Biomedical subjects
Publications and source records attributed to A S Ketcham.
The courses of 11 patients with sigmoid conduit urinary diversion following total pelvic exenteration were reviewed in detail and the results presented. The sigmoid conduit appears to be a safe alternative to the ileal conduit for urinary diversion, and offers in addition the possible advantage of an effective antirefluxing ureterocolic anastomosis.
The first case of metastatic cystosarcoma phylloides in an adolescent is reported. This case also represents the first reported response of this tumor to chemotherapy and irradiation. This tumor showed an unusually rapid rate of cell division probably making it more susceptible to these agents. The importance of an early diagnosis and definitive excision is stressed.
Mice inoculated with MCA-10 sarcoma cells which had previously been incubated with Vibrio cholerae neuraminidase (VCN) demonstrated a significantly lower tumor incidence (9/26) than mice injected with untreated sarcoma cells (10/10) or sarcoma cells incubated with heat-inactivated neuraminidase (28/29) p less than .05. Rechallenge of nontumor-bearing mice from the VCN group with untreated sarcoma cells resulted in a low tumor incidence (4/11), indicating that these mice had developed systemic immunity following the initial injection of VCN-treated tumor cells. These mice also demonstrated significant lymphocytotoxicity against MCA-10 target cells compared with normal control mice (p less than .05). Subsequent cytotoxicity experiments, utilizing groin lymph node and splenic lymphocytes from mice five days following leg injection of VCN-treated, heat-inactivated VCN-treated or untreated MCA-10 cells, demonstrated that the mice injected with VCN-treated tumor cells demonstrated greater antitumor immunity both locally and systemically. This magnification of tumor immunity is postulated as the mechanism by which neuraminidase treated MCA-10 sarcoma cells grew less well in C57 mice than cells incubated with heat-inactivated VCN or cells left untreated.
Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).
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Various factors have been found to be predictors of the relative risk of breast cancer (Table 2). Epidemiologic variables influencing breast cancer risk include age, marital status, geographic location, racial or ethnic extraction, and socioeconomic status. The risk of developing mammary carcinoma is increased with advancing age, among unmarried women, in the United States and Europe, and among women of higher socioeconomic classes. Conversely, a decreased breast cancer risk is observed among fertile married women in Asian countries, among Oriental women, and in lower socioeconomic classes. Reproductive history plays an important role in determining breast cancer risk. The risk of developing mammary carcinoma is increased by an early menarche and decreased by delayed first menses. A late natural menopause increases breast cancer risk while an early oophorectomy offers protection. Hormonal factors are thought to play important roles in the etiology of breast cancer, but the contributions of estrogenic and androgenic influences to mammary neoplasia have not been delineated. Certain estrogen fractions have been implicated as mammary carcinogens, while certain adrenal androgenic steroids have been shown to be promotors of breast cancers. Chronic cystic mastitis is associated with an increased breast cancer risk. A positive family history increases the risk of developing mammary carcinoma and a past history of breast cancer markedly increases the possibility of subsequent breast neoplasia.
Sarcoma-bearing mice treated with cryosurgery demonstrated significantly greater tumor immunity (as measured by lymphocytoxicity assays) than untreated tumor-bearing mice (p less than .001). However, cryosurgically treated mice did not show greater cytotoxicity than tumor-bearing and tumor-amputated mice which were treated with frozen exogenous tumor antigen. These results suggested that the mechanism by which cryosurgery stimulates systemic tumor immunity is through the release of antigen from the neoplasm. Thus, tumor-bearing mice treated with cryosurgery in these experiments underwent definitive ablative therapy while at the same time they received active tumor immunotherapy.
A retrospective study to determine the value of bone and brain scans was performed in preoperative patients with melanoma, sarcoma, cancer of the head and neck and carcinoma of the pelvis. No occult metastases were identified in 170 patients in whom brain scan was performed. On late follow-up data, eight patients had neurologic symptoms develop and had brain metastases identified on scan. Of 223 bone scans performed, only one distant metastatic lesion was identified. It is, therefore, suggested that, in these types of patients, bone and brain scans be reserved for those with symptoms referable to the neurologic or skeletal systems.
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Over the past 7 years, 151 patients with malignant melanoma have been treated with BCG immunotherapy alone or as an adjunct to surgical therapy. Direct injection of metastatic melanoma lesions limited to skin resulted in 90% regression of injected lesions and 17% regression of uninjected lesions in immunocompetent patients. Approximately 25% of these patients remained free of disease for 1 to 6 years. Direct injections of BCG into nodules of patients with subcutaneous or visceral metastases resulted in a lower incidence of local control and no long term survivors. Attempts to improve the results of immunotherapy in these patients by palliative surgical resection of large metastatic lesions to lower tumor burden followed by BCG immunotherapy significantly improved the results although many patients still developed recurrent disease. Early results of a clinical trial combining BCG immunotherapy with regional lymphadenectomy in patients with melanoma metastatic to lymph nodes have been encouraging and promising. Further controlled clinical trials are necessary to elucidate the role of BCG in immunotherapy. However, since BCG is but one of a number of potential immunologic adjuvants, even more effective immunotherapy will be possible as further knowledge of the interactions of cellular and humoral immunity is acquired.