Endoluminal brachytherapy for recurrent laryngeal carcinoma

Early-stage squamous cell carcinoma of the larynx is usually treated with local field radiotherapy. Surgery is used for salvage following recurrence. Further recurrences present a more difficult therapeutic problem which requires individualized management. The aims of local control, survival, maintenance of function and minimizing side effects all need to be balanced according to the site and extent of disease. The present case study looks at the management of a 54-year-old man with multiple recurrences from a squamous cell carcinoma of the larynx. It describes a technique of endoluminal brachytherapy using an iridium-192 wire spiralled around the outer part of a tracheostomy tube that achieves good local control while enabling self-insertion and self-cleaning during the procedure. The dose given was 2500 cGy at 5 mm over 25.2 h and was achieved with minimal early or delayed side effects. The patient had no further symptoms relating to the stomal recurrence until his death from metastatic disease 6 months later.     

含巨菊形团的玻璃样变梭形细胞肿瘤--附3例报告及电镜分析

含巨菊形团的玻璃样变梭形细胞肿瘤 (ＨＳＣＴＧＲ)是近年来才被命名的间叶性肿瘤 ,光镜下类似低度恶性纤维粘液肉瘤。作者观察了 3例ＨＳＣＴＧＲ的光镜、电镜及免疫组化表现。3例中男性 2例 ,分别为 41和 5 4岁 ,女性 1例 ,6 2岁。肿瘤位于深部软组织 ,2例在下肢 ,1例在上臂。大体上 ,最大径 3～ 13 3ｃｍ不等 ,境界清楚 ,呈棕红色或黄白色 ,质实 ,可伴囊性变 ,其中发生于小腿的 1例合并有股骨骨肉瘤 ,小腿部肿块仅做了活检。光镜下 3例图像相似 ,均有纤维粘液样区 ,2例伴有玻璃样变 ,1例有灶性骨化。肿瘤细胞为温和的卵圆形至梭形细胞 ,…     

Mechanical clot dissolution: new concept

The authors present preliminary data on in vitro mechanical clot dissolution by means of a catheter with a tiny high-speed propeller enclosed in a special housing. Preweighed human blood clots were subjected to the catheter in a test tube with saline at various propeller speeds and durations of application. After filtration of the resultant slurry, the clot residue was weighed and examined histologically. Clot dissolution was found to be related to both the duration and speed of propeller rotation. No fibrin residue was seen after dissolution, although potential embolic material, composed of clumps of cellular debris as large as 208 microns in longest dimension, was found. Mechanical clot dissolution could possibly be used in any natural or synthetic blood vessel in which there is acute or subacute thrombosis, with fewer complications and lower cost than obtained with traditional methods.     

Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography

A prospective study was undertaken to compare the accuracy of surface coil magnetic resonance (SCMR) imaging, metrizamide myelography (MM), and computed tomography with metrizamide (CTM) in the determination of cervical radiculopathy. Surgical findings were the objective measure of accuracy. Fifty-two patients underwent all imaging studies. Studies were evaluated for disease location and type (bone vs. soft tissue). Twenty-eight patients underwent subsequent cervical surgery at 39 levels form an anterior interbody approach. Predictions made with SCMR imaging were surgically confirmed in 74% of patients, with CTM in 85%, and with MM in 67%. There was 90% agreement with surgical findings when SCMR imaging and CTM were used jointly, and 92% agreement when CTM and MM were used jointly, In general, SCMR imaging was as sensitive as CTM for identification of disease level, but not as specific for type of disease. MM was the modality least specific for disease type. The major advantage of CTM was its ability to distinguish bone from soft tissue, for which contrast material is unnecessary. SCMR imaging is a viable alternative to MM and, together with computed tomography, if needed, provides a thorough examination of the cervical region.     

Cervical radiculopathy: value of oblique MR imaging

Eighteen patients with cervical radiculopathy were entered into a prospective study to compare the accuracy of surface coil magnetic resonance (MR) imaging with that of metrizamide myelography and computed tomography (CT) with metrizamide. All MR studies included tailored axial and oblique images as well as routine sagittal images. All imaging studies were evaluated for topography and type of disease. Nine of 18 patients subsequently underwent cervical surgery with an anterior interbody approach at 11 levels. The surface coil MR findings concerning disease topography and type concurred with the surgical findings at nine of 11 levels (82%). At three levels, the oblique view added important information not available on the sagittal images or clarified changes seen on the axial images. Metrizamide myelography with CT metrizamide myelography had findings concurrent with surgical findings at ten of 11 levels (91%).     

Treatment of patients over 50 years of age with acute myelogenous leukemia with a combination of rubidazone and cytosine arabinoside, vincristine, and prednisone (ROAP)

We administered a combination of rubidazone, cytosine arabinoside, vincristine, and prednisone (ROAP) to 91 patients with acute myelogenous leukemia who were 50 yr of age or older. These patients had been identified in previous studies to be a group with a relatively poor prognosis. One-third of the patients had an antecedent hematologic disorder prior to treatment. Forty patients (48%) obtained a complete hematologic and clinical remission. A history of an antecedent hematologic disorder, male sex, and absence of Auer rods were adverse factors for achieving remission in this older population. More than half of the patients achieved remission in one course. The major cause of failure to obtain a remission was death due to infection, 40% of which were caused by fungi. Resistance to chemotherapy, although uncommon, was noted more frequently in patients with an antecedent hematologic disorder. Univariate and multivariate prognostic factor analysis was used to compare these patients with a historical control group treated with a program in which adriamycin was used instead of rubidazone (AdOAP). No significant difference in remission rate was detected. Cyclocytidine was used as a maintenance agent in this study, and while the median remission duration was only 37 wk, 30% of patients are expected to be in remission for 2 yr. Chemotherapy programs combining an anthracycline with cytosine arabinoside, given to older patients in similar fasion to younger patients will achieve remissions in one-half of a group of older patients. These remissions are of comparable quality to those of younger patients. Mathematical models derived from analysis of prognostic factors are of use in identifying patients likely to fail these programs who are in need of innovative approaches to treatment.     

Monocyte-mediated inhibition of lymphocyte blastogenesis in Hodgkin disease

Mononuclear leukocytes isloated from the blood of previously treated patients with advanced active Hodgkin disease contained high concentrations of monocytes and showed poor lymphocyte blastogenesis to mitogens. In five of eight patients with disseminated disease, blastogenesis became normal or improved markedly when the leukocyte suspensions were depleted of monocytes before culture. Addition of autologous macrophages to the monocyte-depleted lymphocytes resulted in a reappearance of the inhibition of blastogenesis. Monocyte inhibition was associated with the presence of active disease, lymphocytopenia, and low lymphocyte/monocyte ratios in the peripheral blood. The role of previous treatment is uncertain, since inhibition tended to disappear when the patients were retreated. Inhibitory monocyte-lymphocyte interactions may be one of the causes of impaired cell-mediated immunity in Hodgkin disease.     

COMPARING THE EFFICACY OF CISAPRIDE AND RANITIDINE IN OESOPHAGITIS: A DOUBLE-BLIND,PARALLEL GROUP STUDY IN GENERAL PRACTICE

SUMMARY Patients with endoscopically confirmed oesophagitis (n=49) were treated for 8 weeks with either cisapride (10 mg four times a day) or ranitidine (150 mg twice a day) in a double-blind study in general practice. Mean overall symptom scores fell from 10.8 to 4.5 in the cisapride group and from 9.9 to 4.4 in the ranitidine group over the course of the study. The proportion of patients reporting improvements in individual symptoms in the two treatment groups (cisapride and ranitidine respectively) were: heartburn, 66% and 55%; acid regurgitation, 53% and 47%; epigastric pain, 60% and 52%; satiety, 57% and 47%; bloating, 69% and 71%; belching, 65% and 72%; nausea, 62% and 85%; vomiting, 77% and 66%; poor appetite, 50% and 75%. Improvement in the endoscopic grade of oesophagitis was observed in 66% of patients receiving cisapride and 63% of those receiving ranitidine. It was concluded that cisapride is as effective as ranitidine in relieving the symptoms of oesophagitis and in healing oesophageal erosions.     

Reply to the article 'Hepatitis C virus (HCV) infection and MALT-type ocular adnexal lymphoma (OAL)' by P. Arnaud, M.-C. Escande, M. Lecuit et al. (Ann Oncol doi:10.1093/annonc/mdl369)

According to the interesting letter from Arnaud et al. [1],the prevalence of hepatitis C virus (HCV) infection in ocularadnexal lymphoma (OAL) patients diagnosed at the Institut Curieis 2%, which is significantly lower compared with the 13% observedin our series [2]. Intriguingly, the single French patient withOAL and HCV infection displayed a disseminated lymphoma andwas the sole patient who died of lymphoma progression, whichis in line with the negative prognostic