Psychopathic Traits and Theory of Mind Task Performance: A Systematic Review and Meta-analysis

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes, from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy.

Coping Using Sex, Health-Related Behaviors, and Mental Health During COVID-19 Lockdown in the UK

BACKGROUND

Peoples' sexual behaviors have changed during the period of enforced COVID-19 social distancing, in some cases, to cope with negative feelings during lockdown. Research on coping using sex is relatively restricted to samples of men with a history of sexual offending, and it is unknown whether coping using sex is associated with health-related behaviors and mental health in the general population.

AIM

We examined if coping using sex before and during lockdown was associated with adverse outcomes (i.e., self-perceived reduction in health-related behaviors and mental health) in a community sample.

HYPOTHESES

We hypothesized that participants who reported greater use of sex to cope in the weeks preceding lockdown would show a greater decline in health-related behaviors and mental health during lockdown. Furthermore, that changes in coping using sex resulting from lockdown would account for further variance in the worsening of health-related behaviors and mental health.

METHODS

Participants were UK residents, aged 18-60 years, and fluent in English. 789 participants completed an online survey, providing demographic information, self-reported social distancing, loneliness, and coping using sex over a 14-day period during lockdown, and retrospectively preceding lockdown.

OUTCOMES

Participants reported perceived changes in health-related behaviors and mental health symptomatology during lockdown compared to before the pandemic. They also self-reported levels of stress, anxiety and depression during lockdown.

RESULTS

Greater coping using sex prior to lockdown predicted positive change in health-related behaviors, for example, higher scores were associated with participants reporting having exercised and slept more. It was also associated with higher trait levels of anxiety, stress and depression during lockdown. Changes in coping using sex from before to during lockdown did not predict perceived changes in health related behaviors or mental health symptomatology.

CONCLUSIONS

Overall, greater coping using sex prior to lockdown was associated with worse mental health symptomatology during lockdown (anxiety, depression and stress), however, it was also associated with perceived positive change in health-related behaviors compared with before lockdown. This suggests that coping using sex may be associated with negative emotional reactions during lockdown, but may also be linked with positive change in health-promoting behaviors.

241 IMPLEMENTATION OF AN INTRACEREBRAL CEREBRAL HAEMORRHAGE CARE BUNDLE

Background

Mortality for Intracerebral haemorrhage (ICH) is 31% (Irish National Audit Stroke, 2019). An ICH care bundle focusing on acute anticoagulation reversal, blood pressure lowering, and a neurosurgical care pathway was associated with improved survival. Translating evidence-based medicine into clinical practice is challenging. The aim of this study was to determine feasibility and outcomes of implementation of a care bundle.

Methods

An ICH care bundle was developed using an iterative process involving expert stakeholder review of the evidence-based literature. A pre-and-post quasi-experimental research design was employed to evaluate this intervention. Baseline data were collected before implementation (January 2016-June 2018). Implementation took place in a staged manner in a single university teaching hospital with multiple ‘Plan Do Study Act cycles’ (June 2018 to January 2021). Data on compliance, process measures and outcomes were collected.

Results

Systolic blood pressure (first 24-hours) and anticoagulant reversal were significantly better controlled post-implementation (χ2 (1, N = 91) = 5.34, P = 0.02), (χ2 (1, N = 25) = 5.85, P = 0.016), respectively. DNAR orders were significantly lower in the post-implementation group (χ2 (1, N = 25) = 5.85, P = 0.029). However, ‘Do Not Actively Resuscitate’ status did not significantly differ when accounting for low GCS as a surrogate measure for poor prognosis (χ2 (1, N = 34) = 0.00, P = 0.966). Modified Rankin Scale on discharge did not differ significantly pre-and-post-implementation (z = −0.075, P = 0.94). A greater proportion of patients survived in the post-implementation group; however, this was not statistically significant (χ2 (1, N = 133) = 0.77, P = 0.38). Length of stay significantly increased post implementation.

Conclusion

An ICH care bundle was developed based on expert stakeholder feedback. The feasibility of implementing this bundle of care was demonstrated in a real-world clinical practice setting. A cluster-randomized trial or a large registry study is the next step to evaluate the overall impact of this care bundle on patient outcomes.

Maternal Obesity and Neck Circumference

Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (p < 0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.

Improved quality of life in adults undergoing tonsillectomy for recurrent tonsillitis. Is adult tonsillectomy really a low priority treatment?

There is a paucity of studies on patient-reported outcome measures in adult tonsillectomy. Our aim was to add to the body of health-related quality of life (HRQOL) evidence on adult tonsillectomy at a time when this intervention is being branded a low priority treatment in the United Kingdom (UK). We designed a prospective questionnaire study that was carried out in two UK district general hospitals. 41 patients were recruited into the study and completed a pre-operative short form 36 questionnaire. All 41 were contacted at least 1 year after tonsillectomy and were asked to complete the same SF-36 questionnaire and three additional HRQOL questions. There was a significant improvement in quality of life shown by both the mean SF-36 scores and the HRQOL questions. The SF-36 summary measures and the total SF-36 scores improved significantly (p < 0.01). The study emphasises the importance of tonsillectomy being available on the National Health Service to adults with recurrent tonsillitis. This proven quality of life improvement is also highly likely to confer a secondary health economic benefit from less GP attendances and fewer missed work days.

[CT evaluation of locoregional spread of carcinoma of the gallbladder]

OBJECTIVE

This study aims to assess the diagnostic capability of CT to preoperatively detect evidence of locoregional spread of gallbladder cancer.

PATIENTS AND METHODS

Two radiologists independently performed retrospective review of CT scans on 20 patients who had undergone surgical resection for carcinoma of the gallbladder. Local spread was categorized by the TNM system and the results were correlated with surgical and pathologic findings.

RESULTS

All cases of hepatic spread (14 cases), common bile duct extension (four cases), pancreatic spread (three cases) and duodenal spread (three cases) were correctly diagnosed by helical CT. One of three cases of peritoneal spread and two of three cases of gastric spread were misdiagnosed. CT evaluation of T stage (T1: one case [5%]; T2: four cases [20%]; T3: four cases [20%], and T4: 11 cases [55%]) was accurate in 85%. The sensitivity and positive predictive value (PPV) of T1-T2 lesions were 80%. The specificity and negative predictive value (NPV) were 93%. For T4 lesions sensitivity, specificity, PPV and NPV were 100%.

CONCLUSION

Helical CT provided 85% accuracy in the diagnosis of the locoregional extent of gallbladder cancer. It allows an acceptable classification according to the TNM staging system and predicts prognosis.

Bromodeoxyuridine induces keratin protein synthesis at a posttranscriptional level in human lung tumour cell lines

Keratin intermediate filaments are formed in epithelial cells in a cell- and tissue-specific manner, but much remains unknown regarding the mechanisms which control the synthesis of these proteins. We examined the effect of the differentiation modulation agent, bromodeoxyuridine (BrdU), on two human keratin-negative (by immunocytochemistry) lung cell lines, DLKP and H82, and showed immunohistochemically that treatment with 10 microM BrdU over 7 days induced K8 and K18 protein synthesis in both lines. Immunoprecipitation and Western blot analyses revealed low levels of K8 and K18 proteins in untreated cell homogenates. These levels increased following treatment with BrdU for 7 days. K8 and K18 mRNAs were detected by Northern blot and reverse transcriptase polymerase chain reaction analyses in both lines before BrdU treatment, but no increase in mRNA levels was observed in either cell line over 21 days of treatment. This suggests, firstly, that keratin synthesis is normally blocked at a posttranscriptional level in DLKP and H82 cells, and secondly, that BrdU can reverse this block. A549 is a human lung cell line which contains K8 and K18 proteins. Treatment with BrdU increased K8 and K18 protein levels in these cells. No corresponding increase in K8 mRNA levels occurred, while an apparent increase in K18 mRNA levels was detected. HL-60 is a leukaemic cell-line of haematopoietic rather than epithelial lineage which contains K8 and K18 mRNA transcripts prior to BrdU treatment, but does not contain keratin proteins. Again, K8 and K18 mRNA levels remained unchanged during BrdU treatment. However, neither K8 nor K18 proteins were detected following treatment, although BrdU is known to alter expression of other genes in HL-60 cells. BrdU thus appears to act at a posttranscriptional level and in an epithelial-specific manner to reverse a block in keratin synthesis in keratin-negative lung cancer cells and increase synthesis in keratin-positive lung cancer cells. This may represent a regulatory step in early lung development or a mechanism whereby tumour cells downregulate expression of a differentiated phenotype.

Carcinoma of the intact uterine cervix treated with radiotherapy alone: a French cooperative study: update and multivariate analysis of prognostics factors

PURPOSE

To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993.

MATERIALS AND METHODS

Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 12%; IIb: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I-II and in 10% of Stages III-IV, more than 5 cm in 13.5% of Stages I-II, and in 16% of Stages III-IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I-II and in 32.5% of Stages III-IV.

RESULTS

1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) is 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific survival because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III-IV: Stage and positive lymphangiogram are predictive factors for relapse and death. The MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I-II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I-II (p = 0.05 and p = 0.005, respectively).

CONCLUSIONS

The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.

ENT surgery in children with inherited bleeding disorders

Inherited bleeding disorders are frequently considered an absolute contraindication to tonsillectomy and other ENT procedures. Over a 15-year period we have performed ten elective tonsillectomies and five bilateral myringotomies on children with inherited bleeding disorders. All procedures were carried out with the close co-operation of the Haematology Department in the hospital. All patients underwent uneventful surgery. One patient returned after tonsillectomy with a secondary haemorrhage which did not require surgical intervention. We present our team approach to the management of these children and demonstrate that necessary surgical intervention can be undertaken safely in this select group of patients.

Fractures and dislocations of the digits

Digital trauma is a common, but often underappreciated, entity in podiatric practice. This article outlines the pathomechanics, diagnosis, and treatment of digital fractures and dislocations as well as injuries to the toenail and nailbed.

mdr1 ribozyme mediated reversal of the multi-drug resistant phenotype in human lung cell lines

An mdr1 hammerhead was introduced into two adriamycin-selected multi-drug resistant human lung cell lines both of which over-express p-glycoprotein. Expression of the ribozyme resulted in a decrease in mdr1 mRNA expression and an increase in drug sensitivity in both cell lines. This would suggest that the use of specific ribozymes may represent an effective and specific approach in order to restore cellular sensitivity towards anti-cancer drugs.

Observation of the mechanism of snoring using sleep nasendoscopy

We have performed sleep nasendoscopy on 54 adult snorers in whom obstructive sleep apnoea had been excluded by an overnight sleep study. The purpose of the study was to identify the site or sites of noise production in each case. This was successfully achieved in 50 of the 54 and 70% showed palatal flutter snoring only. In a further 20%, palatal flutter snoring was combined with evidence of noise generation at another site. The second site was supraglottic in 10%, tonsillar in 8% and tongue base in 2%. The tongue base was also the sole site of noise generation in 8% and the epiglottis was the sole site in 2%. This study suggests that sleep nasendoscopy can identify different mechanisms of snoring in individual patients. This information is likely to be of use in formulating a logical surgical treatment plan.

Choosing talkers for the BKB/A Speechreading Test: a procedure with observations on talker age and gender

A procedure is described for choosing talkers for the BKB/A (BKB/Australian version) Speechreading Test. The main aims were: to select several talkers from a pool of potential talkers, to avoid adventitiously choosing a markedly atypical single talker; to assess speechreading as a general skill rather than as talker-specific; and to select talkers who were acceptable to speechreaders, relatively easy to speechread, and comparable in their speechreadability. Because of the number of variables involved and the demanding nature of the task for speechreaders, a three-stage selection procedure was adopted. In the resulting BKB/A 21-sentence list Speechreading Test, four of the 16 sentences in a list are each spoken by four talkers, chosen as follows. In Stage 1, 16 talkers (four of each age/gender set: older men, older women, younger men, younger women) were selected from an original pool of 40 (10 of each set), via rankings made by eight hearing-impaired judges with speechreading experience. In Stage 2, the final four talkers (one of each set) were selected from the 16 via the speechreading scores of further hearing-impaired subjects with speechreading experience. In Stage 3, the order of talker appearance within lists (in random order versus over blocks of four consecutive sentences) was determined. This three-stage approach to talker selection identified differences between talker candidates within sets, except for younger men, and suggested that, overall, younger women were the easiest to speechread. The discussion addresses the merits and disadvantages of this approach to talker selection, and suggests some reasons for the documented differences in speechreadability among talkers of different age and gender.

Clinical presentation of congenital convex pes valgus

Congenital convex pes valgus, frequently termed vertical talus in past descriptions, is a malformed foot that requires early diagnosis and treatment. A brief review of clinical features and a case presentation are provided to enhance the understanding of this complex deformity. A successful treatment regimen for infants and children is described, involving manipulation and early surgical correction.

Carcinoma of the cervical stump: a review of 213 cases

From 1970 to 1987, 213 cases of carcinoma of the cervical stump were accrued in a multi-institutional prospective cooperative study. This group accounted for 5.5% of cervical carcinoma diagnosed during the same period. 13 had in situ carcinoma and 200 had invasive carcinoma (96% squamous cell carcinoma, 4% adenocarcinoma). Radiotherapy alone (external and brachytherapy) was given to 77%, brachytherapy and surgery to 15% and surgery alone to 8%). FIGO stage distribution was: I (31%), IIa (15%), IIb (27%), IIIa (5%), IIIb (17%) and IV (5%). Five-year locoregional control per stage was 100% in Ia, 85% in Ib, 82% in IIa, 71% in IIb, 45% in IIIa, 54% in IIIb and 30% in IV. Corrected 5-year survival per stage was 82% in Ib, 78% in IIa, 73% in IIb, 69% in IIIa, 38% in IIIb and 0% in IV. The diameter of disease in stage II strongly influenced the 5-year locoregional control (81% for tumours of less than 3 cm vs. 68% for tumours more than 3 cm). Lymphangiogram was associated with a 44.5% 5-year locoregional control when positive vs. 74% when non-positive. Brachytherapy was advantageous in obtaining locoregional control in patients receiving external irradiation and brachytherapy: 81.5% vs. 38.5% in patients treated with external radiotherapy alone. Surgery was performed only for in situ carcinoma and for part of stages Ia, Ib and IIa. There is no significant difference in locoregional control at equal stage between radiotherapy alone and treatment schemes including surgery. However, lethal complications were observed in 6% of the patients of the surgical group as compared to 0.6% of the patients treated with radiotherapy alone. Radical radiotherapy seems to provide similar results of locoregional control and survival at equal stages in carcinoma of the cervical stump compared to carcinoma developed on an intact uterus. The rate of severe complications reported with the French-Italian glossary is 13% for G3 and 3% for G4, which is close to the observed rate during the same period in our series of radical radiotherapy to the intact uterus.

Topical application of WR-2721 to prevent radiation-induced proctosigmoiditis. A phase I/II trial

Patients undergoing x-ray therapy to the pelvis have intestinal symptoms proportional to the volume treated and the dose delivered. WR-2721, S-2 (3-aminopropylaminoethyl) phosphorothioic acid, is an organic thiophosphate compound that selectively protects normal tissues against radiation effects. A Phase I/II study was done to test the ability of topical application of WR-2721 to protect the mucosa of the rectosigmoid from radiation damage. Thirty-one patients were enrolled in this study, of which, seven were control subjects. Twenty-four patients received WR-2721 daily, in enema form, 45 minutes before treatment. The patients were assigned by groups of three to receive increasing doses of WR-2721 beginning with 100 mg/enema to 450 mg/enema. Rectal mucosal biopsies were obtained within the treated field before, during, and at the end of therapy. The degree of damage to the rectal mucosa was scored on the basis of a 0 to 4 scale (with 0, least damage to 4, most damage) as determined by the percentage of damaged mucosal crypt glands. The patients' symptoms were recorded once a week during the entire course of therapy. The biopsy scores of the control group were slightly higher than those of the treatment groups; however, this difference did not appear to be significant. In the treated groups, there was a slight decrease in the biopsy scores with increasing doses of WR-2721, but this trend was not sustained. There were no differences among any of the groups in the symptoms experienced during the course of therapy. This study showed that WR-2721 could be administered safely in enema form in doses ranging from 100 to 450 mg/enema, but this drug did not protect the rectosigmoid mucosa from radiation damage at the doses administered.

Cervical and vaginal cancer associated with pessary use

From 1967 to 1990, 96 previously untreated patients with cervicovaginal cancer associated with a history of vaginal pessary use to control uterovaginal prolapse were referred to eight radiation therapy departments in France. Sixty-eight patients had cervical cancer, and 28 had vaginal cancer. The mean interval between pessary insertion and cancer diagnosis was 18 years, with a range of 1 to 41 years. Most patients received radiation therapy and brachytherapy. Few (5%) had Grade 3 treatment side effects. The overall 5-year relative survival rate was 54%; nonsurvival was related to locoregional recurrence. Because almost all tumors occurred at the site of pessary insertion, foreign body chronic inflammation in association with viral infection may be the cause of the tumors.

Modification of the crescentic osteotomy for hallux valgus correction. A preliminary report

A new proximal osteotomy for hallux valgus correction, which has several advantages, is presented. These advantages include good stability; ease of rigid, two-point internal fixation; accurate, reproducible correction of the intermetatarsal angle; minimal shortening or elevation of the metatarsal; and early weightbearing. Preliminary results on 12 feet of 12 patients over a 3-year period have been encouraging and may indicate that this osteotomy is a viable alternative when considering proximal osteotomy for correction of hallux valgus.

Lateral subtalar dislocation. A literature review and unusual case report

An unusual case of suspected lateral subtalar joint dislocation was reported. A review of the literature found that medial dislocations were reported four times more frequently than lateral dislocations. Half of the cases of subtalar dislocation reviewed here described associated fractures, the incidence of which was higher in lateral dislocations. In both types of dislocations examined, almost half were reduced nonoperatively. In most cases, long-term results of repair of these injuries were considered favorable.

Pre-operative radiotherapy as adjuvant treatment in rectal cancer

From January, 1975 to December, 1987, 241 patients with rectal cancer underwent pre-operative irradiation and surgical resection. The radiation was delivered with 25 MeV photons, 5 days per week by 2.4 grays fractions up to a total dose of 36 grays. Surgery was curative in 195 patients; 57% had abdomino-perineal resection. Irradiation had to be discontinued in 3 patients and 4 patients subsequently developed severe acute ileitis. Postoperative mortality rate was 2.9%. The most frequent postoperative complications were delayed healing of abdominal wounds (18%) and perineal wounds (14%). Severe late complications occurred in 27 (13%) patients. The incidence of intestinal obstruction was 5%. Follow-up survivors ranged from 18 months to 13 years. Local failure occurred in 24 (12%) of the 195 patients. Local failure rates were 10% for Dukes' A tumors, 11.6% for Dukes' B, and 22.7% for Dukes' C tumors. Five and 10 year actuarial survival rates after curative surgery were 70% and 52%. The Dukes' classification was the only factor that influenced survival.

Lisfranc's fracture-dislocation. A review of the literature and case reports

The authors present an in-depth discussion of Lisfranc's fracture-dislocations, including classifications, mechanisms of injury, radiographic evaluation, and a literature review. Four cases are presented for review. Lisfranc's fracture-dislocation is a rare injury that can lead to prolonged disability if undiagnosed or if there is a delay in treatment.

Fracture-dislocation of the talus in the pediatric patient. An unusual injury

Subtalar fracture-dislocations in children are unusual, perhaps because of the greater elasticity of bone in children. The authors have presented a case of medial subtalar dislocation in a 13-year-old boy, accompanied by a rare fracture of the entire posterior process of the talus. This particular fracture has not been previously reported in association with a subtalar joint dislocation, nor has it been reported in a child. The patient was treated successfully by closed reduction of both the dislocation and the fractures.

Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial

A prospective clinical trial was designed to evaluate efficacy, toxicity, and patient compliance of concomitant postoperative radiotherapy and Cisplatin infusion in patients with Stage III or IV S.C.C. of the head and neck and histological evidence of extra-capsular spread of tumor in lymph node metastase(s). Cisplatin 50 mg IV with forced hydration was given or not every week (i.e., 7 to 9 cycles) concurrently with radiotherapy. Between 1984 and 1988, 83 patients were randomized: 44 were treated by irradiation without chemotherapy (RT group) and 39 by the combined modality (CM group). There was no significant difference between the two groups in terms of patient characteristics, primary sites, tumor differentiation, T.N. stages, or postoperative prognostic factors. All patients completed the planned radiotherapy. There were seven severe toxicities (greater than grade 3) in the RT group. In the CM group, 30 severe toxicities occurred in 16/39 (41%) patients but none was life-threatening. Seven of 39 (18%) patients received less than two-thirds of the scheduled Cisplatin courses because of intolerance, mainly nausea and vomiting. Preliminary results show a better disease-free survival for the CM group (65% at 24 months) than for the RT group (41% at 24 months). This significant difference is largely due to increased loco-regional control in the CM group (79% vs 59%), the actuarial distant metastasis rates in patients controlled above the clavicles not being statistically different in the two groups.

Radiation therapy of carcinomas of the skin of nose and nasal vestibule: a report of 1676 cases by the Groupe Europeen de Curiethérapie

A retrospective multicentric analysis of the results of irradiation of 1676 carcinomas of the skin of the nose and nasal vestibule was performed by the Groupe Européen de Curiethérapie (Tunis, May 1986). Overall local control was 93% with a minimum follow-up of 2 years. Local control is dependent on the tumor size (diameter less than 2 cm: 96%, 2-3.9 cm: 88%, greater than or equal to 4 cm: 81%), and tumor site (external surface of the nose: 94%, vestibule: 75%). Local control was independent of histology for smaller tumors, but for those larger than 4 cm, basal cell carcinomas were more frequently controlled than squamous cell carcinomas. Recurrent tumors are less frequently controlled than those being treated for the first time (88 vs. 95%). There were few complications and cosmetic results were generally satisfactory. The results of implantation, orthovoltage and megavoltage irradiation are compared with respect to local control, complication rate and cosmesis. Implantation is usually the treatment of choice for vestibular tumors but for those of the external surface the choice depends on the tumor diameter. Implantation and orthovoltage irradiation are equivalent for tumors less than 2 cm. For those from 2 to 3.9 cm, the results of orthovoltage irradiation may be satisfactory in a selected population but implantation is usually more suitable for tumors with rapidly changing contour.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiotherapy alone in carcinoma of the intact uterine cervix according to G. H. Fletcher guidelines: a French cooperative study of 1383 cases

A French Cooperative study of 1383 cases with invasive carcinoma of the intact uterine cervix treated with radiation therapy alone, using the guidelines provided by G. H. Fletcher led to the following conclusions: The techniques of treatment were easily reproducible in 9 French centers, working in a prospective cooperative study; Results similar to those of the original study were achieved in Stages I and IIA (MDAH substaging) with a locoregional failure rate of 7%; In Stage IIB, the locoregional failure rate of 16% is also comparable in both studies; Locoregional failures in Stage III are slightly lower than those reported in Houston, probably reflecting differences in patient's prognostic factors in France and Texas; The 5-year survival rate obtained in advanced Stages (UICC FIGO staging) are among the highest in the literature (76% in Stage IIb, 62% in Stage IIIa and 50% in Stage IIIb); The rate of severe complications remains acceptable and decreased throughout the study thanks to a better use of computer dosimetry.

Enhancement by misonidazole of metastatic tumor nodule formation in the lungs of mice

Investigations were performed to determine whether misonidazole, a hypoxic cell radiosensitizer, influences formation of tumor nodules in the lung of C3Hf/Kam mice and whether it affects the enhancement of tumor nodule formation caused by local thoracic irradiation (LTI). Cells from a chemically-induced fibrosarcoma (FSa) and a spontaneously-developed fibrosarcoma (NFSa) formed twice as many tumor colonies in the lungs of mice that received misonidazole as in untreated mice. The effect was observed only with doses of misonidazole of 1 mg/g or higher given within 2 days prior to i.v. injection of tumor cells. A similar twofold amplification of the effect of LTI occurred when 1 mg/g misonidazole was given 30 min before or 0.5 to 2 hours after irradiation. This increase was independent of the dose of LTI and the absolute number of tumor nodules in the lung. The mechanistic possibilities and clinical relevance of the misonidazole effect are discussed.

[Squamous carcinoma of the base of the tongue. On 133 cases treated at the Claudius Regaud Centre (author's transl)]

The authors present a homogeneous series of 133 patients with squamous carcinomas of the base of the tongue, treated mostly by external radiotherapy. The survival rate at the end of three years is 17%, and at five years 13%. Studying the local spread or stage of the tumour and survival, it is seen that only T1, T2, N0 and N1a patients (with a three-year survival of 28%) can, in fact, benefit from a curative course of radiotherapy, in which external radiation and curietherapy are associated. In the other cases, radiosensitization, unusual wavelengths of irradiation, or heavy particle irradiation seem to be the only possible ways of improving the prognosis.

[Cervical lymph nodes metastasis from an unknown primary: diagnosis, treatment and prognosis. A retrospective study of 127 cases observed from 1959 to 1973 (author's transl)]

Authors present clinical records of 127 patients bearing metastatic cervical lymph nodes of unknown origin and referred to the Cl. Regaud Cancer Center between 1959 and 1973. According the prognosis, it is possible to distinguish patients into three groups. In group I, patients (10%) have a lower neck involvement by an adenocarcinoma. The survival is dramatically bad. Group II includes also 10% of patients who have a fairly better prognosis, they are younger people bearing poorly differenciated squamous metastatic lymphonode(s) in the upper neck. Group III. The remaining eighty per cent of patients are heavy drinkers and smokers. Their upper neck is hurt by lymphatic metastases from a well or moderately differenciated squamous cell carcinoma. They have much about the same prognosis than people bearing a known primary carcinoma of the upper aerodigestive tract. After having excluded the first group of patients who is at high risk of having a widely disseminated illness, we can remark that about one half of relapses occurred in the cervical area. A well planned combination of neck dissection and whole cervical lymphatic areas irradiation may further reduce such recurrences and so may enhance the present results: 23% survival 3 years after completion of treatment.

[Fifty cases of penile tumors treated at the Claudius-Regaud center from 1958 to 1973]

From the study of this series of 50 patients suffering from cancer of the penis, and in particular from the comparison of two successive groups, several facts stand out which determine our present attitude: -subjects suffering from cancer of the penis, at least in our area, are aged, fragile people, whose cause of death, in more than half of the cases, was not the penile cancer. Proposable therapeutic methods must take this specific background into account; -tumoral and glandular indications must be looked at separately, as there does not seem to be any strict correlation between the size of the tumor and glandular invasion; -inguinal glandular invasion must as far as possible, be proved histologically, whatever the appearance of adenopathy on palpation; -No and N-patients should not be treated in the inguinal folds, but carefully followed-up; in this connection, very strict follow-up, at least for the first three years, seems to be indispensable; -N+ patients must evidently undergo bilateral removal and subsequent irradiation. This therapeutic attitude, leads to bilateral edema of the lower limbs in a high percentage of cases, against which no therapy is at present active; -tumors of the penis, classified T1, T2, or T3 are best benefitted by the technique of interstitial curietherapy using irridium 192, the only conservative technique offering a high level of local sterilization, without major after-effects; it permits possible reparatory surgery; -on the other hand, T4 tumors cannot be marked, the target-volume being too large, and they justify radical surgery.

[Late progressive radiation myelopathies. A study of 27 cases]

Several conclusions seem evident from this study : firstly radiation myelopathies exist without any doubt; secondly clinical observation, even very attentive, during irradiation is perfectly blind regarding this subject; lastly, one can only, at this time, attempt to anticipate medullary accidents caused by irradiation. Radiation myelopathies exist incontestably. We report 27 new cases which are added to the more than 500 cases already analysed in the world litterature. The improvement of results of cancerology and in particular of radiotherapy make and will continue to make the number of observations published increase. However, if there is no doubt as to existence of these myelopathies, discussions persist concerning their nature : purely vascular, cytotoxic, probably mixed, perhaps maintained and prolonged by a superimposed immunologic phenomenon. Prevention is the sole method at our disposal to be effective. It must be applied as much to the patient as to the technique of irradiation. With regard to the patient treated in a medullary volume, several factors are probably favorable to the development of myelopathy and must cause one to modify eventually the technique of radiation proposed : the existence of anterior vertebral medullary pathology, whatever its nature; two ages demonstrate increased incidences : the young which have relative immaturity of tissue (we report 4 cases patients less than 25 years old), and the old, whose chances of accumulating associated pathologies are great, especially as systemic hypertension and arteriosclerosis are likely to have played a favorable role; the patients for whom restraint is difficult or who present disrupted regions anatomy are qually much more fragile. With regard to the technical plan, several factors incontestably favor the appearance of radiation myelopathy : large medullary volumes irradiated, especially when they encompass the zones of vascular medullary junction; the overlap of fields involving the spinal cord; the reduction of fields too close to the spinal cord not allowing at least 1 cm margin of relative security; the association of physical agents in the measure to which the global dosimetry is uncertain, i.e. in particular the use of high energy electrons for boost dosage, the intensity of which must be chosen with the greatest prudence; finally and most importantly, it seems desirable to us not to surpass at the level of the spinal cord, treating 5 times per week, a dose of 5 000 rads with fractions of 200 rads of 4 500 rads with fractions of 250 rads, and of 4 000 rads with fractions of 300 rads. Can one reasonable pretend always to foresee all radiation myelopathies? No, for on the one hand there exist authentic cases which have occured after doses which were below the limits of tolerance which we have indicated above, in accordance with others authors, and on the other hand, the necessity of sterilising certain inoperable tumors obliges one sometimes to deliver to region of the spinal cord aggressive doses.