Malignant melanoma.
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Biomedical subjects
Publications and source records attributed to H Storck.
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The prognosis for malignant melanoma is dependent on the stage of the disease, sex, size respectively depth of penetration, structure (lentigo maligna melanoma, superficial spreading melanoma, nodular melanoma), location and age of the patient when the disease begins. The method of conventional treatment (X-ray then excision, excision then X-ray, X-ray alone, excision alone) is not important. The decisive factor is early diagnosis (histology) and early treatment (total excision of the tumor). The value of additional immunotherapy and chemotherapy in cases diagnosed early cannot yet be judged. Melanoma is rarer among colored races than among whites, and the frequency of the disease among Caucasians increases as one approaches the equator. Morbidity and mortality are rising throughout the world. The influence of factors such as trauma and sunlight is disputed.
The 3-, 5- and 10-year survival rates in 353 well documented cases of malignant melanoma in stages I, II and III are discussed in relation to condition of the patient when the disease was diagnosed, methods of treatment and the histological classes of CLARK and MIHM. The different forms of therapy (X-ray followed by excision, excision followed by X-ray, X-ray alone, excision alone) produce similar recovery rates. Significant differences observable are due to variations in the patients' condition (differences in the malignancy index). Histological classification confirms the benign nature of lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) in comparison with nodular melanoma (NM).
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A second clinical trial of the compound Ro 6-0787, which is a specific monovalent penicilloyl hapten inhibitor of allergic reactions to penicillin has been conducted by investigators from 9 different European groups in 90 patients allergic to penicillin. The effect of a combined Ro 6-0787-penicillin therapy was considered as clinically successful in the large majority of cases, since treatment with penicillin could be pursued or resumed without allergic manifestation in 42 from 46 cases (91 percent). The effect of Ro 6-0787 alone on acute allergic manifestations after interruption of penicillin therapy was more difficult to evaluate but was nevertheless considered satisfactory in 17 from 26 patients (65 percent). A depression of skin hypersensitivity to PPL and/or penicillin and penicillin derivatives sometimes persisting for weeks and months was obvious in numerous allergic patients submitted to combined Ro 6-0787-penicillin treatment. A depressing effect on antipenicillin antibody titers detected by passive hemaglutination was also manifest in some patients. Failure to suppress allergic manifestations was reported in 11 cases, among which some may have been due to insufficient dosage of inhibiting hapten. The overall tolerance of Ro 6-0787 in allergic patients has been very good. Nevertheless, the major obstacle to a wider general use of Ro 6-0787 at the present time appears to be the occurrence of positive skin reactions to that compound in approximately 5 percent of patients allergic to penicillin. It is not yet ascertained whether the occasional positive skin reactions and urticaria to Ro 6-0787 may have been due to aggregation, or incomplete dissolution of the compound or whether it reflects hypersensitivity to another antigenic determinant. With the reservation that patients with positive skin test to Ro 6-0787 have for the time being to be excluded from combined treatment, this monovalent hapten certainly offers a new possibility to resume and/or pursue penicillin therapy in patients demonstrably allergic to that drug.
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