bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysgerminoma of the ovary: Review of 27 cases
Authors: Susnerwala Shabbir S. , Pande Subodh C. , Shrivastava Shyam K. , Dinshaw Ketayun A.
Published: February 2007

Twenty‐seven patients with pure dysgerminoma were seen at the Tata Memorial Hospital, Bombay, between January 1980 and December 1984. Of the 10 patients in stage I, 2 patients underwent a unilateral salpingooophorectomy (USO) and were kept under observation without any adjuvant therapy, while the remaining patients received adjuvant treatment following surgery. All of the 6 patients in stage II and 4 of 7 in stage III had total abdominal hysterectomy and bilateral salpingo‐oophorectomy (TAHBSO) followed by postoperative radiotherapy. One patient presented in stage IV and 3 patients presented with recurrence after previous definitive treatment undertaken at other institutions. The disease free, as well as the overall survival, at 108 months, for the 24 cases primarily treated at this institution, is 81% and 88% respectively, and, for patients in stages I and II, 100% (Kaplan‐Meier estimation). The need for controlled clinical trials to devise optimal therapy in the early clinical stages and use of chemotherapy for advanced stages of this highly curable entity are stressed.
Characterization of cellular infiltrates in the rat urinary bladder following BCG and thiotepa intravesical therapy
Authors: Shaw Michael , McKiel Charles F. , Ray Vera , Rubenstein Marvin , Guinan Patrick
Published: February 2007

We examined rat urinary bladders following intravesical administration of BCG and thiotepa. BCG administration resulted in a relatively greater increase in the mucosal infiltration of mononuclear cells relative to polymorphonuclear cells (P<0.01) compared to the thiotepa treated bladders. This finding suggests that the mode of action of the therapeutic effects of these agents may be different. These results may also suggest that the mechanism of action of BCG might be immunologic in nature.
Histologic and immunohistologic diversity of non‐hodgkin's lymphoma of lymph node origin
Authors: Ohsawa Masahiko , Aozasa Katsuyuki , Horiuchi Keisuke , Ikeda Hiroshi
Published: February 2007

To examine whether nodal non‐Hodgkin's lymphomas (NHL) share common features in every nodal site, histologic and immunohistologic findings were analysed site by site. Cases selected were nodal NHL of neck (17 cases), submandibular (10 cases), inguinal (9 cases), and abdominal cavity (22 cases). No significant differences in age distribution were found. A slight female preponderance was present in cases with inguinal NHL. Histologic and immunohistologic findings showed that nodal NHL were heterogeneous; (1) T‐cell type was frequent in the neck but exceptional in other sites, (2) frequency of high‐grade tumors was much higher in the intra‐abdominal cavity but low in other sites, and (3) follicular lymphoma was common in the submandibular and inguinal regions. Previous studies indicated that histologic and/or immunologic types of NHL correlated with pathogenesis of lymphoma; EB virus and HTLV‐1 for B and T lymphomagenesis, respectively, and acquired immunodeficiency syndrome (AIDS) for development of high‐grade tumors. The present results may provide an insight to consider as a possible pathogenesis of NHL.
Clinical management of gastric cancer and concomitant esophagogastric varices
Authors: Korenaga Daisuke , Kanematsu Takashi , Watanabe Akihiro , Maehara Yoshihiko , Kitano Seigo , Sugimachi Keizo
Published: February 2007

We report the late results of treatment of 13 consecutive patients with gastric cancer and concomitant esophagogastric varices. Of seven good‐risk patients classified as Child's class A or B, gastrectomy together with selective shunt operation was performed in two, total gastrectomy with splenectomy in three, and distal partial gastrectomy with paraesophageal devascularization without splenectomy in one. The remaining patient with early gastric cancer underwent distal partial gastrectomy following repeated endoscopic injection sclerotherapy (EIS) for treatment of the esophageal varices. Although the majority of patients who underwent surgical repair of varices (i.e., shunt, splenectomy, or devascularization) died, total gastrectomy with splenectomy was the only procedure that led to control of the esophageal varices. Since partial gastrectomy combined with EIS limits the morbidity and mortality of an extensive resection and at the same time controls esophageal variceal bleeding, it is probably the procedure of choice for patients with a carcinoma in the lower two‐thirds of the stomach. Concerning non‐surgical cases, two patients were effectively treated using laser endoscopy and EIS, without the occurrence of variceal bleeding. The remaining four patients, given chemotherapy or irradiation for treatment of gastric carcinoma, died within 4 months with variceal bleeding or liver failure. For the poor‐risk patients with evidence of severe liver dysfunction, laser treatment and EIS would be the treatment of choice.
Mucoepidermoid carcinoma of the salivary glands: A reappraisal of the influence of tumor differentiation on prognosis
Authors: Clode Ana Luisa , Fonseca Isabel , Santos J. Rosa , Soares Jorge
Published: February 2007

Thirty‐nine cases of mucoepidermoid carcinoma of the salivary glands were reviewed for a reappraisal of the influence of the grade of differentiation on the outcome of the disease. The age of the patients ranged between 7 and 84 years. Fifteen patients were females and 24 males. The tumors were located at the parotid gland (n=30), the submaxillary gland (n=1), the soft palate (n=5) and the oral mucosa NOS (n=3). At presentation 4 tumors were intraglandular and 35 extraglandular; three patients had lymph node metastases and one patient lung metastases. The grade of differentiation was assessed using the criteria of Healey et al. Twelve tumors were classified as grade I, 17 as grade II, and 10 as grade III. Follow‐up information was obtained with a duration of 5‐144 months (mean 44.7 months). Six cases recurred locally and 5 developed metastases. Five years cumulative survival was 100% for grade I, 70.1% for grade II, and 47.2% for grade III. The results point to the usefulness of the assessment of the grade of differentiation as a guide to anticipate the outcome of the disease.
Activation and in vitro expansion of tumor‐reactive T Lymphocytes from lymph nodes draining human primary breast cancers
Authors: Hoover Shelley K. , Frank James L. , McCrady Carl , McKinnon J. Gregory , Bear Harry D.
Published: February 2007

The feasibility of in vitro activation of lymphocytes from the draining lymph nodes (DLN) of breast cancer patients was examined. Lymphocytes isolated from 48 DLN from 12 patients were examined for their proliferative responses to rIL‐2, autologous tumor cells, or rIL‐2 plus tumor cells. Three general patterns of cellular responses were observed. Cells from some DLN (17%) were unresponsive to any stimuli. Lymphocytes from 52% of the DLN responded moderately to rIL‐2 alone. The combination of rIL‐2 and tumor antigen had a synergistic effect on the proliferation of cells from 31% of the DLN assayed. Phorbol dibutyrate and ionomycin plus rIL‐2 stimulated expansion of DLN lymphocytes by up to 850‐fold after 35 days. These expanded cell populations, as well as those stimulated with antigen plus rIL‐2, were predominantly CD3+ and CD16‐ cells, varying in proportions of CD4+ and CD8+ subsets. Both populations were cytotoxic against autologous tumor, MCF‐7, and K562 target cells.
Neuroendocrine carcinoid tumours of the breast: A variant of carcinoma with neuroendocrine differentiation
Authors: Van Laarhoven Huub A. J. , Cratama Sibrand , Wereldsma JACK C. J.
Published: February 2007

Carcinoid tumours most frequently develop in the gastrointestinal tract but have been described in many organs of the body. In 1977 the first cases were reported in the mamma, followed by descriptions of argyrophilic carcinoid‐like, neuroendocrine mammary tumours by many investigators who performed immunohistochemical and ultrastructural examinations. The existence of true carcinoids in the mamma is still a controversial issue. Eight mammary neoplasms with monomorphous cytonuclear features, five of the small cell carcinoid‐like variety and three composed of larger cells, were examined by immunohistochemical and ultra structural examination. We believe this kind of tumours are ductal or lobular carcinomas with focal or more extensive neuroendocrine features and are the result of a dual differentiation of neoplastic precursor stem cells along epithelial and endocrine lines. Consequently, we consider that treatment of such cases should not be different from that of the ordinary type of mammary carcinomas.
Carcinoma of the extrahepatic bile ducts
Authors: Chao Tzu‐Chieh , Greager John A.
Published: February 2007

Thirty‐seven patients with carcinoma of the extrahepatic bile ducts (EHBD), diagnosed over 14 years from 1974 to 1987, were studied retrospectively. The most common presenting complaint was jaundice, followed by abdominal pain, nausea and vomiting, and weight loss. The majority of EHBD carcinomas were located at the middle third of the bile duct (43.2%), followed by upper third bile duct (37.8%), and lower third bile duct (18.9%). The resectability of the surgically managed group was 44.4%. The most common histologic type was adenocarcinoma. The 30‐day postoperative mortality was 30.6%. The mean overall survival of the patients with EHBD carcinoma was 11.2 months. Patients with distal third tumors had the best prognosis with a mean overall survival of 16.0 months. The mean overall survival of patients with upper‐third and middle‐third tumors were 10.9 months and 9.4 months. A high index of suspicion of the disease as well as earlier, aggressive surgery may improve patient survival.
Prognostic value of DNA flow cytometry in paragangliomas of the carotid body
Authors: Sauter Edward R. , Hollier Larry H. , Bolton John S. , Ochsner John L. , Sardi Armando
Published: February 2007

A carotid body tumor is a paraganglioma of the carotid bifurcation. Histologic appearance does not correlate with the malignant potential of the lesion, and thus a reliable prognostic marker for these tumors is lacking. To determine whether flow cytometric analysis of paraffin block specimens by DNA index and synthetic phase fraction (SPF) would be of prognostic value, a retrospective chart review of 14 patients with carotid body tumors was performed. Three of 14 tumors were aneuploid and were the only tumors with SPF >15%. One of 3 patients (33%) with an aneuploid tumor (SPF=22%) developed a local recurrence; no patient with a diploid tumor developed a recurrence. Two of 3 (67%) patients with aneuploid tumors (SPF= 18%) but only 1 of 11 (9%) with a diploid tumor were symptomatic preoperatively (P = 0.03). DNA index and SPF may help select a subgroup of patients with more aggressive tumors who are at increased risk for recurrence and therefore require closer follow‐up.
Hormonal receptors in locally advanced breast cancer: Change with response to neoadjuvant chemotherapy?
Authors: Morris Don M. , Edwards Jackie , Gelder Frank
Published: February 2007

Twenty‐one cancers in 20 patients with locally advanced breast cancer were studied. Incisional biopsy was performed without using electrocautery. Tissue was obtained for histology and estrogen (ER) and progesterone (PR) receptors. Patients received chemotherapy after biopsy. All responded and had radical mastectomy performed. Tissue was removed from the mastectomy specimen to confirm residual tumor and for repeat receptor measurements. Initial receptor levels were negative in 13 cancers. Following chemotherapy, both ER and PR levels were unchanged in 11 cancers. Levels in one cancer changed from ER‐PR‐ to ER+PR‐ and one changed from ER‐PR‐ to ER+PR+. Six cancers were ER+PR+ at initial examination. Repeat receptor levels after chemotherapy were ER+PR+ in three. One ER+PR+ tumor became ER‐PR+, one changed to ER+PR‐, and one to ER‐PR‐ One ER+PR‐ cancer remained ER+PR‐ after treatment and an ER‐PR+ cancer became ER‐PR‐ after treatment. Chemotherapy does not significantly alter hormonal levels in breast cancer tissue.
Benign parotid tumors: A 24‐year experience
Authors: Rodriguez‐Bigas Miguel A. , Sako Kumao , Razack Mohammed S. , Shedd Donald P. , Bakamjian Vahram Y.
Published: February 2007

The medical records of 125 patients benign parotid neoplasms surgically treated over a 24‐year period were retrospectively reviewed; 128 tumors were excised. These included 90 pleomorphic adenomas, 33 Warthin's tumors, 3 benign lymphoepitheliomas, and 2 oncocytomas. The surgical procedures consisted of 2 local excisions, 6 enucleations, 88 superficial parotidectomies, 13 subtotal parotidectomies, and 3 radical parotidectomies. The morbidity rate was 49%. There was one total permanent facial nerve paralysis (0.7%), four (3%) partial permanent facial nerve paralysis, five (5%) transient total facial nerve paralysis, and 32 (25%) partial transient facial nerve paralysis. After a median follow‐up of 84 months, there was one recurrence (0.7%). A superficial parotidectomy is the minimum procedure that should be performed for the treatment of a benign parotid neoplasm.
Long‐term vascular access via the inferior vena cava
Authors: Williard William , Coit Daniel , Lucas Alice , Groeger Jeffrey S.
Published: February 2007

A prospective evaluation of long‐term venous access catheters placed via the inferior vena cava was performed to determine their efficacy as well as short‐ and long‐term morbidity. From June 1987 to May 1989,31 catheters were placed in 26 patients, for a total of 3,503 catheter use days. All catheters were placed via an infraumbilical approach when the more conventional supraumbilical route was technically difficult, dangerous, or impossible to be used. There were a total of 14 complications in 12 catheters (one in every 254 catheter use days), with five infectious episodes (one in every 901 catheter use days), six episodes of catheter occlusion or vessel thrombosis (one in every 583 catheter use days), one catheter malfunction, one episode of cuff erosion through the skin, and one catheter that migrated through the inferior vena cava into the retroperitoneum. These results compared favorably with our experience with long‐term catheters of a similar type placed via a supraumbilical approach into the superior vena cava. We conclude that the infraumbilical route for long‐term central venous access is safe and technically easy and should be strongly considered in patients in whom venous access via the supraumbilical approach will be technically difficult or have a high likelihood of failure.
Wound healing complications in soft tissue sarcoma management: Comparison of three treatment protocols
Authors: Bell Robert S. , Mahoney James , O'Sullivan Brian , Nguyen Can , Lancer Fred , Cummings Bernard , Catton Charles , Czitrom Andrei , Fornasier Victor L.
Published: February 2007

A prospective, nonrandomized comparison of three treatment protocols was undertaken in 45 patients with soft tissue sarcoma designated preoperatively as being at high risk of wound healing complications. All patients underwent complete resection of the gross tumour mass (5 with positive and 40 with negative microscopic margins). Fourteen patients received postoperative adjuvant irradiation (group I), 16 preoperative irradiation (group II), and 15 preoperative irradiation and vascularized tissue transfer to the surgical bed after resection (group III). Major wound healing complications (defined as complications requiring at least 1 further surgical procedure) were lower in group III patients (chi‐square = 5.57, P <0.03), as was the mean postoperative hospital stay (P < 0.02, analysis of variance), and the mean number of secondary surgical procedures. Multivariate analysis showed that the only variable influencing length of stay was the use of tissue transfer. Careful intraoperative assessment of the adequacy of resection is essential prior to performing vascularized tissue transfer to ensure that tumour contamination of the donor site is avoided. Since this study is a nonrandomized clinical trial using sequential distribution of patients to the treatment groups, the data should be considered as preliminary, rather than definitive, evidence of the efficacy of vascularized tissue transfer.
Chemotherapy with high dose ifosfamide/mesna plus cisplatin for the treatment of ovarian cancer: A study of the Grupo de Estudio y Tratamiento Latino‐Americano del cancer
Authors: Araujo Carlos E. , Cervellino Juan C. , Pirisi Claudia , Pannunzio Osvaldo , Callegari Jorge
Published: February 2007

Twenty‐one evaluable patients with FIGO stages II–IV epithelial ovarian cancer, median age 57 (range 47–75 years), were treated with ifosfamide (IF), 3 g/m2 diluted in 500 ml saline solution, 8 hour intravenous (i.v.) infusion on days 1–5; mesna 20% of IF dose, i.v. bolus injection, was given at hours 0 and 4; mesna 40% of IF dose by oral route at hours 8 and 12, days 1–5; plus cisplatin 20 mg/m2 diluted in 500 ml saline solution, 2 hour i.v. infusion, days 1‐5. Cycles were repeated every 4 weeks. All patients had metastatic lesions (mesentery, pleura, colon, cervix, abdominal wall, lung, liver, bladder, and nodes). Toxicity ranged from mild to moderate. All patients experienced alopecia, nausea, and vomiting. Neutropenia and anemia ranged from mild to moderate. One patient experienced mild brain confusion and two patients microscopic hematuria. Ten clinically complete responses (47%) and five clinically partial responses (23%) were registered, for an overall 70% objective response. However, after a second look performance in 10 patients with clinically complete response, six of 10 patients showed a pathological complete response and four showed pathological partial response. The median duration of complete response is about 33 months, and median partial response duration is 14 months. Although the numbers are small, these data indicate that combination chemotherapy with high dose ifosfamidei mesna plus cisplatin may be an active treatment for advanced ovarian carcinoma.
Significance of surgical adjuvant chemotherapy for gastric cancer
Authors: Tanigawa Nobuhiko , Morimoto Hideki
Published: February 2007

One hundred and twenty‐four specimens (72 primaries and 52 metastases) in 107 patients with gastric cancer were tested using the human tumor clonogenic assay (HTCA). Assays for 64 specimens (52%, 33 primaries and 31 metastases) were considered evaluable. The clonogenicity of the primaries was less than that of the metastases (P < 0.01). In the primary specimens, well‐differentiated tumors were more highly clonogenic than poorly differentiated or signet ring cell tumors (P < 0.05). Viable malignant cells and clonogenic cells were abundant in the primary tumors with mucosal (m) and submucosal (sm) invasion, i.e., in early gastric cancers by Japanese criteria, and were reduced in numbers as the primary tumors advanced (P0.05). In vitro chemosensitivity corresponded well to the clonogenicity of the primary tumors stratified by the degree of tumor invasion. At the early phase of primary tumor progression and metastasis, clonogenicity and chemosensitivity were high. Aggressive chemotherapy with sensitive drugs after surgery may improve the clinical results for the gastric cancer patients with early phase of metastases.
Intraoperative fine needle aspiration cytology of pancreatic lesions
Authors: Malbercer Ehud , Lemberg Senta , Edoute Yeouda
Published: February 2007

The aim of the present study was to demonstrate the practicality of intraoperative fine needle aspiration (FNA) cytology of pancreatic lesions in 43 patients. The indication for performing this procedure was to determine the nature of pancreatic masses. Conclusive cytologic diagnoses were reached in 41 patients who represent the present study. On the basis of histologic findings in 30 cases (73.2%) and on clinical findings in 11 cases (26.8%), a final diagnosis of malignant pancreatic disease (MPD) was established in 31 and of benign pancreatic disease (BPD) in 10 patients. Among the 31 cases with MPD, the cytologic diagnosis was correct in 30 patients and falsely negative in one patient. Among 10 patients with BPD, all the cytologic findings were reported as benign. The sensitivity and specificity and positive and negative predictive values for cytologic findings were 96.8%, 100%, 100%, and 90.9%, respectively. The diagnostic accuracy of FNA cytology was 97.6%. No complications followed the procedure. We conclude that intraoperative FNA cytology of pancreatic lesions is a simple, safe, highly sensitive, and specific tool in differentiating benign from malignant pancreatic lesions. This procedure should be carried out in any patient with pancreatic mass incidentally found at laparotomy or in a patient undergoing surgery because of suspected nonmetastasizing MPD in whom repeated imaging guided FNA failed to demonstrate malignancy.
Immunohistochemical analysis of plasminogen activator expression in human colorectal carcinomas: Correlation with CEA distribution and tumor cell kinetics
Authors: Kawanishi Hiroshi , Tanaka Kanji , Takai Souichirou , Takada Hideho , Yamamura Manabu , Hioki Koshirou , Nagura Hiroshi , Yamamoto Masakatsu
Published: February 2007

Fifty cases of colorectal adenocarcinoma were immunohistochemically examined for the relationship between distribution of plasminogen activators (PAS) and the degree of differentiation of cancer cells as reflected by carcinoembryonic antigen (CEA) expression as well as tumor cell kinetics. The A chain of urokinase‐type PA (u‐PA‐A) was mainly observed in the apical portions of highly differentiated cancer cells. Increased expression and change in localization to the cytoplasm were found with progressive dedifferentiation. The numbers of DNA polymerase α (pol. α) positive cancer cells also increased in line with u‐PA‐A expression. The B chain of u‐PA (u‐PA‐B), and the A and B chains of tissue‐type PA (t‐PA‐A and ‐B) did not show similar alteration. The present findings suggest that the distribution of u‐PA‐A in colorectal carcinoma tissues, the degree of tumor differentiation, and the proliferation kinetics of cancer cells are closely related.
Tumors in undescended testis
Authors: Kulkarni Jagdeesh N. , Kamat Murali R.
Published: February 2007

We herein report our experience in the management of 21 patients with tumors in undescended testis. The primary tumor was in the abdominal testis in six patients and in the inguinal testis in 15 patients. Seventeen patients had unilateral involvement and four had bilateral. Prior orchiopexy was reported in six (30%) patients, unilateral in three and bilateral in the other three, although tumors occurred in one side of three bilateral orchiopexy patients. Clinical staging showed five as stage I, six as stage IIb, two as stage IIc, seven as stage III, and in one no stage was possible. Microscopy showed seminoma, non‐seminoma, and mixed tumors in 12, six, and three patients, respectively. As per protocol, stages I and IIb had either radiotherapy or retroperitoneal node dissection, giving three and five year survival of 11/11 (100%) and 7/7 (100%). All nine patients with stage IIc and stage III received induction chemotherapy (VAB‐6) first and showed complete response (CR) in four (45%) and partial response (PR) in five (55%). Three and 5 year survival was 45% and 33%, respectively. Overall, 3 and 5 year survival was 70% and 69% respectively in all patients. Early stage disease (stages I, IIb) had excellent survivals, showing the adequacy of treatment, while patients with advanced tumor can still be salvaged with a combination of surgery, chemotherapy, and radiotherapy.
Endobronchial carcinoid and mucoepidermoid carcinoma in children
Authors: Hause Donald W. , Harvey James C.
Published: February 2007

Endobronchial neoplastic disease is rarely encountered in patients under 20 years of age. The great majority of these lesions are carcinoids or mucoepidermoid carcinoma. Symptoms are secondary to bronchial irritation and manifest as recurrent pneumonitis, hemoptysis, persistent cough, reactive airway disease, and chest pain. Early bronchoscopy reliably enables identification and may prevent harmful sequelae resulting from delay in diagnosis. Retrospective data from four cases collected from the Tumor Registry in the Southern California Kaiser Permanente Medical Group is presented and a review of the literature is discussed.
Efficacy of pulmonary metastasectomy for recurrent soft tissue sarcoma
Authors: Casson Alan G. , Putnam Joe B. , Natarajan Giri , Johnston Dennis A. , Mountain Clifton , McMurtrey Marion , Roth Jack A.
Published: February 2007

To evaluate surgical results of resection of second (recurrent) pulmonary metastases from adult soft tissue sarcoma, the survival of 39 patients was analyzed retrospectively. With the exclusion of two patients (one with interval metastases between staged resections and one without histologically proved metastases), three patients were found to have unresectable disease (median survival, 7 months). A significantly (P = 0.0001) longer median survival (28 months) was found for 34 patients whose recurrent metastases were completely resected. The only other factor predicting significantly longer post‐thoracotomy survival was resection of a solitary metastatic nodule (median survival, 65 months). Patients who had two or more recurrent nodules resected had a median survival of 14 months only (P = 0.01). Although trends toward longer survival were noted for other prognostic factors, none reached statistical significance. We conclude that the complete resection of a solitary second (recurrent) pulmonary metastatic nodule from adult soft tissue sarcoma predicts long‐term survival.
Ewing's sarcoma in children: Twenty‐five years of experience at the institute portuagěs de oncologia de francisco gentil (I.P.O.F.G.)
Authors: Patricio Maria Brites , Vilhena Mario , Neves Miguel , Raposo Silva , Catita Jose , De Sousa Valenca , Martins A. Gentil
Published: February 2007

Fifty children with Ewing's sarcoma were consecutively treated from 1962 to 1987 and retrospectively analyzed at the I.P.O.F.G. of Lisbon. At first diagnosis, 10 cases had distant metastases. The remaining 40 patients had clinically localized disease, and different protocols were followed over the years. The best results were obtained with chemotherapy and radiotherapy with or without surgery; and for these children the two‐year survival rate was 42.8% vs. 8.3% for the group of patients submitted to local treatment alone. Besides the treatment modality, other factors influenced the prognosis, such as inflammatory signs, sex, tumor volume, and tumor site as well as evidence of distant metastases.
Carcinoid tumour of the gastrointestinal tract: Prognostic factors and disease outcome
Authors: Agranovich Alexander L. , Anderson George H. , Manji Mohamed , Acker Brian D. , Macdonald Walter C. , Threlfall William J.
Published: February 2007

This study represents retrospective analysis of 87 patients with a carcinoid tumour of the gastrointestinal tract seen and followed in the British Columbia Cancer Agency (BCCA) from 1960 to 1986. In 49 cases, the primary site was the small bowel. The rest of the cases were distributed as follows: 11 appendix, 10 rectum, 5 stomach, and 7 undetermined. We extrapolated the Dukes' and modified Astler‐Coller surgicopathological classifications used for colorectal cancer for use in our cases of carcinoid tumour of the gastrointestinal tract. A strong correlation was found, using this staging, with disease‐specific survival. Other prognostic factors included histologic differentiation, the presence of macroscopic residual disease after initial surgery, and level of 5‐hydroxyindoleacetic acid (5‐HIAA) in urine. Among 51 patients with surgically grossly removed disease, there was a tendency for the development of distant and distant/locoregional recurrence more often than locoregional recurrence alone. The liver was the commonest site of distant recurrence. Analysis of the effect of radiotherapy or chemotherapy on carcinoid tumour of the gastrointestinal tract proved unsuccessful because only a small portion of the patients had this treatment, and it was used mainly for palliation.
Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer
Authors: Hara Nobuyuki , Ohta Mitsuo , Ichinose Yukito , Motohiro Akira , Kuda Tomoharu , Asoh Hiroshi , Kawasaki Masayuki
Published: February 2007

We attempted to define the role of surgery in the treatment of small cell lung cancer (SCLC). Of 81 patients with clinically localized SCLC, 36 underwent surgical resection: 19 underwent initial resection with postoperative chemotherapy, while the remaining 17 were treated initially with chemotherapy, then resection. The remaining 45 patients were treated with a combination of chemotherapy and radiotherapy. The 5‐year survival for the 36 surgical patients was 38%; median survival time (MST) was 33 months. Nineteen patients treated with postoperative chemotherapy showed a 42% 5‐year survival, while 17 patients treated with preoperative chemotherapy showed a 33% 5‐year survival. This difference was not significant. However, stage III survival tended to be better in patients with preoperative chemotherapy (MST, 29 months) than in those who had had postoperative chemotherapy only (MST, 17 months). Although survival of the 45 nonsurgical patients was poor, stage I and II patients, or those with complete remission showed a 25% 5‐year survival with an MST of 33 months, and a 21% 5‐year survival with an MST of 25 months, respectively. We thus concluded that initial resection combined with postoperative chemotherapy is beneficial for patients with stage I, and probably stage II disease. For resectable stage III, particularly in patients with N2 disease, adjuvant resection after chemotherapy may be a favorable choice in the management of SCLC. For advanced stage III, complete remission by chemotherapy should be attempted in combination with radiotherapy.
Elevated serum gastrin levels in patients with gastric cancer
Authors: Rakic Srdjan , Hinder Ronald A. , Adanja Gordana , Demeester Tom R.
Published: February 2007

Elevated plasma gastrin levels have been found in patients with colorectal cancer. We measured fasting serum gastrin levels in control subjects (n = 12), patients with gastric cancer (n = 43), and patients with carcinoma of the esophagus (n = 55). Serum gastrin levels were significantly higher in patients with gastric cancer compared to normal controls (P < 0.005) and those with esophageal cancer (P < 0.05). This information may add to our understanding of the pathogenesis of gastric cancer.
Colorectal cancer patients with high risk of hematogenous metastasis: Correlation with CEA levels in peripheral and draining venous blood during the period of operation
Authors: Tabuchi Yoshiki , Deguchi Hiroyuki , Imanishi Kizuki , Saitoh Yoichi
Published: February 2007

Correlations between carcinoembryonic antigen (CEA) levels of peripheral (p) and draining (d) venous blood during the period of operation, and pre‐ and post‐operatively detected hematogenous metastases were examined in 78 patients with colorectal cancer. The metastases were found in 28 patients (HM group), but not found in the other 50 patients (non‐HM group). The mean values (43 and 198 ng/ml) and positive rates (61 and 96%) greater than 5 ng/ml of p‐ and d‐CEA levels in the HM group were significantly higher than those (6 and 14 ng/ml, and 22 and 48%, respectively) in the non‐HM group. The differences (mean 184 ng/ml and positive rate 49%) of d‐CEA levels between both groups were more significant than those (39 ng/ml and 30%) of p‐CEA levels. The mean value (155 ng/ml) and positive rate (82%) greater than 5 ng/ml of the gradient between d‐ and p‐CEA levels (d‐p CEA gradient) in the HM group were significantly higher than those (8 ng/ml and 34%) in the non‐HM group. These results suggest that patients with a high risk of hematogenous metastases are more effectively checked by the determination of d‐CEA levels and d‐p CEA gradient than of p‐CEA levels, and that they are patients with positive d‐CEA and d‐p CEA gradient levels.
Prospective analysis of masticatory function following lateral mandibulotomy
Authors: Marunick Mark , Mahmassani Omar , Siddoway John , Klein Barbara
Published: February 2007

Based on clinical impressions and subjective reports by patients, it is generally accepted that a loss of mandibular continuity will result in decreased masticatory function while preserving continuity will result in maintenance of masticatory function. Surprisingly, there is a paucity of well controlled studies objectively evaluating masticatory function to support these statements. The purpose of this study was to objectively evaluate masticatory function in a patient who underwent surgical resection for cure of a tonsillar carcinoma where a lateral mandibulotomy was used. Masticatory performance and swallowing threshold were assessed using a 0.5 gm frito as the test food substance and a sieve analysis. The subject was evaluated pre and post surgery and post prosthetic rehabilitation. When compared with pre surgery function, masticatory function and swallowing threshold were maintained and enhanced with prosthetic treatment 1 year post surgery. Maintenance of mandibular continuity did have functional merit for the subject studied.
Subrenal capsule assay using nude mice as a predictor of the response of the gastric cancer to chemotherapy
Authors: Yamauchi Masaji , Satta Tetsuya , Ito Akihiro , Kondo Ken , Akiyama Seiji , Ito Katsuki , Watanabe Tadashi , Takagi Hiroshi
Published: February 2007

Feasibility of utilizing human gastric cancers as first transplant generation xenografts in nude mice for determining tumor sensitivity to chemotherapeutic agents was demonstrated by applying subrenal capsule (SRC) assay. A total of 55 human gastric tumors from patients were tested in this assay. Mitomycin‐C (MMC) and hexycarbamyl‐5‐FU (HCFU, 5‐FU derivative) were selected for the treatment of these patients after surgery and also for this assay as first transplant. Evaluable rate of MMC in this assay was 92.7% and that of HCFU was 90.9%. Sensitivity of tumors to MMC was 25% and to HCFU was 32%. Correlation between response to chemotherapy of human tumors in patients and in nude mice was 78.6%. These results indicate that this assay could predict effective drugs for patients with gastric cancer.
Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer
Authors: Malawer Martin M. , Buch Richard G. , Thompson Willie E. , Sugarbaker Paul H.
Published: February 2007

Palliative amputations were performed on 11 patients (7 men, 4 women) with disseminated disease to control local bony complications. The average patient age was 54 years (range 14‐78 years). The primary diseases were melanoma/sarcoma (seven patients) and carcinoma (four patients). All had pain; eight had intractable pain that could not be controlled by analgesics. All 11 patients had additional severe local complications, which included recurrent pathological fracture (4), sepsis (2), hemorrhage (2), radiation necrosis (2), and iliofemoral thrombosis secondary to tumor (1). Previous attempts of palliation had been made in all 11 patients, and 8 had undergone previous operative procedures (5 had undergone two or more) prior to amputation. Three anterior hemipelvectomies, five posterior hemipelvectomies, two hip disarticulations, and one forequarter amputation were performed. All patients survived the surgery, and there were no intraoperative complications. All patients received dramatic relief of pain. Postoperative complications included two cases of flap necrosis and two infections; all resolved satisfactorily. The six patients who were nonambulatory before surgery ambulated postoperatively, and two eventually ambulated with a prosthesis. Six of 11 patients survived 1 year or longer, with a median postoperative survival period of 13 months (average 16 months). Although major amputations are viewed at times as offering little to already‐compromised patients, they can improve dramatically the quality of life in selected patients.
Intrahepatic cholangiocarcinoma in hepatolithiasis: A frequently overlooked disease
Authors: Sheen‐Chen Shyr‐Ming , Chou Fong‐Fu , Eng Hock‐Liew
Published: February 2007

Five cases of intrahepatic cholangiocarcinoma were found among 101 cases of hepatolithiasis. There was no definite sign of cholangiocarcinoma in ERCP and image studies of four cases. The possibility of the existence of occult cholangiocarcinoma should be kept in mind, especially when unusual presentations, such as body weight loss, anemia, palpable abdominal mass, and intractable pain, appear. An intraoperative frozen‐section examination should be considered under the following circumstances: (1) whitish nodular mass over liver, (2) mucinous substance within bile duct, and (3) enlarged, firm lymph nodes clustered along the hepatic arteries and/or celiac arteries.
Carcinoma of the pancreas: A personal experience with 100 cases
Authors: Crucitti Francesco , Doglietto Giovanni Battista , Costamagna Guido , Frontera Domenico , Ferrante Angela M. R. , Montemaggi Paolo , Trodella Lucio , Dobelbower Ralph R.
Published: February 2007

One hundred patients with pancreatic cancer were evaluated between March 1981 and December 1989. This study showed that 61 were not candidates for definitive surgery because of nonoperability (28 patients) or nonresectability (33 patients). An additional 25 patients had cancers that were unresectable because of metastases (13 patients) or local spread of disease (12 patients) discovered at laparotomy. Fourteen patients had resectable cancers. Ten were treated by total pancreatectomy, three by distal pancreatectomy and one by pancreatoduodenectomy (Whipple). There were two operative mortalities. The median patient survival time was 20.5 months. Two patients survived 5 years. Five patients are alive at 3, 14, 18, and 47 months. Palliative surgical procedures performed in 18 patients included 10 biliary bypasses, 9 gastrojejunostomies, and 6 T‐tube placements. This was associated with an operative mortality rate of 11%. The median survival time was 5 months. Other palliative measures included endoscopic placement of biliary and pancreatic stents (47 patients, 2.7% mortality rate), endoluminal radiation therapy, interstitial radiation therapy and external beam radiation therapy. The median survival time of patients so treated was 4.5 months.
The choice between surgical resection and radiation therapy for patients with cancer of the esophagus and cardia: A retrospective comparison between two treatments
Authors: Welvaart Kees , Caspers Robert J. L. , Verkes Robert J. , Hermans Jo
Published: February 2007

The choice of treatment for patients with cancer of the esophagus and cardia is controversial. Since overall survival is poor, the most important aim of treatment should be improvement of the main complaint: the inability to eat. In a retrospective analysis of 265 patients, referred to the University Hospital in Leiden, the Netherlands, comparisons were made between palliative effects of surgical resection (N = 92) and irradiation (N = 128). Several methods of comparing surgery with irradiation are possible: (1) all surgical patients vs. all irradiated patients; (2) only those surgical patients who survived the operation (N = 70) vs. all irradiated patients (N = 128); and (3) survivors after resection (N = 70) vs. only those irradiated patients treated with “curative” radiation (N = 62). Analysis of prognostic factors showed that in both surgical and irradiated patients, the only statistically significant factor was the (dis)ability to eat. Criteria to be considered to make individual recommendations for either treatment are presented.
Indwelling subclavian catheters and a visit with the “pinched‐off sign”
Authors: Lafreniere Rene
Published: February 2007

Percutaneously inserted indwelling subclavian vein silastic catheters have revolutionized the administration of chemotherapeutic agents. Complications associated with insertion of such lines have always included bleeding, pneumothorax, haemothorax, arterial cannulation, and catheter displacement. Recently a patient receiving 5‐fluorouracil and folinic acid for 11 months for small bowel carcinoma experienced a catheter fracture with distal segment embolization in the right atrium. A literature survey revealed 13 cases where mechanical shearing forces on the catheter caused by compression of the catheter between the clavicle and first rib were thought to be the cause for this complication. Interestingly all cases involved patients receiving chemotherapy. Radiologically, potential candidates for catheter fracture can be identified by the pinched‐off sign with bending and pinching of the catheter at the thoracic inlet. Recommendations are for more lateral insertions of such percutaneously placed catheters and if the pinched‐off sign is seen, then said catheters should be followed radiologically and probably should not remain in situ for longer than 6 months.
Metastatic pattern of infiltrating lobular carcinoma of the breast: An autopsy study
Authors: Lamovec Janez , Bračkko Matej
Published: February 2007

We analyzed the autopsy records and autopsy histological slides of 261 patients with breast carcinoma who died at the Institute of Oncology, Ljubljana, from January 1972 to October 1989, with particular attention to the metastatic pattern of infiltrating lobular carcinoma (ILC) which we compared with infiltrating ductal carcinoma (IDC). In 226 of 261 patients who died with metastatic disease there were 25 cases of ILC, 195 cases of IDC, 4 cases of mixed IDC–ILC, and 2 cases of mucinous carcinoma. There was no statistically significant difference in frequency of metastases to common metastatic sites, such as the liver, bone, and pleura, with the exception of the lungs, in which IDC metastases prevailed (P <0.006). By contrast, a statistically highly significant prevalence of ILC metastases to the peritoneum/retroperitoneum, hollow viscera, internal genital organs, leptomeninges, and myocardium was found (P values of <0.006‐<10‐6). The metastases to these sites were characterized by diffuse growth of neoplastic cells that infiltrated in a lymphoma or leukemia‐like fashion. Such metastases may remain clinically silent for a long time, in spite of their extensiveness. The difference of metastatic pattern between ILC and IDC is insufficiently appreciated in most of the published studies on ILC.
Early hilar lung cancer: Its clinical aspect
Authors: Watanabe Yoh , Shimizu Junzo , Oda Makoto , Iwa Takashi , Takashima Tsutomu , Kamimura Ryoichi , Kitagawa Masanobu , Nonomura Akitaka , Nakamura Shinobu , Tanimoto Kazuo , Matsubara Fujitsugu , Ikegaki Shigeru , Yamada Katuji
Published: February 2007

Early hilar lung cancers are rare, but are curable if they are properly diagnosed and treated. In the past 14 years, we have treated 27 patients with early hilar cancers that fulfilled the criteria proposed by the Japanese Lung Cancer Society (JLCS). Eighteen patients presented with symptoms and 9 were detected by the mass screening examination of sputum cytology. All lesions in both groups were finally diagnosed by bronchoscopy. Twenty patients (74%) had positive sputum cytology, whereas only 7 (26%) had positive chest X‐ray findings. All the patients underwent surgery, and bronchoplasty was the most frequent operative procedure. The 5‐year survival rate was 100%, and the 10‐year survival rate was 91.7%, as one patient died of a second primary lung cancer in the 6th postoperative year. In conclusion, the definition of early hilar lung cancer proposed by the JLCS is thought to be reasonable, and early hilar lung cancer is a curable disease, if it is properly diagnosed and treated.
Metastases to the breast: Differential diagnosis from primary breast carcinoma
Authors: Vergier Beatrice , Trojani Monique , De Mascarel Isabelle , Coindre Jean‐Michel , Le Treut Alain
Published: February 2007

Eight patients with breast metastases from primary tumors other than breast carcinoma were studied: 3 malignant melanomas, 2 rhabdomyo‐sarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid, and 1 epidermoid cervical carcinoma. All had mammographic, histopathologic, and immunohistochemical examinations. The main problem was differential diagnosis from primary breast carcinoma. History of extramammary primary tumor was helpful but breast metastasis was the first clinical feature in 2 cases. Patients had noticed palpable, round, rapid growth masses which were mammographically benign. Pathologic diagnosis was difficult and immunohistochemical studies necessary, whenever the proliferation had histologic features of primary breast carcinoma or when no primary tumor was known. However, some histologic features were of value for diagnosis of metastasis: atypical histologic features for a primary breast carcinoma, a well‐circumscribed tumor with multiple satellite foci, the absence of an intraductal component, and the presence of many lymphatic emboli. In adults, the most frequent types of tumors metasta‐sizing in the breast are malignant melanoma and neuroendocrine‐like tumors, especially small cell carcinoma and carcinoid. In children, rhabdomyosarcoma is the most common. Accurate diagnosis of breast metastasis is important to avoid unnecessary mastectomy and to implement an appropriate systemic therapy.
Gastric carcinoma metastatic to the breast
Authors: Hamby Leigh S. , McGrath Patrick C. , Cibull Michael L. , Schwartz Richard W.
Published: February 2007

A patient with signet ring adenocarcinoma of the stomach with metastatic disease to the breast treated at our institution is presented and added to the 14 cases reported in the literature. A review of the common clinical features and possible mechanisms of metastases is given. While the majority of patients present with symptoms referable to their gastric malignancy, the patient in this case initially sought treatment because of her breast mass. Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. For this reason, immunohistochemistry utilizing carcinoembryonic antigen (CEA), C‐ERB B‐2, and gross cystic protein were used in this case to confirm an extramammary source. In order to prevent unnecessary breast surgery and provide proper treatment of the gastric primary, the patient's complete clinical presentation must be used to guide diagnostic evaluation.
Cytoreductive surgery impedes metastasis and enhances the immune response: A preliminary report
Authors: Grinis Gedas , Targonski Paul , Shaw Michael , Rubenstein Marvin , Guinan Patrick D.
Published: February 2007

In an effort to determine the effect of cytoreductive surgery on the metastatic process, MAT‐LyLu flank tumors were excised from Copenhagen X Fischer rats and the effects of this surgery on metastatic lung lesions were observed. Cytoreduction resulted in a decrease in lung lesions (P < 0.05). Adjuvant cyclophosphamide (CTX) further enhanced this beneficial effect. A concurrent increase in the helper/suppressor ratios suggested that this beneficial response might be mediated by the host's immune response.