bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer‐induced immunosuppression: Implications for therapy?
Authors: Pollock Raphael E. , Roth Jack A.
Published: February 2007

Cancer‐induced immunosuppression can be caused by a variety of effects. These include factors produced by the host in response to the presence of tumor or factors elaborated by the tumor itself. Disseminated tumor can lead to host debility with associated anergy. Some immunosuppressive effects are due to the manner in which the host processes (or fails to process) the tumor as an antigenic stimulus. Lastly, antitumor treatments can have a detrimental impact on host antitumor immunity. Recent research findings from our laboratories implicate surgical stress effects and tumor‐mediated production of growth factors such as transforming growth factor Beta (TGF‐Beta) as being important causes of host immune impairment. An accurate understanding of the mechanisms underlying host antitumor immune impairment will be critical in the successful development of immunotherapy strategies for use in the surgical oncology patient.
Active specific immunotherapy in malignant melanoma
Authors: Morton Donald L. , Foshag Leland J. , Nizze J. Anne , Gupta Rishab K. , Famatiga Estela , Hoon Dave S. B. , Irie Reiko F.
Published: February 2007

We have recently initiated clinical trials of active specific immunotherapy evaluating a new polyvalent melanoma cell vaccine in patients with high‐risk and/or recurrent melanoma. The vaccine has been administered alone, or in combination with low‐dose cyclophosphamide, as an immunomodulator of suppressor cells. Cyclophosphamide is effective in lowering suppressor cell activity in some patients undergoing active specific immunotherapy. This is not associated with an enhanced humoral immune response to melanoma‐associated antigens, nor is the clinical course of those patients receiving cyclophosphamide favorably influenced. We are hopeful that other immunomodulators, alone or in combination with lower does of cyclophosphamide, may be effective in some patients, particularly in those patients whose suppressor cell activity remains high. The optimization of the vaccine and the use of immunomodulators will enhance humoral and cellular immune responses to antigens in the allogenic vaccine that cross react with those present in the autologous melanoma, which should more favorably influence the prognosis of melanoma patients.
Present status of serum markers
Authors: Minton John P. , Chevinsky Aaron
Published: February 2007

Tumor markers presently in use generally meet only one or two of the criteria for the ideal marker, which are: tumor specificity, correlation with tumor bulk and stage of the disease, decrease to normal after successful treatment, and rise prior to clinical manifestations of recurrence. In addition, virtually all are elevated in some benign conditions. Currently their greatest usefulness is for confirmation of clinical suspicion and for monitoring known disease. Some tumor markers which are not effective as screening tests can be used to evaluate the patient's response to therapy. The discovery of oncogenes holds great promise for a new generation of tumor markers. Major breakthroughs in the fields of molecular biology and tumor immunology seem imminent with eventual application possibly in the treatment of cancer.
Active immunotherapy in colorectal cancer
Authors: Hoover Herbert C. , Hanna Michael G.
Published: February 2007

Seventy‐four patients with Dukes' B2 through C3 colon or rectal cancer were entered into a prospectively randomized, controlled trial of active specific immunotherapy (ASI) with an autologous tumor cell‐BCG vaccine. Primary tumors were dissociated enzymatically and cryopreserved by techniques that maintain cell viability. Patients were randomized into groups treated by resection alone (control) or resection plus ASI. All patients with rectal cancer received 5,040 rads of pelvic irradiation post‐operatively. With a median follow‐up of 56 mo, there is a moderately significant difference in the distribution of time‐to‐recurrence (P = .037) and a comparably significant difference in the distributions of time‐to‐death (P = .031); both comparisons favor the ASI group. Most of the difference was due to the subgroup with colon cancer. With such small numbers of patients, we cannot conclude that ASI is of proven therapeutic benefit. The results are sufficiently encouraging that the trial is continuing and a national multi‐institutional prospectively randomized trial is being conducted.
Clinicopathologic studies of gastric carcinoma
Authors: Mori Masaki , Sugimachi Keizo
Published: February 2007

We reviewed the clinical and pathologic experiences of gastric carcinoma cases seen in our department. Early diagnostics of the carcinomas were documented, especially in the cases of small gastric carcinoma, carcinoma of the gastric cardia, and in cases of young patients. The importance of lymphadenectomy in surgical treatment was emphasized as a cure for patients with gastric carcinoma. The surgical treatment and results for far advanced cases were also demonstrated. Several pathologic factors related to prognosis were shown; these included growth patterns, special gross or histologic types, stromal reactions, immunohistochemical studies, and others. We emphasize that a full understanding of the pathologic characteristics of gastric carcinoma is indispensable for providing adequate treatment.
DNA analysis and prognosis of digestive tract cancers
Authors: Kuwano Hiroyuki , Sugimachi Keizo
Published: February 2007

Cytophotometric DNA analysis was performed on esophageal and gastric carcinomas. In 35 cases of mucosal and submucosal carcinoma of the esophagus, patients with types I and II (relatively regular in DNA distribution) had an uneventful postoperative course and no recurrence, whereas 3 of 15 (20%), and 5 of 9 (55.6%) with type III and type IV, respectively (widely scattered DNA distribution), died following a recurrence. Cytophotometric DNA analysis using biopsy specimens from 75 patients with esophageal cancer in various stages also showed a close relationship between the DNA distribution pattern and prognosis. However, the growth mode and the DNA ploidy of mucosal gastric cancer correlated well in the investigation of 66 cases. Thus, data of this method closely reflected the outcome in patients with digestive tract cancers. These results suggested the potential usefulness of cytophotometric DNA analysis for assessing the prognosis, even in the early stage of cancers.
Surgical strategy for primary hepatocellular carcinoma associated with cirrhosis
Authors: Kanematsu Takashi , Shirabe Ken , Sugimachi Keizo
Published: February 2007

We evaluated the applicability of limited hepatic resection in cases of hepatocellular carcinoma (HCC) in cirrhotic patients. According to the severity of impaired hepatocellular function, 37 patients underwent limited resection, and for 13, standard major hepatic resection was done. There were no significant differences in the mortality and survival rates between the two groups. This limited resection can be selectively used to treat cancer associated with cirrhosis and encapsulated tumors

For further evaluation of this limited procedure, an attempt was made to elucidate the manner in which the surgical margin is linked to a recurrence after curative resection for hepatocellular carcinoma in patients with cirrhosis. Forty patients were divided into two groups; those in whom the margin from the cut surface to HCC in the fresh specimen was less than 10 mm wide [TW( + )] and patients in whom the surgical margin was equal to or exceeded 10 mm [TW( − )]. There were 24 and 16 patients in the TW( + ) and TW( − ) groups, respectively. There was no statistically significant difference in the rate of recurrence between the two groups. In patients with a tumor less than 4 cm in diameter, the extent of TW is not linked to an early recurrence. However, when the tumor size exceeds 4 cm, 10 mm of TW is inadequate to achieve curability. When a wide resection is not feasible, then adjuvant therapy should be aggressive.
Aldosterone‐producing tumors (Conn's syndrome)
Authors: Merrell Ronald C.
Published: February 2007

Adenomas of the adrenal cortex which produce aldosterone (APA) are among the surgically correctible causes of hypertension accounting for 0.5 to 1.0% of all hypertensive etiologies. The adenomas have a 5:1 predilection for women and generally present with hypertension or profound hypokalemia. A low plasma renin activity completes the triad for primary hyperaldosteronism which could be caused by adrenocortical cancer, a neoplasm with an average diameter of 12 cm, or idiopathic hyperaldosteronism (IHA), a bilateral hyperplasia of the zona glomerulosa of the adrenal cortex which responds poorly to surgical resection. The adenomas are small (2 cm) but can be localized by imaging or selective venous sampling. Resection has a high success rate with minimal morbidity.
Hormonal therapy for prostate cancer
Authors: Rosenberg Andrew G. , Von Eschenbach Andrew C.
Published: February 2007

Since the demonstration in 1941 by Huggins and Hodges that prostatic cancers are androgen dependent, hormonal treatment by androgen ablation has been the principal treatment for patients with advanced adenocarci‐noma of the prostate. Although not able to permanently and totally eradicate every cancer cell since prostate cancer cells are quite heterogeneous in their sensitivity to androgens, hormonal therapy can produce dramatic subjective improvement as well as objective remissions. This results in an improved quality of survival and for patients with metastatic adenocarci‐noma, endocrine therapy does reduce the death rate from cancer, and if death from other concurrent illness is controlled, there is an absolute increase in survival. At present, a variety of strategies are available for ablation of testicular and adrenal androgens, but results are not clinically significantly better than orchiectomy.
Current status of endocrine treatment of carcinoma of the breast
Authors: Buzdar Aman U.
Published: February 2007

Sequential administration of endocrine therapies can result in objective remission in a significant fraction of patients with metastatic breast cancer. Combined hormonal therapies and combined hormonochemothera‐pies have not resulted in better results than the sequential administration of these same therapies. Tamoxifen (an antiestrogen) given as an initial therapy results in local control of the disease in a significant fraction of patients with locally advanced breast cancer who are not candidates for cytotoxic therapy. Tamoxifen as an adjuvant therapy for operable breast cancer prolongs disease‐free survival and reduces mortality in patients >50 yr of age with higher estrogen receptor concentrations

The role of tamoxifen as adjuvant therapy for patients <50 yr of age remains unclear. Also, adjuvant tamoxifen in combination with cytotoxic drugs has not produced superior results, and the duration of adjuvant tamoxifen therapy remains to be determined. Experimental data suggest prolonged administration of tamoxifen may be needed to control microme‐tastases.
Hormonally active gynecologic tumors
Authors: Morgan Linda S.
Published: February 2007

Hormonally active gynecologic tumors include gestational trophoblastic disease (GTD) and some of the primary ovarian tumors. The presenting symptoms in patients with these tumors are frequently related to their endocrine activity. The main hormone produced by gestational tropho‐blastic disease is human chorionic gonadotropin (HCG) and the main symptoms are those associated with a normal pregnancy, except they are frequently exaggerated. The endocrinally active ovarian tumors are mainly those of the sex—cord stromal group and these may produce any of the sex steroids (estrogens, androgens, or progestins). Some germ cell tumors of the ovary are hormonally active because they contain syncytio‐trophoblastic cells which produce HCG. There are two specialized types of mature teratomas that are discussed: struma ovarii, which produce thyroid hormones, and carcinoids, which produce serotonin.
Thymoma
Authors: Couture Mark M. , Mountain Clifton F.
Published: February 2007

A review of the evaluation, treatment, and end results for 52 patients with thymoma treated at The University of Texas M.D. Anderson Cancer Center (1950‐1984) is presented. The objective of the study was to examine the influence of a number of clinical characteristics on survival, including histologic and staging classifications, associated diseases, symptom status, and treatment. Forty‐nine patients (94%) underwent surgical exploration; 13 were stage I, 12 were stage 11, and 24 were stage 111. Complete resection was accomplished in all of the stage I and I1 groups and in 6 of the stage I11 patients. An asymptomatic history, surgical stage I disease, lymphocytic thymoma cell type, and complete resection favorably influenced prognosis. The cumulative 5‐year survival rate for all patients was 40%. No patient with stage I thymoma had recurrent disease, however, there were 9 recurrences (50%) in the completely resected stage II/III patients, six of whom remained disease‐free following treatment with radiotherapy, chemotherapy, or a combined approach.
Current status of parathyroid autotransplantation
Authors: Brunt L. Michael , Sicard Gregorio A.
Published: February 2007

Autotransplantation of the parathyroid glands is a clinically useful modality for the management of patients with certain forms of hyperparathyroidism. In conjunction with total parathyroidectomy, this procedure has been used to treat patients with primary and secondary hyperparathyroidism who have generalized parathyroid hyperplasia. Parathyroid autotrans plantation is also an important adjunct to the management of patients undergoing radical thyroid or laryngeal surgery to prevent permanent hypoparathyroidism from devascularization of all in situ parathyroid tissue. The technique of parathyroid cryopreservation has been well established and provides surgeons with greater flexibility in the approach to patients undergoing reoperative parathyroid surgery in whom there is uncertainty about the functional status of the remaining parathyroid tissue. Parathy‐ roid allotransplantation has been successfully performed in immunosuppressed patients but is rarely indicated. Parathyroid autografts can be placed heterotopically in a forearm muscle or in the sternocleidomastoid, but the former site is preferred in patients with hyperplastic or adenomatous tissue. This technique results in a low incidence of permanent hypoparathyroidism after radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissue.
Update on pancreatic islet cell transplantation
Authors: Jung Pa Jong , Merrell Ronald C.
Published: February 2007

The biological validation of islet grafts would free total pancreas resection from the onus of severe diabetes mellitus. Islet cell transplants can reverse diabetes mellitus and prevent complications in animal models. Immune rejection has foiled attempts at human transplantation despite moderate success with whole pancreas grafts. Aggressive rejection of islet grafts has been extensively studied in animal models and seems no different in substance from standard cell‐mediated rejection but vastly different in tenacity. Rejection cannot be prevented by immunosuppression strategies effective for transplantation of heart, kidney, or liver. New strategies to circumvent islet rejection include encapsulation of the islets to obfuscate immune recognition, pretreatment of the islets in vitro to reduce immunogenicity, donor manipulation to provide specific tolerance, and combination strategies. In the development of these strategies, much has been learned or confirmed about the nature of immune rejection, and another round of human trials can be anticipated.
APUD Update
Authors: Douglas Harrison W. , Hocking Michael P.
Published: February 2007

Apudomas are a diffuse group of tumors that have interested surgeons for a long time. With recent developments in their radiological localization and pharmacological control, they are now treated in a truly multidisciplinary approach. In this chapter, recent developments in the radiological, surgical, and medical approaches to these tumors are reviewed. Emphasis is placed on how non‐surgical developments have affected the surgical treatment of specific apudomas. Resulting changes in surgical philosophy are also reviewed.
Nitrous oxide: A cause of cancer or chemotherapeutic adjuvant?
Authors: Koblin Donald D.
Published: February 2007

The administration of nitrous oxide rapidly inactivates the vitamin B12‐dependent enzyme methionine synthase. This inactivation disrupts the normal interrelationships between vitamin B12 and folic acid, and results in altered levels of folic acid derivatives and certain amino acids and their metabolites. Attempts have been made to use the antifolate properties of nitrous oxide to treat patients with leukemia. Although transient improvements may be observed in patients with leukemia who are given nitrous oxide, prolonged administration of nitrous oxide is highly toxic and causes marked hematological and neurological abnormalities. Animal and in vitro studies suggest that the action of nitrous oxide may be tumor selective, and that nitrous oxide may interact with and enhance the therapeutic effect of other antitumor agents. However, there is a delicate balance between the possible beneficial and harmful effects of nitrous oxide, and the conditions for which nitrous oxide may prove useful as a chemotherapeutic adjuvant remain to be defined

Concern has also been raised that nitrous oxide may have carcinogenic potential, especially in operating room and dental personnel who are chronically exposed to trace concentrations of this gas. However, there is no convincing evidence to date that nitrous oxide causes cancer in either animals or humans.
Pain management of the oncologic patient
Authors: Arter Olga E. , Racz Gabor B.
Published: February 2007

After the first 5 years of life, cancer is one of the three most common causes of death. Most investigations of cancer pain have shown that 50–70% of patients suffer needlessly. Pain may be due to the tumor or a co‐existant benign pain syndrome

Methods of pain management include: 1) neurolytic blockade: stellate ganglion block, celiac plexus block, lumbar sympathetic block, epidural phenol, subarachnoid neurolysis; and 2) non‐pharmacologic methods: radiofrequency thermocoagulation lumbar sympathectomy, transcutaneous nerve stimulation (TENS), dorsal column stimulation (DCS)

In summary, we utilize every possible combination of therapeutic modalities for cancer pain management. With so many safe procedures available, we encourage the primary physician to refer patients early in their disease process. Neurolytic procedures should be performed prior to initiation of high dose narcotic therapy, radiation, chemotherapy, and surgery when possible.
Intraspinal narcotics for treatment of cancer pain
Authors: Lubenow Timothy R. , Ivankovich Anthony D.
Published: February 2007

Inadequate pain relief remains a problem for many patients with cancer. Narcotic administration by the epidural or subarachnoid route is a relatively recent innovation and is indicated when pain is poorly controlled with high doses of systemic narcotics, or when patients experience limiting narcotic side effects. When given by the epidural or intrathecal route, narcotics have a longer duration of action and a lower dose is effective. These techniques involve personnel trained in catheter insertion and maintenance. Epidural and intrathecal administration of narcotics is an alternative when oral narcotics are ineffective

In this report the term “intraspinal” refers to epidural and/or subarachnoid placement of catheters and drugs.
Ambulatory anesthesia
Authors: Philip Beverly K.
Published: February 2007

Ambulatory surgical procedures are a large and increasing fraction of all surgery in the United States. A specialized health care team must be assembled to care for these patients and meet their special needs. Ambulatory surgery patients should be selected according to medical and psychosocial criteria. Patient preparation includes a history and physical examination, limited laboratory tests, empty stomach, and appropriate monitoring. Premedication should be supportive, and verbal as well as medicinal; drugs include ataractics and analgesics. All forms of general or regional anesthesia may be used. Recovery goals must be well defined, aiming for “home readiness.” Ambulatory anesthesia care is concluded with postdischarge follow‐up, for quality assurance and risk management.
Incidence of regional lymph node metastasis in operable osteogenic sarcoma
Authors: Caceres Eduardo , Zaharia Mayer , Calderon Ruth
Published: February 2007

Records of 182 consecutive patients with the diagnosis of operable osteogenic sarcoma, treated between 1954 through 1980 by the Breast, Bone and Mixed Tumors Department of the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru), were reviewed to study the incidence of regional lymph node metastases in this disease.

All the patients included in this study had radical surgery, which means the complete resection of the bone where the tumor is located, including the proximal joint, which permitted excision of the regional lymph nodes.

Nineteen patients (10.4%) had evidence of sarcoma metastatic to draining lymph nodes. A comprehensive analysis of the literature shows that the incidence of metastasis to the lymph nodes in this study, is higher than those cited in a review of the literature, probably due to the policy in the management of osteogenic sarcoma in our institution, during the period of study.
Transabdominal radical nephrectomy in ninety‐one consecutive patients with Wilsm' tumor
Authors: Pow‐Sang Julio E. , Benavente Victor , Pow‐Sang Julio M. , Aguero Victor
Published: February 2007

Ninety‐one children that were subjected to transabdominal radical nephrectomy are reviewed. The patients' ages ranged from 20 days to 10 years. Forty cases had a right side tumor and 44 a left side tumor; bilateral tumor incidenc e was 7.70% (7 cases). The tumor weight incidence was 75% for ⩾500 g and 37.5% for ⩾1,000 g. Incidence of local extension of the disease was 21.98%. Intraoperative complications were 12 ruptures of the kidney capsule, 1 laceration of the cecum, 1 opening of the pleura, 1 section of the superior mesenteric artery, and 1 section of the right common iliac artery. The mortality rate in unilateral surgery, because of intraoperaive massive hemorrhage, was 3/83 (3.61%). One patient with bilateral tumor died because of accute renal insufficiency and sepsis. One patient with caval thrombus which extended up to the right atrium died because of intraoperative massive pulmonary embolism.
Bilateral ilioinguinal lymph node dissection in the management of cancer of the penis
Authors: Pow‐Sang Julio E. , Benavente Victor , Pow‐Sang Julio M. , Pow‐Sang Mariela
Published: February 2007

Twenty‐nine patients with squamous cell carcinoma of the penis underwent bilateral ilioinguinal groin dissection 6 weeks after removal of the primary penile lesion. Eighty percent of the patients were alive and without evidence of disease at 5 years when the dissected lymph nodes were negative. When positive nodes were found, 62.5% of the patients were alive and without evidence of disease at 5 years: two of these patients had one iliac deep node positive each. The mortality rate at 5 years because of progression of disease was 6.6% when the dissected lymph nodes were negative, as compared to 37.5% when the dissected lymph nodes were positive.
Surgical treatment of non‐small cell lung cancer by stage
Authors: Martini Nael
Published: February 2007

Resection is the treatment of choice for stage I and II non‐small cell lung carcinoma. The 5‐year survival following resection is 72% in stage I carcinoma and 49% in stage II carcinoma. Resection alone or combined with radiation and/or chemotherapy is also indicated in some patients with stage IIIa disease. The 5 year survival with resection is 56% in tumors invading chest wall (T3NO), 30% in superior sulcus tumors, 30% in patients with N2MO disease, and 36% in patients with tumors in proximity to carina. Surgery is of very limited value in patients with tumors invading the mediastinum and in patients with stage IIIb or stage IV disease. Details of case selection in each treatment category are presented.
Diagnosis and treatment of pleural mesothelioma
Authors: Rusch Valerie W.
Published: February 2007

Pleural mesotheliomas are uncommon tumors. They can be broadly classified as localized and diffuse. The localized form is a non‐epithelial neoplasm that occurs as commonly in women as in men and is not related to asbestos exposure. It is usually asymptomatic, and is occasionally associated with paraneoplastic syndromes. Localized mesotheliomas arise more frequently from the visceral than from the parietal or mediastinal pleura. The long‐term outcome of these tumors is determined mainly by their clinical presentation, and by whether or not they can be completely resected.

Diffuse pleural mesotheliomas are invariably malignant. They are clearly related to asbestos exposure, and are far more common in men than in women. Histologically, they are completely or partially epithelial tumors. Diffuse mesotheliomas present with dyspnea, chest pain, and weight loss and are not associated with paraneoplastic syndromes. Distinguishing malignant mesothelioma from metastatic adenocarcinoma can be difficult and usually requires a large tissue biopsy on which immuno histochemistry and electron microscopy can be performed. The management of diffuse malignant mesothelioma remains controversial. Treatment appears to prolong survival which ranges from 6 to 12 months with supportive care alone. Surgical resection, either with extrapleural pneumonectomy or by pleurectomy/decortications remains the mainstay of treatment because of the relative ineffectiveness of radiation and chemotherapy. Surgical resection alone, however, is inadequate, so most current treatment regimens combine operation with radiation and/or chemotherapy. Even with aggressive multimodality treatment, the median survival currently ranges from 18 to 24 months. A better understanding of prognostic factors, a better staging system, and innovative treatment strategies are desperately needed in this disease.
Prognostic indicators in patients with pulmonary metastases
Authors: Putnam Joe B. , Roth Jack A.
Published: February 2007

Pulmonary metastases from different primary neoplasms have different biological characteristics which may correlate with patient survival. Objective criteria to reliably select or exclude patients who would benefit from resection of these metastases are not available; however, various prognostic indicators have been studied for their correlation with postresection survival. Prognostic indicators differ among various tumor histologies. Prognostic indicators identified preoperatively which may influence post‐resection survival include age, sex, histology and location of the primary tumor, tumor doubling time, disease free interval, the number of nodules on preoperative roentgenographic studies, and the number of metastases resected. Following surgery, resectability, and the number of metastases resected may predict expected survival for patients meeting certain criteria. No single criterion should be used to exclude patients from surgery as resection will provide numerous patients with significant postresection survival.
Neck dessection: Concepts, Controversies, and Technique
Authors: Byers Robert M.
Published: February 2007

The various types of neck dissections are described. The indications for each type of neck dissection are discussed for patients with necks staged No, N +, for the patient with an unknown primary and for the patient whose neck dissection is in conjunction with radiation. The technical aspects of modified neck dissections are addressed but not in great detail. The indications for the use of postoperative radiation are emphasized. The nodal groups at risk for metastases from various primary sites are identified and a terminology for neck dissection is suggested.
Advances in radiation therapy for head and neck cancer
Authors: Toonkel Leonard M.
Published: February 2007

Radiation therapy either as a single modality or as part of multimodality plans remains an integral part of curative treatment for cancers of the head and neck. This paper traces the modernization of radiation therapy regarding tumors of the head and neck using examples of sites of malignancy where radiation therapy is the sole modality or where radiation therapy can be combined with surgery and chemotherapy for optimal results. As local‐regional control rates have improved with the use of combined radiation therapy and surgery and aggressive hyperfractionation schemes for advanced primary tumors, distant metastases and second primary neoplasms are now accounting for a larger proportion of treatment failures. Until such time as more effective systemic therapy and cancer control mechanisms are developed to address these problems, radiation therapy will continue to play a major role in the overall management of patients with cancers of the head and neck.
Current advances in reconstruction of the mandible in head and neck cancer surgery
Authors: Marx Robert E.
Published: February 2007

Today's reconstruction of head and neck cancer related deformities is based on an in‐depth knowledge of soft and hard tissue repair coupled with the technical ability to transplant and reorient soft and hard tissues into a functional and cosmetic improvement for each patient. The recent advances of (1) the science of bone regeneration, (2) myocutaneous flaps, (3) hyperbaric oxygen, and (4) allogeneic bone cribs have resulted in reconstructions which are now predictable outcomes with few complications and minimal morbidity. This writing will discuss the contribution and mechanism of each of these four advances and how their application can be used to consistently reconstruct even large deformities with both hard and soft tissue loss, as well as in tissues which have been severely radiated.
Incidence of carcinoma of the thyroid in nodular goiter
Authors: Cole Warren H. , Watne Alvin L.
Published: February 2007

Since the incidence of cancer in nontoxic nodular goiter as reported by us in 1944 appeared high (17.1%), we made another study during the next four years and discovered an incidence almost identical (17.2%). Our figures on incidence of cancer in nontoxic nodular goiter appeared so high because we were the first authors to break down the goiters into the three different types and to discover that the incidence was high in only one type of goiter and not in the others. The incidence of cancer was only 4.6% in toxic nodular and toxic diffuse goiter added together

For decades, we have known that goiter is a geographic disease. It is possible that carcinoma of the thyroid is slightly geographical. At least it appears that there is a slightly geographical relationship in regard to the 16 patients we have observed in our clinic with cancer during 1944–1949; of these 16 patients, 11 had advanced malignant disease. We cannot have accurate figures on results regarding treatment of our cases until long‐term follow‐up is concluded.
Medullary carcinoma of the thyroid: Current diagnosis and management
Authors: Lairmore Terry C. , Wells Samuel A.
Published: February 2007

Medullary thyroid carcinoma (MTC) accounts for 5–10% of thyroid malignancies and occurs in either a sporadic or a familial form. The familial form is inherited in an autosomal dominant pattern, and expressed clinically as multiple endocrine neoplasia (MEN), types IIa and IIb, or as familial MTC alone. This neoplasm is derived from the parafollicular or C‐cells, and has the ability to secrete a variety of polypeptide hormones including calcitonin, which serves as a tumor marker for the presence of MTC. The development of a calcitonin radioimmunoassay and the screening of patients at risk for the familial forms of MTC allows the diagnosis of the neoplasm in an occult stage when total thyroidectomy results in virtually 100% cure. We will present our experience with the diagnosis, treatment, and postoperative follow‐up of our patients with this interesting neoplasm.
Neck dissection for thyroid cancer
Authors: Ballantyne Alando J.
Published: February 2007

Decisions concerning the extent of surgical treatment for thyroid cancer remain controversial. Limited surgical procedures, designed to remove only the cancer that is clinically evident, can be successful since the primary determinants in survival are age, sex, and histologic type rather than number of positive nodes or other factors. A retrospective review of 339 patients who had surgical procedures for cancer of the thyroid at MDA hospital from 1975 to mid‐1989 did not show a conclusive advantage for any type of neck dissection. The operations were tailor‐made to include all evident clinical cancer. Secondary procedures such as surgery, radioactive iodine, or radiation therapy were successful in treating recurrences, which occurred in all surgical groups, whether limited or radical.
Head and neck irradiation in childhood: Increased risk of developing thyroid disease
Authors: Sako Kumao
Published: February 2007

A nodule of the thyroid in a patient with a history of prior irradiation to the head and neck area in childhood is more likely to be malignant than a nodule in the general population

Thirty‐two of 144 such patients (22%) who came to surgery were found to have a carcinoma of the thyroid. A relative short‐term (6 mo) trial with suppressive therapy with a thyroactive agent may be helpful in selecting out those nodules that may be malignant

Although considerable controversy continues to exist as to the proper surgical treatment, our current surgical management involves performing a total extracapsular thyroidectomy.
Role of thyroid stimulating hormone suppression in the management of thyroid cancer
Authors: Thomas Colin G.
Published: February 2007

Well‐differentiated thyroid cancers (papillary, follicular, and some Hurthle cell tumors) contain membrane receptors for TSH. Responsiveness of these tumors to TSH stimuli is documented by increased radioactive iodine uptake, secretion of thyroglobulin, increase in thyroid size, and potential progression to an anaplastic type. Although TSH suppression has a variable effect on the growth of existing tumors and the incidence of recurrent disease, there is a sound rationale for long‐term TSH suppression in all patients with differentiated tumors of the thyroid. The ultrasensitive TSH test permits ready monitoring of the adequacy of thyroxine dosage. The cost is minimal (approximately. 10/day) and the risks are negligible if one assumes the avoidance of hyperthyroxinemia.
Follow‐up of patients after primary colorectal cancer resection
Authors: Pommier Rodney , Woltering Eugene A.
Published: February 2007

Improved survival rates for patients with colorectal cancer may depend on early detection of metachronous colon lesions and early detection of distant disease. Frequent serial CEA determinations and history and physical examination are the two most useful techniques for diagnosing early recurrent disease. Colonoscopy rarely detects early recurrent disease but is useful in finding metachronous colon lesions. Other radiographic and hematologic examinations have an extremely low yield and should be used to localize and stage disease discovered by other means. Simplified follow‐up can be expected to minimize early detection of recurrent and metachronous lesions yet offers minimal patient risk and expense.
Imaging prior to second‐look surgery for carcinoma
Authors: Bennett William F. , Bova James G.
Published: February 2007

Technical advances in imaging are barely keeping pace with the need for detailed pre‐operative imaging in second‐look surgery. Although the majority of intra‐abdominal recurrence can be detected at surgery, pre‐operative knowledge of possible sites of involvement will provide more efficient use of operative time. Dynamic incremental bolus CT is the modality of choice when evaluating these patients, even though magnetic resonance imaging is approaching, and may exceed, computed tomography in utility in the abdomen. Monoclonal antibody radioimmunoscintigraphy is useful for extra‐abdominal sites of recurrence. Further technical advancement is needed to make it useful in the abdomen.
Excision of pulmonary metastasis of colorectal cancer
Authors: Murray Kevin D.
Published: February 2007

Metastasis of colorectal cancer to the lung is a frequent occurrence. Resection of pulmonary metastasis provides the only effective treatment. The initial detection of disease is usually with a chest radiograph. A CAT scan determines the number of lesions, resectability and other metastatic disease. Candidates for surgical excision are those patients with completely resectable singular, multiple, and bilateral metastasis, and those with metachronous liver lesions excised for cure. Exposure of unilateral disease is via a thoracotomy and of bilateral disease via a sternotomy. Metastatic lesions are removed by wedge resection with conservation of lung tissue. Postoperative recovery is usually rapid with low morbidity and mortality. Long‐term success for these resections remains controversial.
Impact of radioimmunoguided surgery®
Authors: La Valle Gregory J. , Chevinsky Aaron , Martin Edward W.
Published: February 2007

Radioimmunoguided surgery (RIGS®) is a technique employed to locate tumor deposits with the aid of intravenously injected, tumor‐specific, radiolabeled monoclonal antibodies and a small gamma detecting device. The gamma detecting probe (GDP) is a small, portable unit which has the capacity to be used intraoperatively to survey the entire peritoneal surface for increased radioactivity indicative of targeted tumor tissue during abdominal exploration for colorectal cancer. Trials in humans have demonstrated the ability of this system to locate clinically nonpalpable tumor deposits in patients undergoing carcinoembryonic antigen second‐look laparotomies. This feature may be of value in improving the definition of tumor location and extent as well as allowing a more thorough resection of tumor‐bearing tissue to be performed and hopefully improving overall patient survival.
Second‐look surgery for recurrent colorectal carcinoma: Is it worthwhile?
Authors: Bleday Ronald , Steele Glenn
Published: February 2007

Second‐look surgery for recurrent colorectal carcinoma has been advocated for over four decades. Routine follow‐up procedures gave way to clinically directed or carcinoembryonic (CEA)‐directed procedures in the mid‐1970's. In this paper, we review the results of second‐look surgery for recurrent colorectal carcinoma and ask the question, “Is it worthwhile?” Excluding surgery for symptomatic patients, we conclude that second‐look surgery should only be performed for recurrent colorectal carcinoma with the intent of rendering the patient disease‐free. Without effective systemic therapy, “palliative” or “debulking” procedures probably do not increase survival. The most likely candidates for such a curative approach with second‐look surgery are those with isolated liver, pulmonary, and, less frequently, regional recurrences.
Active specific immunotherapy and immunochemotherapy in the treatment of lung and colon cancer
Authors: Hollinshead Ariel
Published: February 2007

In this seminar, we describe 1) the immunogen TAA used for lung cancer immunotherapy and the immunogen TAA used for colon cancer immunotherapy, 2) the methods used in the administration of these immunogens in clinical trials of specific active TAA immunotherapy, 3) the results of clinical trials of specific active immunotherapy for lung cancer and for colon cancer patients, 4) the results of immune response monitoring evaluations, and what they indicate, and 5) the way in which certain drugs, selected for their action in the immune system, may be synergistic with specific active TAA immunotherapy, in combination therapy, especially for resected patients of later stages.
Immunotherapy of breast cancer: A review of the development of cell‐specific therapy
Authors: Lytle Glenn H.
Published: February 2007

A brief history of immunotherapy for breast cancer is presented, with emphasis on how theories developed as the field of immunology became more sophisticated. Non‐specific therapies, such as Bacillus Calmette‐Guérin, levamisole, interferon, interleukin, and others are reviewed. A form of cell‐specific immunotherapy is then presented, and some current results are summarized. Problems and proposals for the future development of immunotherapy for breast cancer are then presented.
Surgical considerations in needle localization procedures
Authors: Depalo Angelo J.
Published: February 2007

There is an increasing need for needle localization biopsies. Cancers so detected are usually at an earlier stage and should result in an increased cure rate. The surgeon involved in these procedures should, of necessity, be proficient in evaluating mammographic abnormalities, since there is considerable variation in the way they are reported by various radiologists. Localization can be accomplished with various hooked wires or dye, but accuracy of placement is more important than the method used and this point is well understood by cooperative radiologists. Since 70–80% of these lesions will be benign, cosmesis should be kept in mind. Incisions should be placed centrally, if possible, and the volume excised should be minimal and not lead to deformity. When poorly localized, excision of these lesions can be a trying experience for the experienced surgeon.
Pathological assessment of nonpalpable breast lesions
Authors: Rosen Paul Peter
Published: February 2007

Effective pathological examination of breast specimens from patients with nonpalpable radiologically detected lesions requires close cooperation among the pathologist, surgeon, and radiologist. Whenever possible, excision of the lesion should be documented by specimen radiography of the intact excisional biopsy. Diagnosis of the lesion and evaluation of margins should be based on permanent paraffin sections. Frozen section examination is not recommended routinely but may be employed in exceptional circumstances. Thermal damage to the tissue caused by electrocautery scalpels can reduce hormone receptor levels and can interfere with histological diagnosis.
Management of the high‐risk patient
Authors: Sclafani Lisa
Published: February 2007

While breast cancer is affecting American women at an epidemic rate, certain patients are identified as being at particularly high risk because of environmental, endocrine, genetic, and pathologic risk factors. Risk assessment, dietary, and psychological counseling, as well as breast cancer screening, are the function of a high‐risk breast cancer program. Our own program is discussed.
Primary treatment for breast cancer
Authors: Kinne David W.
Published: February 2007

Adequate local‐regional treatment of patients with primary operable breast cancer involves controlling multicentric disease in the breast, and axillary dissection to stage the disease and control it in the axilla, when present. Two options, showing equal survival rates in prospective, randomized studies, are breast preservation and mastectomy. In breast preservation, adequate tumor excision with clear histologic margins and axillary dissection is followed by breast irradiation. The mastectomy option involves no radiation therapy and can be followed by reconstruction. Careful selection of patients and detailed description of the pros and cons of each approach should be undertaken on an individual basis.
Salvage mastectomy
Authors: Osborne Michael P.
Published: February 2007

Local‐regional relapse after breast‐conserving surgery and radiation therapy is operable and not associated with concurrent distant metastases in most cases. Salvage mastectomy results in local‐regional control for most patients. The extent of the surgery relates to the extent of the local‐regional recurrence and does not carry an increased complication rate. The outcome of salvage mastectomy depends on the disease‐free interval from initial breast‐conserving surgery and radiation therapy to local‐regional recurrence. Additional factors, such as the extent and histologic type of the recurrence, as well as the axillary lymph node status, either at the time of initial breast conservation or at salvage mastectomy, may influence outcome and require further study

Prospective trials are required to determine the safety of further breast‐conserving surgery after local‐regional relapse and the role of systemic therapy in improving postsalvage survival.
Bilateral breast cancer
Authors: Fracchia Alfred A. , Borgen Patrick I.
Published: February 2007

Bilateral breast cancer has a cumulative incidence of 7% to 20% in patients with primary operable breast cancer, and the majority of these lesions are metachronous. A consensus on the management of the contralateral breast has been elusive. Much of the confusion arises from the fact that there exist marked differences of opinion regarding the impact of a second primary breast cancer on the overall prognosis. The risk of developing a contralateral breast cancer is influenced by the age of the patient, the presence of in situ disease, lobular histology of this new lesion, multicentricity, exposure to certain types of ionizing irradiation, and, possibly, family history of breast cancer. Management options include observation (clinical and mammographic surveillance), contralateral biopsy, and, rarely, prophylactic mastectomy. It is hoped that trials of breast cancer prevention, employing drugs such as tamoxifen, will identify agents capable of abrogating the risk of contralateral breast cancer and improve the ultimate outcome.
Male breast cancer
Authors: Borgen Patrick I.
Published: February 2007

Breast cancer in the male is an uncommon disease, occurring less than 1% as often as in females. Because of its rarity, this disease has not been as extensively studied as its female counterpart. Male breast cancer is evaluated and managed in a fashion very similar to that for female breast cancer. Primary management in early stage disease is usually a modified radical mastectomy. First line hormonal therapy for metastatic disease, in our institution, is tamoxifen for patients with positive estrogen receptors. Second line therapy consists of progestins or antiandrogens/LHRH analogs. No firm recommendations can be made concerning adjuvant systemic therapy. However, it is likely that studies from female patients are adaptable. Unfortunately, carcinoma of the male breast is such an infrequently encountered tumor that unfamiliarity with the disease can lead to delays in diagnosis and treatment. An increased awareness of the disease may be expected to result in earlier detection and institution of therapy at a stage when cure may be possible.
Psychological reactions to breast cancer in the pre‐ and post‐surgical treatment period
Authors: Massie Mary Jane , Holland Jimmie C.
Published: February 2007

Breast cancer has been widely studied with respect to its psychological impact because it is a disease which threatens an organ that is intimately associated with self‐image, self‐esteem, sexuality, femininity, and reproductive and nurturing capacity. Breast cancer is a significant stress for any woman; however, women vary widely in their response to diagnosis and treatment. In this manuscript we review the following issues: social, psychological, and medical variables that contribute to the psychological response, and the usual responses of women in the pre‐ and postsurgical treatment period.