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Biomedical subjects

D S Kapp

Publications and source records attributed to D S Kapp.

At least 91 records · Page 5Linked to original sources
PubMed1985

Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale.

Oral cavity and oropharyngeal cancer in younger adults is a rare entity with an incidence of 2.7% among 1014 patients seen or treated at the Department of Therapeutic Radiology, Yale - New Haven Medical Center between 1958 and 1980. Although there are reports of contrastingly divergent therapeutic experiences, the authors contend that even early stage cancers frequently fail definitive therapy with a rampant course, causing a rapidly fatal outcome. The three-year actuarial survival was a mere 17% at Yale. The authors speculate that younger adult oral cavity and oropharyngeal cancers are possibly related to a genetic disorder or immunodeficiency, and recommend aggressive surgical and radiotherapeutic approaches combined with possible adjuvant immunotherapy.

Adolescent↗
PubMed1985

Cauda equina compression secondary to metastatic carcinoma of the uterine corpus: preservation of neurologic function and long-term survival following surgical decompression and radiation therapy.

Spinal cord or cauda equina compression secondary to epidural metastasis rarely develops in patients with endometrial carcinoma and the early signs and symptoms of compression can therefore be inadvertently overlooked. A 78-year-old patient who developed bone metastasis with destruction of the fifth lumbar vertebral body and blockage of the cauda equina at L-4, L-5 as the only sites of metastasis is reported. This occurred 2 years after initial treatment of a stage IB, well-differentiated, grade I, adenosquamous carcinoma of the endometrium. The patient remains alive, with good neurological function and free of metastatic disease, 2 1/2 years following vertebrectomy, radiation therapy, and adjuvant Provera (medroxyprogesterone acetate) therapy. This patient represents the only case of metastatic endometrial cancer with cauda equina compression in the literature in whom long-term disease-free follow-up has been noted.

Adenocarcinoma↗
PubMed1985

Pure dysgerminoma of the ovary with elevated serum human chorionic gonadotropin: diagnostic and therapeutic considerations.

Pure ovarian dysgerminomas with associated elevation of human chorionic gonadotropin (hCG) are rare, and their optimum management is unclear. We report here a 24-year-old woman with stage III dysgerminoma of the ovaries, with bulky intrapelvic disease, paraaortic adenopathy, and elevated pre- and postsurgical serum beta-hCG titers. Following administration of whole abdominal-pelvic and mediastinal irradiation therapy, the patient's adenopathy regressed, her serial beta-hCG titers returned to normal, and she has remained free of disease for the past 30 months. Histopathological studies revealed a pure dysgerminoma with scattered giant cells which were negative for hCG by immunoperoxidase staining. The literature is reviewed with reference to the significance of elevated hCG levels, the presence of giant cells in association with dysgerminoma of the ovary, and therapeutic implications. Serial determinations of beta-hCG titers may prove to be as valuable in the management of these patients as they are in patients with testicular tumors.

Adult↗
PubMed1985

Fallopian tube carcinoma.

Twenty-one patients with fallopian tube carcinoma from Yale-New Haven Medical Center are reviewed. Most patients who died of disease did so in the first two years after diagnosis, even following complete resection, clearly indicating the need for adjuvant therapy. Negative second-look surgery did not provide assurance of permanent remission. There was a high recurrence rate with Stage I and completely resected Stage II and III disease (8 of 14 patients). Some recurrences occurred late, up to nine years after initial diagnosis. We recommend whole abdomino-pelvic radiation if no disease greater than 2 cm3 bulk exists after surgery. Chemotherapy may be an alternative to radiation as primary adjuvant treatment in early stage disease. Chemotherapy for unresectable disease or recurrent disease has shown palliation with occasional prolonged survival but no patient with recurrent disease survived longer than two years.

Adenocarcinoma↗
PubMed1985

Treatment selection for stage IIIA Hodgkin's disease patients.

Two treatment policies for the therapy of patients with Stage IIIA Hodgkin's disease are compared. From 1969-1976, 49 newly diagnosed and pathologically staged IIIA patients received total nodal irradiation (TNI) alone (no liver irradiation). Although actuarial survival was 80% at 5 years and 68% at 10 years, actuarial freedom from relapse was only 38% at 5 years. Accordingly, a new treatment policy was instituted in 1976. Patients with either CS IIIA disease, multiple splenic nodules, IIIA with a large mediastinal mass or III2, received combined modality therapy (combination chemotherapy and irradiation). All others received TNI. Thirty-six patients have been treated under the new program. The actuarial survival is 90% at 5 years and the relapse-free survival is 87%, suggesting the superiority of this approach.

Adult↗
PubMed1985

Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay.

Presented is a retrospective review of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment.

Brachytherapy↗
PubMed1985

Acute bilobar collapse secondary to endobronchial metastatic seminoma.

We report here a patient with tracheal and endobronchial metastatic seminoma who presented with acute respiratory failure with right upper and middle lobe collapse. Diagnosis of the etiology of the atelectasis was made by fiberoptic bronchoscopy. Radiation therapy caused a marked reversal of the atelectasis.

Acute Disease↗
PubMed1984

Production of systemic hyperthermia in the rat.

The design of clinical trials employing whole-body hyperthermia in cancer therapy has been hampered due to lack of a suitable animal model. We describe a technique for reproducibly and efficiently inducing whole-body hyperthermia in Sprague-Dawley rats, using halothane and oxygen anesthesia and immersion in a hot water bath. Core body temperatures of between 41.5 and 43 degrees C were induced and maintained for periods of up to 200 min and survival curves were determined. The time of exposure at a given temperature that resulted in death in 50% of the animals within 24 hr after heating (LD50/24 hr) was calculated by linear logistic regression analysis. LD50 24 hr values of 115, 61, 57, 25 and 16 min were obtained for temperatures of 41.75, 42.0, 42.25, 42.5 and 42.75 degrees C respectively. This heating technique is compared to several more toxic methods for inducing whole-body hyperthermia with respect to possible pharmacological and physiological differences.

Anesthesia, Inhalation↗
PubMed1984

Temperature elevation during brachytherapy for carcinoma of the uterine cervix: adverse effect on survival and enhancement of distant metastasis.

Possible effects of fever during intracavitary radiation therapy on patient survival, local-regional control or metastatic spread of disease were analyzed in a group of 398 patients with previously untreated, invasive carcinoma of the uterine cervix, managed with a combination of external beam irradiation and intracavitary radium (ICR) applications at Yale-New Haven Medical Center and affiliated hospitals from January 1953 through December 1977. Cox step-wise proportional hazard models were used to test for the influence of elevated temperatures during ICR placements, controlling for the influence of other pretreatment patient parameters, including FIGO stage, age, blood count, prior supracervical hysterectomy and number of prior pregnancies. Increasing maximum temperatures noted during ICR placements were associated with: decreased patient survival (p = 0.014) and increased frequency with time of distant metastasis as the initial sites of treatment failure (p = 0.038). When patients were dichotomized on the basis of maximum temperature during ICR, distant metastasis as the initial site(s) of treatment failure was noted twice as frequently in patients with maximum temperatures greater than or equal to 101.0 degrees F (12.5%; 10/80 patients) than in those with maximum temperatures less than 101.0 degrees F during ICR placement (6.3%; 20/318 patients). No statistically significant differences were noted between the two groups in their distributions by stage, age, histology, year of diagnosis, or pretreatment hemoglobin, and the sites of distant metastasis and time course for clinical detection were similar in both groups. These results are in agreement with prior clinical studies in cancer of the uterine cervix which noted a poor prognosis in patients with cancer of cervix who developed fever during treatment. In addition, the finding of an association between an increased frequency of distant metastasis and temperature elevation during the ICR provides, for the first time, clinical data supporting the reports of an alteration or enhancement of distant metastasis following the application of whole body hyperthermia in murine, rabbit and canine tumors.

Adenocarcinoma↗
PubMed1984

Anatomical site-specific modalities for hyperthermia.

The clinical application of hyperthermia in the treatment of deep-seated tumors remains an empirical science. The pleomorphic nature of the neoplasms and the great diversity in the anatomy and physiology of the individual tumor locations make the treatment of nearly every neoplasm a unique challenge. A wide variety of devices is required, both for the administration of hyperthermia and for the measurement of the temperatures achieved. At Stanford University, these include the BSD Medical Corp. annular phased array system, an isospherical ultrasound device, and interstitial radiofrequency for deep heating. Ultrasound transducers and a variety of microwave applicators are used for superficial hyperthermia. Six illustrative case studies, selected from the 91 patients treated in our program since October 1981, are presented, with discussion and comparison of treatment devices. Difficulties in deep heating were encountered in several instances, believed secondary to the thickness of the s.c. fat, the relatively high heat-induced tumor blood flow, and the presence of adjacent bone. It is suggested that ultimate improvement in clinical results will be possible once a better understanding is achieved of such anatomical and physiological factors.

Adenocarcinoma↗
PubMed1984

Development and decay of systemic thermotolerance in rats.

The development and decay of thermotolerance to the lethal effect of systemic hyperthermia were investigated in Sprague-Dawley rats. Systemic hyperthermia was induced by partial submersion of gas-anesthetized rats in a controlled-temperature water bath. Survival was determined for rats challenged for periods of 10 to 90 min at 42.5 degrees at intervals of 24 to 144 hr after a sublethal conditioning exposure of 41.8 degrees for 1 hr. Survival curves and times of exposure at 42.5 degrees lethal to 50% of the animals (LD50) were determined for the conditioned animals and compared with those obtained for simultaneously treated control (unconditioned) rats. The thermotolerance ratios (LD50 for conditioned animals at various times after sublethal conditioning exposure divided by the LD50 for the control animals) were calculated and compared with the ratios reported in the literature for cells heated in vitro or for tissues heated locally in vivo. Pretreatment of rats at 41.8 degrees for 1 hr resulted in an increase in the LD50 for rats challenged 24 to 96 hr later, with a maximum increase noted at 48 hr (56.5 min compared with 25 min for control; thermotolerance ratio, 2.3). The animals remained relatively resistant to the second heat treatment at 96 hr and returned to control levels of heat sensitivity by 120 hr. The development and kinetics of thermotolerance to lethality induced by wholebody hyperthermia need to be considered in the design of multiple-fraction treatment plans.

Animals↗
PubMed1983

Radiotherapy.

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Female↗
PubMed1983

Radiotherapy.

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Breast Neoplasms↗
PubMed1983

The role of the radiation oncologist in the management of gynecologic cancer.

Optimal management of patients with gynecologic malignancies requires a multidisciplinary approach with close cooperation between the primary care physician, the gynecologic oncologist and the radiation therapist. In order to obtain maximum survival rates with minimal morbidity, treatment should be based on a detailed knowledge of tumor localization, potential sites of occult spread, and tumor-host interactions. A careful delineation of patterns of recurrence will permit the identification of patients at increased risk for treatment failure and will aid in the design of alternative treatment protocols tailor-made to control potential site(s) of tumor spread. The technological advances in radiation oncology and their influence on survival rates are presented, with illustrations taken from the literature and from the recent results of the Patterns of Care Study for treatment of carcinoma of the cervix. The role of radiation therapy in the treatment of carcinomas of the cervix, uterus, and the epithelial tumors of the ovary are reviewed, emphasizing treatment protocols based on consideration of technical, tumor, and host factors. Ongoing clinical research trials and potential areas for further improvement in the management of gynecologic malignancies are discussed.

Clinical Trials as Topic↗
PubMed1983

Intense eosinophilic stromal infiltration in carcinoma of the uterine cervix: a clinicopathologic study of 14 cases.

Stromal responses to tumor, usually characterized by the intensity of the lymphoplasmacytic infiltration, have been felt to be of prognostic significance in a wide range of neoplasms. Little attention has been focused on stromal reactions composed primarily of infiltration by eosinophilic leukocytes. We describe here the clinical and histopathological findings in 14 patients with invasive carcinoma of the uterine cervix in whom pronounced eosinophilic infiltration was observed in the stroma in the initial diagnostic biopsy material. These patients tended to have early stage disease, had associated increased lymphoplasmacytic stromal response, and were somewhat younger than the patients lacking this intense eosinophilic infiltration. A suggestion of improved survival was noted in patients with intense stromal eosinophilia treated primarily with radiation therapy.

Adult↗
PubMed1983

Thermal tolerance to whole body hyperthermia.

Thermal tolerance, that is, a reduced sensitivity to a succeeding heat treatment, has been noted in vitro and following local hyperthermia in normal tissues and malignant tumors. However, information is sparse concerning thermal tolerance following systemic hyperthermia, thereby limiting our ability to design optimally fractionated systemic hyperthermia treatment protocols. A technique for reproducibly inducing systemic hyperthermia in the rat is described, and the survival curve for rats exposed at 42.5 degrees C for periods of up to 75 minutes is presented. Using this system, increased survival of rats to systemic hyperthermia at 42.5 degrees C was demonstrated 30 hours after an initial sublethal conditioning exposure (41.8 degrees C for 1 hour). The LD50 (the time of exposure lethal to 50% of the rats) at 42.5 degrees C was increased by a factor of approximately 2 in the animals exposed to the sublethal conditioning. This increase in LD50 demonstrates the development of thermal tolerance to killing by whole body hyperthermia.

Acclimatization↗
PubMed1983

Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariable analysis of the effect of age, stage, histology and blood counts on survival.

From January, 1953 through December, 1977, 910 previously untreated patients with invasive carcinoma of the uterine cervix (Stages IB-IVB) were seen at Yale-New Haven Medical Center and affiliated hospitals. An extensive retrospective analysis was undertaken in an attempt to identify prognostically significant pretreatment factors. The patients studied were uniformly staged according to the current FIGO recommendations and the majority of patients had been treated under standardized protocols combining external beam radiation therapy and intracavitary radium. Pretreatment parameters, including prior medical illnesses, gross tumor characteristics, histology, and blood parameters were studied, employing stepwise Cox regression analyses to identify the possible effects of all factors and all two-way interactions among factors on survival, disease-free survival and freedom from local-regional failure, controlling for stage of disease. FIGO stage, patient age at diagnosis, pretreatment neutrophil count and hematocrit, uterine position, prior subtotal hysterectomy, histology, history of diabetes mellitus and number of pregnancies were all found to have prognostic significance. When other factors including stage of disease were controlled for, increased tumor size was associated with decrease disease-free survival and local-regional control rates.

Adenocarcinoma↗