Biomedical subjects
H R Barber
Publications and source records attributed to H R Barber.
The postmenopausal palpable ovary syndrome.
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Current concepts in the management of ovarian cancer.
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Symposium on gynecologic cancer: foreword.
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Current status of the treatment of gynecologic cancer by site: ovary.
Cancer of the ovary is the leading cause of death from gynecologic cancer. The constant challenge presented by ovarian cancer is that about 11,000 women die from ovarian cancer each year and the results in 1974 are no better than have been achieved in the previous two decades. Standard practice of treatment for truly invasive common epithelial ovarian cancer includes total hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, and post-surgical insertion of tubes and administration of P32 (if the disease is of limited extent). Although it is occasionally necessary to resect isolated segments of bowel, exenterative or ultraradical surgery in the management of ovarian cancer is not usually chosen because of the natural history of the disease. However, aggressive surgery is indicated not so much because it is curative, but because it potentiates other forms of treatment. All stages I through IV are treated surgically, to remove as much tumor as possible without running a risk of a gastrointestinal or genitourinary fistula. Radiation therapy has been utilized in addition to the surgical therapy in stage IV to control supraclavicular and/or inguinal node involvement. Single agent alkylating chemotherapy is chosen for the treatment of common epithelial ovarian cancers. Combination chemotherapy does not produce better results at this time, except in the treatment of embryonal tumors. The treatment of the common epithelial tumors by stage is outlined. The treatment of germ cell tumors, gonadal stromal tumors, ovarian tumors in childhood, ovarian tumors in pregnancy, as well as tumors not specific for the ovary, will also be discussed.
Isolation of tumor-specific antibodies from effusions of ovarian carcinomas.
Peritoneal effusions of patients with ovarian cancer contain sizable amounts of free and complexed immunoglobulins. By means of salt precipitation procedures, antibodies were recovered that after purification and concentration displayed a high degree of specificity against ovarian carcinoma cells. In indirect immunofluorescence, immunoglobulins recovered from seven different peritoneal effusions showed bright cytoplasmic staining with tissue cultures and fresh suspensions of ovarian carcinoma cells but not of normal ovaries or non-ovarian tumors. Immunoglobulins isolated from fluids of benign ovarian cysts or from effusions of non-ovarian tumors were negative in immunofluorescence tests. Autologous antibodies recovered from peritoneal effusions will be hopefully utilized in sensitive radioimmunoassay tests that are greatly needed for the early detection of ovarian cancer, the leading cause of death from gynecologic neoplasia.
Histologic and nuclear grading and stromal reactions as indices for prognosis in ovarian cancer.
Ovarian cancer is one of the most frustrating problems in gynecology. Each year about 14,000 new cases are diagnosed in the United States and almost 11,000 patients die from their ovarian cancer. The results from treatment are no better in 1973 than they were in the previous two decades; Early diagnosis is a matter of chance rather than a scientific method. Until early diagnosis can be made and treatment instituted with predictable promise for cure, attention must be directed to study the natural history of disease, its histologic and nuclear grading, as well as the stromal reaction of the cancer. This approach should further validate end results and, in the future, help improve the survival rate in ovarian carcinoma. With these criteria, 174 fresh cases were evaluated. The study showed that undifferentiated cancers were mainly in the unfavorable histologic and nuclear grades, while the better differentiated tumors were in the more favorable group. Mucinous cancers were characterized by the greatest number of tumors with favorable histologic and nuclear grades and generally had a better survival rate. Since the potency of tumors vary within a given stage, treatment should be tailored to the cancer rather than the stage of disease; In general, stage of disease was more important than histologic or nuclear grades in determining prognosis.
Cellular immunologic responsiveness to extracts of ovarian epithelial tumors.
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The case for and against estrogen therapy.
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Electron microscopy, tissue culture,and immunology of ovarian carcinoma.
The ultrastructure of the major histologic types of ovarian carcinoma was investigated as part of a multilateral study of this tumor. The nuclear and nucleolar changes in size, shape, and structure correlated well with the degree of malignancy and tumor grading. Cytoplasmic organelles and intercellular junctions were abundant and fairly well differentiated even in ovarian carcinomas of higher grade and stage. Active processes of synthesis and secretion taking place in most of these tumors were suggested by the presence of a richly granulated endoplasmic reticulum, dilated cisternae, and numerous secretory granules. Seventy-eight different ovarian carcinomas of all histologic types were cultured in vitro for periods of up to 300 days, and their morphology in light and electron microscopy was compared to that of the original tumors. The cultures displayed a consistent pattern of growth which led to the conclusion that ovarian cancer cells in vitro preserve their salient features and are representative of the tumors of origin. Heterologous antisera raised with pooled extracts of various types of ovarian carcinomas reacted specifically in immunodiffusion and immunofluorescence tests only with ovarian carcinomas and not with normal ovaries, benigh ovarian tumors, and nonovarian malignant neoplasms, indicating the presence of a cross-reacting specific antigen for ovarian carcinomas. In other studies, autologous antibodies were isolated from antigen-antibody complexes recovered from peritoneal effusions of patients with ovarian carcinomas. These antibodies displayed a high degree of specificity against ovarian carcinoma cells when tested in immunofluorescence assays.
Cancer of the endometrium.
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Current concepts in cancer: updated cervix cancer III. Stages III and IV. Management of failures and complications of cancer of the cervix.
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Ovarian cancer in children--guide for a difficult decision.
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Ovarian cancer: Part I.
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New frontiers in ovarian cancer diagnosis and management.
Ovarian carcinoma is now the leading cause of death among women. Surgery has reached its limits, and further aggressive surgery will result in an inordinate morbidity and mortality. Ovarian carcinoma is ideally treated by complete surgical removal of the cancer, followed by anti-cancer chemotherapy. Since it is often impossible to remove all of the cancer, adjunctive chemotherapy is playing an increasingly important role in the management of the cancer. New anti-cancer drugs must be found or synthesized, and new combinations of current anti-cancer drugs with mechanisms to protect the bone marrow must be explored. The field of genetics and the identification of the patient at high risk because of a familial history of ovarian cancer must be expanded. The role of tumor markers and oncogenes requires more in-depth study so that these signs can play a greater role in monitoring and identifying the patient with early ovarian cancer. The emerging fields of genetic engineering and biologic response modifiers are opening up new avenues for additional modalities of therapy. The expanding areas of research in cancer are starting to dispel the doom and gloom of the last three decades with a spirit of optimism for the diagnosis and treatment of ovarian cancer, as the new century approaches.