Search

All abdominoperineal resections for carcinoma of the rectum carried out 1963-1972 in two small community hospitals are reviewed. Seventy-six patients were found: males slightly outnumbered females; the average age was 61. There were 67 adenocarcinomas, 7 squamous cell carcinomas and one each of villous adenoma and carcinoid. Distribution of Dukes' classification was: A-20, B-26, C-21, D-9. In an average case the operative time was 3 hours, 25 minutes, 4 units of blood were used, and postoperative hospital stay was 30 days. Postoperative complications were recorded in over 50% of the patients with reoperation needed in 26% of all patients and delayed complications occurred in 41%. The operative mortality was 1.3%. Five year followup was possible in 40 of 43 patients; survival according to Dukes' classification was A-80%, B-53%, C-9% and D-25% with overall survival 45%.

Ninety-six cases of Wilm's tumour have been reviewed, as far as clinical features, treatment and progress are concerned. An overall survival for all cases of 30 per cent was obtained, and in early cases (those treated by operation first, followed by irradiation) the overall survival was 48 per cent. Complications and steps taken to prevent some of these are mentioned.

In 166 cases of Hodgkin's disease with lymph node biopsy, 61 showed only partial involvement of the lymph node by tumour. The overall survival rate following treatment was better in these cases than in those showing complete replacement of the architecture. This effect could be demonstrated in the ‘Mixed’ type and in the long-term survival of the Nodular-Sclerosing variety, but not in the Lymphocytic/Histiocytic or Lymphocytic depletion forms. However, it is suggested that partial involvement of the lymph node can be used as an additional histologic guide to prognosis in assessing the biological characteristics of the tumour.

A system is described in which larvae of the turbot, Scophthalmus maximus L., were reared from hatching to, and beyond, metamorphosis. Larvae were fed initially on rotifers, followed by Artemia nauplii and subsequently larger stages of Artemia . After metamorphosis, which occurred between 23.0 and 30.0 mm in length, the fish were fed a diet of trash fish. Overall survival from hatching to metamorphosis was low, approximately 1%. Data on the growth rates of hatchery-reared and wild fish indicated that under artificial conditions a minimum market size of 30 cm could be attained in a little over one year from hatching.

A comparison of the various stages in the life cycle of three members of the Tropisternus mexicanus (Castelnau) complex revealed no significant differences in the durations of the instars in the different races. Egg production rates and overall survival rates were also very similar. Genetic crosses between the three races proved possible, and the evidence from these crosses indicates that the three should retain their current taxonomic position as subspecies of T. mexicanus. The three races appear to be closely related physiologically, although a beginning of divergence is suggested between T. m. mexicanus and T. m. viridis Young and Spangler.

The use of an optimal rearing technique in the investigation and evaluation of crowded and undercrowded experimental populations of Aedes aegypti (L.) is suggested. To facilitate the study of high larval densities an attempt was made to determine the feasibility of using proportionally reduced experimental universes. The criteria used to determine optimal development were percent survival, pupation rate, and pupal weight. Experiment I tested reduced experimental universes of 13 larvae/26 ml and 7 larvae/14 ml proportional to a previously determined standard of 40 larvae/80 ml. In all respects the standard and the universe with 13 larvae were identical. There was a difference in pupal weights between the universes with 40 and 13 larvae, respectively, and the universe with 7 larvae, although there was no significant difference in either initiation of pupation, pupation rate, or overall survival. Using the same criteria as in experiment I, the 2nd experiment attempted to test whether density levels 4 and 10 times that of the proportionally reduced universe of 13 larvae/26 ml would be equivalent to 4 and 10 times the standard. The comparable densities did not differ significantly, i.e., 4 times the standard did not differ from 4 times the reduced equivalent, and 10 times the standard did not differ from 10 times the reduced equivalent, although there was a significant difference between each pair. It was concluded that the proportionally reduced rearing method could be employed for studying parameters of highly crowded populations previously inhibitive because of the excessive time required to handle large numbers of larvae.

In this study we utilized information obtained from more than 2000 operable breast cancer patients who had been entered since 1957 into the National Breast Project by 45 institutions. The purpose was to further evaluate the concept that the size of breast neoplasms influences patient prognosis. Only 5% of patients had tumors smaller than 1.0 cm, 48% were larger than 2.9 cm, and 28% exceeded 4.0 cm. The findings, when compared with those previously reported by others, suggest that little progress has been made since about 1950 relative to the removal of smaller breast tumors. Since these data are probably more nearly representative of the size of breast tumors at surgery in this country during the past decade than most other data that are available, they provide a baseline for the evaluation of the worth of a variety of recently employed and proposed diagnostic procedures. Results obtained categorically agree with current thinking that the larger the tumor the more likely that axillary nodes will be positive, that 4 or more rather than 1-3 nodes will be involved, and tumor recurrence and mortality rates will be greater. Such an unqualified statement, however, is an oversimplification of the findings, provides no indication of the magnitude of recurrence and mortality differences to be anticipated from tumors of various sizes, and should be accepted only with reservation. It is speculated, as a result of the data presented and certain assumptions, that if all tumors 2.0 cm or larger (70% of the total) had been removed when they were 1.0-1.9 cm in size, at the end of 5 years the recurrence rate for all patients entered might have only decreased by 10-18%, and the overall survival might have increased 11-20%. From certain considerations and the results obtained, it is concluded that size may not necessarily relate to “earliness” or “lateness” of a tumor, nor is it as consequential to the fate of the patient as are other factors relative to the tumor and /or host that may be present from its inception and which determine the development of metastases. Such a conclusion does not deprecate effort toward earlier diagnosis and tumor removal. It does emphasize, however, that the reasons for such an endeavor may be different from those generally considered at present.

The effect of 6-MP therapy on the duration of remissions induced by adrenal corticosteroids has been studied as a model for testing of new agents. Ninetytwo patients under age 20 entered the study and were accepted for analysis. Sixty-two (67 per cent) had complete or partial remissions induced by corticosteroids. Patients in remission were randomly assigned to maintenance therapy with either 6-MP or placebo. The median duration of 6-MP-maintained complete remissions was 33 weeks and for placebo, 9 weeks. A sequential experimental design was used to analyze remission times while the study was in progress. This resulted in the study being stopped after analysis of the remission times of 21 pairs of patients (42 patients). Overall survival was not significantly different for the two treatment programs, since patients maintained on placebo were treated with 6-MP when relapse occurred. The activity of the known active antileukemic compound 6-MP was readily detected by this experimental design without compromise of optimal survival. Such a design should prove useful for the evaluation of new agents and also permit study of the remission maintenance activity of a compound separately from its remission inducing activity.

The treatment of 27 infants presenting with omphalocele or gastroschisis was analyzed. Several different methods of therapy were available, but various treatment plans were chosen on an individual basis. The defects were classified according to the size of the anomaly, the presence or absence of sac rupture, and the presence of coexisting abnormalities. Infants with intact omphalocele sacs less than 5 cm in diameter were best treated by surgical closure of the musculofascial defect or by skin closure alone. Intact omphaloceles over 5 cm in diameter or those associated with other life-threatening anomalies were treated conservatively with local applications of mercurochrome. Ruptured omphalocele or gastroschisis required immediate surgical coverage. If skin closure was not possible, a plastic prosthesis of Silastic covered Marlex was useful as a temporary cover for the exposed intestine. Infectious complications from the exposed prosthesis were minimized by the use of 0.5% silver nitrate dressings. An overall survival rate of 70% was obtained using the most appropriate treatment plan for the particular anomaly.

A group of patients with a disease such as cancer of the breast will contain some who would survive five years without any treatment and others who would die within five years despite any treatment. The presence of these has a serious effect on the chance of showing a difference between two methods of treatment. Controlled series in cancer therapy should be carefully chosen, otherwise equivalent results are likely to be obtained and real differences which are present may be obscured. This type of reasoning is applied to McWhirter's proposal that the overall survival rate is the crucial figure in judging methods of treatment for cancer of the breast. If one method of treatment is superior to another for one stage of the disease only, then this difference may be obscured if groups containing all the stages are compared. Yet staging as ordinarily practised is a crude device and tends to give fallacious answers. We suggest co-operation between treatment centres using different types of therapy to obtain detai...

Seven cases of complete or incomplete amputations of the upper extremity are presented with an overall survival rate of 67%. Various aspects of operative and post-operative management are discussed. Careful selection of patients is emphasised avoiding replantation of grossly damaged limbs. A need for early rehabilitation is stressed.

Objective: To compare the outcomes of living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC) in different selection criteria. Methods: Data of patients with HCC who underwent liver transplantation between 2005 and 2013 at our center were reviewed. Clinical data of LDLT recipients and DDLT recipients were compared. The postoperative recurrence-free survival (RFS) rate and overall survival (OS) rate after LDLT versus DDLT were compared in the Milan recipients, the University of California, San Francisco (UCSF) recipients, the up-to-seven recipients, the Hangzhou recipients and the Chengdu recipients. Results: Data of 255 patients were retrospectively reviewed in this study. Seventeen DDLT recipient and 9 LDLT recipients died during the perioperative period. Among the remaining 229 recipients (NLDLT=66, NDDLT=163), 96 patients met the Milan criteria, 123 recipients met the UCSF criteria, 135 patients met the up-to-seven criteria, 216 patients met the Hangzhou criteria, and 229 recipients met the Chengdu criteria. The overall RFS and OS rates of the Milan recipients, the UCSF recipients, the up-to-seven recipients, the Hangzhou recipients and the Chengdu recipients after LDLT and DDLT were all similar. Conclusion: Using well-studied selection criteria, LDLT offers similar outcomes to DDLT for patient with HCC, even using expanded selection criteria.

✓ A comparison is made between limited field and whole brain irradiation in the treatment of 60 patients with intracranial glioblastomas, 34 of whom were picked at random for either treatment and 26 who were selected for specific treatment. A significant increase in overall survival time and tumor-free period was found in the limited field treatment groups and this was especially significant in those patients selected for limited field treatment. The improved results are felt to be due to the higher dose permissible because of avoidance of more sensitive brain-stem structures. Tumor location in the frontal lobe also appears significant in the longer survival of those patients selected for limited field treatment. More exact localization of the lesion by brain scan, surgery, and angiography also contribute to more efficient treatment and consequently better survival.

Variation in survival of breast cancer patients has been examined for relationship to three demographic variables known to affect incidence rates—geography, socioeconomic status and age at birth of first child. Three-year relative survival ratios in two areas with high incidence rates (Boston, USA and Glamorgan, Wales) were 75.3% and 66.4%, respectively. In an area with a low incidence rate (Tokyo, Japan) the ratio was 85.6%. The overall survival ratios differed significantly between areas, but the pattern is not such as to suggest a consistent correlation — either positive or negative — with incidence rates. The differences in survival ratios between areas were not explained by differences in the extent of disease at diagnosis. Survival ratios did not vary consistently with socioeconomic status, as measured by duration of schooling. Neither childbearing nor age at which porous patients first became pregnant was related to probability of survival.

Although major advances in surgery of the colon and rectum have been made over the past 50 years, the overall survival associated with “curative resections” has changed little in the past two decades. Cancer chemotherapy is investigated as an adjunct to resection of operable primary cancers in an attempt to diminish the incidence of local recurrence and visceral metastases.

Of 21 patients with pontine glioma treated with external 60Co from 1958 to 1969, histological confirmation was obtained in 8. Twelve had a complete follow-up, and 2 of these 12 remained free of disease for more than five years after surgical exploration and visual confirmation of the tumor. No cyst evacuation was done. Only one patient had a Torkildsen's procedure prior to irradiation. Patients treated with large radiation fields had a better overall survival rate than patients treated with medium or small fields. Randomized clinical trials combining surgery, irradiation, and chemotherapy are suggested.

Summary A striking improvement in the results of infants with gastroschisis has occurred in recent years. The overall survival of 47 patients in a 25-yr period was 53%. In the first 20 years of this experience, only six of 20 lived (30%). In the past 5 yr, 19 of 27 have survived (70%). Two methods have given very satisfactory results. The skin-closure technique involves a major postoperative problem of respiratory support and a lesser problem of impaired wound healing. Furthermore, later hospitalizations for staged repairs of the ventral hernias are required. Despite these problems, there have been only two deaths in the 13 patients handled in this fashion in the last 5 yr. The silo technique is much simpler from the standpoint of the initial procedure and has the great advantage of avoiding significant postoperative respiratory embarrassment. Early technical problems with the material used. separation or tearing of the silo, and infection have largely been solved and the recent results have been very satisfactory. Although the recent experience with both techniques has been comparable in terms of mortality, the much reduced morbidity with the silo technique recommends it as the preferred method.

Several malignant tumors are unique to infants and children. Earlier diagnosis, improved surgical techniques, and recent developments in radiotherapy have increased overall survival rates. Chemotherap

The authors analyzed the results of palliative irradiation in 102 cases of primary inoperable rectal and rectosigmoid cancer and recurrent cancer of the rectum. Symptomatic relief followed irradiation in 80% of the patients; overall survival was 5%, colostomy was avoided in 71%. In 13 of 16 cases of primary inoperable carcinoma, treated intensively with the hope of conversion from inoperability to operability, the tumor regressed sufficiently for exploration; 9 neoplasms could be resected. Of the 13 patients, 23% were alive at 60 months (18% of the 16).

REHN 1 reported the first successful cardiorrhaphy in 1896. Dr. Luther L. Hill (father of Lister Hill, co-sponsor of the Hill-Burton Act) was the first American to achieve a similar success in 1902. 2 Penetrating wounds of the heart and great vessels are occurring with increasing frequency. 3 Surgeons in large and small hospitals must be prepared to care for these wounds in an effective and expeditious manner. We have reviewed the clinical experiences at Mobile General Hospital in an effort to identify an "effective and expeditious manner." Clinical Material The clinical material consists of 13 cases treated during the ten-year period from 1956 to 1966. Ten patients were treated surgically with 100% survival. Three patients were treated conservatively with one death. The overall survival rate was 93%. This apparent success in the management of these wounds should not be misleading. Delay in diagnosis and delay in definitive surgery after

SUMMARY Three groups of recipient dogs were conditioned for transplantation by supralethal exposure to total body irradiation from dual 60Co sources and then given hemopoietic grafts from DL-A-matched littermates. Group 1 consisted of 17 dogs given marrow cells only and not treated with immunosuppressive therapy postgrafting. Group 2 was made up of 11 dogs given a combination of marrow and peripheral blood leukocytes and no postgrafting immunosuppression. Group 3 included 13 dogs given a combination of marrow and peripheral blood leukocytes and intermittent methotrexate (MTX) therapy for 102 days postgrafting. Nine of the 17 recipients in group 1 died between 30 and 230 days after grafting with graft-versus-host (GVH) disease. Eight recipients survived beyond 230 days without GVH disease. Seven of 11 recipients in group 2 died with GVH disease after 12–151 days and 4 survived beyond 200 days. One dog in group 3 died on day 61, and 12 survived beyond 200 days without evidence of GVH disease. Thus, fatal GVH disease was seen in a number of canine recipients not given postgrafting immunosuppression despite DL-A matching with their littermate donor. The addition of peripheral blood leukocytes to the marrow inoculum did not significantly change the overall survival but increased the severity of GVH disease. Therapy with intermittent MTX postgrafting significantly prolonged survival (P

Results of near-total small bowel allotransplantation in pigs are considered. The overall survival is 5.5 days which is comparable to the results in untreated canine transplants. The application of this form of transplantation clinically is briefly discussed. Some specific problems related to the procedure in the pig are considered.

Objective: We aimed to analyze the expression of ERCC1, RRM1 and TUBB3 in 305 patients with advanced non-small cell lung cancer (NSCLC) and investigate whether these genes can be used as biomarkers for predicting tumor response and clinical outcome. Methods: Total 305 patients with unresectable and locally advanced NSCLC were collected between January 2007 and December 2008. cDNA of ERCC1, RRM1 and TUBB3 was isolated by a fluorescence-based real-time detection method. Results: All the patients were followed up until December 2012. One hundred seventy five patients showed good response and 130 patients showed poor response to chemotherapy. 126 patients died and 166 patients showed progressive disease during the follow-up period. The median levels of ERCC1, RRM1 and TUBB3 mRNA were 0.53±0.13, 0.31±0.15 and 0.18±0.16, respectively. We found that patients with low ERCC1 expression showed a significantly higher rate of good tumor response, and the adjusted OR (95% CI) was 2.16(1.32-3.45). By Cox regression analysis. We also found that low ERCC1 expression level were correlated with longer overall survival of NSCLC patients, with the adjusted HR (95% CI) was 2.15 (1.26–3.35). Conclusion: This study showed that ERCC1 mRNA expression can not affect the response to chemotherapy and clinical outcome of advanced non-small cell lung cancer (NSCLC) patients.

From Jan., 1972 to Dec., 1973, 303 newborns required assisted ventilation. Weights ranged from 660-5030 Gm (mean 1731) with 148 infants

Thirty cases of intussusception in children from the Hopital Albert Schweitzer (HAS) in Deschapelles, Haiti, were compared with 35 cases from Yale-New Haven Hospital (YNHH) during a similar period. Most epidemiologic factors were similar. The principal difference was later appearance and diagnosis at HAS. The overall survival rate for this disease at HAS was 53%, while 100% of patients at YNHH survived. Careful preoperative management with fluids, electrolytes, and antibiotics, combined with the more routine use of the Mikulicz procedure, should help to reduce the high mortality that accompanies pediatric intussusception in Haiti.

To The Editor.— The prognosis for patients with diabetes mellitus dependent on hemodialysis is indeed grim if other centers confirm the 22% oneyear survival statistics given by Ghavamian et al. 1 Fortunately, other centers have had somewhat more success in dealing with these patients. Knepshield et al 2 recently summarized the experience among the Georgetown and Peter Bent Brigham diabetic dialysis populations. They had 29 patients with 347 patient-months of dialysis experience with an overall survival of 76%. We have had 40 diabetic patients with 589 patient-months of dialysis. One patient recently died after 53 months of dialysis and another is alive and well after 45 months. Seventeen of the patients were blind. Eleven deaths occurred during the first year of dialysis, eg, a one-year survival rate of 72%. Beyond the first year, the patients generally are clinically stable and there have been only four deaths. Of the deaths, five

Rapid evacuation and sophisticated initial treatment has notably enhanced the overall survival of those wounded in the Vietnam conflict. Following injury, the patients undergo wound cleansing and debridement at nearby field hospitals. When stabilized, they are transferred in stages to other military institutions for definitive care. Many wounds become infected through unavoidable interruptions in therapy during transit. Aqueous silver nitrate (AGNO 3 ) (0.5%) is effective as a topical bacteriostatic agent in massively burned patients. 1 Its use against a wide variety of organisms has been demonstrated. 2,3 The arrival of a series of patients with infected war wounds at Portsmouth Naval Hospital has stimulated the application of the solution on such nonthermal soft tissue injuries. Materials and Methods Twenty-three missile and schrapnel wounds received by 12 patients an average of five days before admission were studied. The injuries varied between localized avulsions of skin and underlying muscle, to massive soft

Success in the treatment of Hodgkin's disease during the last few years has followed improved methods to detect the extent of the disease, better estimation of the likely rate of advance, and more efficient application of radiation therapy and chemotherapy. All three (detection of involvement, forecast of further dissemination, and extent and method of treatment) have contributed to or depended on a better understanding of the modes and directions of spread of the disease. Misunderstandings and inaccuracies in the estimate of degree of spread may be overcome to some extent by making splenectomy and total nodal irradiation routine procedures. While this is likely to improve overall survival figures, some patients will receive more extensive treatments than they need, which may be dangerous. The chance of success with chemotherapy may be seriously prejudiced in those patients who still develop spread to nonlymphoid organs. Thus, a better understanding of the mode and

Thirty consecutive cases of histologically proved Wilms' tumor followed for a minimum of two years have been reviewed. The overall survival rate was 70%, with 47% beyond the period of risk (Collins'). Of 14 children treated by nephrectomy and postoperative radiotherapy, 43% (6 of 14) are living and apparently free of tumor. Of 13 children treated with dactinomycin in addition to nephrectomy and postoperative radiotherapy, 92% (12 of 13) are living and apparently free of tumor. It was concluded that the survival of children with Wilms' tumor is markedly prolonged by the administration of dactinomycin at the time of diagnosis. The beneficial effect of dactinomycin was attributed to the "cidal" action of this drug on small or poorly established metastases.