bluuebunny/crossref_metadata_2025 huggingface dataset:
The risky shift
Authors: Spratt John S.
Published: February 2007

Currently, there seems to be a great hurry to develop guidelines for the clinical management of everything. Many evolving guidelines are proffered to be consensus decisions, which means, in most cases, that the guidelines were agreed on by multidisciplinary groups or committees. There is an unfortunate tendency to assume that consensus decisions are, a priori, correct and constitute the best and only way to address different problems.
Patterns of DNA‐ploidy in operable colorectal carcinoma: A prospective study of 100 cases
Authors: Russo Antonio , Bazan Viviana , Plaja Sergio , Leonardi Patricia , Bazan Pietro
Published: February 2007

A prospective study of cellular DNA content was made by means of flow cytometry in a nonconsecutive series of 100 patients undergoing surgery for primary colorectal adenocarcinoma. DNA‐aneuploidy was present in 80% of cases (80/100); 39% of these were multiclonal (31/80). There was no significant correlation between DNA‐ploidy and the clinical and pathological features examined, except for the primary tumor site (right colon vs. left colon vs. rectum: P <0.001). After a minimum follow‐up of 30 months, out of 40 patients with no local invasion and/or distant metastases, 100% (9/9) of those with DNA‐diploid neoplasias showed no signs of disease relapse, vs. 55% (17/31) of the DNA‐aneuploid cases (P <0.05). Furthermore, in 45 cases with a minimum follow‐up of 30 months, overall survival was 90% in patients with DNA‐diploid carcinomas and 43% in the DNA‐aneuploid cases (P <0.05).
Results of multimodal therapy in Ewing's sarcoma: A retrospective analysis of 20 patients
Authors: Ben‐Arush Myriam , Kuten Abraham , Perez‐Nahum Monique , Cohen Yoram , Bialik Victor
Published: February 2007

A retrospective analysis was performed of 20 patients with Ewing's sarcoma treated by combined modality therapy, consisting of surgery, radiotherapy, and chemotherapy. Fourteen patients (70%) achieved complete remission and 5 patients (25%) were in partial remission at the end of treatment. One patient (5%) failed to respond to combined modality therapy. The overall 5 year actuarial survival was 64% and the disease free survival, 55%. Persistent or recurrent disease occurred in 8 patients (40%); one of them was salvaged by surgery and chemotherapy. Site and extent of primary lesion were prognosticators of patients' outcome. One patient developed radiation‐related‐sequelae. The efficacy of aggressive management consisting of wide surgery, radiotherapy and intermittent high dose chemotherapy is discussed.
Benign cartilaginous tumors of the upper airway
Authors: Frank James L. , Schwartz Beth R. , Price Linda M. , Neifeld James P.
Published: February 2007

Benign cartilaginous neoplasms of the laryngotracheal apparatus are uncommon clinical entities. Two cases of cartilaginous lesions of the upper airway are reported. Resection with maintenance of upper airway structural integrity is the preferred treatment. Temporary tracheostomy is often necessary and can provide access for stenting of the tracheal repair.
Thoracoscopy in the diagnosis of pleural effusion of ambiguous etiology
Authors: Sharma Sanjay , D'cruz Anil
Published: February 2007

Between 1985 and 1989, 27 patients underwent thoracoscopy for an undiagnosed pleural effusion. Prior thoracocentesis (in all patients) and a needle pleural biopsy (in 15 patients) had been nondiagnostic. The rigid thoracoscope was used in 21 patients, the cystoscope in 4 patients, and the flexible bronchoscope in 2 patients. We had one mortality, and there was no operative morbidity. Thoracoscopy was diagnostic in 24 of the 27 patients (4 benign, 20 malignant). The average duration of stay in the hospital was 48 hr. We conclude that thoracoscopy is an important diagnostic aid in the management of a pleural effusion of ambiguous origin and that it is a relatively safe procedure that can be performed with an acceptable morbidity and mortality.
Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age
Authors: Korenaga Daisuke , Baba Hideo , Kakeji Yoshihiro , Orita Hiroyuki , Haraguchi Masaru , Maehara Yoshihiko , Saku Motonori , Sugimachi Keizo
Published: February 2007

To evaluate the benefit of R2 gastrectomy for gastric cancer in Japanese patients over 80 years of age, data on 93 patients who underwent gastrectomy between 1967 and 1989 were collected retrospectively from charts filed in the Kyushu University Hospital and two affiliated national hospitals. Of 93 patients, 62 had a localized tumor without evidence of metastatic spread. These 62 patients were classified into two groups according to the procedures performed: 35 underwent R1 gastrectomy and 27, R2 gastrectomy. The clinical and pathological characteristics of the patients in the two groups were comparable at the time of surgery, except that the group who underwent R1 gastrectomy was older. R2 gastrectomy involved a significantly longer operation time (P < 0.01) and greater intraoperative blood loss (P < 0.05) when compared to R1 gastrectomy, but no patient undergoing this extensive surgery died. The difference in the morbidity rate between the two groups was not statistically significant. The 5‐year survival rate was 55.8% in the R1 group and 65.4% in the R2 group. When gastric cancer invaded the serosa and/or secondary nodes, a substantial increase in survival time was gained with R2 gastrectomy when compared to an R1 operation. These findings suggest that an R2 gastrectomy is feasible, even for patients over 80 years, but is indicated mainly when the carcinoma has invaded the serosa and/or secondary nodes and the patients are at good risk for major surgery.
Mammogram‐directed fine‐needle aspiration of nonpalpable breast lesions
Authors: Arishita Gary I. , Cruz Bradley K. , Harding Clark T. , Arbutina David R.
Published: February 2007

A prospective study was undertaken to evaluate the effectiveness of mammogram directed fine‐needle aspiration cytology in women with nonpalpable abnormalities detected on mammogram. Seventy patients were entered into the research protocol, with 61 patients undergoing mammogram directed fine‐needle aspiration. Forty‐three of the aspirates were adequate for diagnosis. Fine‐needle aspiration yielded an accurate diagnosis in 12 of the 14 carcinomas in which the sample was considered adequate, for a sensitivity of 87%. No patients were falsely diagnosed with malignant disease, a specificity of 100%. The predictive value of a positive test was 100%, and that of a negative test was 93%. We conclude that fine‐needle aspiration cytology can aid in making a diagnosis when nonpalpable breast abnormalities are detected on mammogram.
Survival of patients with metastatic breast cancer diagnosed between 1955 and 1980
Authors: Debonis Daniel , Terz Jose J. , Eldar Samuel , Hill L. Robert
Published: February 2007

In order to determine whether current programs for the management of metastatic breast cancer have led to improved patient survival, we determined the median survival times for five‐year intervals of 849 patients admitted to the City of Hope National Medical Center with metastatic breast cancer from 1955 to 1980. Survival curves were constructed from the dates of first diagnosis of breast cancer and to the first metastasis for all population subsets and clinical subsets: menopausal status, presence or absence of visceral metastases, length of disease‐free interval, and pattern of palliative therapy. In this analysis, the median survival in each successive interval of five years from diagnosis of the primary tumor was 52.1, 45.0, 49.9, 41.1, and 36.0 months, and the survival times from the first metastasis were 31.9, 23.0, 24.2, 23.9, and 18.7 months. Survival times in each of the clinical subsets remained unchanged during the period of observation, regardless of the therapeutic modalities included in the treatment regimens. This study indicates that changes in palliative therapy for metastatic breast cancer during the 25 years of observation have not influenced overall survival. Therefore, it seems appropriate that the therapeutic risk/benefit ratio and impact on quality of life should be reassessed when asymptomatic patients are treated, or when aggressive palliative therapy is used outside a clinical research setting.
Frequency and experience with carcinoma of the thyroid at a private, a veterans administration, and a university hospital
Authors: Flynn Michael B. , Tarter Jeremy , Lyons Kela , Ragsdale Terry
Published: February 2007

We evaluated the treatment experiences with thyroid carcinoma at a private, a Veterans Administration, and a University hospital to determine the frequency, treatment, and outcome of patients with this uncommon malignant tumor. All 120 patients with thyroid carcinoma were identified through hospital tumor registries between 1953 and 1988, representing 0.3% of the total cancer registry cases during this period. Well‐differentiated carcinoma of the thyroid represented 73%, medullary carcinoma 7%, poorly differentiated carcinoma 18%, and Hürthle cell carcinoma 2% of histologic varieties. Seventy‐eight percent of patients were treated initially by surgery or by surgery plus postoperative irradiation. The remaining patients received other treatment. At 10 years after treatment, 90% of patients with well‐differentiated carcinoma survived, while only 20% of patients with medullary and poorly differentiated carcinoma survived. Sixty percent of recurrences for all histologic types appeared within the first 12 months after treatment. Patients with well‐differentiated carcinoma had sporadic recurrences over a 21‐year period. Recognition of these time intervals allows for better follow‐up management.
Clinical usefulness of chemosensitivity testing using the MTT assay
Authors: Furukawa Toshiharu , Kubota Tetsuro , Suto Akihiko , Takahara Tetsuya , Yamaguchi Hiroshi , Takeuchi Tooru , Kase Suguru , Kodaira Susumu , Ishibiki Kyuya , Kitajima Masaki
Published: February 2007

The results of in vitro chemosensitivity testing using the MTT assay of tumor cells from 140 patients were analyzed with reference to the clinical antitumor effects of the chemotherapy. One hundred and twenty‐four (88.6%) of 140 specimens were successfully tested by the method of Mosmann (J Immunol Methods 65:55–63, 1983) with some modifications. When the results of the assay were compared with the clinical effects of chemotherapy in 22 patients with remaining measurable tumor lesions, the overall prediction rate was 86.4% (19/22). Among 31 patients with stage III‐V gastric and colorectal carcinomas without remaining measurable tumor lesions, the survival rate of nine patients treated with drugs shown to be effective in the assay was significantly (P < 0.05) better than that of 22 patients treated with drugs shown to be ineffective.
Correlation between pathological risk factors and pelvic lymph node metastases in stage I squamous carcinoma of the cervix: A multivariate analysis of 194 cases
Authors: Ayhan Ali , Tuncer Z. Selçcuk , Küçükali Türkan , Tuna Tarik , Enünlü Tayfun
Published: February 2007

This study includes 194 patients with stage I cervical cancer subjected to surgical therapy. Of 14 pathological factors analyzed, microscopic parametrial involvement (P = 0.001), depth of invasion (P = 0.001), and lymphovascular space invasion (P = 0.029) were found to be the most significant factors for positive pelvic lymph nodes. Combination of significant factors permitted categorization of patients into risk groups with pelvic lymph node metastases ranging from 0.0% to 90.9%.
Therapeutic effects of liposomal adriamycin in combination with tumor necrosis factor‐α
Authors: Maruo Yuji , Konno Hiroyuki , Baba Shozo
Published: February 2007

Liposomes as drug carriers in cancer chemotherapy have attracted considerable interest. To enhance the therapeutic effect of Adriamycin entrapped in liposomes (Lip‐ADM) on human solid tumors, we investigated the therapeutic effects of Lip‐ADM in combination with recombinant human tumor necrosis factor‐α (rTNF‐α), which is known to have specific effects on tumor vasculature. rTNF‐α or saline solution was injected intravenously into nude mice bearing a human colon cancer strain, HC‐1, at 1 hour before intravenous administration of Lip‐ADM. The significant therapeutic effect of Lip‐ADM in combination with rTNF‐α was demonstrated by the evaluation with tumor growth curve and the actual tumor weights, in comparison with groups of mice treated with saline solution, rTNF‐α alone, or with a Lip‐ADM after saline. Levels of Adriamycin in tumor tissue in the Lip‐ADM in combination with rTNF‐α‐treated group were higher than those in Lip‐ADM with saline solution‐treated group.
Primary neoplasms of the small bowel
Authors: Serour Francis , Dona George , Birkenfeld Shlomo , Balassiano Moshe , Krispin Mayer
Published: February 2007

Primary neoplasms of the small bowel are unusual and constitute 1‐5% of all gastrointestinal tract neoplasms. Preoperative diagnostic difficulties, frequent dissemination at the time of the diagnosis, and poor prognosis are characteristic of this pathology. During a period of 26 years we treated 61 patients with tumors of the small bowel, 44 malignant and 18 benign (1 patient had both). The most common symptoms were abdominal pain (62%), weight loss (41%), and gastro‐intestinal bleeding (31%). More than half of the patients were treated as emergencies and among the remaining, the most useful diagnostic test was the small intestinal barium study. Seventeen patients were operated on for intestinal obstruction, 6 of them due to intussusception of the tumor, while 8 other patients presented with perforation and 7 with massive gastrointestinal bleeding. Leiomyoma was the most frequent benign lesion. Among malignancies lymphoma was encountered in 38.6%, followed by adenocarcinoma (29.6%) and leiomyosarcoma (22.8%). Lymphoma was predominant among Sephardic Jews. Curative procedures were attempted in all but one of the benign cases and in 21 of the malignant cases. At the time of surgery metastases were present in 23 patients. The postoperative mortality was high (20% and 14% in the benign and malignant groups, respectively) most probably due to the high incidence of emergency surgery in a high risk population. The prognosis of the malignant tumors was poor with a 5‐year survival of 18%. Their disappointing course seems to be related to late diagnosis because of nonspecific symptoms and difficulty in bringing the tumor to the fore. Hopefully, a greater awareness will lead to an earlier diagnosis and improve the prognosis.
Solitary metastases from renal cell carcinoma: A review
Authors: Tongaonkar Hemant B. , Kulkarni Jagdeesh N. , Kamat Muralidhar R.
Published: February 2007

Nineteen patients with solitary metastatic lesions from renal cell carcinoma, 5 synchronous and 14 metachronous, were seen at the Tata Memorial Hospital over a 7 year period between 1981 and 1987. The mean metastatic interval for the metachronous lesions was 31.2 months. The commonest sites of metastases were bone, lung, and liver. The solitary nature of the metastasis was confirmed by appropriate investigations. All patients underwent nephrectomy for the primary kidney lesion. The metastatic lesions were treated with intent of cure. Only 1 patient with synchronous metastasis survived for 2 years and none survived 5 years while in the metachronous metastasis group, the estimated overall survival was 50% at 2 years and 25% at 5 years. The patients with a long metastasis‐free interval were found to have a better survival. The patients with liver metastasis did poorly as compared to those with metastases at other sites. The stage of the disease also had a bearing on the survival.
Elevated CA19‐9 as the most significant prognostic factor in advanced colorectal carcinoma
Authors: Kouri Mauri , Pyrhönen Seppo , Kuusela Pentti
Published: February 2007

Tumor markers such as carcinoembryonic antigen (CEA) and CA19‐9 were analyzed as response indicators and prognostic factors in advanced colorectal carcinoma. Eighty‐five patients participated in a phase II chemotherapy study from October 1984 to July 1990. A three‐drug schedule was administered including low dose epirubicin and sequential methotrexate 5‐fluorouracil, followed by leucovorin rescue. Serum specimens for CEA and CA19‐9 were obtained prior to the initiation of chemotherapy, and subsequently at 4‐6 weeks' intervals. In univariate analysis Karnofsky, the site of the primary tumor, the extent of metastases, the presence of abdominal or liver metastases, serum CEA (cut‐off of 20 μg/1), and CA19‐9 levels correlated with survival. In stepwise multivariate analysis an elevated CA19‐9 level, a poor Karnofsky, and the presence of liver metastases were independent adverse prognostic factors. Tumors originating from the left colon had a better prognosis than the others. This was related to a higher response rate in this patient group. Serum CA19‐9 level was the most significant prognostic factor whether it was entered as a continuous or as a dichotomized variable into the model. The median survival of patients with a normal CA19‐9 level was 30.0 months (lower 95% confidence interval: 16.4 months; upper limit was not calculable), and with an elevated CA19‐9 value 10.3 months (8.0‐12.6 months, 95% confidence interval). Five of 85 patients had a complete response and 20 a partial response, the overall response rate being 29%. When compared with tumor shrinkage, “CEA response” and “CA19‐9 response” had a sensitivity of 84% and 88% and specificity of 77% and 67%, respectively. In conclusion, serum CEA value seems to be the best tumor marker for response prediction, while CA19‐9 level is one of the best available prognostic indicators in advanced colorectal carcinoma.
Increased drug resistance of cultured human cancer cell lines in three‐dimensional cellular growth assay using collagen gel matrix
Authors: Furukawa Toshiharu , Kubota Tetsuro , Watanabe Masahiko , Kase Suguru , Saikawa Yoshiro , Nishibori Hideki , Kuo Tsong‐Hong , Kodaira Susumu , Ishibiki Kyuya , Kitajima Masaki
Published: February 2007

We have conducted a three‐dimensional cellular growth assay using collagen gel matrix with an endpoint of the 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl‐2H tetrazolium bromide (MTT) assay, on four human gastric and colonic cancer cell lines. Three‐dimensionally growing cells in collagen gel matrix were 2‐ to 180‐fold more resistant to mitomycin C, doxorubicin, 5‐fluorouracil, and cisplatin than those in monolayer culture, and these resistances were increased further when the cells increased their three‐dimensionality. Furthermore, the influence of fibroblasts in the collagen gel matrix on the chemosensitivity of cancer cells was less than that in monolayer culture. Since this new assay using collagen gel matrix with an endpoint of the MTT assay was able to detect the increase of drug resistance of human cancer cell lines by three‐dimensional cellular growth using a simple and convenient procedure, it was considered to be more useful than conventional monolayer cultures for evaluating the chemosensitivity of cancer cells.
Marginal mandibulectomy for carcinoma of the floor of the mouth
Authors: Shaha Ashok R.
Published: February 2007

Resection of primary tumors of the floor of the mouth mandates consideration of the management of the mandible which may be either involved by direct invasion or by close proximity. Segmental mandibulectomy can usually be performed when the tumor is either massive or directly invading the mandible. However, the cosmetic and functional results of segmental mandibulectomy are unsatisfactory. Whenever the tumor is close to the mandible or adherent to the periosteum, consideration should be given to marginal mandibulectomy. Over a period of 8 years, we have treated 65 patients with carcinoma of the floor of the mouth. Of these, 22 underwent marginal mandibulectomy. The number of patients staged T1, T2, and T3 were 4, 13, and 5, respectively. Most had oblique marginal mandibulectomy including the resection of the upper rim and medial cortex of the mandible. Vertical or horizontal mandibulectomy was rarely used. In each patient the preoperative workup included dental X‐rays, panoramic films, and computerized tomography (CT) scan of the head and neck. The decision as to the extent of mandibulectomy was made primarily based on the clinical judgement. Seven patients underwent marginal mandibulectomy through the open mouth. However, in the remaining 15 patients, the cheek flap approach was utilized. The defect following marginal mandibulectomy was reconstructed either with split thickness skin graft, tongue flap, or myocutaneous flap. Small defects were left open to heal by granulation and secondary intention. Split thickness skin grafts healed very well over the surface of resected mandibles. Good local tumor control was achieved at the primary site and the functional and cosmetic results were excellent.
Intravenous nitrogen mustard given immediately after mastectomy: Possible effect on local recurrence
Authors: Hines James R.
Published: February 2007

A small group of patients with Stage I and II ductal breast carcinomas were treated with intravenous nitrogen mustard the day of mastectomy and the first two postoperative days. Long term follow‐up revealed that only one patient developed isolated local recurrence, a rate much lower than usually reported. It is possible that early use of chemotherapy could reduce local recurrences in the recently traumatized tissue.
Carcinoid tumors and inflammatory bowel disease
Authors: Kortbeek John , Kelly James K. , Preshaw Roy M.
Published: February 2007

Three cases are described in which carcinoid tumors arose in previously established inflammatory bowel disease: two were in the ileum in cases of Crohn's disease, and one was in the rectum in a case of ulcerative colitis. Review of this association in the literature suggests that it may be more than fortuitous.
Malignant granular cell tumor of the breast
Authors: Chetty Runjan , Kalan Manhar R.
Published: February 2007

A primary malignant granular cell tumor (MGCT) in the breast is presented. The tumor showed mitoses, pleomorphism, necrosis and regional lymph node spread. While local excision is the best form of treatment, MGCT can spread rapidly to lymph nodes, lungs, liver, and bone. This lesion is an uncommon primary malignancy of breast with only 4 other cases reported.
Cancer of the esophagus: Esophagogastric anastomotic leak—A retrospective study of predisposing factors
Authors: Patil Prakash K. , Patel Snehal G. , Mistry Rajesh C. , Deshpande Raman K. , Desai Prafulla B.
Published: February 2007

An esophagogastric anastomotic leak, especially in the mediastinum or the chest, is a life‐threatening complication of surgery for cancer of the esophagus. Of 617 patients who underwent esophageal resection and esophagogastric anastomosis between January 1980 and December 1989, 39 (6.32%) had anastomotic leakage; of these, 25 (64.10%) died. Various biologic parameters, operative techniques, and the management of leaks were analysed. Albumin concentration below 3 gm/dL (χ2 = 3.9; P = 0.047), neoplastic permeation of the anastomotic cut margin (χ2 = 4.7; P = 0.04), and cervical anastomosis (χ2 = 12.32; P = 0.0004) were associated with a higher incidence of anastomotic leakage. Hemoglobin level, type of suture material used for the anastomosis, preoperative radiotherapy, and the experience of the operating surgeon under supervision were found to be statistically insignificant factors and did not influence anastomotic leakage. Mortality due to leak in the first postoperative week was 85% and was statistically significant as compared to the mortality occuring in the second postoperative week (χ2 = 6.04; P = 0.013). Surgical or conservative management of the leak did not influence mortality (χ2 = 1.2; P = 0.27). The salvage rates for cervical and intrathoracic anastomotic leakage were 80% and 29.4%, respectively. This difference is statistically significant (χ2 = 29; P = 0.088).
Prostate‐specific antigen, digital rectal examination, and transrectal ultrasound in predicting the probability of cancer
Authors: Drago Joseph R. , York Jeffrey P.
Published: February 2007

Over a 4 1/2 year period, 1,940 asymptomatic men were entered in a prostate cancer detection program consisting of digital rectal examination (DRE), prostate‐specific antigen (PSA), and transrectal prostate ultrasound (TRUS). Four hundred and sixteen biopsies were performed resulting in the diagnosis of 79 cancers; 82% had clinically organ confined tumors. A recommendation for biopsy was made in 260 (62%) based on the TRUS alone, 55 (13%) by DRE alone, 92 (22%) when the DRE and TRUS were both abnormal, and in 9 (2.2%) cases when only PSA levels were elevated. The DRE, PSA, and TRUS were abnormal in 1,261 (65%), 989 (51%), and 1,552 (80%) of the patients with cancer, respectively. Prostate cancer detection increased as the serum PSA level increased above 4 ng/ml. The positive predictive value of both DRE and TRUS were significantly influenced by an elevated PSA, (P = .042 and P < .00005, respectively). The results of this study support the idea that, although the prostate cancer detection rate is influenced by these three modalities and the detection rate of localized disease can be improved by early detection programs, its effect on mortality rates remains undefined at this time.
Chest wall resection for locally recurrent breast cancer: Indications, technique, and results
Authors: Brower Steven T. , Weinberg Hubert , Tartter Paul I. , Camunas Jorge
Published: February 2007

A series of 100 patients with locally advanced carcinoma of the breast was analyzed for chest wall recurrence alone after primary treatment. Five patients were found to have had chest wall recurrence alone and were treated with en bloc chest wall resection. This group of patients was analyzed for the pathophysiology of recurrence including characteristics of the primary tumor, location of the chest wall recurrence, and overall local salvage and survival after chest wall recurrence. In this series, local recurrence after radical chest wall resection was 20%. The incidence of systemic recurrence after chest wall resection was 60%. The mean survival for the entire group was 17 months after chest wall recurrence and radical resection. The main surgical objectives, including relief from painful, inflammatory, and bleeding complications, were achieved in all patients after chest wall resection. Although patients with isolated chest wall recurrence included a highly selected group, chest wall resection with myocutaneous reconstruction may provide long‐term disease‐free survival for these patients.
Upper extremity occlusive arterial disease after radiotherapy for breast cancer
Authors: Atabek Umur , Spence Richard K. , Alexander James B. , Pello Mark J. , Camishion Rudolph C.
Published: February 2007

Upper extremity arterial occlusive disease is a rare complication of radiation therapy for breast cancer. We present the case of a 74 year old woman who developed upper extremity ischemia 32 years after mastectomy and radiation therapy. Arteriography identified a stenotic proximal brachial artery lesion within the previous radiation field. Ballon angioplasty was unsuccessful. An axillo‐brachial bypass relieved the ischemia and is still patent after 24 months. The previous literature shows that arterial bypass procedures have been uniformly successful in this circumstance. Little experience has been reported with balloon angioplasty for these lesions.
Stage III breast cancer: Is neoadjuvant chemotherapy always necessary?
Authors: Frank James L. , McClish Donna K. , Dawson Kathy S. , Bear Harry D.
Published: February 2007

Optimal management of locally advanced breast cancer is controversial. Claims of superiority for neoadjuvant systemic therapy are based on comparisons with outdated historical control groups who received no chemotherapy. Between 1978 and 1987, 118 patients with locally advanced breast cancer underwent treatment and follow‐up at the Medical College of Virginia. Median follow‐up was 44 months (range 3‐1 19 months). Actuarial 5‐year survival for the entire group was 54%. This compares favorably with recent series using neoadjuvant chemotherapy in which 5‐year survival rates of 40‐65% have been reported. Primary tumor size larger than 9 cm, metastases to more than 50% of regional lymph nodes, and the presence of inflammatory disease were significant prognostic indicators. This series represents a contemporary control group of patients with locally advanced breast cancer in whom conventionally accepted guidelines for local and postoperative systemic adjuvant therapy were used. Until the optimal sequence of therapy is determined by prospective randomized trials, series such as this may serve as more appropriate controls to which the results of new therapies could be compared. © 1992 Wiley‐Liss, Inc.
Long‐term survival in thyroid carcinoma. Patients with follicular the Oslo experience: Variations with encapsulation, growth pattern, time of diagnosis, sex, age, and previous thyroid surgery
Authors: Høie Johan , Stenwig Anna E.
Published: February 2007

In 98 follicular thyroid carcinoma patients with a follow‐up of 10‐32 years, 10‐year survival varied in subgroups from 15.5‐63.4%. Survival with encapsulated primary tumors was 46.7%, compared to 26.9% in widely invasive tumors, and varied from 59.9‐35.8% with growth pattern. In patients younger than 60 years of age at diagnosis 10‐year survival was 68% of expected survival, compared to 32% in patients older than 60. Patients treated after 1970 had an improved survival of 24.2%. Thirty‐one patients had previous thyroid operations for benign lesions. Review of histopathologic slides and medical records demonstrated follicular adenomas in 17 cases, and overlooked carcinomas in 11. Calculating survival from the first surgical intervention improved reported 10‐year survival by 14.5%. Papillary carcinoma patients matched for age and sex had significantly better 10‐year survival. © 1992 Wiley‐Liss, Inc.
Leptomeningeal carcinomatosis following craniofacial resection of an ethmoid tumor
Authors: Wen B‐Chen , Hussey David H. , Clamon Gerald H. , Codersky John C.
Published: February 2007

Leptomeningeal carcinomatosis (LMC) is a rare complication following treatment for head and neck cancer. In this paper, we report a case of LMC following surgery and localized radiation therapy for an ethmoid carcinoma, in which laceration of the dura during craniofacial resection may have provided an access for cancer cells into the cerebrospinal fluid (CSF). As a result, the patient developed LMC manifested as multiple spinal nerve root involvement. The patient died 3 months after the diagnosis of LMC. To avoid this type of complication, special care must be taken to prevent tears in the dura during craniofacial resection. Also, we recommend CSF examination be performed prior to radical surgery if there is any suspicion of meningeal invasion. © 1992 Wiley‐Liss, Inc.
Simultaneous primary lung sarcoma and carcinoma
Authors: Mann Marianne , Asuncion Celedonio
Published: February 2007

Synchronous primary lung tumors are uncommon, and primary lung sarcomas are especially rare. We report an unusual case of a poorly differentiated carcinoma and a primary sarcoma of the lung. The surgical approach to patients with synchronous primary lung tumors should be aggressive. © 1992 Wiley‐Liss, Inc.
Breast metastases from malignant melanoma
Authors: Arora Raman , Robinson William A.
Published: February 2007

We review here 15 patients with cutaneous malignant melanomas metastatic to the breast. All but one were premenopausal females with a median age of 38 years. Most patients had a primary lesion on the upper extremities or trunk (80%), with only one patient having a lower extremity primary. The median interval between diagnosis of the primary and breast involvement was 33 months, with one patient developing breast involvement 11 years later, at the time of her second pregnancy. Five patients had bilateral breast involvement, and all had other sites of metastases at the time of diagnosis. The median survival after diagnosis of breast metastases was 10 months, portending a poor prognosis. © 1992 Wiley‐Liss, Inc.
Postprandial hypoglycemia in islet beta cell hyperplasia with adenomatosis of the pancreas
Authors: Tibaldi Joseph M. , Lorber Daniel , Lomasky Steven , Steinberg J. J. , Reisman Robert , Shamoon Harry
Published: February 2007

Organic hyperinsulinism causing hypoglycemia in adults is caused by insulinoma, islet hyperplasia, or a combination of adenomata and hyperplasia. We present a patient with long‐standing symptoms of postprandial hypoglycemia occurring within 15 minutes of meals in the absence of fasting hypoglycemic symptoms. An intravenous glucagon stimulation test resulted in a rise of plasma insulin from 194 to 21,883 pmol/L at 7.5 minutes. Blood glucose simultaneously rose from 4.9 to 5.9 mmol/L. A glucose tolerance test revealed an exuberant insulin response. A euglycemic hyperinsulinemic clamp demonstrated incomplete suppression of plasma C‐peptide. At surgery, three nodules were found and a 50–60% distal pancreatectomy was performed. The pancreas revealed a combination of multiple β‐cell islet adenomata and islet hyperplasia with no evidence of nesidioblastosis. The coexistence of islet adenomata with hyperplasia must be considered in the differential diagnosis of postprandial hypoglycemia. © 1992 Wiley‐Liss, Inc.
Melanoma of the external ear
Authors: Cole David J. , Mackay Gregory J. , Walker Bruce F. , Wooden William A. , Murray Douglas R. , Coleman John J.
Published: February 2007

Management of melanoma of the external ear is controversial. Thirty‐one patients treated for this disease were identified at our institution between January 1, 1974 and December 31, 1989. Follow‐up was an average of 7.12 years (range 1–15). Local therapy performed included 16 wedge resections, 3 split thickness skin grafts after excision to the perichondrium, 10 partial and 2 total amputations. There were two local recurrences, four metachronous cervical metastases, and four distant metastases. Three elective and five therapeutic neck dissections were performed. Survivors at 1, 5, and 10 years were 93, 77, and 47%, respectively. There was no relationship between DNA ploidy, local surgical therapy, and eventual recurrence. Clinical stage and tumor thickness demonstrated a statistically significant correlation with likelihood of recurrence (P = .02 and .05). There is no evidence that melanoma of the ear has a poorer prognosis or different prognostic factors than melanoma at other cutaneous sites. In selected cases, local disease can be controlled by excision and skin graft rather than the more aggressive current procedures. © 1992 Wiley‐Liss, Inc.
Prognostic significance of dna measurement determined by image analysis in human breast carcinoma
Authors: Mir Rabia , Johnson Houston , Margolis Melissa , Teplitz Steven , Wise Leslie
Published: February 2007

The nuclear DNA of human breast carcinoma cells was studied by image analysis using archival paraffin‐blocked tissues from two groups of patients with breast cancers. One group had survived > 10 years (N = 20) and the other <3 years (N = 26) after the initial diagnosis. Cellular preparations were made from pepsin‐digested deparaffinated sections. The nuclear DNA was stained with Feulgen stain and measured by a computerized image analysis system. The data show that in addition to nodal status the pattern of DNA histograms obtained from image analysis can provide powerful prognostic information in breast carcinoma. The prognostic value of DNA histogram patterns may be independent of nodal status. © 1992 Wiley‐Liss, Inc.
Cancer of the esophagus in young adults
Authors: Patil Prakash K. , Patel Snehal G. , Mistry Rajesh C. , Deshpande Raman K. , Desai Prafulla B.
Published: February 2007

Clinicopathological features and survival data of squamous cell carcinoma of the esophagus were analyzed from the viewpoint of age differences in 453 patients treated at the Tata Memorial Hospital, Bombay, India. Two groups were studied: group A, aged 35 years or less; and group B, aged above 35 years. There was no significant difference among the two groups with regard to sex distribution, site and length of the tumor, operability, morphology, histological grade, vascular and lymphatic invasion, and lymph node metastasis. The primary lesion was more advanced and the rate of incomplete resections was higher in younger patients. The incidence of cardiopulmonary complications and postoperative deaths was significantly lower in younger patients. Recurrence of the disease following complete resection was more frequent in the younger age group (chi2 = 2.61; P = .1063), although the pattern of recurrence remained the same in both groups. Disease‐free survival in younger patients following complete resection of the tumor was poorer as compared to the older patients, but the difference is statistically not significant (chi2 = 1.882; P = .1701). These findings suggest either a delayed diagnosis or a biologically sinister disease in the younger group; further studies of the two groups vis‐a‐vis their biologic parameters (DNA ploidy, etc.) are in progress and will form the subject of another communication. © 1992 Wiley‐Liss, Inc.
Serum squamous cell carcinoma antigen levels in invasive squamous vulvar cancer
Authors: Rose Peter G. , Nelson Beth E. , Fournier Lawrence , Hunter Richard E.
Published: February 2007

Squamous cell carcinoma (SCC) antigen levels were studied in 34 patients with primary (N = 27) or recurrent (N = 7) SCC of the vulva. In primary disease, the SCC antigen level was greater than 2.5 ng/ml in only four patients (15%). Elevated antigen levels ranged from 2.7–18.0 ng/ml. All of these patients had advanced disease by either clinical or surgical staging systems. Four of twelve patients with inguinal metastasis had elevated SCC antigen levels. In two of these patients the inguinal nodes were abnormal to palpation. No association of the SCC level and the degree of tumor differentiation was observed. SCC antigen levels were increased slightly (2.7–4.5 ng/ml) in three of six patients with locally recurrent disease. In one patient with distant recurrence the SCC antigen was 15.3 ng/ml. In both primary and recurrent disease all elevated SCC antigen levels decreased with effective therapy. Vulvar cancer is primarily a local disease that is easily assessed by physical examination. An effective tumor marker in vulvar cancer would benefit only the rare patient with distant but not local disease. © 1992 Wiley‐Liss, Inc.
Schedule dependent inhibition of thymidylate synthase and tumor growth by 5‐fluorouracil in yoshida sarcoma bearing rats
Authors: Tsujinaka Md Toshimasa , Kido Yoshihiro , Shiozaki Hitoshi , Mori Takesada , Karakousis Constantine P.
Published: February 2007

Schedule dependent inhibition of thymidylate synthase (TS) and tumor growth by 5‐fluorouracil (FUra) was examined in Yoshida sarcoma (YS) bearing Donryu rats. After implantation of YS cells (1 × 104), FUra (20 mg/kg/day) was continuously (group C) or daily bolus injection (group B) administered for 6 days. On day 7, tumor weight was 1.57 ± 0.58 g in group C and 0.45 ± 0.10 g in group B (P < 0.01), free TS was 2.23 ± 83 fmol/mg protein in group B and 96 ± 55 fmol/mg protein in group C (P < 0.05), and inhibition rate of TS was 88.3 ± 5.3% in group C and 94.7 ± 3.0% in group B (P < 0.05). A significant correlationship was found between free TS and tumor weight (P < 0.05). As the next step, continuous infusion (group C) or daily bolus injection (group B) for 6 days was started on day 5 after implantation of YS cells. The relative increase of tumor on day 9 was 256 ± 111% in group C and 112 ± 22.1% in group B (P < 0.05). On day 11, total TS of the resected tumor was 650 ± 153 fmol/mg protein in group C and 391 ± 124 fmol/mg protein in group B (P < 0.05), and inhibition rate of TS was 78.8 ± 12.4% in group C and 84.4 ± 8.6% in group B. Daily bolus injection of FUra causes a superior antitumor and antimetabolic effect. The schedule dependent cytotoxicity of FUra should be taken into account when a chemotherapeutic protocol is designed. © 1992 Wiley‐Liss, Inc.
Long‐ and short‐term survivors after pancreatoduodenectomy for ampullary carcinoma
Authors: Yamaguchi Koji , Nishihara Kazuyoshi
Published: February 2007

Out of 36 consecutive patients who underwent a pancreatoduodenectomy for carcinoma of the ampulla of Vater, eight patients (long‐term survivors) survived more than 5 years after surgery, while eight other patients (short‐term survivors) survived less than 12 months after intervention. Both the eight long‐term survivors and eight short‐term survivors were compared clinicopathologically. The long‐term survivors did have some preferable factors such as a high value of peripheral lymphocytes, a low concentration of carcinoembryonic antigen, a small protruding tumor, a shallow depth of invasion, a well‐differentiated histopathologic type, an infrequent venous invasion, and no perineural infiltration. However, these differences were not significant. A multivariate regression analysis regarding the 18 prognostic variables showed that both perineural invasion and the grade of histopathologic differentiation were significant parameters. Out of the eight long‐term survivors, three patients lived more than 10 years while another died from ampullary carcinoma 74 months after surgery. Pancreatoduodenectomy not only produces long‐term survivors but can also effect a complete cure in patients with ampullary carcinoma. A long clinical follow‐up of more than 5 years after surgical intervention is thus warranted. © 1992 Wiley‐Liss, Inc.
Surgical complications of intraoperative radiation therapy: The radiation therapy oncology group experience
Authors: Noyes R. Dirk , Weiss Steven M. , Krall John M. , Sause William T. , Owens Jake R. , Wolkov Harvey B. , Lanciano Rachelle , Hanks Gerald E. , Hoffmann John
Published: February 2007

Intraoperative radiotherapy (IORT) is being used with increasing frequency in many institutions in the United States but little is known about the surgical complication rates. The Radiation Therapy Oncology Group initiated three prospective studies in IORT in 1986 and we report here the experience in advanced malignancies of the stomach, pancreas, and rectum. The incidence and nature of major surgical complications were reviewed and presented with their implications in regard to future IORT trials. Two hundred twenty‐seven patients were entered on three studies by 20 participating institutions between 1985 and 1989. One hundred twenty‐nine patients received IORT while 98 patients were found to have too advanced disease to be benefited by IORT and underwent palliative surgical procedures only. IORT doses ranged from 12–22 Gy and bowel anastomoses were not irradiated. Wound infection in the IORT group was 6% vs. 2% in the non‐IORT patients but this was not significant at the P = 0.05 level. Other complications included anastomotic leak (n = 5), operative bleeding (n = 10), pancreatitis (n = 2), and were not statistically different in the IORT and non‐IORT groups. The mortality rate for the IORT and non‐IORT groups combined was 1.8%. This large multi‐institutional experience in patients with advanced malignancy demonstrates that patients receiving IORT do not have a higher surgical complication rate than those not receiving IORT. Long‐term survival data await the implementation of Phase III trials in advanced intra‐abdominal malignancy. © 1992 Wiley‐Liss, Inc.
Oncological aspect of immediate breast reconstruction in mastectomy patients
Authors: Noguchi Masakuni , Fukushima Wataru , Ohta Nagayoshi , Koyasaki Naohiro , Thomas Michael , Miyazaki Itsuo , Yamada Tetsuji , Nakagawa Masaaki
Published: February 2007

In this study, we compared the relapse‐free and overall survival of 83 patients who underwent mastectomy with immediate reconstruction (MIBR) using a musculocutaneous flap with or without silicone implant with those of 153 patients with breast cancer who underwent mastectomy without immediate reconstruction. In univariate analysis, the overall and/or relapse‐free survival of reconstructed patients with four or more positive axillary lymph nodes or those with menopausal status were significantly inferior compared with those of nonreconstructed patients. In multivariate analysis, however, the immediate breast reconstruction did not appear to have a significant adverse influence on all patients, and on the subgroups stratified by menopausal status or axillary lymph node metastases. Therefore, it was concluded that MIBR using a musculocutaneous flap did not compromise the survival of patients with breast cancer. © 1992 Wiley‐Liss, Inc.
The role of fine needle aspiration in the diagnosis of thyroid nodules: Analysis of 795 consecutive cases
Authors: Piromalli Domenico , Martelli Gabriele , Del Prato Ivan , Collini Paola , Pilotti Silvana
Published: February 2007

The utility of fine needle aspiration (FNA) and physical examination for selecting patients with palpable thyroid nodules for surgery was evaluated in 795 consecutive cases. Surgery was performed in 216 patients based upon the cytological diagnosis and clinical criteria. Excluding 42 patients who were lost to follow‐up, the remaining 537 were regularly followed up (range, 2–10 years). Cytological findings were classified as malignant, histologic control recommended (suspicious), follicular tumor, benign, and unsatisfactory. Thirty‐six aspiration biopsies were positive for malignancy and the diagnosis was confirmed histologically in 34 of them. In 65 patients with final histological diagnosis of malignancy, cytology was positive in 34, suspicious in 20, benign in 3 cases, and unsatisfactory in 8. All patients with cytological diagnosis of follicular tumor had a benign lesion at histology. There were two false positive and three false negative cytological results among the 216 histologically confirmed cases. Excluding unsatisfactory specimen sensitivity, specificity and the predictive value for a positive and a negative result were respectively 95%, 97.5%, 94.5%, and 97%. We conclude that FNA is a very reliable diagnostic test in the evaluation of thyroid nodules and is the best guidance in addition to clinical criteria for selecting patients to be submitted to surgery. © 1992 Wiley‐Liss, Inc.
Adenocarcinoma arising within a gastric duplication cyst
Authors: Coit Daniel G. , Mies Carolyn
Published: February 2007

A rare case of carcinoma arising within a gastric duplication cyst in a 72 year old woman is presented. This is the oldest patient in whom neoplastic transformation of this usually benign developmental abnormality has been reported. The clinical and pathologic features of this patient are demonstrated and reviewed in the context of prior reported cases. © 1992 Wiley‐Liss, Inc.
Atrophic chronic gastritis and esophagogastric anastomotic leak after resection and reconstruction for esophageal carcinoma
Authors: Rakic Srdjan , Pesko Predrag , Milicevic Miroslav , Gerzic Zoran
Published: February 2007

The incidence of anastomotic leakage after esophagectomy for cancer and reconstruction with the stomach was analyzed with respect to the presence of coexistent atrophic chronic gastritis (ACG). Of a total of 28 operated esophageal cancer patients with ACG, 6 patients developed an anastomotic leak at the cervical esophagogastrostomy (21%). Of a total of 8 operated esophageal cancer patients none of the patients developed an anastomotic leak. The ACG positive and the ACG negative patients were found to be well matched for age, sex, type of operation, transplant route, level of the anastomoses, and suture technique, and all were operated on by the same surgeons. The difference in leakage rate did not reach statistical significance. © 1992 Wiley‐Liss, Inc.