bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer
Authors: Furey Patricia C. , Macgillivray Dougald C. , Castiglione Charles L. , Allen Lisa
Published: February 2007

A retrospective study was done to evaluate the frequency and severity of wound complications in 112 patients with breast cancer who received adjuvant chemotherapy following mastectomy with immediate breast reconstruction. Data on wound complications were available for 120 mastectomies. The rate of complications in 36 mastectomies treated with chemotherapy after mastectomy and immediate reconstruction was compared to that in 84 mastectomies not receiving adjuvant therapy. There were 25 wound complications (20.8%) in the entire group. The rate of wound complications was 27.8% (10 of 36 mastectomies) in the group treated with adjuvant chemotherapy and 17.9% (15 of 84 mastectomies) in the group that did not receive adjuvant therapy (P = 0.13). No patient had a delay in the initiation of adjuvant therapy because of wound complications secondary to immediate reconstruction. Logistic regression analysis found no correlation between age, type of operation, tumor pathology, stage, number of lymph nodes harvested, type of prosthesis or chemotherapy, and wound complications in patients undergoing immediate breast reconstruction after mastectomy. The frequency of wound complications was not increased in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction. The administration of adjuvant chemotherapy does not need to be delayed in patients who have had immediate breast reconstruction following mastectomy for breast cancer. © Wiley‐Liss, Inc.
Compartment syndrome of the leg secondary to leukemic infiltration: A case report and review of the literature
Authors: Veeragandham Ramesh S. , Paz Isaac Benjamin , Nadeemanee Auayporn
Published: February 2007

Leukemic infiltration of muscle is an unusual cause of compartment syndrome. High index of suspicion with early fasciotomy may be the only way to save the leg and prevent life‐threatening complications. Biopsy of the muscle should be done when the etiology of the compartment syndrome is not clear. The probable mechanisms and treatment approaches are discussed. © Wiley‐Liss, Inc.
α‐fetoprotein‐producing rectal cancer: Calculated tumor marker doubling time
Authors: Sato Yoshihiro , Sekine Takeshi , Ohwada Susumu
Published: February 2007

α‐fetoprotein (AFP) production by rectal cancer is very rare. In the English literature there are only a few reported cases in which serum AFP level was >1,000 ng/ml.

A 43‐year‐old Japanese man with rectal cancer and liver metastases had a high serum AFP level (941 ng/ml) when first evaluated. Three weeks later, the serum AFP level was extremely elevated (7,060 ng/ml). He underwent abdominoperineal excision of the rectum and biopsy of liver metastases. The placement of an intrahepatic‐arterial infusion catheter into the proper hepatic artery via the right gastroepiploic artery was also performed. Immunohistochemically, AFP‐positive cells were identified in both the rectal and liver tumors. Nine days postoperatively, the serum AFP level was 2,000 ng/ml. In spite of intensive chemoimmunotherapy, serum AFP level was increased and 14 weeks after surgery was extremely elevated (267,300 ng/ml). The patient succumbed to cancer 3 months after surgery. To our knowledge, this is the first case of an AFP‐producing rectal cancer in which AFP doubling time could be calculated as 12.8 days. © Wiley‐Liss, Inc.
Lipiodolization for unresectable hepatocellular carcinoma: An analysis of 205 patients using univariate and multivariate analysis
Authors: Urata Keiko , Matsumata Takashi , Kamakura Tatsuro , Hasuo Kanehiro , Sugimachi Keizo
Published: February 2007

Since 1982 we have developed and successfully performed lipiodolization on 205 patients with unresectable hepatocellular carcinoma. The 1‐, 2‐, 3‐, 4‐, and 5‐year survival rates were 55.6%, 31.7%, 16.3%, 8.7%, and 2.9%, respectively, while the median survival was 413 days, and 20 patients survived longer than 3 years after the first lipiodolization. Our study demonstrated that the factors for a comparatively good prognosis were as follows: patient older than 50 years, nodular type hepatocellular carcinoma <5 cm in diameter, negative tumor invasion of portal vein, <10 intrahepatic metastases, serum alpha‐fetoprotein level <400 ng/ml, and Okuda stage I. Lipiodolization did not cure hepatocellular carcinoma. It did, however, in this study, achieve a prolongation of the patient's survival. © 1994 Wiley‐Liss, Inc.
Prognostic factors in head and neck soft tissue sarcomas: Analysis of 128 cases
Authors: Kowalski Luiz P. , San Chen I.
Published: February 2007

Soft tissue sarcomas make up a heterogenous group of rate malignant tumors originating from mesodermal tissues. Although there have been several improvements in diagnostic methods, staging, and treatment over the past few years, the prognosis of head and neck sarcomas remains worse than those sited at the trunk or extremities. The purpose of this retrospective study was to report the survival results of 128 consecutive patients with soft tissue sarcomas of the head and neck treated from 1953 to 1985. Of the 93 patients submitted to surgical resection, the procedure was considered radical in 67 patients. Of the operated gruop, 46 patients (49.5%) developed recurrence of disease. Thirty‐two patients underwent further treatment (surgery, radiotherapy, or chemotherapy), and 14 patients were salvaged, giving the ultimate result of 65.6% disease control rate in the operated group. The univariate survival analysis showed no statistical difference (P> 0.05) according to age, race, sex, and site or histologic type of the tumor. Radicality of surgery was an important prognostic factor affecting survival (P= 0.0014 for disease‐free interval andP= 0.0183 for overall survival). The multivariate analysis showed that the radicality of surgery and tumor histology were independent prognostic factors affecting recurrence. The same variables and age group were related to the risk of death. Every effort must be made to make an early diagnosis and a radical surgical resection of these tumors must be tried (except for embryonal rhabdomyosarcoma), because it offers the best chance for cure. © 1994 Wiley‐Liss, Inc.
Phylloides tumor of the breast: A report of 14 cases
Authors: Hopkins M. Laura , McGowan Thomas S. , Rawlings Gayle , Liu Fei‐Fei , Fyles Anthony W. , Yeoh J. Lim , Manchul Lee , Levin Wilfred
Published: February 2007

The objective of this retrospective study is to determine the role of radiation therapy in the management of benign phylloides tumors. Fourteen patients with a diagnosis of benign phylloides tumor (PT) and registered at the Princess Margaret Hospital are included in the study. Definitive surgery consisted of either lumpectomy in seven patients or mastectomy in the other seven patients. One patient died of her disease, and the remaining patients had no evidence of disease at last follow‐up (median 38.4 months). Among these 13 patients, 4 had at least one recurrence and the recurrence rate was higher for the group who underwent lumpectomy (43% compared with 28%). One patient was treated by lumpectomy and adjuvant radiation therapy, and had no subsequent recurrence (follow‐up time 35.5 months). The role for radiation therapy in the management of this disease remains unclear. © 1994 Wiley‐Liss, Inc.
Induction chemotherapy in the treatment of patients with carcinoma of the esophagus
Authors: Maipang Tanaphon , Vasinanukorn Prasert , Petpichetchian Chit , Chamroonkul Santi , Geater Alan , Chansawwaang Somchai , Kuapanich Roongroj , Panjapiyakul Chingyiam , Watanaarepornchai Somchai , Punperk Supaporn
Published: February 2007

A prospective randomized phase III trial was carried out at Songklanagarind Hospital from August 1988 to December 1990. The objectives of the study were to evaluate the effect of chemotherapy regimen in squamous cell carcinoma of the esophagus and to determine whether induction chemotherapy improves symptom‐free period and survival in these patients compared to surgical treatment alone. Twenty‐four patients were randomized to receive 2 cycles of chemotherapy, cis‐platinum 100 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 loading dose on day 3, followed by 10 mg/m2/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 mg/m2 given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical response (13%), 6 (40%) had a partial response, and 7 patients (47%) had no response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of patients. Twenty‐two patients were randomized to conventional treatment (surgery alone). Median survival time was 17 months in both groups. However, early survival appeared to be better in the control group. Kaplan‐Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respectively. The survival time differences were not statistically significant (P = 0.186). These findings demonstrate that although this chemotherapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be better in the control group. The 6‐month survival discrepancy between both groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy. © 1994 Wiley‐Liss, Inc.
Triple approach in the diagnosis of dominant breast masses: Combined physical examination, mammography, and fine‐needle aspiration
Authors: Kaufman Zvi , Shpitz Baruch , Shapiro Myra , Rona Ronny , Lew Sylvia , Dinbar Alex
Published: February 2007

In an attempt to reduce the number of breast biopsies done for benign breast disease in patients with breast lumps, we evaluated prospectively the sensitivity and specificity of the combination of three diagnostic modalities: clinical examination, mammography, and fine‐needle aspiration cytologic examination (FNA). A total of 234 patients with a breast mass had a physical examination, a mammogram, and FNA, and were listed as malignant/suspicious or benign. All patients underwent a subsequent biopsy: 110 were found to have breast cancer, and 124 had a benign lesion. The sensitivity and specificity of the individual tests were as follows: 89% and 73%, respectively, for mammographic examination; 93% and 97% for FNA cytologic examination; and 89% and 60% for physical examination. For the combined triad of tests, the sensitivity was 100% and specificity 57%. All patients who had breast cancer had positive findings for malignancy in one or more of the diagnostic tests, i. e., 100% sensitively. All patients who had negative findings for malignancy in all three diagnostic tests had benign lesions, i. e., a negative predictive value of 100%. We conclude that breast masses can be diagnosed with a high degree of accuracy by combined physical, mammographic, and fine‐needle aspiration cytologic examination. Patients in whom physical examination, mammography, and FNA were negative for malignancy can be safely observed, obviating the need for an open biopsy. © 1994 Wiley‐Liss, Inc.
Risk analysis of carcinogenesis in the remnant stomach with measurement of ornithine decarboxylase activity
Authors: Kitao Yoshitaka , Yamane Tetsuro , Kikuoka Norikazu , Matsumoto Hirohiko , Oya Kazuhiko , Inagake Masao , Takahashi Toshio
Published: February 2007

Gastric ornithine decarboxylase (ODC) activity was measured as a biomarker of tumor‐promoting activity in the remnant stomach of rats and humans. Gastrectomy of Wistar rats utilizing the Billroth I method caused a significantly high induction of ODC, and use of the Billroth II method caused a significantly higher induction of ODC than the Billroth I method. In humans, ODC activity of remnant gastric cancer tissue, normal‐appearing mucosa of remnant gastric cancer patient, and remnant gastric mucosa without cancer after the Billroth II method were significantly higher than that of normal gastric mucosa without gastrectomy. ODC activity of remnant gastric mucosa without cancer after the Billroth II method was significantly higher than that after the Billroth I method. Risk of carcinogenesis was high in the remnant stomach, especially after the Billroth II method. © 1994 Wiley‐Liss, Inc.
Dose intensity of mitomycin C in adjuvant cancer chemotherapy for patients with gastric cancer
Authors: Kubota Tetsuro , Kumai Koichiro , Kitajima Masaki , Abe Osahiko , Fujisaki Masato , Yamada Yoshinori , Ushijima Yasuhide , Ishibiki Kyuya
Published: February 2007

Using a cohort of macroscopic curative resections of gastric cancer at stages II, III, and IV, a randomized controlled trial was performed to elucidate the dose efficacy of intensive adjuvant cancer chemotherapy with mitomycin C. Between June 1983 and December 1986, 336 patients with gastric cancer from 31 institutes were enrolled in the study. The cohort was stratified randomly by the telephone method into two arms. Group A received 20 mg and 10 mg of mitomycin C per body intravenously (IV) on postoperative days 0 and 1, respectively, and then tegafur at 600 mg/body daily perorally (PO) from postoperative week 2 for 1 year. Group B also received 0.2 mg of mitomycin C per kg IV at 3, 6, 9, and 12 months after surgery. The background factors in groups A and B were essentially identical, and the adverse effects were tolerable in both groups. The total administered doses of mitomycin C were significantly higher in group B than in group A, according to the protocol. Although no significant differences were observed in the actuarial overall survival rates between groups A and B at stages II, III, and IV, favorable survival was observed in group B, which received histologically absolute curative resection. This dose‐intensive adjuvant cancer chemotherapy would be useful for gastric cancer patients treated by histologically curative surgery. © 1994 Wiley‐Liss, Inc.
Prognostic factors of colorectal cancer: K‐ras mutation, overexpression of the p53 protein, and cell proliferative activity
Authors: Tanaka Matsuhei , Omura Kenji , Watanabe Yoh , Oda Yoshio , Nakanishi Isao
Published: February 2007

Between June 1990 and April 1991,62 colorectal tumors were assessed in a prospective fashion on the basis of various tumor characteristics. Parameters included K‐ras mutation, overexpression of the p53 protein, and proliferating cell nuclear cell antigen, as well as standard histopathologic examination. A multivariate analysis showed that K‐ras mutation correlated with vascular invasion (P< 0.01) and hematogenous metastasis (P< 0.01). With regard to survival time, multivariate analyses using the Cox proportional hazard model suggested that status of lymph node metastasis (P<0.01, relative risk [rr]=7.27), TNM stage (P< 0.05, rr=5.37), lymphatic invasion (P< 0.05, rr=4.48), and K‐ras mutation (P< 0.06, rr=3.69) are the most independent prognostic factors. We compared the prognostic value of the molecular assays and standard TNM prognostic factors by multivariate analysts. © 1994 Wiley‐Liss, inc.
Estrogen and progesterone receptor concordance between primary and recurrent breast cancer
Authors: Li Benjamin D. L. , Byskosh A. , Duda Rosemary B. , Molteni A.
Published: February 2007

Estrogen and progesterone receptor status in breast cancer can determine therapeutic options and may provide prognostic information. The purpose of this study is to compare the concordance of the primary breast cancer steroid hormone receptor status to that of the recurrent breast cancer and to determine whether the type of second lesion (local recurrence, second primary, or metatastic lesion) and adjuvant therapy received changed the receptor concordance. The records of eighty‐three patients with estrogen receptor (ER) analysis available for primary (p) and recurrent (r) breast cancer for 1976‐1990 were reviewed. In addition, 32 of these patients also had available progesterone receptor (PR) values for primary and recurrent breast cancers. Statistical evaluation was performed by chi‐square, Student's r‐test, and Wilcoxon signed‐rank test. ER concordance (primary/ recurrent, p/r) was identified in 59/83 (71 %) patients; PR concordance was identified in 18/32 (56%) patients. Whether the second lesion was a local recurrence, second primary, or a metastatic lesion did not affect ER concordance or PR concordance. Adjuvant chemotherapy, hormonal therapy, or radiation therapy, either alone or in combination, did not affect ER or PR concordance. The disease‐free survival (DFS) for patients with ER (p+)/(r‐) (primary receptor positive/recurrent receptor negative) was significantly shorter than those with ER (p‐)/(r+)(27.6 ± 7.4 months versus 50.6 ± 7.6 mo, P=0.04). The DFS for PR (p+)/(r‐) patients was 28.8 ± 7.9 months compared to the DFS of 46.8 ± 11.8 months for PR (p‐)/(r+) patients (P=NS). A significantly shorter DFS for ER (p+)/ (r‐) patients compared to ER (p‐)/(r+) patients and a trend towards a shorter DFS for PR (p+)/(r‐) patients compared to PR (p‐)/(r+) patients may reflect a loss of hormonal regulation or an increase in cancer aggressiveness. © 1994 Wiley‐Liss, Inc.
Skip mediastinal lymph node metastasis in non‐small cell lung cancer
Authors: Tateishi Masahiro , Fukuyama Yasuro , Hamatake Motoharu , Kohdono Satoshi , Ishida Teruyoshi , Sugimachi Keizo
Published: February 2007

We retrospectively investigated 186 non‐small cell lung cancer cases with N2 disease in order to clarify the significance of skip metastasis. Of the 186 patients with N2 disease, negative N1 nodes recognized to be skip metastasis were seen in 62 patients (33%). The incidence of skip metastasis was not statistically different regarding histology, T status, or M status. The incidence of the skip metastatic site consisted of 35 cases (56%) at sites 1, 2 and 3, while 8 cases (13%) were found at sites 8 and 9. Among the patients with right lung cancer, the skip metastatic incidence for site 7 (subcarinal) was higher in patients with either middle lobe or lower lobe cancer than in those with upper lobe cancer (P < 0.05). The 5‐year survival rates of all N2 patients in comparison to those with skip metastasis were 22% and 24%, respectively. When the sites of mediastinal lymph nodes were classified as superior, aortic, and inferior, the 5‐year survival rates of the patients with superior skip metastasis, aortic metastasis, and inferior metastasis were 23%, 36%, and 15%, respectively. No statistical difference was observed. The 5‐year survival rate of the skip N2 patients with only aortic region involvement was 50% (n=7). However, no statistically significant difference was found between the two groups (P=0.08). Our results thus suggested that mediastinal involvement for the aortic region alone might have a better prognosis than the others. We thus conclude that a dissection of the complete hilar and mediastinal lymph nodes should be the procedure of choice in standard operations for non‐small cell lung cancer because of the high frequency of skip metastasis. © 1994 Wiley‐Liss, Inc.
Lymph node involvement correlation with survival in advanced gastric carcinoma: Univariate and multivariate analyses
Authors: Shimoyama Shouji , Kaminishi Michio , Joujima Yoshiaki , Oohara Takeshi , Hamada Chikuma , Teshigawara Wataru
Published: February 2007

The aim of this study was to elucidate what factors affect the survival of patients with advanced gastric carcinoma. The relationship between the survival of 282 patients over a period of 15 years and 12 prognostic factors was investigated. In univariate analysis, lymph node involvement, depth of invasion, gross form, type of operation, maximum tumor diameter, and lymphatic invasion were found to correlate significantly with survival. Lymph node involvement, gross form, type of operation, and depth of invasion were selected by the Cox proportional hazard model with variable selection methods and found significant. Lymph node involvement was shown to correlate most significantly with survival by both univariate and multivariate analyses. Kaplan‐Meier survival curves could indicate that the survival rates of the selected factors were worsening in proportion to the relative risk ratios. These results suggest that further contrivance of therapies should be considered for patients in high risk categories. © 1994 Wiley‐Liss, Inc.
Effect of improved diagnosis of renal cell carcinoma on the course of the disease
Authors: Kessler Oded , Mukamel Eliahu , Gillon Gabriel , Servadio Ciro , Hadar Herzlia , Konechezky Miriam
Published: February 2007

The impact of the improved diagnosis of renal cell carcinoma (RCC) on the course of the disease was evaluated in 188 patients who were diagnosed and treated at a single medical center. Sixty‐seven patients (group A) who had undergone nephrectomy between 1979 and 1983 for RCC initially diagnosed by intravenous pyelography (IVP) were compared with 121 patients (group B) who had undergone nephrectomy between 1983 and 1989, diagnosed by ultrasound and/or computed tomography (CT) scan. Incidental asymptomatic tumors were found in 18 of 67 (26.9%) group A patients and in 57 of 121 (47.1%) group B patients (P < 0.001). The incidence of small tumors of <5 cm in diameter was significantly lower in group A compared to group B (25.4% vs. 47.9%, respectively, P < 0.01). The disease‐free 5‐year survival rate for group A was 40% compared to 80% for group B. It is concluded that the introduction of modern imaging techniques has improved the survival of patients with RCC and decreased the progression rate of the disease. © 1994 Wiley‐Liss, inc.
Clinical significance of multidrug resistance and P‐glycoprotein expression in patients with gastric carcinoma
Authors: Fujii Hidenori , Tanigawa Nobuhiko , Muraoka Ryusuke , Shimomatsuya Takumi , Tanaka Takeo
Published: February 2007

Twenty‐four fresh tumors of gastric carcinoma were assessed by flow cytometric detection of P‐glycoprotein (P‐gp) using monoclonal antibody C219. Eight patients were P‐gp positive. Differentiated gastric carcinomas contained significantly higher concentrations of P‐gp positive. Incidence of P‐gp positive was high in advanced stage. In 16 cases estimated chemosensitivity was test assessed by thymidine incorporation assay (TIA). Seven of nine multidrug‐resistant cases according to TIA were P‐gp positive and all of seven nonmultidrug resistant cases were P‐gp negative. Expression of P‐gp and multidrug resistance were closely correlated (P< 0.01). Also, in 89 patients with operable gastric carcinoma, the relation between in vitro chemosensitivity test (TIA) and their clinicopathologic features as well as their survival lengths were studied. Thirty‐one of 89 specimens from gastric carcinoma patients were multidrug resistant according to TIA. Patients in the multidrug‐resistant group had a significantly poorer cumulative survival rate than those who were not multidrug resistant (P< .05). The multivariate analysis showed that multidrug resistance is a useful indicator of prognosis (P< 0.1). We suggest that multidrug‐resistant cases or P‐gp‐positive cases of gastric carcinoma are highly malignant, and these determinations are clinically useful. © 1995 Wiley‐Liss, Inc.
Breast cancer complicated by pleural effusion: Patient characteristics and results of surgical management
Authors: Apffelstaedt Justus P. , van Zyl J. A. , Muller A. G. S.
Published: February 2007

To evaluate the efficiency of pleurodesis (PD) in the management of symptomatic malignant pleural effusion (PE) in breast cancer, we reviewed 46 patients undergoing 49 PDs. When radiotherapy was part of the initial treatment, 41% of PEs were ipsilateral to the primary, if not, 85% of PEs were ipsilateral (P < 0.0075). Six percent of patients presented dyspneic with exertion, 32% during daily routine; 61% at rest. All except 1 were improved after PD; 74% had no dyspnea, 23% had exertional dyspnea. PD relieved chest pain in 4 and cough in 5 patients. With 31 Talc/Iodine PDs, 2 mortalities and 2 minor complications occurred. Of 17 tetracycline PDs, 1 was complicated by bronchopleural fistula and 1 failed. 1 Mustine PD was uncomplicated. Survival at 6, 12, and 24 months was 58%, 40%, and 13%, respectively. Primary local radiotherapy may prevent ipsilateral PE. Talc/Iodine and tetracycline PD reliably provide relief from the distressing symptoms of malignant PE. © 1995 Wiley‐Liss, Inc.
Gastric cancer in the young, with special reference to 14 pregnancy‐associated cases: Analysis based on 2,325 consecutive cases of gastric cancer
Authors: Maeta Michio , Yamashiro Hiroshi , Oka Atsuo , Tsujitani Shunichi , Ikeguchi Masahide , Kaibara Nobuaki
Published: February 2007

Clinicopathologic features of gastric cancer in young women were analyzed with special reference to pregnancy (P). Among 2,325 consecutive patients, there were 152 young patients under 40 years of age (57 males and 95 females), and 14 P‐associated cases were identified. The male‐to‐female ratio was 1.7:1.0 on the whole, but 1.0:1.7 in the young group with more females predominating as the age of patients decreased. Among characteristics of gastric cancer in the young females, we noted a significantly higher frequency of both Borrmann type 4 cancer and poorly differentiated adenocarcinoma with the scirrhus type of growth and peritoneal metastasis. These characteristics were more pronounced in the P‐associated cases. Although we were unable to determine the mechanism for these tendencies, our findings suggest that the development and growth of gastric cancer in young women may be influenced by their natural, biological and hormonal circumstances. The prognosis of the young women with or without associated pregnancy was good afer curative surgery. Both early detection of gastric cancer and subsequent potentially curative surgery are the best ways to obtain good survival for young women, as is the case for members of other age and sex groups. © 1995 Wiley‐Liss, Inc.
Ovarian mucinous cystadenocarcinoma with sarcoma‐like mural nodules
Authors: Hamada Tetsuo , Sasaguri Takakazu , Tanimoto Akihide , Arima Nobuyuki , Nakano Ryuji , Sasaguri Yasuyuki , Miyayama Haruhiko
Published: February 2007

A rare case of ovarian mucinous cystadenocarcinoma with sarcoma‐like mural nodules is reported. Macroscopically, nodular or granular lesions were scattered over the inner surface of a huge, multilocular tumor in the left ovary. The histopathological features were consistent with those of previously documented cases, except significant squamous metaplasia in the present case. The pleomorphic sarcoma‐like cells showed a positive reaction for vimentin and α‐antichymotrypsin but were negative for carcinoembryonic antigen and common epithelial membrane antigen by immunohistochemistry. Electron microscopically, the tumor cells had neither desmosomes nor secretory granules, but they possessed abundant intermediate filaments. Both immunostaining and ultrastructure suggested that the sarcoma‐like nodules were derived from reactive proliferation of fibrohis‐tiocytic cells. The fibrohistiocytic reaction seemed to occur in response to hemorrhage, because hemorrhage was reported to be associated with the mural nodules in most of the previous cases as well as ours. © 1995 Wiley‐Liss, Inc.
Adenomatous polyposis coli, protein kinases, protein tyrosine phosphatase: The effect of sulindac
Authors: Waddell William R. , Miesfeld Roger L.
Published: February 2007

A putative explanation of the effect of sulindac on adenomatous colon and duodenal polyps from clinical observations and related in vitro experiments is presented. In cells with mutant APC genes, persistent high prostaglandin content of polyps leads to desensitization, downregulation of adenylate cyclase, uncoupling of cAMP synthesis from prostaglandin, and inactivation of protein kinase A (PKA). It is suggested that in normal cells, (APC) protein binds to catenins and microtubules to maintain structure and contribute to cell‐cell communication, adherence, and the dephosphorylated state, a necessary condition for such functions. Cells with mutant APC product become isolated, deprived of communication and adhesion to other epithelial cells, overphosphorylated, and without corrective capability. The latter is largely due to downregulation of cAMP synthesis and protein kinase A activity secondary to high prostaglandin. Three main biochemical defects ensue: (1) the restrictive influence of PKA catalyzed phosphorylation of Raf‐1 kinase and resultant effects on the MAP kinase cascade and transcription is lost, (2) the transcription of immediate early genes, including cyclooxygenase is stimulated, and (3) the stimulation of protein tyrosine phosphatase (PTPase) by PKA is in abeyance.

These putative abnormalities are reversed by inhibition of cyclooxygenase‐1 by sulindac. cAMP synthesis and PKA activity return to normal. PKA catalyzed phosphorylations block Raf‐1 kinase at the confluence of the Ras and protein kinase C pathways. The MAP kinase cascade is inhibited as is transcription of immediate early genes. At the same time PKA stimulates PTPase, which dephosphorylates the cytoskeleton and restores cell‐cell communication, adherence, and structure. The transformed phenotype is circumvented by adjustment of the phosphorylation state and mutant cells rejoin the epithelial community. The redox state of cytoplasm in mutant cells may be shifted toward reduction. © 1995 Wiley‐Liss, Inc.
Wilmss' tumor: The northern israel oncology institute experience
Authors: Arush Myriam Weyl Ben , Nahum Monique Peretz , Maor Jehuda‐Adi Bar , Dale Janet , Kuten Abraham
Published: February 2007

Between 1971 and 1992, 42 children (median age = 2 years) with histologically proven Wilms' tumor were evaluated at the Northern Israel Oncology Institute. Most patients were staged according to National Wilms' Tumor Study (NWTS) criteria by which 18 were clinical stage I‐II and 24 were III‐IV. Combined therapy (surgery, chemotherapy, and radiotherapy) was given with a change to lower dose radiotherapy (<2,000cG) after 1981. The pre‐1981 group (13 patients) suffered six relapses, most of which were pulmonary, whereas the 1981‐1992 group (29 patients) had three relapses. The actuarial 5‐year survival rate using Kaplan‐Meier tables was 79% for the entire group but 100% for the 1981‐1992 group and 38% for the 1971‐1980 group. One case of immediate hepatic toxicity and one sudden death, unknown cause, of a patient in remission occurred in the group. Late deleterious effects were seen in five other patients; four had scoliosis and one developed osteoid osteoma of a rib. Despite these encouraging results, the necessity of ongoing monitoring for further longterm toxicities is apparent.
DNA ploidy and PCNA index in pancreatic lesions producing hyperinsulinemic hypoglycemia
Authors: Losada J. , Sarria R. , Fernandez Val J. F. , Lopez Ariztegui M. A.
Published: February 2007

DNA nuclear content and PCNA index (proportion of PCNA reactive cells) have been studied by flow cytometry in eight pancreatic lesions producing hyperinsulinemic hypoglycemia to assess DNA ploidy and tumoral growth fraction. Adult nesidioblastosis had a diploid DNA index, two adenomas were near diploid, and four of the adenomas and the carcinoma were aneuploid. The median value of PCNA index (6.056% ± 6.76) was significantly correlated (p <0.05) with the mean tumor diameter (2.43 cm ± 1.96). Tumors with a PCNA index <6.056% showed a diameter less than the mean tumoral diameter and a benign clinical course. Tumors with PCNA index <6.056% generally displayed a diameter bigger than the mean tumoral diameter, being associated with lymph node metastases in one case. The authors conclude that nuclear DNA and PCNA index cytometric studies are useful parameters to assess the biological behaviour of pancreatic lesions producing hyperinsulinemic hypoglycemia.
Erythrocyte membrane fatty acid profile in patients with primary carcinoma of the gallbladder
Authors: Pandey Manoj , Khatri Ajay K. , Dubey Sheo S. , Gautam Amitabh , Shukla Vijay K.
Published: February 2007

Erythrocyte fatty acids were determined in patients with gall stones and carcinoma of the gallbladder. Significantly low levels of myristic acid (p < 0.01) and stearic acid (p < 0.001) and significantly high levels of palmitoleic acid (p < 0.05) and oleic acid (p < 0.01) were observed in cancer patients. Arachidonic and linolenic acid were significantly high in gallstone patients, but there was no significant difference in the lauric acid and palmitic acid levels. Thus an altered lipid metabolism in cancer patients suggest existence of a possible association between gallstones, fatty acids, and carcinoma of the gallbladder.
Value of high‐resolution intraoperative ultrasonography in the determination of limits of horizontal tumor spread during surgery for gastric malignancy
Authors: Demirci Salim , Cetin Recep , Yerdel Mehmet Ali , Kocaoglu Hilmi , Tunc Gunduz , Unal Muttalip
Published: February 2007

Determination of the resection margins during surgery for gastric malignancy is a subject of controversy because accurate detection of horizontal limits of tumor spread is difficult by current methods. In this study, we investigated the value of intraoperative‐ultrasonography (IUS) in the detection of proximal and distal limits of horizontal tumor spread (HTS) in 19 gastric adenocarcinoma (Group I) and five gastric lymphoma (Group II) patients. After sonographic and clinical limits of HTS were marked, resections were carried out 2 cm away from the IUS limits, and biopsies from IUS limits and resection margins were obtained. Then, the gap between IUS and clinical limits were recorded and compared with results of pathology. In both groups, the distance from clinical to IUS limits ranged from 0 cm to 3 cm and IUS limits were never inside the clinical limits. In Group I, results of sonographic proximal limit detection were satisfactory in all patients excluding recurrent cases (n:2) and a patient with early gastric cancer. Sonographic accuracy of distal limit detection was 68%. In Group I, only one resection margin (distal) was found to be infiltrated with cancer. In Group II, the success rate of IUS‐guided HTS detection was 40%. IUS seems to be a valuable method for determining the extent of HTS during operation for gastric adenocarcinomas, especially so for the most problematic proximal limits. In recurrent cancers and lymphomas, however, results of IUS may be frequently misleading. IUS can be advocated as a routine procedure to determine the tumor limits and thus the resection margins during surgery for primary gastric adenocarcinomas.
Carcinoma of the axillary breast
Authors: Evans Douglas M. , Guyton Daniel P.
Published: February 2007

A review of the world literature regarding carcinoma of ectopic breast tissue along with the addition of one cases is reported. A total of 90 cases of carcinoma of ectopic breast tissue were found, 64 of which occurred in the axilla. The combined survival beyond the 4‐year post‐treatment period was 9.4%. No survival advantage was found for radical or modified radical mastectomy over that of local excision combined with axillary dissection or radiation. The addition of radiation therapy to either type of mastectomy provided no additional benefit. The correct preoperative diagnosis was rarely made. Outcome was reported in 42 cases; 28 survived longer than 1 year, with 12 recurrences at the time of reporting, and 6 were alive with no evidence of disease at 4 years or longer. Improved prognosis requires diagnostic suspicion and early biopsy of unidentified lesions of the axilla or embryonic milk line.
Bipedicle delayed flap closure of persistent radiated tracheocutaneous fistulas
Authors: Jacobs John R.
Published: February 2007

Increasing numbers of patients have had tracheostomies for prolonged periods of time and when subsequently decannulated have developed persistent tracheocutaneous fistula. A substantial percentage of these patients have undergone successful combined modality therapy excluding surgery for advanced head and neck cancer with resulting healing deficits of the remaining tissues. Although these patients may be deemed suitable for decannulation at this particular point, the potential still exists that access to the trachea will be required sometime in the future. This situation requires a method of closure that is reasonably reliable and yet, at the same time, relatively easily reversible. The surgical technique presented appears to meet these demands.

After primary inversion of the edges of the tracheocutaneous fistula, a bipedicle flap is developed and positioned over the tracheostomy site. The inferior edge of the flap is left open for temporary air escape to decompress the suture line. This line subsequently heals by secondary intention over the succeeding weeks. Although there has not been, to date, the need to reverse the closure, the relative thinness of the tissue as opposed to alternative techniques suggests that it should not be difficult.
Taxol and platinum chemotherapy in the treatment of pancreatic and jejunal carcinoma
Authors: Cornelison Terri L. , Goldberg Jeffrey M. , Steven Piver M.
Published: February 2007

Pancreatic cancer and jejunal cancer are aggressive diseases with grim prognoses. The long term survival of pancreatic carcinoma is still one of the worst of all cancers. Ninety‐five percent of the patients die of their disease within 5 years [Wagener et al: Ann Oncol 5(Suppl 3): S87‐S90, 1994]. Eighty‐five percent of patients with jejunal carcinoma die of their disease within 5 years [Lioe, Biggart: J Clin Pathol 43: 533‐536, 1990]. To date, there are disappointingly few effective cytotoxic agents in the treatment of these cancers.

We present a case of advanced‐stage pancreatic carcinoma and a case of advanced stage jejunal carcinoma, each showing marked response to Taxol and platinum chemotherapy.
Curative resection of gastric cancer: Limitation of peritoneal lavage cytology in predicting the outcome
Authors: Abe Shun'Ichi , Yoshimura Hiroshi , Tabara Hideki , Tachibana Mitsuo , Monden Naomi , Nakamura Teruhisa , Nagaoka Saburou
Published: February 2007

Patients with stage T3N0∼2M0 gastric carcinoma (n = 108) were studied for relevant prognostic factors. Peritoneal lavage cytology (PLC) was performed in all. In univariate analysis, 5‐year survival rates were better with smaller serosal invasion (diameter <3.0 cm vs. ≥3.0 cm, 61% vs. 37%,P< 0.05) and fewer metastatic nodes (≤5 vs. ≥6, 57% vs. 29%,P< 0.05). In multivariate analyses, only these two factors were significant. The predictive value of PLC was not shown in both univariate and multivariate analyses. Peritoneal recurrence occured in 14 (22%) of 77 patients with negative PLC, and in 3 (18%) of 17 with positive PLC, the difference being not significant. Our results indicate that PLC is insensitive in predicting the development of peritoneal recurrence. Its role in the estimation of survival is limited, as many will die of visceral or locoregional recurrence if not of peritoneal dissemination.
Prospective randomized study of hyperthermia combined with chemoradiotherapy for esophageal carcinoma
Authors: Kitamura Kaoru , Kuwano Hiroyuki , Watanabe Masayuki , Nozoe Tadahiro , Yasuda Mitsuhiro , Sumiyoshi Kohei , Saku Motonori , Sugimachi Keizo
Published: February 2007

From January 1988 to June 1992, 66 patients with resectable squamous cell carcinoma of the thoracic esophagus underwent preoperative adjuvant therapy. These patients were prospectively divided into two treatment groups; 32 were treated with radiofrequency wave local hyperthermia combined with chemoradiotherapy (hyperthermochemoradiotherapy; HCR), while the remaining 34 patients were treated with chemoradiotherapy alone (CR).

There were no procedural complications in either group and the postoperative mortality was zero. In the HCR group, no viable cancer cells were found within the entire 5 mm‐width slices of the resected specimen in eight patients (25%), while only two (5.9%) in the CR group (P < 0.05) demonstrated no viable cancer cells. The cumulative 3‐year survival rate was 50.4% in the HCR group and 24.2% in the CR group.

The present prospective trial demonstrated that the addition of hyperthermia to chemoradiotherapy resulted in a better local control and an improved long‐term survival when treating patients with advanced esophageal carcinoma. © 1995 Wiley‐Liss, Inc.
Randomized study with mitomycin C + 5‐fluorouracil + cytosine arabinoside (MFC) + 5‐fluorouracil, MFC + tegafur and uracil (UFT), and MF + UFT in advanced gastric cancer: Interinstitutional differences in a multicenter study in Japan
Authors: Furukawa Hiroshi , Iwanaga Takeshi , Nakajima Toshifusa , Okabayashi Kenzo , Nakazato Hiroaki , Hiratsuka Masahiro , Ohta Keiichiro , Kito Tsuyoshi , Yamamura Yoshitaka , Goto Shoji
Published: February 2007

In a phase III randomized trial of adjuvant chemotherapy for gastric cancer, interinstitutional differences were analyzed. A trial of three regimens: mitomycin C, 5‐fluorouracil(5‐FU) and CA (MFC) + continuous oral 5‐FU (Group C); MFC + continuous oral UFT(tegafur and uracil) (Group B); and MF + UFT (Group C) after operation was conducted in 466 patients with gastric cancer (stage II and III) at four hospitals in Japan (CIH, CAD, ACC and NCC). Patients were stratified by the institution, stage, and tumor size (8 cm ><). The 5‐year survival rates were in the order of Group A (79.0%) > B (70.0%) > C (61.0%) (P = 0.1228) in total, A (95.0%) > B (80.0%) > C (58.0%) (P < 0.05) at CAD (82 patients), A > C> B at CIH (215), C> A > B at ACC (95), and B > A > C at NCC (78). The survival rate of patients with S2(serosal exposure), 8 cm < and NO‐1 cancer was higher at CIH than at the other institutions. The interinstitutional differences in patient characteristics and surgical technique were more powerful than the differences among the three groups. © 1995 Wiley‐Liss, Inc.
Optimal management of malignant mesothelioma after subtotal pleurectomy: Revisiting the role of intrapleural chemotherapy and postoperative radiation
Authors: Sauter Edward R. , Langer Corey , Coia Lawrence R. , Goldberg Melvyn , Keller Steven M.
Published: February 2007

Malignant pleural mesothelioma (MPM) is a generally fatal disease with no standard treatment. There are encouraging reports using intraperitoneal chemotherapy to treat peritoneal mesotheliomas and intrapleural chemotherapy (IPC) to treat malignant pleural effusions. Our objective was to evaluate the efficacy of IPC after subtotal pleurectomy. Between 1988 and 1992, 20 consecutive patients with diffuse MPM limited to one hemithorax underwent subtotal pleurectomy. Thirteen patients with biopsy‐proven MPM known prior to thoracotomy were enrolled in a phase II combined modality protocol consisting of perioperative intrapleural cisplatin (100 mg/m2) and ara‐C (1,200 mg) after subtotal pleurectomy, followed by systemic cisplatin (50 mg/m2/week × 8) and mitomycin‐C (8 mg/m2, days 1 and 36). Seven patients with MPM could not be enrolled because their diagnosis was made post‐thoracotomy. These patients underwent subtotal pleurectomy with (n = 4) or without (n = 3) adjuvant radiation (4,500–5,000 cGy in 3 patients, 2,100 cGy in 1 patient). One of three patients who developed chemotherapy‐related nephrotoxicity died, the only treatment‐related mortality. All 3 patients requiring postoperative readmission received IPC. Significant morbidity did not occur in patients not receiving chemotherapy. Median survival and time to progression were significantly longer in patients not receiving IPC (21 vs. 9 months, P = 0.04; 12 vs. 6 months, P = 0.01). In conclusion, intrapleural and postoperative systemic chemotherapy resulted in significant toxicity and did not improve survival in our patients who underwent subtotal pleurectomy for MPM. © 1995 Wiley‐Liss, Inc.
Prognosis of breast cancer: Evidence for interaction between c‐erbB‐2 overexpression and number of involved axillary lymph nodes
Authors: Mittra Indraneel , Redkar Alka A. , Badwe Rajan A.
Published: February 2007

The prognostic significance of c‐erbB‐2 oncogene amplification or overexpression in relation to axillary lymph node metastasis is controversial. We investigated this question in 159 cases of operable breast cancer: 56 patients with node negative disease and 103 patients with pathological involvement of axillary lymph nodes. c‐erbB‐2 overexpression was assessed by immunohistochemistry using a polyclonal antibody raised against a synthetic peptide fragment of the oncoprotein. The overall incidence of c‐erbB‐2 overexpression was 35%. c‐erbB‐2 overexpression was significantly related to survival when all patients were considered (P =0.0124), and also for patients with positive axillary lymph nodes (P= 0.0026). c‐erbB‐2 overexpression had no influence on survival of node negative patients (P =0.7972). A multivariate survival analysis using the Cox proportional hazard model revealed thatnumberof involved lymph nodes, c‐erbB‐2 overexpression, ER status, and tumour size were independently related to prognosis (P =0.0000, 0.0012, 0.0112, and 0.0204, respectively). When an interaction term was introduced in the Cox model between c‐erbB‐2 overexpression and number of involved axillary lymph nodes, a statistically highly significant interaction between these two factors was observed (P = 0.0002), suggesting that the expression of prognostic power of c‐erbB‐2 overactivity is related to the number of involved axillary lymph nodes. The 159 patients were then subdivided into three groups: node negative (‐ve) (56); 1–6 node positive ( + ve) (55); and ≥7 node +ve (48). This cutoff criterion gave the most numerically equitable distribution of the 159 patients into three groups. The relative risk of death increased stepwise from 0.86 (95% CI 0.26–2.78) for node negative patients, to 1.95 (95% CJ 0.82–63) for 1–6 node positive patients, to 2.23 (95% Cl 1.15–4.35) for >7 node positive patients. Our results suggest that the prognostic influence of c‐erbB‐2 overexpression increases arithmatically with increasing number of involved axillary lymph nodes. © 1995 Wiley‐Liss, Inc.
Hepatic artery chemoembolization or embolization for primary and metastatic liver tumors: Post‐treatment management and complications
Authors: Berger David H. , Humberto Carrasco C. , Hohn David C. , Curley Steven A.
Published: February 2007

This paper describes complications and patient management issues associated with hepatic arterial chemoembolization (HACE) and embolization (HAE) used to treat liver malignancies and characterizes patient survival based on histologic tumor type. We performed a retrospective review of all patients treated with HACE or HAE between January 1, 1988 and December 31, 1990. During the study period, 314 HACEs and HAEs were performed in 121 patients. Ninety‐six of the patients (79%) were treated for neoplasms metastatic to the liver. The morbidity rate following HACE and HAE in this study was 5.1%. The major complications included portal vein thrombosis, hepatic abscess, and liver failure. The treatment‐related mortality rate was 4.1%. Fever and ileus were the most common management problems following HACE or HAE. Median survival for patients with liver metastases varied according to histologic type, and median survival for patients with hepatocellular cancer was 306 days. Morbidity and mortality from HACE and HAE to treat liver tumors can be minimized by proper selection and careful management of patients. HACE or HAE alone was not curative in any of these 121 patients. An understanding of treatment‐related side effects is necessary to aid in the management of patients following HACE or HAE. © 1995 Wiley‐Liss, Inc.