Adenoid cystic carcinoma: factors influencing survival.

We have reviewed our experience with 264 patients treated for adenoid cystic carcinoma of salivary origin. This study updates a previous report from our hospital and includes all patients treated during a 30 year period who were eligible for a minimum follow-up of 10 years. The tumor arose in minor salivary (mucous) glands in two thirds of the patients; half had received treatment elsewhere, and both sexes were equally represented. Actuarial survival curves and "cure" rates calculated by the direct method confirm that clinical staging provides a reliable prognostic guide. We are unable to demonstrate that the microscopic appearance of the tumor exerts a predictable effect on treatment results. Although some patients lived for many years after resection despite local recurrence and distant metastases, prolonged survival was unusual in patients with stage 3 lesions, particularly in those with sinus or submaxillary gland primaries. Based on the site of origin of the tumor and its clinical stage, it is now possible to select which patients with adenoid cystic carcinoma have the most ominous prognosis and perhaps plan a more appropriate operation. More importantly, these data may help focus on the subpopulation at greatest risk, which is vital to the design of any prospective study to assess the value of adjunctive irradiation and chemotherapy.     

Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging

The clinical and histologic status of cervical lymph nodes has been correlated with the results of treatment in 1,069 consecutive patients who underwent radical neck dissection as part of the initial treatment of a primary epidermoid carcinoma arising in either the oral cavity or oropharynx.The influence on “cure” rates of size, number, location, and fixation of involved nodes, correlated with the specific site of origin within the oral cavity, was evaluated in determinate patients with proved nodal metastasis. As the extent of lymph node involvement increased from solitary to multiple ipsilateral and to bilateral enlarged nodes, cure rates dropped progressively. Survival was not invariably decreased in those whose involved nodes were large or considered fixed, and there was considerable variance among examiners when size and fixation were evaluated. These data suggest that the N system of staging presently advocated might be improved. Rather than designating contralateral or bilateral node involvement as N₂, this category might be reserved for those with multiple ipsilateral cervical node metastases. Those with contralateral and bilateral as well as so-called fixed metastases might better be relegated to the N₃ category. The results of treatment were uniformly poor in the latter group of patients, provided the term “fixed” indicated immobility of involved lymph nodes and not merely the presumption that tumor had extended beyond the capsule of the node.     

Synthesis and in-vitro activity of novel 1beta-methylcarbapenems having spiro[2,4]heptane moieties

The synthesis of a new series of 1beta-methylcarbapenems having spiro[2,4]heptane moieties is described. Their in-vitro antibacterial activities against both gram-positive and gram-negative bacteria were tested and the effect of substituents on the pyrrolidine ring was investigated. Most compounds were shown to be more active than the compared meropenem and imipenem against Escherichia coli. One particular compound, IIIb, having hydroxy a moiety showed the most potent antibacterial activity.     

Pharmacokinetics and Pharmacodynamics of Valproate Analogues in Rats. I. Spiro[4.6]Undecane-2-Carboxylic Acid

The pharmacokinetic and pharmacodynamic properties of the spiro carboxylic acid, spiro[4.6]undecane-2-carboxylic acid (SUCA, ADD 93024), were investigated in rats and compared with those of the standard anticonvulsant carboxylic acid, valproate (VPA). The clearance of SUCA was dose-dependent, although the observed nonlinearity did not appear to be due to classical saturable elimination. The change in clearance across doses was consistent with end-product inhibition or cosubstrate depletion. The volume of distribution of the spiro compound also evidenced nonlinearity, possibly due to concentration-dependent binding to serum proteins. In contrast, the dose-dependent clearance displayed by VPA was composed of both saturable and nonsaturable components. Furthermore, the disposition of VPA was characterized by a significant enterohepatic recirculation, whereas no such recirculatory process was apparent for SUCA. Both compounds afforded significant protection from pentylenetetrazol (PTZ)-induced seizures, and the time course of anticonvulsant effect did not correspond to that of drug concentrations in serum for either anticonvulsant. The apparent dissociation between the pharmacokinetics and pharmacodynamics of VPA may be a function of the mechanism of antiepileptic action and not due to the presence of active metabolites of the drug.     

Complications after laryngectomy

The charts of 100 consecutive patients who underwent laryngectomy at Memorial Hospital were reviewed to assess those factors that contribute to postoperative complications. Laryngectomy was performed for epidermoid carcinoma in 94 patients and for laryngeal incompetence in 6. Total laryngectomy was performed in 48 patients and partial and circumferential pharyngectomies in addition to laryngectomy in 40 and 12 patients, respectively. Significant complications, which delayed discharge, occurred in 13 patients (27 percent) who had simple laryngectomy, including the formation of two fistulas (4 percent). After laryngopharyngectomy, the complication rate was 77 percent (40 of 52 patients) with pharyngocutaneous fistulas in 19 patients (37 percent). The fistula rate of formation was not increased in irradiated patients; however, the duration of time to closure of a pharyngocutaneous fistula, if it occurred, was longer. Planned pharyngostomy or staged deltopectoral flap reconstruction after extended laryngopharyngectomy was associated with excessive morbidity. Newer techniques of reconstruction utilizing flaps or gastric transposition offer the prospect of reduced morbidity after laryngopharyngectomy.     

A facile synthesis and anticancer activity evaluation of spiro[thiazolidinone-isatin] conjugates

The synthesis and evaluation of the anticancer activity of 3'-aryl-5'-arylidene-spiro[3H-indole-3,2'-thiazolidine]-2,4'(1H)-diones and spiro[3H-indole-3,2'-thi-azolidine]-2,4'(1H)-dione-3'-alkanoic acid esters were described. The structure of the compounds was determined by (1)H and (13)C NMR and their in vitro anticancer activity was tested in the National Cancer Institute. Among the tested compounds, (5'Z)-5'-(benzylidene)-3'-(4-chlorophenyl)spiro[3H-indole-3,2'-thia-zolidine]-2,4'(1H)-dione (IIa) and (5'Z)-3'-(4-chlorophenyl)-5'-[4-(1-methylethyl)-benzylidene]spiro[3H-indole-3,2'-thiazolidine]-2,4'(1H)-dione (IIb) were superior to other related compounds.     

Carcinoma of the cheek mucosa: A retrospective analysis

A 16 year experience with 121 patients treated for squamous cell carcinoma arising in the cheek mucosa is described. Treatment was almost exclusively surgical, and 5 year determinate cure rates ranged from 77 and 65 percent in stage I and II lesions to 27 and 18 percent in those with stage III and IV lesions, respectively. Twenty-four percent of previously treated patients remained alive and well at 5 years. The 42 percent overall salvage rate was low, reflecting the high proportion of patients who developed cervical metastasis during the course of the disease. In an attempt to improve local control, we now advocate irradiation of the primary tumor and neck after aggressive resection with radical neck dissection in any patient who has clinical evidence of nodal involvement or other unfavorable findings.     

靛红Morita-Baylis-Hillman碳酸酯参与的不对称烯丙基化反应研究进展

本文对靛红Morita-Baylis-Hillman这一不对称反应在近几年的研究进展进行了综述,认为靛红Morita-Baylis-Hillman碳酸酯的烯丙基烷基化反应是合成光学纯3,3-二取代2-氧化吲哚衍生物的一种有效方法。     

Cervical node metastasis of occult origin

This study reviewed a 12 year experience with 132 patients who were treated for metastatic carcinoma of the cervical lymph nodes with no apparent primary tumor. Using radical neck dissection as the main treatment modality, a 5 year survival of 50 percent was achieved in 79 patients with epidermoid carcinoma. Survival varied significantly depending on the extent of the tumor in the neck. It was 74 percent in those with stage N₁ disease compared with 41 percent in patients with N₂ or N₃ disease. Recurrence in the neck, the major reason for treatment failure, can probably be reduced by more aggressive use of adjunctive radiotherapy. Primary tumors were identified after therapy in only 15 percent of these patients, and this appeared to have relatively little impact on the outcome. Irradiation and chemotherapy were the preferred treatment modalities in 29 patients with metastatic adenocarcinoma of occult origin. All but one patient died within 29 months. A 53 percent 5 year survival was achieved in 13 patients with anaplastic or undifferentiated carcinoma. Radical neck dissection was employed in 11 patients with melanoma. No primary tumor was ever identified in this group and only one patient remained alive and well after 5 years.