said said Dr. Edward Cattau, a gastroenterologist who was a member of the examining team, had ``strongly urged'' after the examination last March that [Reagan] be given a colonoscopy ``as soon as possible.'' [Larry Speakes] said he had been told by all three White House doctors yesterday that although Cattau had recommended a colonoscopic examination, the recommendation ``did not stress a sense of urgency.'' In fact, he said, the White House was more aggressive in pursuing a colonoscopy than the recommendation from the Bethesda examining team suggested. [Walter W. Karney] said in the interview that the Bethesda hospital had been getting ``a bum rap'' from civilian experts who contend, with the benefit of hindsight, that a colonoscopy should have been performed 14 months ago, when the May 1984 physical found a small, benign inflammatory piece of tissue in Reagan's colon
PROQUEST:63189096
ISSN: 1932-8672
CID: 82211

PRESIDENT'S CARE HOTLY DEBATED [Newspaper Article]

Altman, Lawrence K
[Larry Speakes] said the White House had a letter from [Edward Cattau] recommending that, if the polyp detected in March was confirmed not to be an adenoma, or potentially cancerous polyp, then six more blood-stool tests should be performed. Only if one or more of those tests were positive, Speakes said, did Cattau recommend that a colonoscopy be performed
PROQUEST:90957093
ISSN: 0744-8139
CID: 82212

REAGAN'S MEDICAL FUTURE [Newspaper Article]

Altman, Lawrence K
Dr. [Steven Rosenberg], when asked directly, did acknowledge that he could not be sure that Mr. [Reagan]'s cancer had not already begun to spread. ''There is a possibility that the cancer can return,'' Dr. Rosenberg said. But a pathologist not connected with Mr. Reagan's case said he was confused about why the President's doctors were so conservative in their prognosis, of a greater than 50 percent chance of survival. Dr. Michael Kyriakos, a surgical pathologist at Washington University in St. Louis, said the description provided at the news conferences Monday by Mr. Reagan's doctors suggested a Dukes A colon cancer, with a more favorable prognosis, and not the less favorable Dukes B classification that Dr. Rosenberg gave. One yardstick is how the malignant cells appear to pathologists when they look at them through a microscope. Pathologists use the term well-differentiated when speaking of cancer cells whose architecture is well-constructed and which often grow more slowly. Pathologists use the term anaplastic to describe malignant cells with a more chaotic structure, which are likely to grow more quickly. Mr. Reagan's ''moderately well-differentiated'' cancer, as Dr. Rosenberg described it, is on the favorable side. ''A competent colonoscopist should be able to pass the instrument to the cecum in approximately 90 percent of examinations in 15 to 45 minutes,'' according to ''Internal Medicine,'' a medical textbook edited by Dr. Jay H. Stein
PROQUEST:953976481
ISSN: 0362-4331
CID: 82213

REAGAN'S DOCTORS FIND CANCER IN TUMOR BUT REPORT REMOVAL LEAVES HISCHANCES EXCELLENT> [Newspaper Article]

Altman, Lawrence K
It was good news because tests showed that the cancer was limited, confined within the muscle of his bowel wall, and had showed no signs of spreading elsewhere in the bowel. ''The chances are excellent that this tumor will not occur again,'' said Dr. Steven Rosenberg of the National Cancer Institute, a member of the surgical team caring for the President. While Dr. Rosenberg said that in Mr. [Reagan]'s case ''there is a greater than 50 percent chance'' that he was completely cured, he did not identify the cancer as being Dukes B-1 or B-2. Other experts, however, have estimated the survival rate at about 80 percent for B-1 and in the range of 50 to 60 percent for B-2. Dr. Rosenberg recognized the controversy about such therapy. ''This is an area in which oncologists may have some differing opinions,'' Dr. Rosenberg said. London Doctor Devised System The prognosis Mr. Reagan's doctors gave was based on the Dukes staging, a system named for Dr. Cuthbert E. Dukes, a pathologist at St. Mark's Hospital in London, who reported his classification plan in 1932.
PROQUEST:953971141
ISSN: 0362-4331
CID: 82214

THE DOCTOR'S WORLD; New Drug for Sleeping Sickness [Newspaper Article]

Altman, Lawrence K
African sleeping sickness of humans is caused by two strains of trypanosomes that can only be distinguished by laboratory tests and that are distinguished primarily by epidemiologic factors. East African trypanosomiasis causes its damage in a few months, more swiftly than the West African form that can become chronic, taking years to develop. (A Central and South American form called Chagas' disease, which is spread by bedbugs and affects 10 million people, is caused by yet another strain of trypanosome.) Blood-sucking tsetse flies inoculate the parasite as they bite humans or animals. The first symptoms are nonspecific: a swollen area at the site of the bite, and then headache, mild fever, fatigue, swollen lymph nodes that sometimes become tender and a faint rash that fades in about a week. The liver and spleen may swell. Meanwhile, the parasites replicate in the body and eventually make their way to the central nervous system. As that invasion occurs, a victim's speech slows to a mumble, spontaneous conversation stops, a vacant stare develops, the gait shuffles, the hands and tongue tremble, apathy and indifference turn into somnolence, sometimes alternating with insomnia during the night, and then coma. A sleeping patient may be roused but, because of lack of interest, soon falls asleep again. DFMO's role in trypanosomiasis came about when researchers interested in enzymes and cell growth began a series of biochemical manipulations in the mid-1970's. They were also interested in polyamines, substances that exist in all living cells and that play important roles in processes required for rapid cellular growth and replication. A key enzyme in the production of polyamines is ornithine decarboxylase, or ODS, and DFMO irreversibly inhibits ODS. Dr. Cyrus J. Bacchi of Pace University said a key step occurred in about 1977 when he began collaborating on DFMO after meeting Dr. Peter P. McCann of Merrell Dow at a Gordon conference. That led to the discovery of a dramatic curative effect of DFMO in mice; the drug cured the mice infected with a virulent strain of trypanosome within a week. Since then, DFMO has had widespread use as a biological tool in research, and chemists have begun synthesizing other suicide inhibitors in hopes of finding cures for other diseases.
PROQUEST:953972161
ISSN: 0362-4331
CID: 82215

Doctors wary of cancer possibility [Newspaper Article]

Altman, Lawrence K
WASHINGTON - In removing a large polyp Saturday afternoon from President [Ronald Reagan]'s colon, Dr. Dale Oller and his team of surgeons did not know if it was malignant or benign, and so they acted according to prudent medical practice and proceeded as if the polyp was a cancer. Thus they removed not only the polyp but also about a two-foot-long piece of Reagan's bowel, which is tubular in shape. Then they sewed the two ends of the remaining bowel together, one from the ileum, or the last section of the small bowel, to the transverse, or second section, of the large bowel. The missing section of bowel is not expected to interfere with Reagan's bowel function, Oller, a Navy captain, said after the operation. Oller described it as ``a no-touch'' cancer procedure, one in which the surgeons avoid touching the polyp for fear of spreading cancer cells, if they were present, in the body. The section of bowel containing the polyp was not opened while it was in Reagan
PROQUEST:61282160
ISSN: 1074-7109
CID: 82216

PRUDENT MEDICAL PRACTICE [Newspaper Article]

Altman, Lawrence K
In removing a large polyp this afternoon from President Reagan's colon, Dr. Dale Oller and his team of surgeons did not know if it was malignant or benign, and so they acted according to prudent medical practice and proceeded as if the polyp was a cancer. Thus they removed not only the polyp but also about a two-foot-long piece of Mr. Reagan's bowel, which is tubular in shape. Then they sewed the two ends of the remaining bowel together, from the ileum, or the last section of the small bowel, to the transverse, or second section of the large bowel. The lack of a section of bowel is not expected to interfere with Mr. Reagan's bowel function, Dr. Oller, a Navy Captain, said after the operation. A diagram in some copies yesterday accompanying a description of President Reagan's surgery failed to show the full extent of the section of bowel removed. In the procedure, a right hemicolectomy, approximately two feet of bowel were removed, beginning with part of the transverse colon and continuing along the entire ascending colon, plus the cecum of the colon and part of the adjoining section of the small intestine called the ileum
PROQUEST:953965161
ISSN: 0362-4331
CID: 82217

Reagan's operation classified as major [Newspaper Article]

Altman, Lawrence K
[Reagan], now 74 years old, tolerated major surgery well four years ago, when surgeons at George Washington University Hospital opened his chest and removed a bullet that had lodged near his heart after an assassination attempt. Since then Reagan's doctors have repeatedly described him as being in excellent condition. The human intestine, or bowel, is divided into two portions, the large and the small intestine. The small intestine begins at the stomach and leads to the large intestine. The first portion of the large intestine is known as the cecum, and that is where Reagan's villous adenoma was found. To physicians knowledgeable about intestinal polyps but not connected with Reagan's case, the fact that polyp was too large to be removed during the colonoscopy suggested that it might be a sessile one, that is, attached directly to the intestinal wall at the base of the polyp and not attached by a stalk. If the polyp had been attached by a stalk to the intestinal wall, as many are, then it probably could have been removed by the snare in the colonoscope, no matter what its size
PROQUEST:61281666
ISSN: 1074-7109
CID: 82218

QUOTATION OF THE DAY [Newspaper Article]

Altman, Lawrence K
Polyps of the villous adenoma type are termed ''precancerous'' because they have a much higher chance of becoming malignant than other types of adenomas, or polyps. About 30 percent of villous adenomas become cancerous, in contrast to only 2 to 5 percent of all adenomas. Also, villous adenomas that are malignant tend to recur. To physicians knowledgeable about intestinal polyps but not connected with Mr. [Reagan]'s case, the fact that the polyp was too large to be removed during the colonoscopy suggested the possibility that it might be a sessile polyp, meaning that it is attached directly to the intestinal wall at the base of the polyp and not attached by a stalk. If the polyp had been attached by a stalk to the intestinal wall, as many are, then it probably could have been removed by the snare in the colonoscope, no matter what its size. Questions of whether Mr. Reagan should have undergone tests sooner have come up again this year because blood was found in tests of Mr. Reagan's stool, and blood is less likely to come from a smaller polyp than a larger one. Although the tests were repeated and were reported to show no evidence of further bleeding, polyps, which are one of many possible causes of blood in the stool, can bleed on an intermitten basis
PROQUEST:953960141
ISSN: 0362-4331
CID: 82219