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Biomedical subjects

J L Lewis

Publications and source records attributed to J L Lewis.

At least 271 records · Page 15Linked to original sources
PubMed1980

Malignant melanoma of the vagina--report of 19 cases.

Sixteen previously unreported cases of primary vaginal melanoma were studied, 8 from the Memorial Sloan-Kettering Cancer Center (1935 to 1976) and 8 from the Connecticut Tumor Registry (1934 to 1976). In addition, 3 previously reported cases from the former institution are updated. Local control was obtained by means of primary radical surgery in 5 of 7 patients, 3 of whom are known to have subsequently died of disseminated disease. One patient initially treated with radical surgery had a local recurrence with metastasis to a regional node, but has now survived for more than 14 years following a second radical surgical procedure. Eight patients were treated primarily with radiotherapy, and 6 have died with metastatic melanoma; another died following pelvic exenteration for persistent local disease. Only 1 patient showed evidence of transient control after radiotherapy, but this patient had a local recurrence 36 months later and died with metastases. The overall 5-year survival rate for these 19 patients was 21%.

Adult↗
PubMed1979

Dysgerminoma of the ovary.

From 1938 to 1977, 21 patients with pure dysgerminoma were treated at Memorial and James Ewing Hospitals, now Memorial Sloan-Kettering Cancer Center. Twelve patients were considered to have their initial therapy begun or completed at our institution. Eleven (91.7%) of 12 patients were found free of disease from 2 to 38 years (median 6 years). Nine patients were referred with recurrent disease. Only 4 (45%) could be salvaged 2 to 21 years (median 9 years). Because of the lower survival rate in the treatment of recurrent disease in this series, it is difficult to advocate overly conservative therapy initially in all early lesions. The survival rate depends on the original size of the tumor, initial adequate staging and appropriate therapy based on the extent of disease. Recommendations for a treatment protocol are proposed.

Adolescent↗
PubMed1978

Dislocations after total hip-replacement arthroplasties.

In a series of 300 total hip replacements, nine (3 per cent) dislocated. Precise measurements of the orientation of the acetabular cup were made and it was found that anterior dislocations were associated with increased acetabular-component anteversion. There was no significant correlation between cup-orientation angle and posterior dislocation. The dislocation rate for cup orientation with anteversion of 15 +/- 10 degrees and lateral opening of 40 +/- 10 degrees was 1.5 per cent, while outside this "safe" range the dislocation rate was 6.1 per cent. Other factors that were documented include time after surgery (with the greatest risk in the first thirty days) and surgical history (with a greater risk in hips that have had prior surgery).

Adult↗
PubMed1978

The number of total joint replacements in the United States.

By comparing estimates from several sources an assessment can be made of the number of total joint replacement procedures performed annually in the United States. Approximately 80,000 hips and 40,000 knee joints were replaced in the U.S. during 1976. Total hip replacement has been accepted by the orthopedic community as an efficacious mode of treatment of the many painful and disabling forms of arthritis. A substantial patient population could benefit from perfection of designs for treating joints other than the hip.

Hip Joint↗
PubMed1977

Intravenous Corynebacterium parvum: an adjunct to chemotherapy for resistant advanced ovarian cancer.

This is a prelimianry report of an effort to treat women with advanced (Stage III and IV) ovarian cancer who had progressive disease in spite of previous surgery, chemotherapy and/or radiation by a program of reductive surgery, intensive immune stimulation and combination chemotherapy. An initial laparotomy was done where possible to reduce tumor burden, and then all patients were given intravenous corynebacterium parvum (C.P.) in escalating doses over a 10- to 14-day period. Cyclic chemotherapy with Cytoxan, adriamycin and 5-fluorouracil (CAF) was started and repeated monthly. Maintenance subcutaneous C.P. was given weekly. All patients had frequent follow-up clinical and laboratory examination. Immune function was measured by skin tests and in vitro tests prior to treatment and periodically during therapy. Two-thirds of the patients had depressed DNCB and PHA stimulation responses prior to treatment, and almost all had severely depressed lymphocyte counts. Thirty-nine patients entered the program. Exploratory laparotomy was done in 16 patients and in eight, successful tumor reduction was accomplished. Eleven patients received intravenous C. Parvum and all expired before receiving chemotherapy. Four patients received C. Parvum and less than three cycles of CAF; all expired within 2 months. Twenty-four patients received C. Parvum and less than or equal to three cycles of CAF. Four patients had complete regression of measurable disease and were living free of disease 9-12 months after starting CAF. Eight patients had more than 50% regression for a minimum of 3 months, and five were living with disease (LWD) 5-11 months. Five patients had 25% to 50% regression and three were LWD 4-8 months. Seven patients had no regression and all expired within 4 months. Of eight patients who had successful reductive surgery prior to treatment, three were free of disease, median of 10 months, and five had partial responses and were living with disease, a median of 9 months. Although pre-treatment immune function was better in the patients who had a good response to CP and CAF (10 of 12 were DNCB+) vs that in patients with a poor response (4 of 12 were DNCB+) immune function was not significantly improved during therapy. The initial treatment results in this program are encouraging and suggest that this approach may be useful in patients with earlier disease.

Adult↗
PubMed1977

Stage II endometrial adenocarcinoma. Memorial Hospital for Cancer, 1949-1965.

Of 617 patients receiving initial therapy for endometrial adenocarcinoma from 1949 to 1965, 90 patients were retrospectively assigned to Stage II (FIGO) by reviewing preoperative, operative, and pathologic findings. In 66 patients (73%) the cervical spread of endometrial cancer was occult and detected only microscopically in the hysterectomy specimen, whereas in the other 24 (27%) it was detected clinically prior to surgery. The survival rate for patients with occult cervical involvement was better (61%) than in those patients with gross cervical spread of tumor (48%), but the difference was not statistically significant. When the surgical specimen revealed that the only spread was to the cervix, those having only occult spread had a better 5-year corrected survival rate (89%) than those with grossly detectable spread (57%). Spread of tumor beyond the uterus occurred in over one-third of the patients with each kind of cervical spread. Study of lymphadenectomy specimens in 31 patients revealed a similar incidence of lymph node metastases for both groups: 25% in those with grossly detectable spread and 21% in those with occult spread. Only 1 of the 7 patients with positive pelvic lymph nodes had clinically positive paraaortic nodes in addition to the positive pelvic nodes. Thus, only 1 of the 31 patients having the stnadard pelvic lymph node dissection was found to have paraaortic metastasis, as it was routine to sample only clinically positive paraaortic lymph nodes. These data suggest that in Stage II endometrial adenocarcinoma both gross and occult cervical involvement have a relatively bad prognosis and require aggressive therapy.

Adenocarcinoma↗
PubMed1976

Clear cell adenocarcinoma of the cervix and vagina. A clinicopathologic study of 21 cases with and without a history of maternal ingestion of estrogens.

Twenty-one cases of clear cell adenocarcinoma of the cervix and vagina have been reviewed. Fifteen cases occurred in females under 25 years of age and four in women over 45 years. In seven cases, a positive history of maternal ingestion of diethylstilbestrol (DES) was obtained. One mother gave a history of medication with conjugated estrogens and ethisterone. Of the 13 patients with a negative history, three were born during the time period when DES was commonly used to prevent abortion. Fifteen carcinomas were cervical in origin; seven of these also involved the vagina. In six cases the carcinoma was entirely vaginal. Vaginal involvement of the carcinomas was more common in the estrogen-related group. Two non-estrogen-related cases had coexisting congenital malformations with double uterus and vagina and unilateral renal agenesis. The histopathologic appearance was similar in both groups. In most cases, a mixture of papillary, microcystic, tubular, and solid features was seen. Vaginal adenosis was found in nine cases, six of which were estrogen-related. Surgical therapy was employed in most cases and was generally superior to radiation therapy. Five patients had lymphatic involvement. All died from carcinoma. The survival rate among sixteen patients followed for 2 years or more was 62.5%. The probable müllerian origin of clear cell adenocarcinoma is discussed. It is suggested that DES, by virtue of being an estrogen, interferes with the normal process of differentiation and degeneration of müllerian epithelium in the fetal vagina. The persistence of müllerian cells altered at the subcellular level could form the basis for development of carcinoma in later life. However, a similar sequence of events must also be accepted to occur "spontaneously" since clear cell adenocarcinoma can develop in women without a history of maternal estrogens.

Adenocarcinoma↗
PubMed1976

Malignant ovarian tumors in childhood: prognosis in relation to initial therapy.

Twenty-two children with malignant ovarian tumors (12 malignant teratomas, six endodermal sinus tumors, and four embryonal carcinomas) were studied from 1960 through March 1975. Comparison is made between different modalities of therapy, such as surgery alone or surgery in combination with either radiation or chemotherapy. Because of the poor results obtained with the aforementioned treatment methods, a new approach, consisting of more aggressive initial surgery followed immediately by radiation therapy and an intensive chemotherapeutic regimen called the T2 protocol, was begun in 1971 with encouraging results. To date six of ten patients are alive and free of disease with a median observation period of 22+ months. A new grouping defining the extent of disease is also provided. Of the ten patients on the T2 protocol, only one was a Group I; eight were Group III and one was Group IV at the time treatment was initiated. An analysis of the mode of spread, as well as a discussion of the results obtained with previous modalities of therapy in relation to initial grouping and pathology, constitute the background for the proposed treatment.

Adolescent↗
PubMed1976

Current status of treatment of gestational trophoblastic disease.

A brief summary is given of the developments leading to the current status of treatment of gestational trophoblastic neoplasms, both nonmetastatic and metastatic. Hydatidiform mole has been identified as the precursor type of pregnancy in approximately 50% of those women developing metastatic disease. The other half developed this as consequences of either a full-term delivery or some type of abortion. Sensitive assays for human chorionic gonadotropin (HCG) are needed in the diagnosis, management, and follow-up of these patients. Current therapy is outlined: nonmetastatic disease receives single agent chemotherapy with methotrexate or actinomycin D, with approximately 100% cure and 90% retention of reproductive function; metastatic disease, "low risk", receives single agent chemotherapy with the same drugs, with an expected cure rate of 95-100%; metastatic disease, "high risk", receives initial therapy with multiple agent chemotherapy, with a cure rate of approximately 75%. Current unresolved questions are discussed briefly.

Choriocarcinoma↗
PubMed1976

Endodermal sinus tumors of the ovary in children. The role of radiation therapy in relation to the clinical course.

Endodermal sinus tumor of the ovary in children has been characterized by its general resistance to therapy and its almost uniform fatality. The multidisciplinary treatment of 5 such cases is described. The author's experience suggests that these tumors are responsive to irradiation. The rationale for a combined approach is discussed, and radiation treatment volumes and doses are suggested.

Adolescent↗