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Biomedical subjects

M E Randall

Publications and source records attributed to M E Randall.

53 records · Page 3Linked to original sources
PubMed1989

A new, rapid safe method for local radiation of intrathoracic sites.

A technique for intraoperative, intrathoracic placement of afterloading catheters for post-thoracotomy radiation therapy is described. This technique offers speed and simplicity and requires no advance planning of radiation therapy. It uses materials that are readily available in operative theaters and radiation oncology units. No radiation exposure of operating room personnel is involved. It also avoids the mechanical problems of crimping and dislodgment associated with the traditional method of individual placement of small afterloading catheters for local radiation therapy. Isodose curves derived from radiographs showing postsurgical source positions demonstrated that it was possible to achieve a uniform therapeutic radiation dose distribution to the chest wall at the site of desired radiotherapy.

Adenocarcinoma↗
PubMed1988

Results of the radiotherapeutic management of carcinoma of the cervix with emphasis on the influence of histologic classification.

The histology of 365 of 396 patients (92%) treated with radiation therapy at the University of Virginia from 1968 to 1978 has been reviewed. Staging and treatment policies were consistent throughout this period, and have enabled the influence of histologic classification on treatment results to be evaluated. Large cell nonkeratinizing carcinoma (LCNK) was the most common type, 69%; followed by keratinizing (KSCC), 13%; and adenocarcinoma, 6.6%. Other varieties included adenosquamous, 3.6%; small cell undifferentiated carcinoma, 2.7%; papillary squamous, 1.6%; and glassy cell, 1.4%. Overall survivals by stage were similar to those reported from other centers. When examined by histologic type, the 5-year survival rates ranged from 64% for adenosquamous to 13% for small cell. The most common varieties, LCNK and KSCC, had survival rates of 61% and 40% (P = 0.008). Considering both stage and histologic type, the differences between LCNK and KSCC persisted and were significant for Stage IIB (P = 0.023). Of particular interest are the poor results in small cell carcinoma and adenocarcinoma, except in the earliest stages, and the good results for adenosquamous carcinoma. The patterns of failure by histologic type showed that local failures were higher in cases of KSCC than in LCNK, indicating a probable difference in radiosensitivity. Distant spread was similar for both types. Both small cell carcinoma and adenocarcinoma showed high rates of distant spread and local failure except in the early stages. Considering survival and failure rates, three prognostic groups could be identified. In descending order of curability these were: 1) LCNK and adenosquamous carcinoma; 2) KSCC, papillary squamous carcinoma, and adenocarcinoma; and 3) small cell carcinoma and glassy cell carcinoma.

Brachytherapy↗
PubMed1988

Afterloaded radiation carrier for carcinoma of the palate. A clinical report.

Although every brachytherapy procedure is individualized, similar factors must be considered for each patient. Dental prostheses with modification may be useful in brachytherapy for managing selected patients with malignancies of the oral cavity. The prosthesis described in this article allowed an irregular surface to be treated with a relatively uniform radiation dose, while minimizing radiation exposure to uninvolved tissues and medical personnel. Whereas uniformity of dose is usually desirable in brachytherapy, it assumed even greater importance for this patient because of previous RT.

Brachytherapy↗
PubMed1988

Spinal cord compression due to extramedullary hematopoiesis in thalassemia: long-term follow-up after radiotherapy.

Spinal cord compression as a consequence of mass lesions due to extramedullary hematopoiesis is a well-described but rare syndrome occurring in thalassemia and some other hematologic conditions. After low-dose radiotherapy alone, a rapid and durable response occurred in a patient with thalassemia. No side effects were encountered and the patient has been stable neurologically for over 7 years since treatment. The results of the current case, and those previously reported in which radiotherapy alone was given, suggest that low-dose radiotherapy should be considered as a primary treatment modality for the management of this syndrome, at least in patients with thalassemia.

Adult↗
PubMed1988

Whole abdominal radiotherapy following cytoreductive surgery and chemotherapy in ovarian carcinoma.

Persistent or recurrent disease following surgery and chemotherapy in ovarian carcinoma remains a major therapeutic dilemma. Between January 1980 and December 1985, there were 26 patients who had previously undergone cytoreductive surgery and chemotherapy and were treated with external beam radiotherapy. Twenty-one of these patients had been treated with platinum-adriamycin-cytoxan (PAC) regimen and 5 were treated with other combinations. Surgical reevaluation was performed in 21 of the 26 patients and only 4/21 (19%) patients were free of disease. All 26 patients were irradiated with a planned dose of 2500 cGy/100 cGy/day or 2280 cGy/120 cGy/day to the whole abdomen and a final calculated dose to the pelvis of 4500 cGy. Initial evaluation showed a 3-year actuarial survival rate of 51% and a disease-free survival rate of 42%. Follow-up analysis yields survivals of 45 and 35%, respectively. Severe gastrointestinal complications were observed in 3/26 patients and all hematologic complications resolved. Variables of prognostic significance were chemotherapy tolerance, grade, and volume of residual disease. We conclude that a proportion of patients with disease following cytoreductive surgery and chemotherapy may be salvaged with abdominopelvic irradiation.

Abdomen↗
PubMed1986

Uncommon variants of cervical carcinoma treated with radical irradiation. A clinicopathologic study of 66 cases.

Although certain histologic types are uncommon in cervical carcinoma, these tumors as a group comprise almost one in five patients. The present study throws some light on the therapeutic approaches that are appropriate. From 1968 through 1978, 396 patients with carcinoma of the cervix were treated primarily with radiation therapy, at the University of Virginia Medical Center. The treatment policy remained consistent throughout the study interval. Diagnostic pathologic material was reviewed and uniformly classified in 365 cases (92.2%). Over 80% were invasive keratinizing or nonkeratinizing squamous cell carcinoma. There were 66 patients with uncommon histologic types including 24 adenocarcinomas (6.6%), 13 adenosquamous carcinomas (3.6%), 10 small cell carcinomas (2.7%), 6 papillary squamous carcinomas (1.6%), 5 glassy cell carcinomas (1.4%), and 8 miscellaneous types (2.2%). These 66 patients form the basis for this report. Five-year survival rates and causes of failure are presented along with management recommendations.

Adenocarcinoma↗
PubMed1986

Papillary squamous cell carcinoma of the uterine cervix: a clinicopathologic study of nine cases.

Papillary squamous cell carcinoma (PSCC) of the uterine cervix is an infrequently described subtype of cervical malignancy. Nine cases of PSCC encountered at the University of Virginia Medical Center are reviewed. The clinical course of these patients, including a propensity for late metastases and recurrences, appears distinctive. The papillae of PSCC are lined by dysplastic cells, unlike verrucous carcinoma. PSCC may exist in an in situ state, and demonstration of invasion, when present, requires deep biopsies or cervical conization. Therapy for PSCC appears to be the same as for ordinary squamous cell carcinoma of equivalent clinical stage.

Adult↗
PubMed1985

Lymphoepithelioma-like carcinoma of the uterine cervix. A distinctive, undifferentiated carcinoma with inflammatory stroma.

Two cytologically uniform, light-microscopically undifferentiated carcinomas of the uterine cervix are described. The tumors were morphologically identical to nasopharyngeal lymphoepitheliomas, including the presence of an intense inflammatory stromal reaction with prominent lymphocytes, eosinophils, and plasma cells. One neoplasm occurred in a 29-year-old, was clinically Stage IB, and was successfully treated with radiation therapy, with 10-year disease-free follow-up. The second tumor developed in a 58-year-old, was clinically Stage IIIB, and resulted in the patient's death 17 months after diagnosis. When the malignant cells in these tumors were widely separated by inflammation, they could be easily overlooked or confused with lymphoproliferative lesions. Immunocytochemical stains were performed on one case. The tumor cells stained strongly for keratin and epithelial membrane antigen, but were negative for leukocyte common antigen, verifying their epithelial nature. Until the biologic behavior of this cytologically distinctive tumor is more clearly understood, it should be separated from conventional cervical cancers with prominent stromal inflammation.

Adult↗
PubMed1985

Palatal anteversion as part of the iniencephaly malformation sequence.

We describe a fetus with hydrocephalus and the cranial and cervical findings of iniencephaly (enlarged foramen magnum, fusion of the upper cervical vertebrae, and a retroflexed, webbed neck) who had an unusual palatal abnormality ("palatal anteversion"). The posterio-lateral border of the secondary palate arose at the oral commissures, giving the palate an appearance of being folded so that the uvula was directed anteriorly. There were no clefts. Histologic sections of the junction of the secondary palate with the inner aspect of the oral commissures revealed continuity of the epithelial basement membranes and no unusual disarray of collagen fibers. This indicates that the unusual palatal orientation occurred during palatal formation and was not due to adhesion formation later in development. Failure of rotation of the palatal shelves prior to fusion and merging could account for the observed findings.

Abnormalities, Multiple↗
PubMed1977

Catecholamine metabolism during heroin use.

The authors examined urinary levels of catecholamines and metabolites during a 10-day period of heroin use in 9 subjects. Catecholamine and metabolite excretion increased over baseline values on the first day of heroin use, but markedly different patterns of change emerged later. In contrast to the significant increase in normetanephrine and decrease in metanephrine excretion in all 9 subjects during heroin use, only 4 subjects showed an increase in 3-methoxy-4-hydroxyphenyl glycol (MHPG) excretion. Moreover, it appeared that the increase in MHPG excretion in this subgroup began on the day before heroin administration, which suggests the possibility of an anticipatory or conditioned response.

Catecholamines↗
PubMed1975

The effects of heroin on catecholamine metabolism in man.

In a study of the effects of heroin administration in nine human subjects, urinary catecholamines and metabolites were examined during an initial drug-free baseline period, a ten-day period of heroin administration and a subsequent period of methadone detoxification. All catecholamines and metabolites tended to be increased over baseline values on the first day of heroin administration. However, markedly different patterns of change emerged on subsequent days of heroin administration. Norepinephrine and normetanephrine remained increased throughout heroin administration. Epinephrine was increased during the early phase of heroin administration but returned to baseline values during the latter phase of heroin administration. After the increase on the first day of heroin administration, metanephrine decreased and substantial decrements below baseline values occurred during the latter phase of heroin administration. After increasing on the first day of heroin administration, 3-methoxy-4-hydroxy-mandelic acid (VMA) returned to approximately baseline values. During heroin administration, an increase in 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion was observed in a subgroup of four of the nine subjects studied. This is in contrast to the increase in normetanephrine excretion and the decrease in metanephrine excretion that was observed in the entire group of nine subjects. It is conceivable that persistance of, or development of, tolerance might account for the failure to observe an increase in MHPG excretion in all of the subjects. It appeared as if the increase in MHPG excretion began on the day prior to the administration of heroin in the subgroup of patients with increased MHPG excretion during heroin administration, suggesting the possibility of an anticipatory or conditioned response, with the anticipation of heroin producing an increase in MHPG excretion.

Catecholamines↗
PubMedDate not supplied

Interstitial radioactive implants for oral and oropharyngeal cancer: dentistry's role.

Five patients with oral or oropharyngeal cancer were treated with external beam radiation therapy and interstitial radioactive implants as part of their tumor management. The radiation oncologists used various radioisotopes and techniques for placement. Local anesthesia, and in most cases conscious sedation, were used instead of general anesthesia to insert the implants. The dental team, working in conjunction with the radiation oncologists, was able to provide this service which resulted in safe, cost-effective care for the patients.

Aged↗
PubMedDate not supplied

Radiotherapy in epithelial ovarian cancer: state of the art.

Modern advances in surgery, chemotherapy (CT) and radiotherapy (RT) have not, unfortunately, impacted the overall survival for patients with ovarian cancer (OC). Despite its long history in the treatment of OC and its proven curative role in patients with microscopic or minimal residual disease, the proper role of RT in the management of OC is controversial and not clearly established. Similarly, the potential roles of RT in the consolidative treatment and as salvage therapy following CT failure remain controversial. In the present review current issues in the radiotherapeutic management are discussed along with possible future clinical research directions.

Carcinoma↗
PubMedDate not supplied

Relapse in the skull after myeloablative therapy for high-risk neuroblastoma.

Patterns of relapse were determined for 20 high-risk neuroblastoma patients treated with chemotherapy, surgery, primary and metastatic site radiation (21 Gray), myeloablative chemotherapy, peripheral blood stem cell rescue, and 13-cis-retinoic acid. The median follow-up duration after transplant is 21 months (range, 8-34 months). The event-free survival and overall survival at 2 years were 45 and 75%, respectively. There were 2 primary site recurrences. Metastatic sites that became MIBG-scan negative on induction chemotherapy were not irradiated. Four patients relapsed in irradiated metastatic sites, 3 in the skull, 1 in the liver. Failure also occurred at 2 skull sites treated with chemotherapy only, and at 5 new sites: 1 skull, 2 distant lymph nodes, and 2 bones other than skull. Eight of 20 patients had skull metastasis at presentation; 6 were irradiated and 3 were controlled. Skull metastasis warrants more aggressive evaluation and treatment.

Antineoplastic Combined Chemotherapy Protocols↗