bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemotherapy of ovarian germ cell tumors and sex cord stromal tumors
Authors: Gershenson David M.
Published: February 2007

Malignant ovarian germ cell tumors (ogct) and sex cord stromal tumors (scst) are much less common than epithelial ovarian cancer, each accounting for less than 5% of all ovarian malignancies. The combination of vincristine, dactinomycin, and cyclophosphamide (vac) became the standard chemotherapy for patients with ogct in the 1970s; it produced excellent sustained remission rates in patients with stage i disease but less than 50% sustained remission rates in those with metastatic tumor. With the introduction of cisplatin for the treatment of testicular cancer in the late 1970s, platinum‐based regimens replaced the vac regimen by the mid‐1980s. Currently, the most popular regimen for all patients with ogct is the combination of bleomycin, etoposide, and cisplatin (bep). The bep regimen appears to be superior to vac, with sustained remission rates of more than 75% in patients with metastatic tumor. For patients with metastatic pure dysgerminoma, chemotherapy appears to have supplanted radiotherapy as standard treatment with the advantage of preserving fertility in most patients. For patients with scst, no standard therapy exists. Surgery alone is currently acceptable treatment for all patients with scst except those with metastatic disease, sarcomas, or sertoli‐leydig cell tumors with poor differentiation or heterologous elements. Currently, platinum‐based combination chemotherapy is favored for these latter patients but activity with such regimens is only modest. © 1994 Wiley‐Liss, inc.
Role of radiation in the management of adult patients with sarcoma of soft tissue
Authors: Suit Herman D. , Spiro Ira
Published: February 2007

Radiation in moderate dose levels, viz. 60‐65 Gy at 2 Gy/fraction, administered in combination with conservative surgery, yields local control frequencies at least comparable to those achieved by radical resectional surgery alone. The clinical interest in this management strategy is the reduction in the scope of the resection and a consequent gain in cosmetic and functional status. This combined approach is favored for sarcomas so situated that resection with wide margin, ≧ 2 cm at the most narrow, cannot be realized unless there is a clinically important loss in function. Where radical surgery is planned, there must be great care in assessment of the probability of achieving good margins. The patient is ill served if there is radical surgery and then, because of close margins, postoperative radiation is required. There appears to be clinical gain for the patient with a large sarcoma by administering the radiation preoperatively. Advantages include smaller treatment volume and higher local control rates. The management of the surgical wound in the irradiated patient is discussed. Also, brief consideration is given to current use of brachytherapy, high linear energy transfer (LET) radiation, and combination of radiation and chemotherapy. © 1994 Wiley‐Liss, Inc.
Chemotherapeutic approaches to soft tissue sarcomas
Authors: Edmonson John H.
Published: February 2007

Conventional chemotherapy for adult type soft tissue sarcomas is not very effective. Rarely are patients with advanced soft tissue sarcomas curable by systemic chemotherapy. Thus, the benefits from chemotherapy have been equivocal even when treatment is given postoperatively to patients whose primary sarcomas have been excised. Current research is directed toward the achievement of a high percentage of complete tumor regressions in patients with advanced metastatic disease in hope that this can be translated into truly effective adjuvant therapy. Several recent new approaches to systemic treatment for soft tissue sarcomas are assessed including prospects for possible enhancement of chemotherapy by agents which stimulate cellular immunity. Some unexpectedly favorable responses to chemotherapy + granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) in an ongoing study are discussed. © 1994 Wiley‐Liss, Inc.
Gynecological sarcomas
Authors: Disaia Philip J. , Pecorelli Sergio
Published: February 2007

Sarcomas of the uterus, ovary and lower genital tract are fortunately rare, since the prognosis is quite often poor. The most frequent are sarcomas of the uterine corpus, and these account for only 4% of all uterine tumors. Ovarian sarcomas are less frequent, and the prognosis is even poorer when compared to the uterus. Sarcoma of the lower genital tract (vagina and vulva) in adults in often published as a case report, given their very infrequent occurrence. © 1994 Wiley‐Liss, Inc.
Laparoscopic approaches to abdominal malignancy
Authors: Greene Frederick L. , Brown Pamela A.
Published: February 2007

The use of laparoscopy for diagnosis and staging of intra‐abdominal malignancies is not an exclusive procedure. It is another modality in the armamentarium of caring for the patient. The selection of the appropriate patients is discussed in detail and must include a determination of the long‐range plans for intervention. The technical issues include problems of previous abdominal surgery, adhesions, ability to tolerate general endotracheal anesthesia, and ability to properly position the patient for an adequate examination. The endoscopic surgeon must be able to differentiate between the benign and malignant process during endoscopic examination and must be skilled in obtaining appropriate biopsies. In the staging of lymphoma, laparoscopy has virtually replaced the open celiotomy technique. Laparoscopic removal of appropriate lymph nodes is essential. The role of laparoscopy in a second‐look operation is discussed as well as contraindications and complications of the procedure. © 1994 Wiley‐Liss, Inc.
Apneumic laparoscopy in surgical oncology
Authors: Schneider James J. , Smith R. Stephen , Organ Claude H.
Published: February 2007

Minimally invasive techniques now play an important role in virtually every aspect of general surgery. While it is unlikely that celiotomy for malignant disease will fall into obscurity as rapidly as open cholecystectomy, greater use of videoscopic techniques in surgical oncology are inevitable and will undoubtably improve patient care. Techniques of isopneumic laparoscopy have already proven useful in trauma, chole‐cystectomy, bowel resection, herniorrhaphy, and a variety of other procedures. Further advances in this technique are dependent on the development of “user friendly” abdominal wall retraction systems. © 1994 Wiley‐Liss, Inc.
Laparoscopy for construction of feeding enteral tubes and diverting stomas
Authors: Duncan Titus D. , Mason Edward M.
Published: February 2007

Laparoscopy has now assumed a new and important role in the treatment of malignant diseases. An important part of this role is the establishment of feeding enterostomies and stomas. This function is vital in both those patients who may not be candidates for curative therapy and those being staged for definitive therapy. © 1994 Wiley‐Liss, Inc.
Minimally invasive surgery for pulmonary and esophageal tumors
Authors: McKenna Robert J.
Published: February 2007

The development of endoscopic video capabilities has opened a new era in thoracic operations. This paper discusses video‐assisted thoracic surgery (VATS) as part of the armamentarium of the thoracic surgeon. VATS is the procedure of choice for a solitary pulmonary nodule. It is also a useful staging procedure in selected patients with pulmonary and esophageal tumors. The role of VATS in the definitive resection of certain lung cancers is discussed and there is a call for randomized controlled studies to determine if there is an advantage for the utilization of VATS. The use of VATS for resection of esophageal tumors is discussed. It is currently under development and investigation. © 1994 Wiley‐Liss, Inc.
The role of laparoscopy in the management of gynecologic malignancy
Authors: Nezhat Camran , Nezhat Farr , Teng Nelson N. H. , Edraki Babak , Nezhat Ceana H. , Burrell Matthew O. , Benigno Benedict B. , Ramirez Carlos E.
Published: February 2007

With the advent of minimally invasive laparoscopic techniques, most gynecologic procedures for benign conditions can be performed in an outpatient setting. However, the role of such techniques in gynecologic oncology is not well defined. By reviewing the literature and presenting some new data, we attempt to elucidate the applications of operative videolaparoscopy in gynecologic oncology. Advanced laparoscopic techniques are utilized for the management of cervical cancer as well as the staging and treatment of endometrial and ovarian cancers. Such techniques are used in performing radical hysterectomy for early stage cervical cancer, pelvic and paraaortic lymphadenectomy, and second look laparoscopy following chemotherapy for ovarian cancer. Even though preliminary data are encouraging, large prospective controlled studies with long‐term follow‐up are necessary to better define the role and limitations of laparoscopy in the treatment of gynecologic malignancies. © 1994 Wiley‐Liss, Inc.
Natural history of clinically localized prostate cancer
Authors: Barry Michael J.
Published: February 2007

The natural history of clinically localized prostate cancer is controversial. However, the data that is available suggests outcomes are good for men with well and moderately differentiated disease, but relatively poor for men with poorly differentiated cancer. For example, in one synthesis of individual‐patient level data from six series, ten‐year prostate cancer‐specific mortality for men with well, moderate, and poorly differentiated disease was estimated at 13%, 13%, and 66%, respectively. Tumor grade is the dominant predictor of prognosis. Few studies report on risks of morbidity due to local cancer progression; the data available suggest this risk is relatively low. Cancer‐specific mortality figures overestimate the impact of disease among older men with competing causes of mortality. Given the available data on prognosis of men with localized prostate cancer not treated for cure, clinical trials designed to measure the effectiveness of aggressive therapy will need to be large. © 1995 Wiley‐Liss, Inc.
Anatomy of the prostate and distribution of early prostate cancer
Authors: Greene Damian R. , Fitzpatrick John M. , Scardino Peter T.
Published: February 2007

Many of the difficulties in understanding diseases of the prostate have arisen through poor understanding of the anatomy of the prostate. The recent description of histologically separate zones in the prostate has been an important advance, allowing evaluation of separate cancers arising in the transition and peripheral zones of the prostate. While the majority of cancers sampled at transurethral resection of the prostate (TURP) are of transition zone origin, most of these prostates contain separate cancers in the peripheral zone. The peripheral zone cancers have a higher grade‐to‐volume ratio and are more frequently associated with histological features of progression (extracapsular extension, seminal vesicle invasion) than transition zone cancers. Furthermore, peripheral zone cancers are frequently associated with prostatic intraepithelial neoplasia, in contrast to transition zone cancers. These findings suggest a greater biological activity for cancers arising in the peripheral zone. The majority of cancers detected by digital rectal examination are of peripheral zone origin. While associated transition zone cancers are less frequently present than in TURP sampled prostates, a similarly high association of peripheral zone cancers with histological indicators of biological activity is seen. DNA ploidy analysis of separate foci in radical prostatectomy specimens confirms a significantly higher rate of non‐diploidy in cancers of peripheral zone origin, some of very small volume, which further suggests a greater biological activity compared to transition zone cancers. © 1995 Wiley‐Liss, Inc.
Incidental carcinoma of the prostate
Authors: Van Andel George , Vleeming Ruud , Kurth Karlheinz , De Reijke Theo M.
Published: February 2007

Transrectal ultrasonography (TRUS), digital rectal examination (DRE), and quantification of serum prostate‐specific antigen (PSA) are accepted and evaluated methods for detecting prostate cancer. Positive predictive values (PPV) of DRE and TRUS are low, and only slightly enhanced when used in combination with PSA. PSA lacks sufficient sensitivity and specifity to be used alone as a screening test for prostate cancer. The parameters PSA‐density and PSA‐velocity make PSA a better tumor marker, but they are not reliable on an individual basis. Age‐specific reference ranges have the potential to make PSA a more sensitive tumor marker for men less than 60 years of age and a more specific one for men beyond 60 years. With currently available diagnostic methods approximately 10% of patients undergoing transurethral or open resection of the prostate for presumed benign prostatic hyperplasia will have carcinoma detected in the histologie material. In 392 patients successively treated in our clinic for presumed BPH and thoroughly investigated to exclude prostatic carcinoma (DRE, TRUS, biopsy when PSA > 4 ng/ml or PSA‐D > 0.15), the tumor was found incidentally in 4%. Another finding in this study was the detection of prostatic carcinoma by random biopsy in patients without a palpable or visible tumor by imaging and without PSA increase ( > 4 ng/ml). Biopsies were performed because of a hypoe‐choic zone in the opposite lobe which turned out to be negative. Such tumors cannot be properly classified in the current TNM system. Treatment options for patients with incidental prostatic carcinoma are age‐ and stage‐dependent. Patients less than 60 years old may be treated with a curative approach, irrespective of the T category (Tla or Tib); patients with a life expectancy longer than 10 years and a pTlb incidental carcinoma likewise should be offered a curative therapy. © 1995 Wiley‐Liss, Inc.
Oestrogens reconsidered
Authors: Smith Philip H.
Published: February 2007

Oestrogen therapy or orchidectomy reigned supreme for the treatment of metastatic prostatic cancer for almost 40 years. In the last 15 years many alternative agents have been tested alone and more recently in combination. This contribution evaluates the results of some of these newer therapies considering relief of symptoms, toxicity, quality of life, survival, and benefit to the community. The results are compared with those of oestrogen therapy and with the way in which such treatment might be amended in light of more modern knowledge. © 1995 Wiley‐Liss, Inc.
Hormone refractory disease
Authors: Mahler Charles , Denis Louis J.
Published: February 2007

Hormone refractory disease is observed in less than 20% of newly diagnosed cases of advanced prostatic cancer. In the majority of cases, hormone refractory disease appears after a median time of 18 months of endocrine manipulation and is attributed to the selection and/or cloning of pre‐existing or de novo appearing hormone‐independent or resistant cell lines. There are no generally accepted rules for second‐line management. The varying sets of criteria used by different study groups make comparisons of widely different regimens very difficult. Actually, it seems reasonable to consider length of survival as the only objective response criterion. This implies, however, that there should be an unanimous definition about the moment of primary treatment failure. Indeed, the detection of hormonal escape is a gradual event and the relative length of survival time depends on the chosen moment of therapy administration. To date, monitoring of prostate specific antigen (PSA) has become the best and primary tool to document progression of disease. Earlier diagnosis based on a rise in PSA levels in patients that are still asymptomatic with a good performance status, might provide the opportunity to treat patients that could profit from therapy and give a fair chance to the investigated drug to show efficacity and tolerability. In this paper we will discuss the rationale of the current available second‐line therapeutic options in relapsed pro‐static cancer. © 1995 Wiley‐Liss, Inc.
Clinical use of tumor markers in pancreatic carcinoma
Authors: Chung Maureen A. , Chang Helena R.
Published: February 2007

There is no ideal tumor marker for pancreatic carcinoma. Most of the tumor‐associated antigens in this disease are cell surface mutins, such as CA19‐9, TAG‐72, CA242, CA50, CA195, and CA494. CA19‐9 is the most promising marker. It is used for clinical and pathological diagnosis, prognosis, and response to chemotherapy. The other mucin antigens are currently being investigated for clinical practice. CA242 shows promise as a marker of tumor load and CA494 may play a role in immunotherapy. Oncofetal antigens such as CEA are not specific for pancreatic carcinoma and have a limited use in this disease. Malignancies associated with the endocrine pancreas secrete hormonal products which can be used as tumor markers. Fluid aspirated from pancreatic cysts can also be evaluated. Tumor antigens in aspirated fluid from pancreatic cysts should be interpreted with caution since multi‐locu‐lated cysts do not have a uniform expression of these markers. © 1995 Wiley‐Liss, Inc.
Surgical resection for carcinoma of the pancreas: A historical overview
Authors: Vezeridis Michael P. , Wanebo Harold J.
Published: February 2007

Although attempts to treat pancreatic cancer were made at the end of the nineteenth century, there was no active interest in this field of surgery until 1935 when Whipple and his associates developed and popularized the technique for a two‐stage pancreaticoduodectomy. Several modifications of the original Whipple operation were made in the 1940s. Total pancreatectomy and regional pancreatectomy were introduced in the surgical armamentarium against pancreatic cancer, but they did not gain wide acceptance. Pylorus‐preserving pancreaticoduodectomy was introduced in 1978, but its role in the management of pancreatic cancer needs to be more clearly defined. The operative mortality of pancreatic resections has dramatically declined in large specialized centers during the last decade. A significant improvement in long‐term survival was also reported in recent series. Despite the decline in operative mortality and the improved long‐term survival after resection for pancreatic cancer, the overall prognosis of this disease remains dismal because of the lack of methods for early diagnosis. Future investigations should focus in the areas of early detection and more effective management approaches for locally advanced disease. © 1995 Wiley‐Liss, Inc.
Pancreatic resection for ductal adenocarcinoma: Total pancreatectomy versus partial pancreatectomy
Authors: Farley David R. , Sarr Michael G. , van Heerden Jon A.
Published: February 2007

The controversy regarding total versus partial pancreatectomy for ductal adenocarcinoma of the pancreatic head remains unsettled. Proponents of total pancreatectomy claim wider margins of resection, avoidance of a troublesome pancreaticoenterostomy, and removal of a potentially multicentric disease. Advocates of partial pancreatectomy highlight the retention of exocrine and endocrine pancreatic function, the maintenance of splenic function, and a lower risk of marginal ulceration without sacrificing curative potential. Analysis of the current surgical literature with focus on the facets of each procedure that may differ (operative mortality, long‐term survival, and the six factors mentioned above), may help to resolve the controversy. The data reviewed would suggest that 1) wider resection margins have not transferred into longer postoperative survival, 2) the risk of multicen‐tricity is probably low and of questionable significance, and 3) the morbidity and mortality of pancreaticoenterostomy is currently less problematic. The additional benefits of retaining pancreatic endocrine and exocrine function, maintaining splenic immune competence, and a lower risk of marginal ulceration convinces us to advocate partial pancreatectomy over total pancreatectomy for the majority of patients with a resectable ductal adenocarcinoma of the pancreatic head. © 1995 Wiley‐Liss, Inc.
Preoperative chemoradiation for adenocarcinoma of the pancreas: M.D. Anderson experience
Authors: Evans Douglas B. , Abbruzzese James L. , Lee Jeffrey E. , Leach Steven D. , Charnsangavej Chusilp , Cleary Karen R. , Buchholz Daniel J. , Rich Tyvin A.
Published: February 2007

Pancreatic cancer remains the fourth leading cause of cancer‐related deaths in adults in this country. Its etiology is unknown, and there is currently no effective method of early diagnosis. Although this article wil focus on the proper management of patients with potentially resectable disease, such patients represent the minority of those diagnosed with pancreatic cancer. Therefore, at most medical centers, clinical and basic science research is proceeding in parallel: while attempting to optimize the length and quality of life of patients with localized pancreatic tunors, research is also focusing on developing improved strategies for early and effective systemic therapy. For patients with localized pancreatic cancer, data from our institution support the use of detailed preoperative imaging studied to allow accurate assessment of tumor resectability. Patients found to have locally advanced or metastatic disease do not undergo laparotomy; biliary decompression, when necessary, is performed utilizing endoscopic or laparoscopic techniques. Pancreaticoduodenectomy is performed on carefully selected patients as part of a protocol‐based clinical research program emphasizing the importance of multimodality management for patients with potentially resectable adenocarcinoma of the pancreatic head. ©1995 Wiley‐Liss, Inc.
Preoperative chemotherapy and radiation therapy for patients with pancreatic carcinoma without demonstrable metastatic disease: The fox chase cancer center experience
Authors: Hoffman John P. , Weese James L. , Ahmad Neelofur , Coia Lawrence R. , Litwin Samuel , Engstrom Paul F.
Published: February 2007

Sixty‐three patients were treated with a program of preoperative radiotherapy (RT) and two 96‐hour infusions of 5‐fluorouracil (1,000 mg/m2/day, days 2–5 and 29–32) and a single bolus of mitomycin C (10 mg/m2) on day 2. Those who had no evidence of distant disease nor local unresectability underwent pancreatic resection (16 Whipple resections, 7 total pancreatectomies, 2 distal pancreatectomies). Thirty‐eight percent of the patients had grade 3 or 4 toxicity from the chemoradioth‐erapy (CTRT). One patient died during CTRT of biliary sepsis. Operative mortality for the 25 patients with potentially curative (PC) resections was 4%. One of the four patients with palliative resection died postoperatively. Two other patients with PC resection had major postoperative morbidity. Median survival for those with PC resections was 22 months, while 5‐year survival was 20%. Recurrence was noted in 20 patients, primarily in the liver (50% of patients). Follow‐up is 25 months for 7 patients remaining alive (range 16–77 months). We conclude that this technique is relatively safe, and can produce local cancer control in most patients and prolonged survival in a few with truly localized disease. It is still unclear whether this method of treatment sequencing is any better than postoperative CTRT. © 1995 Wiley‐Liss, Inc.
Adjuvant and systemic therapy for pancreatic cancer
Authors: Clark Jeffrey W. , Glicksman Arvin , Wanebo Harold J.
Published: February 2007

Pancreatic cancer remains a major cause of mortality. Less than 5% of patients survive 5 years. No curative therapy exists for patients not surgically resectable. Although chemotherapeutic and radiation therapeutic approaches can provide palliation, they have not had a significant impact on 5‐year survival. Phase II and III studies are evaluating whether newer approaches integrating chemotherapy, radiation therapy, and surgery will improve survival. Evaluation of new agents (e.g., camptothecins, paclitaxel [and related compounds], gemcitabine, and thymydilate synthase inhibitors) alone and in combination with other agents (including platinum‐related compounds) continue to be pursued. Novel approaches based on increased knowledge about biology of this disease, including high frequency of ras and p53 mutations or expression of a number of growth factor receptors, are being studied preclinically. Approaches utilizing vaccines, gene therapy, and cyto‐kines to enhance the immune response are being developed. Hopefully, new approaches will lead to improved treatment of this often fatal disease. © 1995 Wiley‐Liss, Inc.
Factors affecting choice of initial therapy in oral cancer
Authors: Byers Robert M.
Published: February 2007

Choosing the best initial therapy for squamous carcinoma of the oral cavity depends on patient factors as well as tumor factors. The patient factors which influence the decision include the dental and nutritional status, associated diseases, use of alcohol and tobacco, distance from the hospital, and the reliability, lifestyle, occupation, and choice of the patient. The important tumor factors include size, site, histology, biologic behavior, and type of biopsy. With experience and judgment the treatment team (surgeons, radiotherapists, dentists, and medical oncologists) can use these patient and tumor factors to tailor the therapy to each individual so that not only is the cancer optimally treated, but important aspects of function and cosmesis are preserved. ©copy; 1995 Wiley‐Liss, Inc.
Management of the mandible in oral cancer
Authors: Larson David L. , Sanger James R.
Published: February 2007

Modern head and neck surgery has focused on patient rehabilitation and restoration of form and function in the treatment of oral cancers. An important aspect of that process has been the conservation of the mandible in tumor ablation and the reconstruction of the mandible if segmental resection is indicated. This article outlines the science and clinical data behind rim mandibulectomy and the mandibular osteotomy and “swing” to gain access to tumors of the posterior tongues and pharynx. Additionally, the various methods of reconstruction of the mandible in use today as well as the advantages and disadvantages of each are addressed. © 1995 Wiley‐Liss, Inc.
Evolution of outcomes in cranial base surgery
Authors: O'Malley Bert W. , Janecka Ivo P.
Published: February 2007

Cranial base surgery is a young field of head and neck and neuro‐oncology. It deals with solid tumors at the skull base which were not previously treated with surgery. The development of new cranial base approaches incorporating intracranial exposure and new reconstructive techniques now enable an “en bloc” resection of most of these difficult tumors.

In order to analyze the evolution of cranial base surgery and its contribution to the treatment of carcinomas and sarcomas, we reviewed the results reported in the literature over the past 40 years. We have designated three periods of time that reflect the advances and impact of skull base surgery and have summarized the outcomes of the major contributors in each era. The pioneers of the first period (1960s‐1970s) achieved 3‐ and 5‐year survivals of 52 and 49% while attempting resection of tumors without intracranial or pytergopalatine extension. In the second period (1970s‐1980s), improved surgical techniques allowed resection of more extensive tumors, including intracranial invasion, and 3‐year survivals rose to 57–59% with limited reports of 5‐year survivals in the range of 49%. The third period of cranial base surgery (1980s‐1990s) brought further refinement of techniques, introduced the concept of a coordinated multispecialty approach, and resulted in increased 5‐year survivals to 56–70%. © 1995 Wiley‐Liss, Inc.
Management of cervical lymph nodes in squamous carcinomas of the head and neck
Authors: Houck John R. , Medina Jesus E.
Published: February 2007

Due to the overwhelming prognostic significance of regional metas‐tases, proper management of cervical lymph nodes in cases of squa‐mous cell carcinoma of the head and neck is essential for an optimal outcome. Better understanding of the predictability of incidence and patterns of metastases of these tumors in recent years has led us away from the radical neck dissection as the only surgical therapeutic or staging procedure done on the neck. Recent studies suggest that selective removal of lymph node groups at risk in clinically negative necks, or modified neck dissections that save important structures, like the jugular vein, XI nerve, and sternocleidomastoid muscle, in clinically positive necks, are appropriate in many patients. Careful selection of the type of neck dissection and judicious use of postoperative radiation therapy can optimize cure rates as well as functional and cosmetic results. © 1995 Wiley‐Liss, Inc.
Applications of laser technology in breast cancer therapy
Authors: Lanzafame Raymond J.
Published: February 2007

Breast cancer is an increasingly common problem affecting one in nine women. The optimal management of carcinoma of the breast remains controversial. This paper reviews the rationale for the use of laser technology in the treatment of primary and advanced breast cancer. The CO2 laser has several properties which make it advantageous for breast surgery. The technical details for optimal laser utilization are presented. Experimental evidence documents a marked reduction of local tumor recurrence following surgery with lasers. Preliminary human studies suggest that laser use lengthens the disease‐free interval and may decrease local recurrence. Interstitial laser therapy holds promise for use in the treatment of locally advanced breast tumors and has been suggested by some as a potential modality for the primary therapy of breast cancer. The clinical use of lasers in the treatment of breast cancer is justified. © 1995 Wiley‐Liss, inc.
Photodynamic therapy for recurrent supratentorial gliomas
Authors: Muller Paul J. , Wilson Brian C.
Published: February 2007

We have used photodynamic therapy (PDT) in the treatment of 56 patients with recurrent supratentorial gliomas who had failed radiation therapy and who were candidates for palliative reoperation. There were 34 males and 22 females; their mean age was 41 years and the mean Karnofsky score was 79. Thirty‐two patients had glioblastoma multiforme (GBM), 14 had malignant astrocytoma (MA), 6 had malignant mixed glioma (MM), and 4 had ependymoma (EP). Porphyrin photosensitizer was administered intravenously (i.v.) 12–36 hours prior to photoillumination. All patients had the recurrent tumor sub‐totally resected or cyst drained at surgery followed by intraoperative cavitary photoillumination. In 15 cases interstitial photoillumination using fibers with 2 cm diffusing tips supplemented the cavitary illumination. The total light energy delivered ranged from 440 to 4,500 Joules (J) (median = 1,800 J). The energy administered ranged from 120 to 150 J per fiber and the linear energy density ranged from 65 to 450 J/cm. The energy density ranged from 8 to 110 J/cm2 (median = 38 J/cm2). There were two postoperative deaths and three patients were left with a persistent increase in their postoperative neurological deficit. The post‐PDT median survival of patients with recurrent GBM was 30 weeks with a 1‐ and 2‐year actuarial survival of 18% and 0%, respectively. The median survival of patients with recurrent GBM from first diagnosis was 118 weeks with a 1‐ and 2‐year actuarial survival of 82% and 57%, respectively. The post‐PDT median survival of patients with recurrent MA was 44 weeks with a 1‐ and 2‐year actuarial survival of 43% and 36%, respectively. The median survival of patients with recurrent MA from first diagnosis was 147 weeks with a 1‐ and 2‐year actuarial survival of 86% and 71%, respectively. Patients with MA who received more than the median light dose had a longer survival than those who received less than the median light dose. Recurrent malignant gliomas have a very poor prognosis. PDT is a successful palliative treatment when they recur and are amenable to further surgical treatment. With increasing light doses, better light delivery systems, and more effective photosensitizers further considerable improvement in survival can be expected. © 1995 Wiley‐Liss, Inc.
Photodynamic therapy of head and neck cancers
Authors: Biel Merrill A.
Published: February 2007

Sixty‐five patients with neoplastic diseases of the larynx, oral cavity, pharynx, and skin have been treated with photodynamic therapy (PDT) with follow‐up to 56 months. Patients with carcinoma in situ (CIS) and T1 carcinomas obtained a complete response after one PDT treatment. All but two have remained free of disease. Eight patients with T2 and T3 carcinomas treated with PDT obtained a complete response, but they all recurred locally. This is due to the inability to adequately deliver laser light to the depths of the tumor bed. Five patients with massive neck recurrences of squamous cell carcinomas were treated with intraoperative adjuvant PDT following tumor resection. Only one developed recurrence with 24‐month follow‐up. PDT is highly effective for the curative treatment of early carcinomas (CIS, T1) of the head and neck. Also, intraoperative adjuvant PDT may increase cure rates of large infiltrating carcinomas of the head and neck. © 1995 Wiley‐Liss, Inc.
Polyps: The pathologist's perspective
Authors: Mitros Frank A.
Published: February 2007

Adenomas of the colon and rectum are perhaps the most commonly encountered of human benign epithelial neoplasms. Evidence of their relationship to the development of colorectal carcinoma has mounted over the years. They represent a phase present for significant duration in many fated to develop colon cancer. Because of this, and because of the technical advances in endoscopy, a great deal of effort has been expended on identifying and removing these lesions. Subsequent care of the patient is heavily dependent on the pathologic analysis of these lesions. They must be properly classified; the presence of cancer must be carefully sought. If present, the character and location of the cancer arising in the polyp must be carefully described. Communication between clinician and pathologist is of paramount importance. Attention must be paid to the precise meaning of such terms as dysplasia, carcinoma, and invasion. The pathologist's report needs to detail parameters important in determining prognosis and further therapy. © 1995 Wiley‐Liss, Inc.
Molecular biology of colon polyps and colon cancer
Authors: Allen John I.
Published: February 2007

From a histologic and endoscopic standpoint, colon and rectal cancer (CRC) begins as a small neoplastic polyp which progressively enlarges and transforms through a dysplasia stage into invasive cancer. Recently, molecular abnormalities underlying the adenomacarcinoma progression have been defined. The adenomatous polyposis coli (APC) gene and mismatch repair genes are found to be dysfunctional early in the neoplastic process; either as inherited or somatic mutations. Subsequently, polyps progress to cancer along one of two paths depending on which gene is abnormal. When the APC gene is the initial mutation tumor development follows the “loss of hetero‐zygocity” (LOH) pathway. If mismatch repair genes are altered, the “replication error” (RER) pathway is followed. Somatic mutations of the K‐ras oncogene and the MCC, DCC, and p53 tumor suppressor genes accumulate in the LOH pathway and mark the progression through polyp stages. Microsatellite instability is a characteristic of the RER pathway but the precise genes involved in this pathway currently are not known. Defining these pathways has led to a new classification scheme for CRC with resultant changes in our clinical approach to screening, surveillance, and treatment. © 1995 Wiley‐Liss, inc.
Diet and chemoprevention of colon polyps and colorectal cancer
Authors: Nixon Daniel W.
Published: February 2007

Clinical trials in colorectal cancer prevention are based on carcino‐genesis research and epidemiologic observations that relate certain macronutrients, micronutrients, non‐nutritive factors in foods, and synthetic chemicals to colon neoplasms. These factors appear to act at various points along the putative normal mucosa → adenomatous polyp → cancer sequence. This gives an opportunity to develop innovative clinical trials, both in agent selection and in the use of intermediate markers. Clinical colorectal cancer prevention trials are now in progress that employ dietary fiber, a variety of vitamins and minerals and several synthetic drugs, especially the NSAIDs. Most of these trials use the adenomatous polyp as a surrogate marker for colon cancer, thereby reducing trial duration, number of subjects required and overall expense. This paper is a brief review of the basic and epidemiologic background for colorectal cancer prevention trials and their current status. © 1995 Wiley‐Liss, Inc.
Surgical options for familial adenomatous polyposis
Authors: Ambroze W. L. , Orangio G. R. , Lucas G.
Published: February 2007

Familial adenomatous polyposis (FAP) is a genetic disorder transmitted in an autosomal dominant pattern. One‐half of members of an affected family will carry the gene, and all carriers will succumb to colon cancer or extracolonic manifestations if not detected and treated early. When the diagnosis is made, surgery is indicated. Surgical options include total proctocolectomy with ileostomy, continent ileos‐tomy, total colectomy with ileorectal anastomosis, and total proctocolectomy with ileal pouch anal anastomosis. Many diverse factors, such as extent of rectal disease, the presence and extent of carcinoma, sphincter function, and extracolonic disease, influence which surgical procedure is most appropriate for the individual patient with FAP. This article reviews the surgical options for treating FAP, with emphasis on specific indications, contraindications, and anticipated outcomes. © 1995 Wiley‐Liss, Inc.
Parameter measurements for permanent magnet synchronous machines
Authors: Kondo Minoru
Published: February 2007

The advances in inverter drive technology and permanent magnet materials have enabled the application of permanent magnet synchronous machines (PMSMs) to various fields. PMSMs are rapidly spreading in their applications with their advantage of high efficiency, which is highly needed in many applications in recent years. Although there have been standardized measurement methods of the machine parameters for synchronous machines, they are not intended to apply to PMSMs. Therefore, several new measurement methods suitable for PMSMs have been proposed. This paper presents a review and analysis of these methods. Copyright © 2007 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.
Technical evolution of permanent magnet synchronous motors for home appliances
Authors: Honda Yukio , Takeda Yoji
Published: February 2007

This paper reports on the highly efficient motor technologies used in home appliances in Japan. The permanent magnet synchronous motor (PMSM) is especially suitable because the use of permanent magnets does not require any extra current to produce magnetic power in the rotor, or any other kind of energy. In Japan, there has been a rapid shift from induction motors to PMSMs, and in this paper we will show several examples of PMSMs as applied to the home appliance field. It can be seen that great improvements have been made in high‐efficiency motor technologies. Copyright © 2007 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.
Trends of permanent‐magnet synchronous machine drives
Authors: Noguchi Toshihiko
Published: February 2007

This paper presents recent trends of permanent‐magnet synchronous motor (PMSM) drive technologies in Japan. Since the PMSM drives have many advantages over other drives, e.g. high efficiency, high power density, etc., many of the motor applications have been changing their power sources to the PMSMs. Particularly, interior permanent‐magnet synchronous motors (IPMSM) are epoch‐making and are intensively studied among researchers, scientists and engineers. According to the survey of the recent innovative technical trends, the PMSM drive technologies have been making a remarkable advancement in the fields of analysis‐and‐design techniques, various sensorless‐control techniques, power converter control techniques, and application specific drive systems. Copyright © 2007 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.
Binding assay for incorporation of alkali‐extractable proteins in the Saccharomyces cerevisiae cell wall
Authors: Teparić Renata , Stuparević Igor , Mrša Vladimir
Published: February 2007

Yeasts have developed three different ways of attaching proteins to cell wall glucan. Some proteins are bound to β‐1,3‐glucan non‐covalently, while others are attached covalently, through GPI‐anchor and β‐1,6‐glucan, or directly to β‐1,3‐glucan by alkali‐labile ester linkage between the γ‐carboxyl groups of glutamic acid and the hydroxyl groups of glucoses (Pir proteins). In order to obtain further insight into the binding mechanism, a novel, simple binding assay for Pir‐family proteins was developed. It has been shown that PIR, as well as SCW4 mutants, can bind externally added Ccw5p to their cell walls. A study of appropriate binding conditions revealed the requirement of the native conformation of Ccw5p. The presence of EDTA blocked the binding of Ccw5p, indicating the cation dependence of the reaction. Both wild‐type and mutant cells showed enhanced binding of the Ccw5p in 0.6 M KCl. After disruption of all Pir genes (CCW5, CCW6, CCW7 and CCW8), 67 kDa protein still remained in NaOH extract. SCW4 disruption in the ccw5ccw6ccw7ccw8 mutant resulted in disappearance of the 67 kDa band from the extract, indicating that Scw4p could also be covalently linked to the cell wall by a so‐far unidentified alkali‐labile linkage. Copyright © 2007 John Wiley & Sons, Ltd.
Characterization of Ccw12p, a major key player in cell wall stability of Saccharomyces cerevisiae
Authors: Ragni Enrico , Sipiczki Matthias , Strahl Sabine
Published: February 2007

The GPI‐anchored mannoprotein Ccw12p is a crucial structural component of the cell wall of Saccharomyces cerevisiae. Compared to wild‐type, the mutant ccw12Δ grows more slowly, is highly sensitive to Calcofluor white and contains 2.5 times more cell wall chitin. In this study, electron microscopy of ccw12Δ cell walls revealed that, with respect to wild‐type, the inner glucan layer is thicker with irregular depositions of wall material, whereas the outer mannan layer is less condensed. Biochemical analyses of cell wall glucan suggest that in the absence of Ccw12p, GPI‐anchored cell wall proteins are transferred preferentially to chitin and random deposition of cell wall material reinforces the inner glucan–chitin layer, thereby enhancing the overall stability of the cell wall. To further elucidate the role of Ccw12p, structure–function analysis was performed. We demonstrate that Ccw12p is highly N‐glycosylated. However, loss of N‐glycans does not affect Ccw12p functionality. In contrast, deletion of the repeated amino acid motive TTEAPKNGTSTAAP in the C‐terminal part of the protein affects Ccw12p function. Copyright © 2007 John Wiley & Sons, Ltd.
Disintegrator vectors for single‐copy yeast chromosomal integration
Authors: Sadowski Ivan , Su Ting‐Cheng , Parent Jennifer
Published: February 2007

Vectors were developed for two‐step chromosomal integration of reporter genes or expression constructs. With these vectors, integration produces a disruption of the ADE8, LYS2, MET15, LEU2, HIS3 or FCY1 genes, and integrants can be easily identified by replica‐plating on selective media. Integration using these ‘disintegrator’ vectors produces a single‐copy integration of the construct of interest at the junction of the marker deletion, and removes the additional plasmid sequences. Importantly, the integrated constructs do not contain flanking sequence duplications, and therefore should be highly stable. Each of the vectors was shown to reliably integrate a TEF1–KAN expression cassette and/or GAL1–HIS3 and STE12–LacZ reporter genes. Copyright © 2007 John Wiley & Sons, Ltd.
Acute lymphoblastic leukemia in children: Correlation of musculoskeletal manifestations and immunophenotypes
Authors: Maman Eran , Steinberg David M. , Stark Batia , Izraeli Shai , Wientroub Shlomo
Published: February 2007

Purpose

Studies on musculoskeletal manifestations (MSM) of childhood acute lymphoblastic leukemia (ALL) have yielded variable findings with regard to their clinical impact. We investigated the significance for differential diagnosis, treatment and outcome of musculoskeletal complaints as presenting symptoms of ALL, and their correlation with leukemia immunophenotypes, for which data is lacking.

Methods

Data on 783 children in the national study for childhood ALL between 1984 and 2003 were reviewed retrospectively. Statistical analysis examined possible relationships between MSM at the time of diagnosis and demographic and clinical data, biological features of leukemia (peripheral blood counts, immunophenotype and main cytogenetic aberration), response to initial prednisone treatment, and outcome.

Results

Of 765 children with data on orthopaedic complaints, 240 presented with MSM (31.4%). Among these children, B cell precursor (BCP) was much more common (209/576, 36.3%) than T cell ALL (25/176, 14.2%). Patients with MSM had lower white blood cell counts (WBC) (median of 9 vs. 20 × 109/L, P < 0.001) and percentage of blast cells in the peripheral blood at diagnosis compared to those without (median of 27 vs. 53%, P < 0.001). Hepatomegaly and splenomegaly were less common in MSM group (67 vs. 53% <3 cm, P < 0.001, and 63 vs. 50% <3 cm, P < 0.001, respectively). Poor response to initial treatment with prednisone was recorded in 7.1% of patients with MSM versus 11.5% of those without ( P = 0.086). The analysis revealed no independent effect of MSM on event-free survival (EFS), after correcting for differences in EFS related to immunophenotype or initial WBC.

Conclusions

MSM occur mostly in children with BCP ALL who present with less involvement of extramedullary organs, low peripheral blood blasts and white blood cells counts. These findings highlight the importance of including ALL in the differential diagnosis of MSM even in the presence of an apparently normal peripheral blood count. Our study also suggests that MSM are caused by leukemic cells with enhanced biological propensity to remain relatively confined within the intramedullary bone-marrow space.
Emergency peripartum hysterectomy in the nulliparous patient
Authors: Seffah J.D. , Kwame‐Aryee R.A.
Published: February 2007

Objective: To find out the incidence, indications and outcomes of emergency peripartum hysterectomy in the nulliparous woman. Method: Retrospective study at the Korle Bu Teaching Hospital in Accra, Ghana, between January 1995 and December 2003. Results: During the eight‐year study period there were 92,966 deliveries out of which 36,550 (39.5%) were for the nulliparous. Peripartum hysterectomy was performed for 39 nulliparous women, thus giving an incidence of 1 per 1000 nulliparous deliveries. The indications for the hysterectomy were: atonic uterus 28 (71.8%), ruptured uterus 8 (20.5%) and placenta praevia/accreta 3 (7.7%). The perinatal losses were 8 (20.5%) and the total blood loss ranged from 1 to 4.5 l. There were no maternal deaths but there were 7 near‐missed fatalities. Conclusion: Though rare, peripartum hysterectomy in the nulliparous patients carries high maternal morbidity and perinatal mortality.