RESUMEN
Percutaneous transluminal balloon angioplasty (PTA) was performed in 17 tibial arteries with an average cross-sectional area stenosis of 92% (range 75-99%) in 13 patients (14 limbs) for limb salvage. In 4 of 14 lower extremities, PTA of femoropopliteal arteries was also performed. Technical success with 50% or less residual stenosis was achieved in all 17 tibial vessels. At approximately 2 months after PTA, clinical improvement had occurred in 10 of 14 limbs; no patient was made worse. Most recent follow-up (mean 19 months, range 8-34 months) revealed continued satisfactory clinical success with no further vascular intervention in 9 of these 10 limbs (one patient died). Short segmental stenoses, residual stenoses less than 40% following PTA, and absence of diabetes or gangrene appear to be predictors of favorable clinical outcomes. Our results suggest that PTA of focal tibial stenosis is an effective and safe treatment modality in properly selected patients and that wider use of PTA may be justified.
Asunto(s)
Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Arterias Tibiales , Anciano , Amputación Quirúrgica , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/epidemiología , Femenino , Arteria Femoral , Estudios de Seguimiento , Humanos , Pierna/irrigación sanguínea , Masculino , Arteria Poplítea , Radiografía , Factores de TiempoRESUMEN
The Southwest Oncology Group (SWOG) colorectal adjuvant study 7510 went through two phases. From 1975 to 1977, 309 patients were randomized to chemotherapy alone or the same chemotherapy plus immunotherapy. From 1977 until 1980, 317 patients were randomized among the same two therapy programs and a control group. With a minimum follow-up in either phase of greater than 7 years, data are now mature. They show no difference in relapse-free survival (RFS) nor overall survival (OS) in either the two-way phase or in the three-way phase. There is no indication, except possibly in one very small subset, that the addition of immunotherapy to chemotherapy provides an improvement in OS or in RFS. Using data from patients accrued after randomization to the control group, we fail to find evidence that either chemotherapy alone or chemoimmunotherapy improves OS or RFS when contrasted to outcomes obtained by patients on the control arm. In fact, we have significant evidence, at the P = .016 level, that chemotherapy does not improve OS by at least 50%; we also have significant evidence, at the P = .011 level, that chemoimmunotherapy will not improve OS by at least 25%. No evidence of efficacy was demonstrated for either treatment regimen, even though enough therapy was given to result in significant toxicities. Acute toxicity was at least moderate, but not fatal, in 75% of patients. Recognizable delayed toxicity included rare cases of fatal renal failure and acute leukemia.
Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/terapia , Neoplasias del Recto/terapia , Adenocarcinoma/mortalidad , Adolescente , Adulto , Anciano , Vacuna BCG/administración & dosificación , Ensayos Clínicos como Asunto , Neoplasias del Colon/mortalidad , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Recto/mortalidad , Semustina/administración & dosificaciónAsunto(s)
Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Estreptozocina/análogos & derivados , Adulto , Anciano , Antineoplásicos/efectos adversos , Evaluación de Medicamentos , Femenino , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Leucopenia/inducido químicamente , Masculino , Persona de Mediana Edad , Estreptozocina/efectos adversos , Estreptozocina/uso terapéutico , Trombocitopenia/inducido químicamenteRESUMEN
The Republic of San Marino (RSM) is a 23-square mile independent country within Italy with a population of 20,000. A large percentage of deaths have been found to be due to gastic cancer (9.2% of all death certificate diagnoses for 1969 through 1973). The frequency of gastric cancer in the families of all 36 patients (78% male) who were born and died in RSM with this diagnosis for this period was compared with the frequency in relatives of age and sex-matched controls. Although 42--44% of both groups had relatives with death certificate diagnoses of stomach cancer, 25% of the patients had first degree relatives affected versus 5.6% of the controls. A high prevalence has also been reported in the area of Italy near RSM. San Marino's size and stability of population provide unique opportunities for elucidating genetic and environmental etiological factors in stomach cancer.
Asunto(s)
Neoplasias Gástricas/genética , Adulto , Anciano , Ambiente , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Linaje , San Marino , Neoplasias Gástricas/etiología , Neoplasias Gástricas/mortalidadRESUMEN
Chromomycin A3 was administered iv to 26 patients in a phase I trial. The maximum tolerated dose established in this study was 0.75 mg/m2/day iv X 5 days. The drug was then given to 48 evaluable patients with far-advanced disseminated breast cancer. Two short partial remissions and one clinical improvement were seen. Toxic manifestations consisted of frequent and usually reversible renal toxicity, nausea and vomiting, occasional thrombocytopenia, hypocalcemia, and two instances of semicoma. Drug toxicity may have contributed to the death of two patients.