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Biomedical subjects

M Deutsch

Publications and source records attributed to M Deutsch.

At least 235 records · Page 13Linked to original sources
PubMed1986

Radiation therapy for local-regional recurrent breast carcinoma.

One hundred seven women with recurrent breast carcinoma involving the chest wall and/or regional lymph node regions were treated with radiotherapy between 1970 and 1979. Local-regional tumor was the initial and only evidence of recurrent breast carcinoma in all cases. Forty-seven patients had their disease confined to the chest wall alone and sixty (56%) patients had chest wall involvement as some component of their local-regional recurrent disease. Within five years after the initial mastectomy, 80.5% of recurrences were manifested. All patients had radiotherapy to at least the site of involvement. Eighty-four patients (78.5%) had a complete response. The absolute 5-year survival of all patients following local-regional recurrence was 34.6%. Five year survival was 29% in those patients who had recurrence within 5 years of the original mastectomy. For those patients whose local-regional recurrence occurred after a 5-year disease-free interval, the subsequent 5-year survival was 57%. For patients with recurrence confined to the chest wall, subsequent 5-year survival was 48.9%. Patients who had supraclavicular involvement as part of their local-regional recurrence had only a 16.1% 5-year survival. The majority of patients developed distant metastasis. Twenty-two patients developed carcinoma of the contralateral breast following local-regional recurrence. Five year survival following local-regional recurrence was only 4.3% for patients whose initial treatment for their primary breast carcinoma was surgery and adjuvant chemotherapy. For those patients whose primary breast carcinoma was treated by surgery alone or surgery and post-operative radiotherapy, the 5-year survival following local-regional recurrence was over 40%.

Breast Neoplasms↗
PubMed1986

Influence of irradiation of a primary tumor on the labeling index and estrogen receptor index in a distant tumor focus.

The present investigation reaffirms our observation that removal of a C3H mouse mammary adenocarcinoma results in a perturbation of tumor cells in a metastatic focus. An increase occurs in the proportion of cells undergoing DNA synthesis (labeling index, LI), and a decrease occurs in the proportion demonstrating estrogen receptor (ER index; ERI). The changes are transient but of sufficient duration and magnitude to produce an increase in the size of a distant tumor. This study was conducted to determine whether cytoreduction of a primary tumor by irradiation would produce a similar change in metastatic tumor cells and whether preoperative radiation would obtund the effect of primary tumor removal. The administration of a maximum tolerated dose of radiation (50 Gy) to a primary tumor produced a significant (p less than 0.001) increase in LI and decrease in ERI of a lesser magnitude than that observed following surgical removal of the primary tumor, but still sufficient to enhance the growth of a metastatic focus. Whereas, there was almost a 50% increase in LI in a metastasis 1 and 3 days following removal of a primary tumor the increase was only 13% three days after radiation. There was a 20% decrease in ERI 3 days following radiation and a 37% decrease at that time following tumor removal. Preoperative irradiation of a primary tumor 1, 3, or 5 days prior to tumor removal, obtunds the increase in LI and decrease in ERI following operation. Radiation the day before surgery was most effective because the changes in a distant focus occurring as a result of the radiation and of the surgery were prevented. The clinical relevance of these observations deserves further consideration.

Animals↗
PubMed1986

Connective tissue polarity. Optical second-harmonic microscopy, crossed-beam summation, and small-angle scattering in rat-tail tendon.

Connective tissue polarity has remained an intractable enigma for over two decades. We present new data on optical second harmonic generation in native, wet, rat-tail tendon. Scanning second-harmonic microscopy has revealed, for the first time, the existence of a discrete network of fine, polar, filamentous or columnar, structures, and, also, the presence of strongly polar surface, or near-surface patches. The thickness of these features was probed via crossed-beam optical frequency summation and the polar material is estimated to occupy a few percent of the tendon volume. The three-dimensional spatial distribution of filaments was studied with the aid of small-angle second-harmonic scattering, and the filaments were found to permeate the tendon cross-section in an apparently random fashion. These latter measurements also revealed that essentially all polar filaments had the same directionality. Concomitant studies of the polar collagen fibrils that comprise the bulk of tendon were in full accord with prior electron microscope results that had demonstrated that the directionality of these fibrils varies up/down in a purely random fashion, and thus cannot yield a net macroscopic polarity. Quantitative analysis of the second-harmonic data yields the conclusion that the observed polar structures cannot be simply local regions containing some accidental net excess of similarly oriented fibrils. The analytical expressions used in the analysis of the data obtained for this complex tissue were supported by extensive, realistic computer simulations. The discovery that the polarity of rat-tail tendon, and possibly other forms of connective tissue, resides in discrete structures, some of which are located near the tendon surface, should permit the ready isolation of polar-rich material for further study by a variety of techniques.

Animals↗
PubMed1986

Transbronchial radioactive implantation using a Flexible Injector System. An improved technique for endobronchial brachytherapy.

A new implantation device for endobronchial brachytherapy is described. This implantation system is flexible and can be easily passed through the suction channel of a flexible bronchofiberscope (FBF) for radionuclide implantation of the tumor. All four patients implanted using this system, experienced excellent palliation of their symptoms. We think that the flexible system described is an improvement over the rigid system for endobronchial implantation in most patients.

Brachytherapy↗
PubMed1986

Paraocular lymphoid tumors.

Forty-two patients with paraocular lymphoid tumors were treated with radiation. Histologically, 20 tumors were classified as benign lymphoid hyperplasia (BLH), ten as indeterminate histology (IH), and 12 as malignant lymphoma (ML). Of the patients with an initial diagnosis of BLH or IH, disseminated ML developed in 23%. Cytologic and histologic studies were not helpful in predicting the malignant potential in some of these tumors. The possibility that BLH represents a premalignant condition with subsequent transformation into ML is discussed. A total of 45 eyes were irradiated in these 42 patients. Initial local control rate was 93%, with ultimate control rate of 100% after retreatment with radiation or surgery. Radiation therapy is the treatment of choice for these tumors; local control rates are high, and morbidity is minimal with proper radiation treatment planning.

Aged↗
PubMed1985

Myelography for staging medulloblastoma.

Thirty-eight patients with newly diagnosed medulloblastoma were studied with myelography and cerebrospinal fluid (CSF) cytology studies before radiotherapy. Seventeen (45%) patients had evidence of dissemination beyond the posterior fossa. Spinal cord lesions were demonstrated in ten patients (26%). Negative results of CSF cytology studies did not preclude demonstration of cord involvement. Children younger than 5 years were more likely than older patients to have spinal cord involvement at diagnosis. Patients who were truly M-0 did better in terms of absolute survival but not relapse-free survival when compared with patients with dissemination. Myelography and cytology studies are necessary in the evaluation of all newly diagnosed patients with medulloblastoma and may also be indicated for patients with other brain tumors with a known propensity for dissemination.

Cerebellar Neoplasms↗
PubMed1985

Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.

In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3 per cent of women treated with radiation remained free of breast tumor at five years, as compared with 72.1 per cent of those receiving no radiation (P less than 0.001). Among patients with positive nodes 97.9 per cent of women treated with radiation and 63.8 per cent of those receiving no radiation remained tumor-free (P less than 0.001), although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor.

Breast Neoplasms↗
PubMed1985

Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.

In 1971 we began a randomized trial to compare alternative local and regional treatments of breast cancer, all of which employ breast removal. Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months. There were no significant differences among three groups of patients with clinically negative axillary nodes, with respect to disease-free survival, distant-disease--free survival, or overall survival (about 57 per cent) at 10 years. The patients were treated by radical mastectomy, total ("simple") mastectomy without axillary dissection but with regional irradiation, or total mastectomy without irradiation plus axillary dissection only if nodes were subsequently positive. Similarly, no differences were observed between patients with clinically positive nodes treated by radical mastectomy or by total mastectomy without axillary dissection but with regional irradiation. Survival at 10 years was about 38 per cent in both groups. Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival. The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years. We conclude that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer.

Breast Neoplasms↗
PubMed1985

Tumour specificity of the SCM test for cancer diagnosis.

Phytohaemagglutinin (PHA), a well-known mitogen, and encephalitogenic factor (EF) are recognized by lymphocytes of patients with different malignant diseases as non-specific antigens. Utilizing these two antigens, the SCM (structuredness of the cytoplasmatic matrix) test offers a means of discrimination between malignant and non-malignant diseases. The SCM test can also be used as a specificity test since lymphocytes from donors with a given malignant disease react exclusively with the tumour-associated antigen (TAA) of that disease. Results from 73 donors (15 healthy patients, 38 patients with different types of malignant disorders and 20 patients with autoimmune diseases) indicate the predictive value of the test. First, the non-specific test was applied in order to establish whether the patients suffered from an active malignant disease. The lymphocytes of those patients which were found to suffer from an active malignant disorder were then exposed to different types of tumour tissues. Twenty-five out of the 38 patients with malignant disorders were found by the SCM test to have an active disease. The lymphocytes of 24 out of these 25 patients showed a positive reaction when exposed to tumour tissue of the same type of cancer of which they were found to suffer by other clinical tests, and displayed no reaction with any other tumour tissues for which they were tested. One patient, with an inconclusive value of the SCM test, showed no reaction with any type of tumour to which he was exposed. The remaining 13 patients, who were diagnosed by the test as non-cancerous, did not show any clinical evidence of malignancy at the time of the test, after their tumours had been excised. Eighteen out of 20 patients with autoimmune diseases showed negative results when tested by the general test and by the various specificity tests.

Antigens, Neoplasm↗
PubMed1985

Primary cancers of extrahepatic biliary passages.

We analyzed the records of 22 patients with cancers of extrahepatic biliary passages (EHBP) to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From our data, it is difficult to comment on the effectiveness of chemotherapy. We have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

Adenocarcinoma↗
PubMed1985

The potentials of the saphenous vein in reconstructive surgery of the arteries--state of the art.

In femoro-popliteal reconstructions proximal to the knee joint alloplastic and heteroplastic material are being used increasingly instead of the autologous vein, even though the latter is still unmatched for quality. The 5-year patency rate of reconstructions with autologous vein in stage III and IV is significantly better compared to that obtained with implanted alloplastic material. It is well worth mentioning that the saphenous vein graft is superior to all other vascular substitutes with regard to morphological qualities and biocompatibility. Even though degenerative changes occur, these can be repaired by surgical procedures in about one third of the cases. In stage III and IV of atherosclerotic occlusive disease of the lower extremity, a more aggressive mode of reconstruction like jump grafts or sequential bypasses significantly improves the long-term results and minimizes the need for extensive amputations.

Aged↗
PubMed1985

Immunofluorescent studies of the endometrial arteries in the first trimester of pregnancy.

Endometrial spiral arteries from curetted endometrium of 110 first-trimester pregnancies were studied by immunofluorescent (IF) technics using antibodies against human G, M, and A immunoglobulins, C3, C4, and fibrinogen. Heavy deposition of C3 in the arterial walls was found in 16 (14.6%) cases. Immunoglobulins, C4, and fibrinogen were found in only a few cases, and their staining was weak and not considered in this study. There was also a statistically significant (P less than 0.01) higher deposition of C3 in arterial walls of primipara (14 of 52), as compared to multipara (2 of 58). The possible mechanisms of C3 deposition and the importance of the higher incidence of this deposition in primipara are discussed in relation to suggested immunologic pathogenetic alterations in preeclampsia.

Arteries↗