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Biomedical subjects

D S Kapp

Publications and source records attributed to D S Kapp.

At least 109 records · Page 6Linked to original sources
PubMed1983

Carcinoma of the cervical stump: comparison of radiation therapy factors, survival and patterns of failure with carcinoma of the intact uterus.

Eighty-nine patients with previously untreated invasive carcinoma of the cervical stump were seen at Yale-New Haven Hospital from 1953 through 1977. This represented 9.4% of the carcinomas of the cervix seen during this time period. Eighty-five of the 89 patients (95.5%) had "true" cancers of the cervical stump diagnosed 2 years or more after subtotal hysterectomy, while 4 of the 89 patients (4.5%) had "coincident" cancers diagnosed within 2 years of the subtotal hysterectomy. All cervical cancers were staged by the F.I.G.O. classification. Patient characteristics, methods of management, failure sites and survival of patients with carcinoma of the cervical stump were compared to those patients with carcinoma in the intact uterus. Patients with cervical stump cancers were treated in a similar manner to those with carcinomas of the intact uterus, using a combination of external beam irradiation and intracavitary radium. The stump cancer patients had a similar stage distribution to the patients with cancers of the intact uterus but, on the average, they were older and received less irradiation. The patterns of failure were similar on a stage for stage basis, but the survival and disease-free survival for stump cancer patients were superior to those of the patients with carcinoma of the intact uterus. The 5-year disease-free survival rates according to stage for the patients with carcinoma of the cervical stump were: 83.8% for Stage I, 77.6% for Stage II, 51.0% for Stage III, and 37.1% for Stage IV; compared with 84.2%, 60.9%, 30.1% and 18.3% for the intact uterus in the same stages.

Adenocarcinoma↗
PubMed1983

Ependymomas of the spinal cord.

Many patients with spinal cord ependymomas (SCE) undoubtedly benefit from post-operative radiation therapy; however, because of the wide variability in the total doses given, the optimal post-operative dose for SCE remains unclear. Several recent papers recommend total doses of 4000 rad to 5000 rad in 4 1/2 to 6 weeks. Unfortunately, only a small number of patients reported in the literature have been consistently treated to these high dose recommendations. Nine consecutive adult patients with SCE have been treated in a consistent way at Yale-New Haven Hospital with total doses of approximately 4500 rad to 5000 rad at 180 rad to 200 rad per day. The acute and chronic morbidity from such treatment has been minimal and no patient has had a local recurrence at 8 months to 8 years following treatment.

Adolescent↗
PubMed1982

High-dose fraction radiation therapy for intracranial metastases of malignant melanoma: a comparison with low-dose fraction therapy.

Malignant melanoma is considered unresponsive to conventional radiation therapy when it is delivered at a daily dose rate of 130--300 rad/fraction. Previous studies have suggested that this is in part due to a large shoulder on the radiation survival curve and that higher dose fractions might be beneficial. High-dose fraction therapy is effective for local control of cutaneous, lymph node, and soft-tissue metastases. Results in 46 patients treated with high- or low-dose fractions for intracranial metastases over the last decade in the Melanoma Unit and Department of Radiotherapy at Yale have been examined. Twenty-six patients received high-dose fraction therapy, generally 600 rad/fraction/week to 2400--3600 rad; 20 patients received low-dose fraction radiotherapy with 125--400 rad/fraction daily. All patients were given steroids, and most received chemotherapy. Results in both groups were similar. Comparison of high- and low-dose fraction patients revealed: improvement in 38 and 35%, respectively, stability in 23 and 25%, and deterioration in 38 and 40%. Median survival was three months in the high-dose fraction group and 2 1/2 months in the low-dose fraction group. Presence of hepatic metastases had no significant influence upon median survival in patients who received high-dose fraction radiotherapy. In patients receiving low-dose fraction, survival was 2 1/4 months with and three months without hepatic metastases. Death in most patients resulted from progression of central nervous system disease. Side effects, especially headache, were more prominent in the high-dose fraction group. However, in no instance did side effects require discontinuation of therapy. The greater ease of delivery for weekly high-dose fraction radiotherapy outweighed any other difference between the regimens.

Adult↗
PubMed1982

Subsequent malignancies associated with carcinoma of the uterine cervix: including an analysis of the effect of patient and treatment parameters on incidence and sites of metachronous malignancies.

The incidence and sites of metachronous malignancies were retrospectively determined from the records of 763 patients seen at Yale University medical Center and affiliated hospitals with previously untreated, invasive carcinoma of the uterine cervix from 1953-1972. These patients were treated predominantly with radiation therapy; follow-up status was known for periods of 5-25 years or until time of death in over 96% of the patients. Forty-four patients had second malignancies noted at least 6 months after the initial cervical cancer was diagnosed. The expected incidence of second malignancies was determined from the Connecticut State Tumor Registry data controlling for year of diagnosis of the cervical cancer, patient age, sex, and time at risk (person-years exposure). To correct for any error in estimation of second malignancies introduced by the existence of a latency period for the development of a second cancer, the expected incidence of malignancies was also computed for 5-year time intervals following the cervical cancer. No significant increase in second malignancies was found (observed/expected-44/36) for the entire follow-up period nor for any individual 5-year interval. However, a statistically significant increase in lung cancer and vulva-vaginal cancer was noted and a significant decrease in breast cancer was observed. Cox regression analyses were performed to study the effect of total radium exposure and total external beam treatment, adjusting for other factors. No statistically significant increased risks were found.

Adenocarcinoma↗
PubMed1982

Ovarian cancer.

Explore the source record for details and available documents.

Carcinoma↗
PubMed1982

Combined modality therapy for advanced Hodgkin's disease: long-term followup data.

From 1969 to 1979, 155 patients with advanced Hodgkin's disease were treated with a combined modality protocol (combination chemotherapy and irradiation to all sites of disease). The actuarial 10-year survival of all patients who started therapy is 78%, and the relapse-free survival is 67%. Within the group of patients with advanced disease, age greater than 40 years and/or stage IV disease with multiple extranodal sites of involvement adversely affected prognosis. Since 1978, these patients have been treated with MOPP-ABVD and irradiation, with a resulting 3-year survival of 87% compared with 58% for those treated with MVVPP in prior years. A comparison between MVVPP and MOPP, also begun in 1978, has thus far yielded no significant differences. Second malignancies have occurred in four patients apparently cured of their Hodgkin's disease: two patients with acute leukemia and two with non-Hodgkin's lymphoma. Avascular necrosis of bone has developed in nine patients. There have not been other serious long-term complications. This combined modality treatment approach appear to offer a significant survival advantage compared with treatment programs using chemotherapy alone.

Adult↗
PubMed1982

Histologic variants of cervical involvement by endometrial carcinoma.

Examination of histologic material from 54 patients with endometrial carcinoma, in whom the pretreatment fractional curettage showed adenocarcinoma in the endocervical specimen, demonstrated 4 main patterns. These were designated as tumor separate from endocervical tissue (13 patients), true stage II (23 patients), tumor in stroma (12 patients), and tumor only (6 patients). Patients with tumor separate from endocervical tissue had a better survival rate (expressed as survival to first recurrence) than did patients in the other 3 groups, and this difference was statistically significant. No statistically significant difference between the survival of patients in the true stage II, tumor in stroma, and tumor only groups could be demonstrated. It is therefore suggested that the treatment protocol used for these 3 groups of patients be similar. Among the true stage II groups, only 3 patients had superficial endocervical involvement, whereas 15 had stromal involvement without surface tumor. Therefore, spread to the cervix in endometrial carcinoma appears to be more frequent by tissue spaces or lymphatic channels than by contiguous surface extension.

Adenocarcinoma↗
PubMed1981

Epithelial carcinoma of the ovary: current strategies.

Epithelial ovarian cancer is usually diagnosed late in its biologic course (70% of cases are diagnosed as stage III or IV). Recent advances in chemotherapy and radiation therapy offer the possibility of long-term disease-free survival and the potential for cure. The selection of treatment for disease confined to the pelvis (stage I or II) remains controversial. After total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, high risk patients probably should receive abdominopelvic irradiation or chemotherapy; the relative roles of these two modalities are currently under study. Stage III consists of cases of minimal residual disease at surgery, minimal residual disease after debulking surgery, and residual large bulky tumor masses. Patients with minimal residual disease are best treated with either abdominopelvic radiation or chemotherapy; patients with stage IV or bulky stage III disease, with chemotherapy. Despite the multiplicity of active single agents, only one study to date has shown a statistically significant improvement in survival for patients with advanced disease utilizing combination chemotherapy.

Alkylating Agents↗
PubMed1979

Subarachnoid spread of ependymoma: diagnosis and evaluation of therapy by computerized tomography.

The potential of ependymomas to spread throughout the intracranial subarachnoid space is well documented, though the incidence is disputed. This relates in part to the time required for such metastases to produce symptoms. The diagnosis of such spread, however, is important for therapeutic management. This report demonstrates the effectiveness of computerized tomography in diagnosing spread of ependymoma throughout the basal cisterns and cerebral fissures.

Adult↗
PubMed1979

Thermosensitization by sulfhydryl compounds of exponentially growing Chinese hamster cells.

The effect of various sulfhydryl compounds on the survival of exponentially growing monolayer cultures of Chinese hamster cells (HA1) heated to temperatures of 37-43 degrees was examined. Concentrations of cysteamine which were nontoxic or minimally toxic at room temperature or 37 degrees became increasingly toxic at elevated temperatures, greatly potentiating the killing produced by heat alone in the absence of cysteamine. This enhancement of hyperthermia-induced cell killing increased with increasing cysteamine concentration, increasing duration of cysteamine exposure, and increasing temperature. Studies with synchronized Chinese hamster cells heated at 43 degrees for 1 hr in the presence of 16 mM cysteamine demonstrated that the potentiation of heat killing occurred in all phases of the cell cycle. Similarly, enhancement of hyperthermia-induced cell killing was seen for asynchronous cells exposed to 2-amino-ethylisothiourium bromides and cysteine, but the magnitude of the effect differed for the various sulfhydryl compounds.

Animals↗
PubMed1970

Repair of radiation-induced damage in Escherichia coli. II. Effect of rec and uvr mutations on radiosensitivity, and repair of x-ray-induced single-strand breaks in deoxyribonucleic acid.

Strains of Escherichia coli K-12 mutant in the genes controlling excision repair (uvr) and genetic recombination (rec) have been studied with reference to their radiosensitivity and their ability to repair X-ray-induced single-strand breaks in deoxyribonucleic acid (DNA). Mutations in the rec genes appreciably increase the radiosensitivity of E. coli K-12, whereas uvr mutations produce little if any increase in radiosensitivity. For a given dose of X-rays, the yield of single-strand breaks has been shown by alkaline sucrose gradient studies to be largely independent of the presence of rec or uvr mutations. The rec(+) cells (including those carrying the uvrB5 mutation) could efficiently rejoin X-ray-induced single-strand breaks in DNA, whereas recA56 mutants could not repair these breaks to any great extent. The recB21 and recC22 mutants showed some indication of repair capacity. From these studies, it is concluded that a correlation exists between the inability to repair single-strand breaks and the radiosensitivity of the rec mutants of E. coli K-12. This suggests that unrepaired single-strand breaks may be lethal lesions in E. coli.

Centrifugation, Density Gradient↗