bluuebunny/crossref_metadata_2025 huggingface dataset:
Intralesional cis‐diamminedichloroplatinum and purified collagen treatment of human metastatic malignancies: A feasibility study
Authors: Krag David N. , Théon Alain P. , Schneider Philip D. , Goodnight James E.
Published: February 2007

A feasibility study of the treatment of advanced superficial human malignant tumors utilizing direct intralesional injections of cisplatin mixed with purified bovine collagen was performed. The purpose of using intralesional injection of cisplatin mixed with collagen was to limit the drug exposure to normal tissues while increasing the dose and duration of exposure to the tumor. Fourteen evaluable superficial tumors in four patients (melanoma, breast CA, squamous CA from larynx) received a total of 65 treatments in the outpatient clinic setting. All patients had failed prior treatment with systemic intravenous cisplatin. Lesions were treated at least three times at two‐week intervals. After intramuscular meperidine premedication, multiple injections of cisplatin mixed with collagen were made into the tumors. There was minimal normal tissue toxicity and minimal systemic toxicity. Tumor regression or stabilization occurred in 86% (12/14) of tumors; 50% (7/14) of lesions regressed more than 50% in size. This study suggests that intralesional colloidal cisplatin can overcome resistance to systemic intravenous cisplatin.
Postmastectomy locally recurrent breast cancer
Authors: Humphrey L. J. , Moore D. L. , Lytle G. H.
Published: February 2007

With the popularity of breast‐conserving treatment plans, the natural history of “breast recurrence” in the ipsilateral breast must be distinguished from local recurrence following modified radical mastectomy. Hence, this study considers those patients who develop skin or chest wall recurrence after modified radical mastectomy, whether as a primary procedure or for patients with “breast recurrence” after partial mastectomy. The incidence of postmastectomy locally recurrent breast cancer following modified radical mastectomy (MRM) and adjuvant immunotherapy (IT) is compared to historical controls. The risk factors and treatment of local recurrence in this program as well as in a larger group of patients who recurred after modified radical mastectomy are reported.
Long‐term epidural pain relief using a totally implantable access system
Authors: Denobile John , Chester William , Etienne H. Birt , Ghosh Bimal C.
Published: February 2007

The majority of cancer patients at the terminal stage experience pain as a major symptom, and less than 60% of patients receive adequate pain relief. To relieve this symptom we have placed epidural catheters and attached them to an implantable access system. On this method the patients required 0.4–3.5 mg of morphine per hour with occasional boluses. Catheter life span ranged from 15 to 157 days with an average of 57 days.
Occurrence of intestinal metaplasia of the stomach in thai patients with gastritis, benign ulcer, and gastric cancer
Authors: Pongchairerks Paisal , Chalermsanyakorn Panas , Tanjapatkul Mongkol
Published: February 2007

Pathological sections of gastrectomized specimens of 74 patients with benign gastric ulcer and 79 with gastric cancer were reviewed. Intestinal metaplasia was found in 26 specimens with benign ulcer (35.1%) and in 43 with cancer (54.4%), a difference that is statistically significant. Further analysis of age groups showed that rate of occurrence of metaplasia in cancer patients older than 60 years was 70.3%, which was significantly higher than that of their younger counterparts (40.5%) and of patients with benign ulcer of either age group. A survey was also conducted by taking biopsies of mucosa of antrum and body of the stomach of 250 patients who underwent gastroscopic examinations. Acute and chronic gastritis was found in 22 and 156 patients, respectively. Intestinal metaplasia was found to be associated with acute gastritis in 2 (9.1%) and with chronic gastritis in 25 (16%) patients. In conclusion, intestinal metaplasia was associated with gastric cancer in patients who were older than 60 years in a significantly higher proportion than it was with benign gastric ulcer and gastritis among Thai patients.
Spouse adjustment to cancer surgery: Distress and coping responses
Authors: Keitel Merle A. , Zevon Michael A. , Rounds James B. , Petrelli Nicholas J. , Karakousis Constantine
Published: February 2007

Although often acknowledged, the impact of the surgical treatment of cancer on the spouse of the adult cancer patient is a largely unexplored area. The present study examined distress, coping, and appraisal among spouses (N = 36) and patients (N = 43) assessed prior to and following surgery. The results indicated that at both the presurgical and postsurgical period, spouses were exhibiting significantly greater distress than patients. Surprisingly, spouses' levels of distress remained fairly constant across the presurgery to postsurgery period, while the patients distress decreased. Escape and avoidance behaviors were found to be maladaptive for spouses coping with their partners' surgical treatment. Appraisal was also found to be a critical factor in understanding individual reactions to the stress of cancer surgery. Spouses of cancer patients undergoing surgical treatment appear to be an underacknowledged population at risk.
Is long‐term follow‐up justified after excision of a thin melanoma (≤ 1.5 mm)?: A retrospective analysis of 206 patients
Authors: Brandt S. E. , Welvaart K. , Hermans J.
Published: February 2007

From 1964 to 1988, 231 patients underwent local excision as the single treatment of melanoma with a thickness of ≤ 1.5 mm. We investigated the prognostic value of several factors on cancer‐specific survival and cancer‐specific disease‐free survival, from time of excision on, by performing life‐table analysis on 206 evaluable patients. Recurrence developed in 11 patients; local recurrence occurred in four patients, hematogenic spread in three patients and lymph node metastases in another four patients. Six patients died as a result of the disease. Tumors with a thickness of ≤ 1.5 mm have an excellent prognosis regardless of the localization of the melanoma. At 15 years cancer‐specific survival was 92.3% and cancer‐specific disease‐free survival was 86.9%. Recurrence was successfully treated with hope for cure in 4 patients. This figures does not justify aggressive follow‐up for all patients.
Surgical treatment of patients with nonsmall‐cell lung cancer and mediastinal lymph node involvement
Authors: Ishida Teruyoshi , Tateishi Masahiro , Kaneko Satoshi , Sugimachi Keizo
Published: February 2007

Between 1974 and 1988, 115 patients admitted to our surgical unit underwent resection of nonsmall‐cell lung cancer in the presence of mediastinal lymph node involvement (N2 disease). The overall 5 year survival rate was 18%, and the rates in patients with curative and noncurative operation were 26% and 9%, respectively (P < 0.05). Based on the morphological evidence of N2 disease, the patients were placed in three groups: those with microscopic metastasis, moderate metastasis, and gross metastasis, the incidences being 29%, 28%, and 43%, respectively. The survival rates were 41%, 6%, and 16%, respectively. The difference among microscopic vs. moderate and microscopic vs. gross metastasis was statistically significant (P < 0.01). Survival rates in patients with intranodal and extranodal invasion, as seen in the histologic examinations, were 34% and 11%, respectively (P < 0.01). The incidence of gross metastasis and/or extranodal invasion was higher in those who underwent noncurative operation. Postoperatively adjuvant irradiation was not effective in prolonging the survival in patients with curative operation, but the local residual disease was controlled. Therefore, our working criteria are, if N2 lung cancer is present, a complete resection of the primary tumor and the mediastinal lymph nodes should be done. Patients with microscopic metastasis and intranodal invasion can expect a fairly long survival.
A study of cell membrane structure
Authors: Feinmesser R. , Freeman J. L. , Noyek A. , Brama I. , Van Nostrand P.
Published: February 2007

Neoplastic transformation has been associated with a variety of structural changes, among which are changes in membrane carbohydrates. Not much is known, though, e.g., how early in the tumourogenic event these changes take place and what effect these changes have on cell growth, invasion, and ability to metastasize. We were able to identify the B‐D‐Gal(1–3)DGal‐NAc as a membrane carbohydrate component present in malignant laryngeal tissue, but not on adjacent normal mucous membrane. This carbohydrate structure was found to be present in metastatic as well as in nonmetastatic tumours. It was also found in well‐differentiated as well as poorly differentiated carcinomas. We suggest that changes in carbohydrate components on the cell membrane of the laryngeal cancer cell are an early event in tumour progression and probably are not related to the degree of invasion or the ability to metastasize.
Primary gastric lymphoma: A prospective analysis of 12 cases and review of the literature
Authors: Sharma Sanjiv , Singhal Sandeep , De Sudershan , Chander S. , Rath G. K. , Misra Anup , Khosla Anil
Published: February 2007

The clinicopathological features of 12 cases of primary lymphoma of the stomach are reviewed, and the efficacy of various treatment modalities is evaluated. The presenting symptomatology and the radiological signs were found to be similar to those of gastric carcinoma. Gastroscopy and computed tomography (CT) proved to be effective diagnostic and staging tools. There were two patients of stage I, seven patients of stage II, and three patients of stage IV. Multimodal therapy involving judiciously combined surgery, radiation therapy, and chemotherapy produced early complete remission in all the nine patients with localized disease, and all of them are disease‐free at a minimum follow‐up period of 12 months. These results are irrespective of whether surgery formed part of the treatment regimen. The relevant literature is reviewed, and the present status of the efficacy of nonsurgical therapy is evaluated.
Intraarterial infusion chemotherapy in regionally advanced malignant melanoma
Authors: Calabro Annamaria , Singletary S. Eva , Carrasco Cesar H. , Legha Sewa S.
Published: February 2007

The therapeutic effectiveness of intraarterial cisplatin (CDDP) and dacar‐bazine (DTIC) infusion was examined in 30 evaluable patients with regionally advanced melanoma that was refractory to standard treatments. Objective responses were achieved in 11 patients (37%), including three complete (10%) and eight partial (27%) tumor regressions. Successful debulking surgery was performed in seven of the eleven patients with response. Six remained free of regional disease after a median time of 25 months, and four are also free of distant metastases at 24+, 25+, 41+, and 54+ months. Nineteen of thirty patients with no significant tumor response underwent alternative treatments. Debulking surgery was performed in nine, but with little palliative gain, since seven relapsed at a median time of 5 months. Our results suggest that a combined therapeutic approach—preoperative chemotherapy followed by surgery in responding tumors—represents an effective treatment for patients with regionally advanced melanoma.
Possible association between gastrectomy and subsequent development of esophageal cancer
Authors: Maeta Michio , Koga Shigemasa , Shimizu Tetsu , Matsui Katsuaki
Published: February 2007

To clarify the possible association between gastrectomy and the subsequent development of esophageal cancer, we studied the incidence of subjective gastroesophageal reflux in 287 patients and analyzed the nutritional status and results of endoscopic examination of the esophagus in 62 patients who had survived for a long period after gastrectomy for nonmalignant diseases. The incidence of postoperative reflux was 22.6%. None of the patients had severe deterioration of blood parameters or nutritional status. Endoscopic observation revealed esophagitis in 24.2% of patients, mainly in the lower esophagus. Histologically, there was a high incidence of infiltration of neutrophils and lymphocytes, enlarged papillae, and basal cell hyperplasia. Epithelial dysplasia was detected in 41.9% of patients, and of these there were more patients in whom the degree of dysplasia was more severe in the lower esophagus than in other areas. These data suggest that postgastrectomy gastroesophageal reflux is more likely than postgastrectomy changes in nutritional status to be a possible contributory factor to the development of subsequent esophageal cancer.
Adrenalectomy for adrenal metastasis from lung carcinoma
Authors: Reyes Luis , Parvez Zafar , Nemoto Takuma , Regal A. ‐M. , Takita Hiroshi
Published: February 2007

In the past 3 years, five patients with lung carcinoma were found to have enlarged adrenal glands without any evidence of distant metastasis. The patients were treated with adrenalectomy. The cases are presented in order to discuss optimal methods of diagnosis and treatment for this condition.
Early and late complications of totally implantable venous access devices
Authors: Grannan Kevin J. , Taylor Philip H.
Published: February 2007

We reviewed the records of 66 consecutive patients who underwent placement of totally implantable venous access devices (TIVADs). Fourteen patients (21%) experienced complications related to the TIVAD. Complications included hematoma, infection, pneumothorax, subclavian vein thrombosis, and chronic clavicular pain. The 1 month mortality rate following insertion of a TIVAD was 24% (16 of 66 patients); however, none of the patients died as a direct consequence of port insertion or its associated complications. Overall patient and physician acceptance of TIVADs was good, and we encourage continued use and study of this device.
Pituitary apoplexy following coronary artery bypass surgery
Authors: Shapiro Lorie M.
Published: February 2007

Pituitary apoplexy is a syndrome with variable clinical manifestations depending on which parasellar structures (such as the optic nerves and chiasm, cavernous and sphenoid sinuses, or the hypothalamus) are compressed when the pituitary undergoes rapid enlargement. Factors associated with cardiopulmonary bypass that may lead to pituitary apoplexy include ischemia, hemorrhage, edema, and positive pressure ventilation. Seven cases of pituitary apoplexy following cardiopulmonary bypass have been reported, including the present case. Transsphenoidal surgical decompression in the present case and those previously reported appears to be safe after cardiac surgery and may be helpful in amelioration of compression of nearby structures. Pituitary apoplexy should be considered as a diagnostic possibility in patients who develop visual disturbances or ophthalmoplegia following open heart surgery.
Observations on the natural history and treatment of recurrent major salivary gland cancer
Authors: Armstrong John G. , Harrison Louis B. , Spiro Ronald H. , Fass Daniel E. , Strong Elliot W. , Fuks Zvi Y.
Published: February 2007

In an attempt to define the natural history and the indications for postoperative radiotherapy (RT) in locally recurrent major salivary gland cancers, we reviewed 78 patients treated between 1965 and 1982. All patients underwent resection of the tumor. Group 1 (N = 38) had complete resection of tumors, with low or intermediate grade histology and without lymph node spread. Group 2 consisted of the remaining 40 patients who had high‐risk features (HR) (high grade histology, lymph node metastases, and close or positive margins of resection). Half of the Group 2 patients received radiation therapy. Overall survival was 63% at 5 years, and 35% at 15 years. Survival of Group 1 was 83% at 5 years and 58% at 15 years. Local control for Group 1 was 69% at 5 years, 54% at 15 years, and was size‐dependent. Group 2 survival was 40% at 5 years and 29% at 10 years. Local control at 5 and 10 years was 49% and 35%. Our data indicate that surgery alone yielded good local control in patients with small tumors (≦ 3 cm) and no HR features, suggesting that postoperative RT may be unnecessary for these patients. Other patients have suboptimal local control, and although there is a rationale for the use of postoperative radiotherapy, we cannot assess its impact in this retrospective study.
Natural history and selective management of in transit melanoma
Authors: Wong Jan H. , Cagle Leslie A. , Kopald Kelly H. , Swisher Stephen G. , Morton Donald L.
Published: February 2007

Ninety five patients who developed in transit melanoma either as their initial site of recurrent melanoma or following regional node metastases were retrospectively reviewed. In transit melanoma occurred most frequently on the lower extremity and appeared to be associated with deeply invasive primary tumors. The median time to development of in transit melanoma was 16 months. Eighty‐two (86%) of these patients have progressed to systemic disease from 2 to 244 months (median 16 months) following the development of in transit melanoma, and 72 (79%) died (median survival 19 months). Survival appears to correlate with the extent of in transit melanoma and with the disease‐free interval. These findings suggest that in transit melanoma represents an early manifestation of systemic disease, warranting careful clinical follow‐up and perhaps systemic treatment, when effective therapy becomes available. However, some patients will respond to local immunotherapy, surgical excision, and isolated limb perfusion and will enjoy significant length and quality of life. This sequential approach remains the treatment of choice for this manifestation of metastatic melanoma.
Radiation therapy in the treatment of cervical Cancer: The university of Chicago/Michael reese hospital experience
Authors: Rader Janet S. , Haraf Daniel J. , Halpern Howard J. , Rotmensch Jacob , Spelbring Danny R. , Sutton Harold , Javaheri Godratollah , Weichselbaum Ralph R.
Published: February 2007

A retrospective analysis was conducted on 307 patients referred for radiation therapy at The University of Chicago and Michael Reese Hospital between 1971 and 1986. Median follow‐up was 6.4 years. Treatment techniques varied during the time of the study. Actuarial disease‐free survivals were 78%, 64%, 55%, 33%, 41%, and 60% for stage IB, IIA, IIB, IIIA, IIIB, and IVA, respectively. Stage, size of the cervical lesion, and hemoglobin level during treatment were prognostic factors. Treatment technique as well as time dose factors were analyzed with respect to survival, failures, and complications.
Stomal recurrence: A separate entity?
Authors: Barr Gerald D. , Robertson A. G. , Liu K. C.
Published: February 2007

Uncertainty exists concerning the exact aetiology of stomal recurrence following laryngectomy, although it is generally agreed that, when present, the prognosis is very poor. Fourteen cases of stomal recurrence were compared with 15 cases of other types of aggressive recurrence in the neck, for factors implicated in stomal recurrence. Similarities exist between the two groups and, although stomal recurrence has a greater association with subglottic tumour, this difference is not statistically significant. The possible mechanisms of recurrence are discussed, particularly in relation to aggressiveness, and it is concluded that factors involved in aggressive recurrences are similar. Stomal recurrence can be considered part of a group of aggressive neck recurrences associated with more advanced disease prior to laryngectomy.
Cancer of the male breast
Authors: Morimoto Tadaoki , Komaki Kansei , Yamakawa Takashi , Tanaka Takashi , Oomine Yuken , Konishi Yasunoki , Mori Toshiaki , Monden Yasumasa
Published: February 2007

The purpose of this study was to investigate the biological behavior of male breast cancer. We evaluated 11 cases of male breast cancer with respect to tumor growth, extent of disease, hormone receptor status, and histological grade of the malignancy, in comparison with 241 cases of female breast cancer. The duration of symptoms was 8.6 ± 9.1 months in males and 8.5 ± 18.6 months in females. The incidences of stages I, II, and III were 46%, 27%, and 27%, respectively, in male breast cancer, and 38%, 49%, and 13% in female breast cancer. Metastasis to the lymph node was negative in 60% of the male patients and 54% of the female patients. All cases of male breast cancer were histologically grade I according to Bloom's classification; the histological grades were as follows for the female breast cancer cases: grade I in 99 patients, grade II in 87, and grade III in 55. The rates of hormone receptor positively were 89% for ER and 86% for PgR in male breast cancer, and 64% for ER and 44% for PgR in female breast cancer. Therefore, there was no significant difference in the growth of male breast cancer and female breast cancer, but in male breast cancer the rate of hormone receptor positivity was high, endocrine therapy was effective, and the histological grade was low. Accordingly, the result following appropriate treatment of male breast cancer should be at least comparable to the results with female breast cancer.
Effects of hyperthermia and irradiation on the growth of mouse melanoma tumors following immunotherapy
Authors: Green Daniel M. , Samulski Thaddeus V. , Vervaert Carol , Halperin Edward C. , Oleson James R. , Seigler Hilliard
Published: February 2007

Recent investigations suggest that adjuvant hyperthermia enhances the response of human malignant melanoma to ionizing radiation. A study was undertaken to explore the effect of radiation and hyperthermia on the responsiveness of melanoma following active immunization with lethally irradiated B16 melanoma cells in C57 BL 6 mice. Two groups of mice were treated: group 1 received immunotherapy on days 2–5 following tumor innoculation, and group 2 received immunotherapy on days 15–18 following tumor innoculation. The mice in each group were subsequently randomized into one of three subgroups: 1) no further treatment; 2) radiation therapy alone (6 Gy in a single fraction); 3) radiation therapy and regional hyperthermia (43°C × 1 hour). Tumor sizes were measured regularly, and between day 52 and 63 the animals were sacrificed and the lungs sectioned for counting of metastatic tumors. Results from this study show that the immunomodulated B16 murine melanoma is responsive to radiation therapy alone and that this responsiveness is enhanced by the addition of adjuvant regional hyperthermia. There did not appear to be any significant effect of radiation therapy or radiation therapy plus hyperthermia on the development of lung metastases in this tumor model system.
Pulmonary coin lesions caused by Dirofilaria immitis
Authors: Bailey Timothy S. , Sohrabi Abdolkarim , Roberts Andstuart S.
Published: February 2007

The dog heartworm Dirofilaria immitis has been diagnosed by thoracotomy as the etiology of neoplastic‐appearing nodules in two patients in the Peoria, Illinois area. This brings the total number of reported cases of human pulmonary dirofilariasis to approximately 81 in the United States. The major concern of this benign disease is that in making the diagnosis the patients undergo the risk of surgery because of the presumed preoperative diagnosis of cancer. Greater awareness of this disease is needed as the geographic distribution of human pulmonary dirofilariasis expands in this country.
Extrapericardial tamponade with herniated omentum after transhiatal esophagectomy
Authors: Granke Kenneth , Hoshal Verne L. , Vanden Belt Ron J.
Published: February 2007

An unusual complication following transhiatal esophagectomy for lower esophageal carcinoma is reported in which extrapericardial tamponade and profound shock occurred secondary to a herniated section of omentum in the immediate postoperative period. The two‐dimensional echocardiogram was nondiagnostic, but the diagnosis was confirmed during reex‐ploration of the abdomen. Anatomic and pathophysiologic considerations of this unusual but life‐threatening complication are discussed. The literature suggests that computed tomography is the study of choice to confirm the clinical diagnosis of pericardial pathology, and this case report is yet another example to support routine closure of the esophageal aperture.
Impact of screening mammography and change in surgeons' attitudes on the pattern of primary care of breast cancer at a community hospital
Authors: Goldsweig Howard G. , O'Sullivan Marjorie
Published: February 2007

To gauge the impact of screening mammography and opinions regarding surgical procedures on the pattern of primary surgical care of breast cancer, tumor registry statistics from 1980–81 were compared to those from 1987 at a large community hospital. Over the course of six years, there was a significant increase in the proportion of patients with smaller tumors. Breast‐conserving procedures increased from 8% to 39% of all therapeutic surgery. However, there was no change in the stage of the tumor at presentation because of an atypically low incidence of nodal involvement in 1980–81.
Feasibility and outcome of complete secondary tumor resection for patients with advanced ovarian cancer
Authors: Lawton Frank , Luesley David , Redman Charles , Chan K. K. , Varma Raiiv , Blackledge George
Published: February 2007

From November 1981 to July 1985, 124 women with International Federation of Gynecology and Obstetrics (FIGO) stage III ovarian cancer were treated in prospective studies of surgery and chemotherapy in our institution. Patients with no macroscopic cancer after primary surgery (n = 16) received five cycles of adjuvant cis‐platinum; those with residual cancer after primary laparotomy (n = 108) underwent a second surgical debulking after three or five cycles of cis‐platinum‐based cytoreductive chemotherapy. Total macroscopic tumor clearance was achieved in 26 of these 108 patients. Fourteen patients with total tumor excision at primary laparotomy remain in complete clinical remission a minimum of 36 months after diagnosis, but the median progression‐free interval for the other two groups was 9 and 17 months, respectively. The survival for women who have total tumor clearance only at secondary surgery after chemotherapy is inferior to that for women with primary macroscopic tumor excision followed by chemotherapy.
Synovial sarcoma: A clinicopathological study of 36 cases
Authors: Golouh Rastko , Vuzevski Vojislav , Bracko Matej , Van Der Heul Roy Otto , Cervek Jozica
Published: February 2007

Thirty‐six cases of synovial sarcoma (13 biphasic and 23 monophasic) were subjected to a clinicopathologic study that included electron microscopy and immunohistochemistry. The group consisted of 21 males and 15 females ranging in age from 2 to 63 years. The majority of tumors (27 cases) were found in the hip and lower extremity. Immunohistochemical study revealed that keratin, which was detected in 92% of the biphasic and 57% of the monophasic tumors, was a more sensitive marker of epithelial differentiation than EMA or CEA. The overall 5‐year survival of the patients was 64%. Male sex, older age, presence of tumor necrosis, monophasic pattern, and absence of keratin positivity had an unfavourable effect on survival but lacked statistical significance. Survival was significantly lower in patients with tumors exhibiting more than 15 mitoses per 10 HPF (P < .02) and in those with tumors showing necrosis and a mitotic rate greater than 5 mitoses per 10 HPF (P < .005).
Adenocarcinoma of the esophagus: A survival study
Authors: Harvey James C. , Kagan A. Robert , Ahn Chaewoo , Frankl Harold , Davidson William
Published: February 2007

A 35 year review of adenocarcinomas of the esophagus was undertaken. We found the disease to be one of increasing incidence afflicting white males disproportionately. Risk factors remain to be clarified. Radiation therapy in curative doses and complete resection were competitively effective in terms of long‐term survival. No survival advantage was found with palliative surgery compared with other means of therapy. Optimal combinations of treatment remain to be discovered.
Malignant pleural mesothelioma: A survival study
Authors: Harvey James C. , Fleischman Erik H. , Kagan A. Robert , Streeter Oscar E.
Published: February 2007

Ninety‐four patients with malignant pleural mesothelioma were treated at Southern California Permanente Medical Group Facilities between 1965 and 1988. This retrospective analysis of survival in these patients is compared according to surgical and/or supportive management. Group I patients received supportive care only, including pleurodesis as needed. This group included the majority of patients. Group II patients were managed largely with debulking procedures including decortication and pleurectomy. Group III patients received extrapleural pneumonectomy. This group included the two long‐term survivors of the entire group. This study of survival points out the need for a cooperative protocol as well as the consistent use of proper modern preoperative staging in an attempt to select patients who benefit from extrapleural pneumonectomy.
Treatment for synchronous and metachronous carcinomas of the head and neck and esophagus
Authors: Tachimori Yuji , Watanabe Hiroshi , Kato Hoichi , Ebihara Satoshi , Ono Isamu , Nakatsuka Takashi , Harii Kiyonori
Published: February 2007

In the past 27 years, 75 patients were found to have separate primary carcinomas of the head and neck and the esophagus. Head and neck tumor was discovered first in 41 patients, synchronously with esophageal tumors in 17 patients, and esophageal tumors were recognized first in 17 patients. Reconstruction by graft after resection of head and neck cancer was nec‐ essary in 18 patients and esophagectomy was performed in 62 patients. In eight patients, pharyngeal and esophageal reconstruction was necessary after resection of synchronous and metachronous pharyngeal and esophageal carcinoma. The combined procedure with free tissue transfer was useful for surgical treatment for synchronous or metachronous carcinomas of the head and neck and the esophagus.
Postoperative radiation therapy for major salivary gland malignancies
Authors: Harrison Louis B. , Armstrong John G. , Spiro Ronald H. , Fass Daniel E. , Strong Elliot W.
Published: February 2007

Between 1966 and 1982 there have been 46 patients treated with surgery plus post‐operative radiation therapy for malignant tumors of salivary gland origin. The indication(s) for radiotherapy included positive margins (42%), advanced local tumor (37%), positive nodes (33%), or high grade histology (48%). Overall actuarial local control at 5 years was 73%, being 100% for T1, 83% for T2, 80% for T3, and 43% for T4. Actuarial survival at 5 years was 80% for T1, 83% for T2 60% for T3 and 48% for T4. Patients with positive nodes (N+) did worse than those with negative nodes (No), with locoregional control and survival at 5 years being 58% vs. 83%, ( P=0.025) and 38% vs. 80% (P=<.01), respectively. We found no need for contralateral neck treatment even for those with positive nodes. Also, to date, none of eight patients with adenoid cystic histology has failed locally, as opposed to three of eight failures in patients treated with surgery alone. We believe that post‐operative irradiation provides excellent locoregional control for appropriate patients with malignant tumors of major salivary glands.
Umbilical metastasis diagnosed by fine needle aspiration
Authors: Edoute Yehouda , Malberger Ehud , Kuten Abraham
Published: February 2007

Fine needle aspiration (FNA) is emerging as a useful diagnostic tool in the evaluation of tumor masses, providing high diagnostic yield. Fine needle aspiration for cytologic evaluation was performed on 14 patients suspected of having umbilical metastasis. The site of the primary tumor was known in 12 patients. In nine patients with previously documented malignancy, FNA of the umbilical nodule demonstrated malignant cells compatible with the histologic diagnosis of the primary cancer. In five other patients metastatic umbilical nodule was the first or the only sign for the presence of primary cancer elsewhere and in four of them FNA revealed malignant cells prior to the diagnosis of internal carcinoma. In one case, FNA demonstrated only inflammatory cells while surgery revealed adenocarcinoma associated with inflammation. The sensitivity of FNA in diagnosing malignant umbilical nodule, and the accuracy of FNA findings were 98.2%, while the predictive value of a FNA cytologic finding of malignancy was 100%. It is recommended that an umbilical nodule should alert the clinician to the possibility of malignancy and FNA should be performed as the first diagnostic procedure.

This safe, rapid, reliable, and inexpensive method may diagnose ma‐ lignancy and preclude the need for umbilical biopsy or more complicated diagnostic intervention.
Gastroduodenal artery‐duodenal fistula: A complication of continuous floxuridine (FUDR) infusion into the gastroduodenal artery
Authors: Kernstine Kemp H. , Kryjeski Sheila R. , Hall Lorin J. , Larson Richard E. , Saylor Howard L. , Fortuny Ignacio E.
Published: February 2007

This case report describes a patient who for 31 months has received regional intrahepatic chemotherapy from a continuous infusion pump and who developed a gastroduodenal artery‐duodenal fistula, a previously unreported complication of regional infusion therapy. The patient presented with signs and symptoms of upper gastrointestinal bleeding. The clinical evaluation and management are described. An angiogram was performed through the auxillary septum to identify the source of bleeding. The possible etiologic factors in this case are discussed. We believe that this complication will continue to be rare, but health care providers should be aware of its presentation and its preferred method of evaluation and management.
Clinicopathological features of elevated lesions of the duodenal bulb
Authors: Matsuura Hiroshi , Kuwano Hiroyuki , Kanematsu Takashi , Sugimachi Keizo , Haraguchi Yukiaki
Published: February 2007

We present here our findings on patients with an elevated lesion of the duodenal bulb. All these patients were treated in our clinics between the years 1984 and 1988. These lesions were present in 36 of 8,802 patients who underwent upper gastrointestinal pan‐endoscopy. Two patients had a duodenal carcinoma, 2 an adenoma, and 1 a Brunner's gland adenoma. There were 15 with a hyperplastic polyp, 3 with a heterogenic gastric mucosa, 3 with Brunner's gland hyperplasia, 6 with duodenitis, and 4 with regenerative mucosa. Among these 36 lesions, only 69% (25 lesions) were evident on the upper gastrointestinal X‐ray series. Adenoma and Brunner's gland adenoma were of a pedunculated form of the gross type and had an irregular surface mucosa. Both duodenal carcinomas were detected by endoscopic biopsy and were resected. Histologically, these lesions were limited to the submucosal layer and were of the non‐pedunculated polypoid form, but there were no other characteristic endoscopic features, in comparison with other elevated lesions. Thus, upper gastrointestinal endoscopy with routine observations of the duodenal bulb plus endoscopic biopsy will lead to a definite diagnosis of these elevated lesions and to the early detection and treatment of this rare malignant lesion.
Malignant melanoma occurring during pregnancy: A report of the Northern Israel oncology center (1968–1988)
Authors: Stein Moshe , Fried Getta , Borovik Riva , Halpern Joshua , Beck Danny , Robinson Eliezer
Published: February 2007

Medical records of seven patients treated within a 20 year period for malignant melanoma during pregnancy were reviewed. No significant detrimental prognostic effects could be attributed to pregnancy. The current literature on melanoma and pregnancy is discussed. Based on this, pregnancy seems not to be contraindicated in melanoma patients.
Adenocarcinoma arising in Barrett's esophagus
Authors: Harvey James C. , Kagan A. Robert , Hause Donald , Sachs Todd , Frankl Harold
Published: February 2007

A review of nine adenocarcinomas of the esophagus arising in Barrett's epithelium was undertaken. We found the disease among white males disproportionately. Risk factors and incidence rate remain to be clarified. Only one patient was in a surveillance program and only he had carcinoma discovered “early.” He still survives while only one of the eight whose diagnosis followed investigation of symptoms remains alive.
Obstructing carcinoma of the cecum
Authors: Rovito Peter F. , Verazin Gary , Prorok Joseph J.
Published: February 2007

Carcinoma of the cecum, the third most common location for malignancy of the large bowel, was examined with attention centered upon cecal cancers producing obstruction. Reviewing 136 patients revealed 11 obstructing lesions (8.1%) presenting as distal small bowel obstructions. The mean age of the patients was 74 years. All but one patient had resection for cure which consisted of a right hemicolectomy with ileotransverse colostomy. There was no operative mortality or significant morbidity. Bowel obstruction due to cecal carcinoma is an infrequent occurrence arising in elderly patients and carries a poor survival rate due to advanced disease at the time of diagnosis and treatment.
Rat liver tolerance for partial resection and intraoperative radiation therapy: Regeneration is radiation dose dependent
Authors: Bossola Maurizio , Merrick Hollis W. , Eltaki Ahmed , Bellantone Rocco , Milligan Andrew J. , Doglietto Glovanni B. , Conran Philip , Dobelbower Ralph R. , Crucitti Francesco
Published: February 2007

We studied the feasibility of delivering a large single dose of intraoperative radiation as an adjuvant to partial hepatic resection. Intraoperative radiation therapy (IORT) was delivered to the remaining liver of 84 rats after partial hepatectomy to determine the acute and chronic effects of treatment on blood chemistry values, histology, survival, hepatic regeneration, and cellular appearance of the normal liver. Transient elevations in SGOT, SGPT, and alkaline phosphatase were attributed both to hepatectomy and to liver parenchymal damage induced by IORT. Microscopic examination upon necropsy, performed at frequent intervals post‐treatment, revealed hepatic capsular thickening with some alteration of liver architecture mainly underneath the capsule, with localized inflammation and some areas of necrosis. Survival in all groups was 100% at 45 days. Liver weight increase proved to be dose‐dependent and displayed a biphasic pattern. This study demonstrated that IORT is a feasible adjunct to surgical resection of the liver in the rat model.
Ampullary carcinoma in patients under 50 years of age with a poor prognosis
Authors: Yamaguchi Koji , Enjoji Munetomo
Published: February 2007

Clinicopathologic features of 145 Japanese patients with ampullary carcinoma were compared among three age groups. The 145 patients were divided into three groups by the patient's age at the time of operation; there were 24 patients in group I (younger) aged ⩽50 years, 99 in group II (ordinary) aged 51‐69, and 22 in group III (elderly) aged ⩾70. The three groups showed no significant difference in sex, icterus, duration of icterus, size of the tumor, year of operation, macroscopic type, histopathologic type, tumor margin, lymphatic permeation, venous invasion, or pancreatic invasion. The survival curve of group I was worse than those of groups II and III. Multivariate regression analysis using II prognostic variables failed to reveal that the age of the patient at the time of operation was an independent factor. The younger patients aged ⩽50 fared worse than the elderly patients aged ⩾70, because the group I tumors included a significantly greater number of advanced ampullary carcinoma with more frequent perineural invasion than did the group III tumors.
Metastatic tumors of the umbilicus: A review 1830–1989
Authors: Shetty M. R.
Published: February 2007

Umbilical metastases from known and unknown primary cancers are rare. The eponym “Sister Mary Joseph's nodule” has been used by generations of physicians. The first reports of this clinical sign were from Walshe in 1846. A review of the literature revealed 265 cases from then until 1989. Only 85 cases of umbilical metastasis from unknown primary tumors were found. This review should help us to focus on the common and uncommon primary sites in the diagnosis of patients with this finding. A single case report and the work‐up for the hidden primary tumor are described.
Recurrence of resected esophagogastric adenocarcinoma: Results of re‐resection
Authors: Kurtzman Scott H. , Turnbull Alan D. , Burt Michael , Bains Manjit S.
Published: February 2007

Isolated local recurrence following potentially curative resection for carcinoma of the esophagus or esophagogastric junction does not necessarily imply pending systemic disease and early demise. While radiation alone or in combination with chemotherapy is standard treatment for such patients, resection is another available option. Resection may also be a consideration should localized disease persist after non‐operative therapy in the absence of metastases. A 5 year retrospective review was performed examining 204 resections performed prior to 1989. Only 5 patients underwent resection of locally recurrent esophagogastric (EG) adenocarcinoma during this period. No squamous carcinoma recurrences were resected. One patient is well 15 months later while another died at 18 months of other causes without recurrence. Recurrence after re‐resection occurred at 8, 11, and 24 months in the 3 other patients. Although there were no postoperative deaths, major complications occurred in 4 patients. All 5 patients swallowed normally after operation.
Surgical wound infection and cancer among the elderly: A case control study
Authors: Huchcroft Shirley A. , Nicolle Lindsay E. , Cruse Peter J. E.
Published: February 2007

Surgical wound infection occurs in fewer than 5% of operations. Nevertheless, it represents the second most common type of hospital‐acquired infection and results in increased morbidity and mortality. As with all nosocomial infections, the rate of surgical wound infection increases with age. Patients over 65 years of age run an approximately 15% risk of surgical wound infection.

Two‐thirds of patients with invasive cancer other than non‐melanotic skin cancer are aged 65 years and over. Over half of them are treated surgically for their cancer. Cancer and other chronic diseases have been cited as possible causes of the increased risk of nosocomial infection among the elderly.

Using the Foothills Hospital Wound Study Data Base as the sampling frame, we conducted a case‐control study of surgical wound infection and cancer among the elderly. Cancer was found not to be a risk factor for surgical wound infection. The results are discussed in relation to the role of immunity in both disorders.
The use of interferon alpha‐C in patients with metastatic renal cell carcinoma arising in a congenital solitary kidney
Authors: Merimsky Ofer , Merimsky Ephraim , Chaitchik Samario
Published: February 2007

Three cases of renal cell carcinoma in a congenital solitary kidney are presented. Treatment with recombinant interferon alpha‐C was administered in two cases. A subjective response occurred in one case. The literature is reviewed with respect to treatment options and prognostic factors.
Parathyroid autotransplantation during thyroid surgery
Authors: Shaha Ashok R. , Burnett Carlos , Jaffe Bernard M.
Published: February 2007

Permanent hypoparathyroidism is one of the most distressing complications of thyroid surgery. The incidence of this iatrogenic complication varies between 3 and 25 percent among patients undergoing total thyroidectomy. Parathyroid injury may be caused by inadvertent removal of the parathyroids, ligation of the blood supply, or destruction secondary to capsular hematoma. Attention to such technical details as identification of the parathyroids, dissection close to the thyroid gland, preservation of the blood supply to the parathyroids, and avoiding manipulation of parathyroids reduces the incidence of temporary and permanent hypoparathyrodism. However, if the parathyroids are injured, the best method of preserving their function is by autotransplantation.

Over the past 7 years we have performed 250 thyroidectomies. An attempt was made to identify and preserve parathyroid gland in each case. Even during lobectomy procedures, the ipsilateral parathyroids were identified and preserved. Whenever any of the parathyroids was devascularized or separated from the surrounding structures, it was autotransplanted into the sternomastoid muscle. The sternomastoid was chosen for autotransplantation rather than forearm muscles to avoid an added incision and because selective measurement of parathormone is not essential in this group of patients. Prior to autotransplantation, confirmation of the nature of the tissue was made by frozen section of a small portion of the parathyroid gland. Parathyroid autotransplantation was performed in 15 instances, even when only one parathyroid was injured. Only one member of this group of 15 patients developed temporary hypoparathyroidism, which disappeared after 4 weeks of calcium supplementation. The remaining patients had an uncomplicated recovery.

Autotransplantation of the parathyroid glands should be performed whenever the parathyroid is devascularized or damaged by retraction or hematoma. It is essential for every thyroid surgeon to be familiar with the technique of parathyroid autotransplantation.
Modified anterior compartment resection
Authors: Karakousis Constantine P.
Published: February 2007

In the majority of patients with soft tissue sarcomas of the anterior compartment of the thigh, it is possible to preserve a small portion of the quadriceps with intact nerve supply without compromising on the radicality of the procedure or the local control rate. The distal one‐third of the vastus medialis can usually be spared with a long, slender branch providing its innervation.

Dissection of the femoral nerve below the inguinal ligament and its branch(es) to an uninvolved area of the quadriceps the farthest from the location of the tumor is essential. This modified anterior compartment resection improves dramatically the function of the extremity.
Two prostate carcinoma cell lines demonstrate abnormalities in tumor suppressor genes
Authors: Rubin Steven J. , Hallahan Dennis E. , Ashman Charles R. , Brachman David G. , Beckett Michael A. , Virudachalam Subbulakshmi , Yandell David W. , Weichselbaum Ralph R.
Published: February 2007

Two prostate carcinoma cell lines, DU‐145 and PC‐3, were examined for abnormalities in the retinoblastoma (Rb) and the p53 putative tumor suppressor genes. We found an abnormal Rb gene product in DU‐145 using Western blot analysis. Polymerase chain reaction amplification followed by direct DNA sequencing demonstrated a base substitution mutation that generates a stop codon in exon 21. On Northern, Southern, and Western blot analysis, the p53 gene and its product appear to be normal in DU‐145. PC‐3, however, failed to demonstrate expression of either the p53 transcript on Northern blot analysis or the p53 protein on Western blot analysis, while the Rb gene products appeared to be normal on both Northern and Western blot analysis. This work extends the correlation between abnormal expression of putative tumor suppressor genes and human malignancies.
Implantation of tumor xenografts in nude mice: An improved methodology
Authors: Hudd CHARLES A. M. , La Regina Marie C. , Tolman Kym C. , Johnson Frank E.
Published: February 2007

Xenografting of neoplasms is a common technique in cancer research. Implantation of non‐uniform tumor tissue fragments often yields tumor nodules of irregular size and shape, which is disadvantageous. We therefore developed a device to standardize size and shape of such implants. This instrument is effective, inexpensive to fabricate, and simple to use.