The prognostic significance of basic fibroblast growth factor in cutaneous malignant melanoma

Basic fibroblast growth factor (bFGF) is a growth factor and an angiogenesis factor which may play a role in the evolution of cutaneous malignant melanoma (CMM). In this study, we evaluated the distribution of bFGF in CMM using immunochemical methods and correlated the pattern of bFGF expression with the clinical course. Formalin-fixed, paraffin-embedded sections of 46 CMMs were immunostained with a high-affinity purified antibody raised against human bFGF. CMM were categorized into lesions that exhibited subsequent recurrence (local, regional and/or systemic) or recurrence-free lesions. The minimum follow-up time was 5 years. Expression of bFGF within the tumors and in peritumoral and intratumoral blood vessels was similar in the two groups. Comparable results were attained when 8 recurring vs 8 non-recurring CMM, selected from the above tumors, were matched for age, gender, anatomic site and tumor thickness. These results suggest that the biologic behavior of CMM may not be predicted by immunoreactivity to bFGF in CMM cells or in the local tumor vasculature.     

Phase II trial of acivivin in patients with advanced epithelial ovarian carcinoma

Summary Twenty-four evaluable patients with epithelial ovarian cancer resistant to primary therapy, or relapsing after response to initial therapy, were treated with acivicin utilizing a daily \xs 5 schedule. One patient achieved a partial response lasting five months; the remaining 23 patients showed no objective response. Profound and dose-limiting neurological toxicity was seen in 11 patients. Acivicin is inactive in patients with previously treated ovarian cancer and has a poor therapeutic index due to neurologic adverse effects in this patient population. The profound neurotoxicity may be related to prior therapy with cisplatin, to protein binding in ascitic fluid accumulations or to yet undefined parameters.     

Characteristics of caudal ventrolateral medullary neurons antidromically activated from rostral ventrolateral medulla in the rabbit.

We made extracellular recordings from 107 spontaneously active neurons in the caudal ventrolateral medulla, after identifying the cells by antidromically activating them from the rostral ventrolateral medulla, in urethane-anesthetized rabbits. We tested the response of these neurons to inputs from baroreceptors and chemoreceptors. The median conduction velocity for antidromically activated neurons was 0.84 m/s. Raising blood pressure with intravenous noradrenaline excited 22% of 96 neurons tested, inhibited 61%, and had no effect on the remaining 17%. The spontaneous discharge rate of neurons excited by an increase in blood pressure was 1.6 +/- 0.3 spikes/s, lower than the discharge rate of neurons inhibited by this procedure (4.9 +/- 0.5 spikes/s). Excitation of chemoreceptors by hypoxia increased the discharge rate of 14/16 neurons tested in the group excited by baroreceptor inputs. In the group inhibited by baroreceptor inputs 21/35 neurons tested were excited and 12/35 neurons were inhibited by chemoreceptor inputs. Neurons excited by an increase in blood pressure were located in the previously defined caudal vasodepressor region and in a region just rostral to the obex, intermediate between the vasodepressor region and the rostral sympathoexcitatory region. These neurons may form part of the central inhibitory link in the baroreceptor-vasomotor pathway. Other antidromically activated neurons in the vasodepressor region may be inhibitory vasomotor cells with a function relatively independent of baroreceptor inputs, or they may be A1 catecholamine neurons, with axons passing through the rostral medulla en route to the forebrain.     

Surgical aspects of subungual malignant melanomas. The Scottish Melanoma Group.

The incidence, treatment, and survival of subungual malignant melanomas in Scotland is reviewed from the Scottish Melanoma Group database. Between 1979 and 1989, 100 cases of subungual melanoma were identified (2.8% of all malignant melanomas in Scotland). The tumors tended to be locally advanced at the time of presentation (mean Breslow depth, 4.7 mm +/- 3.0 mm), and this is reflected in an overall 5-year survival of 41%. There was no difference in the survival of patients treated with local/proximal interphalangeal (PIP) joint amputation compared with those having more proximal amputations. Because nearly 70% of these tumors arose on the thumb or hallux, it is concluded that, provided adequate clearance could be obtained, less radical excision should be performed for these lesions to maintain maximum function.     

Pulmonary hamartoma: CT findings

Forty-seven patients with a proved (n = 31) or presumed (n = 16) diagnosis of pulmonary hamartoma were studied prospectively by thin-section computed tomography (CT). CT criteria for hamartoma included a diameter of 2.5 cm or less, a smooth edge, and focal collections of fat or fat alternating with areas of calcification. No case of cancer (n = 283) or metastatic disease (n = 72) fulfilled these criteria. Seventeen hamartomas with no detectable calcium or fat were not diagnosed by means of CT. Two other lesions contained diffuse calcium deposits. In 28 lesions, a CT diagnosis of hamartoma was based on the detection of fat (n = 18) or calcium plus fat (n = 10). Twelve such cases were proved histologically by means of thoracotomy or needle biopsy; the remainder, including eight in asymptomatic patients aged 65 years or older, were managed with conservative follow-up.     

Fracture nonunion: CT assessment with multiplanar reconstruction

Nineteen patients with suspected or possible fracture nonunion underwent computed tomography (CT) with multiplanar reconstruction (MPR). Each case represented a difficult problem in fracture management in which clinical and conventional radiographic examinations had failed to provide a definitive diagnosis. CT with MPR demonstrated nonunion in 13 of 19 cases by delineating the lack of bone bridging across the fracture site in multiple planes. Variable amounts bridging were detected in six cases, indicating partial healing or delayed union. Evaluation of fracture healing with MPR was possible despite remaining metal hardware (ten cases), multiple operations (15 cases), or bone grafting (five cases). CT with MPR aided surgical planning and affected treatment options by providing a more detailed assessment of malalignment and angular deformities, the magnitude of the gap in bone, and the integrity of the adjacent weight-bearing joints in multiple projections. It is an important new modality for evaluating fracture nonunion.     

Cis-platinum in the treatment of advanced or recurrent adenocarcinoma of the ovary. A phase II study of the Gynecologic Oncology Group

Thirty-seven patients with advanced or recurrent adenocarcinoma of the ovary no longer amenable to control with surgery, radiation therapy, or higher prior chemotherapy were treated with cis-platinum, 50 mg/m2 intravenously every 3 weeks. Among the 37 patients, three patients had a clinical complete response (8%) and six had a partial response (16%). Twenty-three demonstrated stable disease (62%), while five demonstrated rapidly increasing disease (14%). Median response duration was 5 months and median survival was 10+ months. Responders survived longer than nonresponders (p = 0.01). Adverse effects included leukopenia (26/37), thrombocytopenia (19/37), nausea and vomiting (35/37), and azotemia (19/37). Adverse effects were generally mild to moderate and tolerable. Cis-platinum thus appears to be highly active in the treatment of adenocarcinoma of the ovary at the dose and schedule tested.     

A randomized comparison of a rapid versus prolonged (24 hr) infusion of cisplatin in therapy of squamous cell carcinoma of the uterine cervix: a Gynecologic Oncology Group study

In this study, 331 patients with advanced or recurrent squamous cell carcinoma of the cervix no longer amenable to control with surgery or radiotherapy were randomized to receive cisplatin 50 mg/m2 as either a continuous infusion over 24 hr or a more rapid infusion at a rate of 1 mg/min. Antiemetic therapy was standardized for the initial course of both regimens as metoclopramide 60 mg at the time of and at 3 and 6 hours after initiation of cisplatin. The overall frequency of objective regression of disease was 18%; the response rate in each regimen was essentially identical. The continuous infusion regimen was associated with a significantly greater percentage of patients who experienced no nausea and vomiting (34% versus 18%, P = 0.002). Other adverse effects included nephrotoxicity, peripheral neuropathy, myelosuppression, and ototoxicity. Both the frequency and severity of these were essentially the same for each regimen.