RESUMEN

Advanced intra-abdominal cancers are frequently associated with malignant ascites. The aim of this study was to document the frequency and clinical course of patients found to have large-volume ( > or = 3 L) malignant ascites when undergoing a major abdominal operation. Between October 1, 1987 and September 1, 1992, 385 patients with malignant ascites were admitted to hospitals associated with a university medical center. Seventeen with large volume ascites underwent exploration for palliation of bowel obstruction or debulking of tumor. Operative mortality was 41% and mortality correlated with the presence of a nonovarian primary and advanced age. We conclude that patients with large volume nonovarian malignant ascites have a high mortality rate following a major abdominal operation. New approaches such as neoadjuvant or intraperitoneal chemotherapy or possibly peritoneovenous shunt placement at the time of the abdominal operation, are needed to improve the dismal results in this subgroup of patients.

Asunto(s)

RESUMEN

Reports the results of a questionnaire survey designed to discover relationships of the emotional responses of cancer patients and their spouses to variables of age, gender, and church attendance. Claims that contemporary high-tech health care developments tend toward a process of despiritualization, and that one-on-one spiritual relationships seldom occur with physicians, nurses, or pastors. Notes that pastors need to assume a greater role as spiritual leaders, encouraging all members of the health care team to contribute to healing the whole person.

Asunto(s)

RESUMEN

PURPOSE: Patients with the heparin-induced thrombocytopenia syndrome (HIT) have heparin-associated antibodies (HAb+), which, in the presence of heparin, are responsible for platelet activation and aggregation. This study addressed the questions: (1) are the antibodies specific for heparin; and (2) how do the antibodies cause platelet aggregation? METHODS: Plasmas from 79 patients with HIT were divided into seven plasma samples: HAb+ plasma sample 1 (24 pooled plasmas); HAb+ plasma sample 2 (50 pooled plasmas); and HAb+ plasma samples 3 through 7 (individual plasmas). Normal patient plasmas were used as controls (HAb-). RESULTS: All seven HAb+ plasma samples caused platelet aggregation (PLA) in the presence of heparin and formed a precipitation line with heparin in gel immunodiffusion plates (HAb- plasmas did neither). The HAb+ plasma samples reacted with heparin, as determined by immunoprecipitation in sodium dodecylsulfate-polyacrylamide gel, with the production of a band at 50 kd (no band with HAb- plasmas). The plasma samples 1 and 2 were passed over heparin sepharose beads three times; the unabsorbed plasmas produced 3+ PLA, the first effluent produced 2+ PLA, and the second and third effluents produced no PLA. The heparin sepharose beads stained 3+, 2+, and 1+, after the respective passages, with fluorescein-labeled goat sera containing anti-human immunoglobulin G antibody. HAb+ plasma samples were digested with pepsin to separate the F(ab')2 fragments from the Fc fragments. The F(ab')2 fragments reacted with heparin as determined by immunoprecipitation in sodium dodecylsulfate-polyacrylamide gel with the production of a band at 25 kd, but did not cause PLA in the presence of heparin. CONCLUSION: Patients with HIT have heparin-specific antibodies that react with heparin in a classic F(ab')2 reaction and require the Fc fragment for platelet aggregation.

Asunto(s)

RESUMEN

In this follow-up report of the treatment of primary breast cancer with adjuvant immunotherapy, a total of 95 patients were studied: 46 patients with stage I breast cancer and 49 patients with stage II breast cancer. All patients underwent standard surgical treatment and received immunotherapy as adjuvant treatment. Patients received a primary series of eight doses (1 mL of tumor-associated antigen preparation given as 0.2 mL intradermally and 0.8 mL subcutaneously) given over 8 weeks, and then booster injections every 3 months for at least 2 years. The 5-year survival with adjuvant immunotherapy was 83% for those with negative axillary nodes and 53% for those with positive nodes; this compares favorably with national 5-year survival statistics from two other studies (node-negative, 72% and 83%; node-positive, 51% and 59%). Based on these data, the addition of immunotherapy to other adjuvant therapies in randomized prospective trials seems both reasonable and justified.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

For many years, various melanoma vaccines have been employed. This is a unique melanoma vaccine in that it is a subcellular tumor homogenate and no adjuvants have been added. This vaccine has been given to 129 stage I and 61 stage II melanoma patients. All were followed at least 5 years and had 87.5% and 63.9% 5-year survival rates, respectively. Sixty-four stage I males and 65 stage I females had 84% and 90% 5-year survival rates, respectively. We saw no difference between those with or without lymph node dissection. Thirty-six stage II males and 25 stage II females had 66.7% and 60% 5-year survival rates, respectively. Of stage II patients, 23 had only one positive node, 22 had two to four positive nodes, and 9 had five or more positive nodes with 69%, 63%, and 55% 5-year survival rates, respectively. Large published series were used as historical controls [6,27,28], and significant differences were noted when compared to our stage II patients (P = 0.001)--those with two to four positive nodes (P = 0.03), and those with five or more positive nodes (P = 0.04). We conclude that there is a significant increase in survival for these stage II patients, at high risk of recurrence, receiving a tumor homogenate vaccine. This vaccine warrants further analysis, development, and use in a phase III randomized clinical trial.

Asunto(s)

RESUMEN

With the popularity of breast-conserving treatment plans, the natural history of "breast recurrence" in the ipsilateral breast must be distinguished from local recurrence following modified radical mastectomy. Hence, this study considers those patients who develop skin or chest wall recurrence after modified radical mastectomy, whether as a primary procedure or for patients with "breast recurrence" after partial mastectomy. The incidence of postmastectomy locally recurrent breast cancer following modified radical mastectomy (MRM) and adjuvant immunotherapy (IT) is compared to historical controls. The risk factors and treatment of local recurrence in this program as well as in a larger group of patients who recurred after modified radical mastectomy are reported.

Asunto(s)

RESUMEN

Prevention and early detection of cancer programs can double the survival rate in the next 5 years. For many programs it will cost more dollars than savings realized. Only through education can government, insurance carriers, and individuals realize that the value of these far exceeds cost when compared to cost of so many lifestyle things of temporary value.

Asunto(s)

RESUMEN

Cancer screening is ideally carried out in free standing centers that are located near shopping centers, are quite visible, and have a warm, friendly appearance. This chapter describes the basic elements of such a center, including the use of a mobile mammogram van based at the center. While the precise size, location, and design of a center will vary depending on the specific demographics of an area, these data should facilitate such planning. Programs that can be carried out in this center are described utilizing information from preceding chapters. This chapter enlarges upon their application and then outlines criteria and services. Furthermore, a large section on general or whole-body screening is included. As in other programs, those at risk and the benefits are discussed. While not a high volume, income producer, this program is a requisite component offering great service to the customer.

Asunto(s)

RESUMEN

Due to his recognition as the discoverer of the first test for visualization of the gallbladder, his profile research on dissemination of cancer and his stimulation and interest in stress and immunity, one of Warren Cole's most significant reports has not been accorded due recognition. In 1944, Cole presented data at the Southern Surgical Association Meeting which clearly identified the premalignant histologic change in the breast. In the published report, Cole and Rossiter [Ann Surg 119:573-590, 1944] presented a classification of benign breast histology: 1) adenofibrosis, 2) parenchymatous hyperplasia, 3) precancerous hyperplasia, and 4) cystic disease. Following the work of Warren in 1940 [Surg Gynecol Obstet 71:257-273], who stated that the chronic cystic mastitis had an incidence of breast cancer over 3 times the expected rate, this report of Cole and Rossiter focused on the worrisome lesion atypical epithelial hyperplasia. Since then, Haagensen ["Diseases of the Breast," Philadelphia: Saunders] has stressed that gross cystic disease is the lesion most associated with increased risk of cancer. In an attempt to resolve these seeming contraindications, we reviewed the charts of patients referred to a private breast clinic. With the advent of mammography, sonography, and thermography, the incidence and management of benign breast diseases has changed over the years. This study focuses on the current management of breast masses and reinforces the significance of Cole's classification.

Asunto(s)

RESUMEN

For the first time, data on 78 breast cancer patients treated by modified radical mastectomy and adjuvant immunotherapy have been reported. Thirty-nine lymph node negative patients with uninvolved lymph nodes had a projected 5 year survival rate of 94 percent and 39 patients with involved nodes had a projected 5 year survival rate of 77 percent and a disease-free survival rate of 70 percent. Results have been presented according to UICC staging. The 100 percent survival rate of stage I patients has been compared with rates obtained by treatment of breast cancer with radiation therapy as the principal modality. The preliminary data are promising enough to warrant randomized, prospective trials with the other adjuvant modalities.

Asunto(s)

RESUMEN

Adjuvant immunotherapy was administered to 84 lymph-node-negative and 25 lymph-node-positive melanoma patients. This active specific homologous cell protein preparation was given after aggressive surgery and given over 2 years. Projected and observed survival rates are presented as well as other clinical and pathologic characteristics such as female-to-male ratio, site of primary, level and depth of invasion. The projected 5-year survival rates are 90% for all stage I with 89% for females and 94% for males. Lower extremity stage I projected 5-year survival rate was 88% for all, 87% for females, and 100% for males. The projected 5-year survival rate for stage II was 68% overall and 100% for lower extremity. Only two of five patients with an unknown primary have expired. All of these results are improved over expected survival. Hopefully a randomized prospective study will be stimulated to ascertain the basis for this improvement.

Asunto(s)

RESUMEN

Confusion remains concerning the role of the regional lymph node in the containment of cancer. Numerous investigators using a variety of assays have reported often conflicting results concerning the immunocompetency of lymphocytes residing in regional nodes. Forty-two axillary lymph nodes from ten stage I and stage II breast cancer patients were studied in lymphocyte blast assays using mitogens and breast cancer antigen (BCA). Three general response patterns to BCA were identified which were related primarily to tumor size. In the patients with the smallest primary tumor (0.5 cm), lymphocytes in the nodes reacted to a much greater extent than peripheral blood lymphocytes (PBL). In two of three patients with intermediate-size tumor (1.0 to 1.5 cm), a mixed pattern of responses was seen with both stimulation suppression occurring within the nodes of the same patient. In the four patients with the largest tumors (2.0 to 3.0 cm), 15 of 19 nodes had a lower stimulation index (SI) than the corresponding PBL. From the results of this study it appears that regional lymph nodes are dynamic immunologic structures which regress in responsiveness as tumor burden increases.

Asunto(s)

Asunto(s)

RESUMEN

Data on cellular immunity of 39 patients with breast cancer and 29 patients with malignant melanoma, is presented. T/B lymphocyte ratios, lymphocyte blastogenesis (LB) with PHA and with cancer antigen preparations were carried out from two to four weeks after cancer surgery, and immediately after eight weeks of immunostimulation with a tumor-specific vaccine. Distinct differences were observed. Small breast cancers do not seem to evoke a host immune response, while small melanomas are associated with a state of immune stimulation. After immunotherapy LB in these breast cancer patients shows significant stimulation while LB in the melanoma patients changed from stimulation to normal response. Quite different results were obtained in patients with Stage II cancers; breast cancer patients showed immune stimulation which did not change after immunotherapy. The melanoma patients showed low normal immune response, which changed to high normal after immunotherapy. Patients with Stage III breast cancer and melanoma were similar in their poor immune responsiveness. Possible mechanisms are offered for these differences.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Lymphocytic infiltration of the primary breast cancer and sinus histiocytosis of the axillary lymph nodes are indications of a favorable prognosis. Similarly, skin test responsiveness such as with DNCB or with tumor extracts correlates in general with stage of disease. This presentation will bring forth preliminary data on cellular immunity of breast cancer patients. Circulating lymphocytes (PBL) were stimulated with mitogens and a breast cancer antigen. PBL from patients with a primary tumor less than 2.4 cm in size reacted as though no immune stimulus existed. PBL from patients with a lump from 2.5 to 5.0 cm in size showed evidence of immune stimulation. An increase in size of the primary tumor over 5 cm and an increase in the number of axillary lymph nodes with metastasis were associaed with a diminution in cellular immunity. However, data from an adjuvant immunotherapy program show that cellular immunity can be improved in certain patients by immunization. Such patients continued to remain disease free, while patients whose cellular immunity was poor or not improved by adjuvant immunotherapy tended to develop recurrent disease.

Asunto(s)

RESUMEN

Recognition of a variety of environmental factors at variance and correlating with colorectal cancer incidence brings hope that prevention by environmental manipulation can be achieved. Refinements in detection methodology continue to optimize the benefit-cost ratio in discovering minimal large bowel cancer. This is the most significant advance in improving end results of treatment for this number one cancer killer in the United States. Little progress has been made in improving surgical procedures, although the no-touch technique stands out as the single important contribution. Adjuvant radiation therapy, chemotherapy, immunotherapy, and chemoimmunotherapy have not improved results over surgery alone.

Asunto(s)