Simultaneous presentation of carcinoma involving the ovary and the uterine corpus

Twenty-nine patients had simultaneous malignant epithelial neoplasms of the uterine corpus and ovary. Three groups were defined on the basis of tumor histology: Group A: those with endometrioid carcinoma in both the uterus and ovary; Group B: those with special variants of corpus carcinoma (papillary, clear cell, mucinous) and identical neoplasms in the ovary; and Group C: those whose uterine and ovarian carcinomas were of dissimilar histologic types. Sixteen women had endometrioid carcinoma in both sites. The median age at diagnosis, 41 years, was younger than is usual for corpus or ovarian cancer. For all 16 patients, the grade of the ovarian endometrioid carcinoma was similar to that of the endometrioid carcinoma of the uterine corpus. Seven patients had bilateral ovarian neoplasms. Only one patient had myometrial invasion by the corpus carcinoma. No patient with simultaneous ovarian and uterine endometrioid carcinoma, regardless of grade, has died of cancer although one vaginal relapse was treated successfully. This excellent survival of patients with simultaneous endometrioid carcinomas is better than would be expected for either Stage III adenocarcinoma of the endometrium or Stage II ovarian carcinoma. These simultaneously occurring endometrioid neoplasms of ovary and endometrium are considered to be separate primary tumors. The morphologic reasons for this view and therapeutic implications are discussed. In contrast to the patients with endometrioid carcinoma, the eleven patients with other histologic types of carcinoma in the ovary and corpus were older (median age, 61 years) and more often postmenopausal (90%). These neoplasms were more aggressive, with frequent deep myometrial involvement (63%), tubal involvement (27%), and extension to other pelvic tissues (36%) at the time of initial diagnosis. Six of these 11 patients succumbed to their cancer despite surgical therapy and radiation. The distribution of tumor in some of these patients with nonendometrioid types of carcinoma is suggestive of a single primary with metastases. The therapeutic implications of these findings are discussed.

Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy

Seventy-four patients with carcinoma of the breast were treated by irradiation without a mastectomy at Stanford between May 1973 and March 1980. Seventy-six breasts were treated because two patients had bilateral simultaneous cancers. Breast edema was noted in 41% of these cases. Analysis of potential predisposing factors revealed that this complication occurred primarily in patients who received a staging axillary lymph node dissection. Lymphedema occurred in 26 of 33 breasts (79%) in patients who had staging axillary dissections; this complication developed in only three of 12 (25%) with axillary samplings and two of 31 (6%) with no axillary surgery. Two groups of patients were identified: (1) 28 patients whose breast edema occurred early (prior to or during radiation therapy), and (2) three patients with late onset edema that developed several months postirradiation. The early edema, which is clearly related to axillary lymph node dissection, gradually improved during the follow-up period with complete or near complete resolution expected by three years. Late onset edema was rare, appears to be related to an axillary radiation dose greater than 5500 rad, and may be irreversible. There was no correlation of breast edema with tumor stage, radiation time/dose factors, the use of bolus, patient weight, or breast size.

Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma

A review of 256 cases of pathologic Stage I uterine adenocarcinoma treated at Stanford University Hospital revealed 26 cases of uterine papillary serous carcinoma (UPSC), a clinically aggressive and morphologically distinct variant of adenocarcinoma which closely resembles ovarian papillary serous carcinoma. These lesions are easily recognized by microscopic examination and typically feature a high degree of cytologic anaplasia and a papillary growth pattern. Invasion of the lymphatics has been a frequent finding. The relapse rate among patients with pathologic Stage I UPSC was 50% (13/26), five times the rate which would have been predicted by the incidence of UPSC. Patients with Stage I UPSC fared significantly worse than the group of nonpapillary grade II or grade III adenocarcinomas (p less than 0.0001). Forty percent of Stage I UPSC patients had deep myometrial invasion, as compared with 12% of those with all other histologic types of adenocarcinoma (p = 0.001). Women with UPSC deeply invading the myometrium tended to do worse than those with deeply invasive lesions of the more usual endometrioid type as reflected by relapse rates (after surgery alone) of 63% and 30%, respectively. Of seven Stage I corpus carcinoma patients whose initial site of failure was in the upper abdomen, six had UPSC. Thus, UPSC shares the tendency of its ovarian counterpart to spread over peritoneal surfaces. In addition to the original study group of 26 Stage I patients, 34 patients with more advanced stages of UPSC were also reviewed. Of these, 26 have been followed and four survive. Eleven of these women presented or relapsed with abdominal carcinomatosis. UPSC is a clinically aggressive neoplasm which should be distinguished from other types of primary endometrial adenocarcinoma. In cases of invasive UPSC the mode of spread, similar to that of ovarian surface epithelial carcinomas, suggests the need for adjuvant upper abdominal and pelvic irradiation or effective chemotherapy.

A children's fair

As outdoor, free, public Children's Fair for Multicultural Health Activities provided appropriate participatory exhibits, experiences, materials, and conversations for predominantly non-Anglo children and families. The purpose was to reduce fears, create greater understanding of the role of parents, and increase awareness of the family's emotional needs when the child is in health care.

Chronic lateral instability of the ankle

The authors present 14 cases of chronic lateral instability of the ankle in 13 patients, in whom we performed ligamentoplasty using peroneus lateral brevis. The importance of careful preoperative evaluation of clinical findings as well as stress-roentgenograms and arthrographies is emphasized and a simple surgical technique is presented. We also realize an assessment of the results obtained which are very encouraging at the present.

Primary mediastinal seminoma

Primary mediastinal seminoma is a rare germ cell neoplasm histologically identical to testicular seminoma. Thirteen patients have been treated with definitive megavoltage radiotherapy at the Stanford University Medical Center, Division of Radiation Therapy, between 1961 and 1976. Doses ranged from 2500 rads over five weeks to 6000 rads over seven weeks. Actuarial survival at ten years is 69% with relapse-free survival of 54%. No patient receiving greater than 4700 rads to the primary lesion had local or systemic relapse. Patterns of relapse and recommendations for diagnostic evaluation are discussed. Primary megavoltage irradiation to the mediastinum and neck with a dose of 4500 to 5000 rads over five to six weeks is appropriate treatment.

Molecular dynamics of hemoglobin subunits as seen by fluorescence spectroscopy

Fluorescent conjugates of beta A subunits and their respective heme-free derivatives have been prepared in which a 1,5-N-iodoacetylaminoethyl-5-naphthylamine-1-sulfonate probe has been specifically placed at the beta-93 or beta-112 cysteine. The fluorescence anisotropy decay and static fluorescence polarization of these conjugates have been examined. Fluorescence measurements have also been made using 1-anilino-8-naphthalenesulfonate complexes, as well as the intrinsic fluorescence of the tryptophan groups. For the cases of the beta-93 and beta-112 conjugates there is substantial evidence for internal rotational freedom of the subunits. The internal mobility of the polypeptide is especially pronounced for the beta-112 conjugate. In contrast, the 1-anilino-8-naphthalenesulfonate probe placed within the heme pocket shows no indication of any rotation, other than that associated with the entire beta-subunit. Tryptophan fluorescence has been measured for the apo-beta subunits and for the peptides beta (1-55) from hemoglobins A and S. Perrin-Weber plots show the presence of multiple rotational modes suggesting mobility of the tryptophan groups.

Defect measurements in digital optical disks

A method of characterizing defects on an unrecorded optical disk is described. Information on the density of defects is obtained by analyzing the statistical distribution of the widths of the pulses obtained when playing back an unrecorded disk. It was shown that disk quality, as measured by bit error rates on actual recording, can be correlated with defect densities measured in this manner. The same method can also be used to characterize defects on uncoated substrates. It was demonstrated that defects on tellurium coated disks are largely the result of defects on the uncoated substrates.

Irradiation with external beam and interstitial radioactive implant as primary treatment for early carcinoma of the breast

The locoregional control of 60 to 61 patients supports the results published by other centers and compares favorably with results of any surgical series. The cosmetic results are excellent with only three of 61 patients having severe fibrosis of the breast develop. No rib fractures, skin ulcerations, symptomatic radiation pneumonitis, edema of the arm or limitation of arm movement have been observed as complications. Ten of the 28 patients who have had axillary dissection had transient edema of the breast develop. Results of numerous studies suggest that primary radiotherapy without mastectomy is appropriate treatment for early carcinoma of the breast. The accessibility of the breast makes it relatively easy to deliver curative doses of radiation with minimal damage to surrounding normal tissues. The cumulative radiotherapy experience has demonstrated the gratifying results of not only maintaining a rather normal breast but also avoiding the negative physical and psychologic repercussions of the mastectomy. Radiation therapy is an alternative to Halsted's radical mastectomy.

125Iodine prostate implants for recurrent carcinomas after external beam irradiation: preliminary results

Fourteen patients with locally recurrent prostate carcinomas after external beam irradiation received 135I seed implants at Stanford between 1975 and 1979. Clinical local control has been obtained in 11 of the 14 patients for follow-up periods of 6 to 36 months. Eight remain without evidence of disease, but 2 of the 3 patients whose pelvic lymph nodes were involved by carcinoma have developed distant metastases. Complications, consisting of either cystoproctitis, urinary incontinence, or the development of a vesicorectal fistula occurred in 4 of the 14 patients. These complications were noted only in those patients who had implantation of high intensity 125I seeds (greater than 0.50 mCi) into large prostatic volumes (greater than or equal to 50 cc). No complications occurred in patients who received lower intensity 125I seed implants in smaller prostatic volumes. We conclude that 125I seed implants may be used in a second attempt to obtain local control after a local relapse following external beam irradiation, if the use of high intensity 125I sources and/or the implantation of large prostate volumes are avoided.

[Retroperitoneal perforation of a duodenal ulcer (author's transl)]

A case or retroperitoneal perforation of a duodenal ulcer is presented. Firstly was erroneously diagnosed as an acute appendicitis, and operated upon. The result were good but four successives surgical gests became necessary : first, to treat a very severe parietal infection ; after that, to resolve one very impressive gastro-intestinal hemorrhage and lastly, to treat the duodeno-cutaenous fistula and the duodenal ulcer. The published cases in the recent literature are very scanty but similar to ourselves. The difficulties of promp diagnosis, the erroneously planned first operation in seriously ill patients would be the main causes of the very high mortality.

Tobramycin nephrotoxicity. A prospective clinical study

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.

Radioactive suture in the treatment of head an neck cancer

I-125 seeds in Vicryl suture have been used as a radioactive suture in 24 cases of advanced malignancy of the head and neck. Twelve cases had metastatic carcinoma attached to the internal or common carotid artery. The goal was to excise surgically as much tumor as possible, then implant any residual tumor with this radioactive suture which remains as a permanent implant (half-life of 60 days). This preliminary study shows that use of I-125 impregnated Vicryl suture in this manner appears to produce improved long-term palliation and may increase local cure rates.