The present status of burn therapy

Extensive burns (that is, of 10 per cent or more of the body surface) are first treated for shock by morphine, external heat, vigorous administration of fluids, and possibly by blood transfusion. As early as possible, gauze saturated with $\text{2}\text{1}\text{2}$ per cent tannic acid solution is applied to the entire burned area and kept moist with this solution for twenty-four hours or more until the burned skin is thoroughly tanned. The burned area is then treated by the open air method under a heated cradle, supplemented by warm boric or soda irrigations. Fluids are pushed, and epinephrin and sodium chloride may be exhibited. Repeated blood transfusions occasionally are indicated. When all sloughs have disappeared and the wound is cleanly granulating, adhesive or rubber tissue strips are applied and scarlet red preparations may be used to accelerate epithelization. Skin grafting occasionally is advisable.For small burns (5 per cent of the body surface or less) the application of soothing ointments containing phenol or picric acids and gauze dressings is the best treatment.     

The role of radiation therapy for primary breast cancer

Radiation therapy for breast cancer has gone through two revolutions in the last two decades: the routine use of radiation therapy in conjunction with breast-conserving surgery as an equivalent treatment to mastectomy, and the use of radiation therapy following mastectomy in advanced or node-positive disease. Indeed, the perception of postmastectomy radiation has gone full circle: from having no benefit when used for all cases, to being detrimental because of cardiac irradiation, to the present in which the selective use of irradiation in high-risk patients provides both an improvement in local control and an improvement of 8% to 10% in the survival rate. Improvements in radiation technique have reduced complications, in particular late cardiac deaths. The major issues still to be resolved are the targets for postmastectomy irradiation, determining which patients do not need radiation therapy for DCIS and for node-negative disease, and the efficacy of delivering radiation to just the affected quadrant rather than to the whole breast. At present, most patients approach radiation therapy for breast cancer with the knowledge that it has a very high probability of being successful.     

Role of radiation therapy in gastrointestinal cancer

The intradiation techniques in the last several decades has resulted in a wider application of radiation therapy to the treatment of gastrointestinal cancer. Controlled and uncontrolled clinical trials have shown benefit for preoperative and/or postoperative irradiation in carcinoma of the rectum and rectosigmoid. Endocavitary radiation techniques have been employed successfully in early, accessible rectal cancers as an alternative to abdominal perineal resection. High-dose external beam irradiation with and without concomitant chemotherapy has produced encouraging results in locally advanced, unresectable pancreatic carcinoma. Benefit for radiotherapy in locally advanced gastric carcinoma has been demonstrated as well. In carcinoma of the esophagus, radiotherapy has resulted in long-term control in selected patients and also has been employed with modest success in combination with surgery. Interstitial radiation techniques, intraoperative electron beam therapy, and fast neutrons, heavy charged particles, and other forms of high linear energy transfer radiation are being investigated and may eventually find greater application.     

Endoscopic laser therapy for esophageal cancer: present status with emphasis on past and future

Although the major initial application for endoscopic laser therapy was for the management of gastrointestinal hemorrhage, it is now more common to use the laser endoscopically for the treatment of gastrointestinal neoplasms. A major body of literature surrounds the use of endoscopic laser therapy for esophageal cancer. The initial patient evaluation to determine if laser therapy is indicated includes a contrast radiograph, a screening endoscopy, and an imaging study. After these tests have been performed, it can be determined whether endoscopic laser therapy (ELT) is the best of the many endoscopic options. There is some difference of opinion as to the specifics of the treatment technique, and these are described. There is general agreement from reviewing the clinical data that it is possible to open the obstructed lumen in a large majority of cases and that functional success (the ability to achieve technically good results as well as clinical improvement without complications) is also possible in the majority of patients. Despite the information suggesting the benefits of ELT for esophageal cancer, there are both conceptual and technical limitations to the current approach to therapy. These limitations as well as potential future applications are discussed.