Biomedical subjects
N Martini
Publications and source records attributed to N Martini.
Surgery for solitary and multiple pulmonary metastases.
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Preliminary report of the lung cancer detection program in New York.
The early lung cancer detection program in New York is described, and preliminary prevalence rate data are reported. Cigarette-smoking men over the age of 45, who are considered at high risk, are encouraged to enroll in the program and, to date, 6,612 have done so. These men receive PA and lateral chest x-rays annually, while a randomly selected sub-population of about half also have sputum cytology every four months. A controlled study of sputum cytology as an adjunct to the chest x-ray is now in progress. There were 15 cases of late lung cancer (pathologic stages II and III) detected at the initial examination, and 11 early cases (pathologic stages O and I). In the population of 3,387 men who had x-rays alone there were three early lung cancers detected; in the population of 3,225 men who had both examinations four early cancers were detected by x-ray and four by cytology. In addition, three cases of larynx cancer were detected by cytology. The early lung cancers detected by x-ray were peripheral and most were bronchiolar or adenocarcinoma; the early cancers detected by cytology were central epidermoid carcinoma of major bronchi. No early carcinomas were detected by both techniques. These findings suggest that a combination of chest x-rays and sputum cytology can be more effective than either one alone in detecting early lung cancer.
Oat cell carcinoma of the lung: combination treatment with radiotherapy and cyclophosphamide, adriamycin, vincristine, and methotrexate.
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Radiologically occult in situ and incipient invasive epidermoid lung cancer: detection by sputum cytology in a survey of asymptomatic cigarette smokers.
Approximately 8000 cigarette-smoking men over the age of 45 have entered into a lung cancer detection program in New York City. Cytologic examinations of sputum were carried out on 4000 subjects and lung cancer was found by this technique in nine men with normal chest x-rays. Seven had in situ or incipient invasive epidermoid carcinoma confined to the bronchus. These seven cases were studied by detailed histologic examinations of the bronchial tree in the resected specimens through sixth generation subsegmental bronchi. It was concluded that: 1) invasive epidermoid carcinoma arises from carcinoma in situ of bronchial surface epithelium or an extension of that neoplastic epithelium in bronchial glands; 2) the site of origin is a segmental bronchus in most instances; and 3) each carcinoma should be considered as unifocal in origin even though there is a continuing risk of another primary lung cancer. It seems unlikely that squamous metaplasia or basal hyperplasia is an essential step in carcinogenesis; rather, we believe that carcinoma may arise in bronchial epithelium without regard to the presence or absence of basal hyperplasia or squamous metaplasia, which should be considered nonspecific reactions to injury that may or may not accompany carcinogenesis.
Intrapericardial installation of radioactive chromic phosphate in malignant effusion.
Treatment of 28 patients with malignant pericardial effusion was accomplished primarily by intrapericardial instillation of radioactive chromic phosphate. At time of diagnosis of pericardial disease, 14 patients had major manifestations of tamponade; the rest had little or no clinical evidence of effusion. Only eight of the 28 patients had further problems with effusion after the initial pericardiocentesis and 32P instillation. Additional aspirations were done on those patients 2 weeks to 5 months later. The average survival was 9 months; seven patients lived more than 1 year.
Oat cell carcinoma of the lung: combination chemotherapy with cyclophosphamide, vincristine and procarbazine.
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Results of surgical treatment in Stage I lung cancer.
One hundred fifteen patients underwent resection for Stage I non-oat cell carcinoma of the lung. Each of these patients was evaluated carefully for extent of disease and classified as having a Stage I cancer only after the resected specimen was reviewed histologically and all regional nodes in the mediastinum were assessed. There were no deaths following operation. At 1 year of follow-up 75 of 81 patients (93 percent) were alive, and at 3 years, 77 percent were alive and free of disease. No patient had local recurrence and none was lost to follow-up. Patient with correctly staged early lung cancers have an excellent survival rate at 2 and 3 years with surgery alone. Merits of various adjuvant programs in this group of patients can be assessed correctly only if follow-up periods are prolonged and the numbers of patients evaluated are large.
Pleural mesothelioma.
Seventy-six patients with pleural mesothelioma were seen at Memorial Hospital from 1939 to 1972. There were 10 with benign and 66 with malignant mesotheliomas. The latter were histologically divided into 39 epithelial and 27 fibrosarcomatous types. Main symptoms were chest pain, dyspnea, and cough. Most of the patients with malignant disease had clinical and radiologic evidence of effusion with or without an intrathoracic mass. Thirty-seven patients had primary untreated mesothelioma and 29 patients had disease that had previously been treated elsewhere. Treatment at Memorial Hospital consisted of surgery, with or without radiation therapy, and supplemental chemotherapy. Survival was related to extent of disease and to treatment. In patients with epithelial mesothelioma confined to the hemithorax, resection was associated with a median survival of 21 months. When irradiation was the primary treatment, the median survival was 8 months. In fibrosarcomatous mesotherlioma, the median survival with resection was 11 months and with radiation, 9 months. Median survival in patients with advanced or recurrent disease was 3 to 6 months. It is concluded that epithelial mesotherlioma with diffused pleural involvement continues to carry a grave prognosis. Better survival is obtained where pleurectomy with resection of the bulk of the tumor is combined with external irradiation and systemic chemotherapy. In fibrosarcomatous mesothelioma, complete resection offers a significant chance of long-term survival. In patients with benign mesothelioma, none had recurrence nor died of disease after adequate resection.
Improved methods of recording data in lung cancer.
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Strategies for the early detection and prevention of cancer.
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Malignant pericardial effusion.
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Immune reactivity in primary carcinoma of the lung and its relation to prognosis.
Detailed studies of immune reactivity were performed in 154 patients with primary lung cancer, 20 patients with benign thoracic lesions, and 109 healthy persons. Reactions to the 2,4-dinitrochlorobenzene (DNCB) skin test were postive in 73 per cent of patients with lung cancer and all (100 per cent) of the patients with benign disease (p less than 0.05). The incidence of DNCB reactions was 78 per cent for Stage I and II cancers (37 patinets), 73 per cent for resectable Stage III cancer (22 patients), and 66 per cent in patients with unresectable or inoperable Stage III cancer. DNCB reactivity showed a relationship to primary histology. The incidence of DNCB positive reactions was 80 per cent in patients with epidermold carcinoma versus 57 per cent in patients with adenocarcinoma, 64 per cent in patients with oat cell cancer, and 80 per cent in patients with terminal bronchiolar carcinoma. In vitro immune studeis correlated best with stage of disease. These included the absolute lymphocyte count and absolute T cell count and lymphoxyte stimulation witalen A (Com A). These values were in the normal range in patients with Stage I cancer but were significantly depressed in patients with Stage III cancer. Svrvival curves were plotted in patients with Stage III disease according to the responses to three immune parameters: DNCB, absolute lymphocyte count, and PHS stimulation. Although patients with normal reactions generally had better survival rates, PHA responses showed the most significant correlation to survival. These tests support the usefulness of immune testing as an additional parameter of assessing biological risk in patients with primary lung cancer.
The management of pulmonary metastases in children with osteogenic sarcoma with surgical resection combined with chemotherapy.
This report concerns a consecutive group of 10 children with metastatic osteogenic sarcoma treated with combined surgery and chemotherapy. Eight of 10 patients had thoracotomy prior to chemotherapy, and 2 after an initial trial of chemotherapy. Sequential chemotherapy was given to all patients and consisted of vincristine, high-dose methotrexate with citrovorum factor rescue, cyclophosphamide, and Adriamycin. Chemotherapy was continuously recycled for 1 year. The encouraging results obtained with these 10 patients are demonstrated with emphasis on the value of aggressive multidisciplinary therapy in salvaging patients with advanced metastatic osteogenic sarcoma.
Indications for pleurectomy in malignant effusion.
One hundred six patients with malignant pleural effusion were treated by pleurectomy; 83 of these were available for a 2-year followup. Sixteen of 83 patients were alive 2 years following the pleurectomy, with a survival range of 2-6 years. The most common neoplasms associated with the development of effusion were carcinoma of the lung in 41 cases, carcinoma of the breast in 33 cases, and mesothelioma in 14. Indications for pleurectomy were: A) failure to control the effusion by tube drainage and instillation of chemical or radioactive agents; B) presence of a trapped lung; and C) presence of malignant effusion at the time of thoracotomy for resection of an intrathoracic tumor.
Pneumocystis carinii pneumonia. Diagnosis by lung biopsy.
Pneumocystis carinii pneumonia was suspected in 52 patients who underwent lung biopsy for diagnosis of diffuse pulmonary infiltrates. All but five of the procedures were limited thoracotomies. There were no instances of significant postoperative hemorrage or of pneumothorax compromising ventilation. The diagnosis of P. carinii pneumonia was made rapidly from imprints of the lung stained by the Gram-Weigert method in the 18 patients who had P. carinii pneumonia. Over-all, the rate of recovery from Pneumocystis pneumonia after treatment with pentamidine isethionate was 41 percent. However, among patients with no other pulmonary lesion (group A), the survival rate was 58 per cent; none of the patients with coexisting pulmonary disease (group B) recovered. The pulmonary infiltrates in the other 32 patients represented a variety of processes, of which 5 were fungal infections and 5 were due to lymphoma. Fifteen patients had an organizing interstitial and intraalveolar pneumonia of undertermined origin.
Interstitial irradiation for unresectable carcinoma of the lung.
From 1963 to 1971, 105 patients with histologically proved cancer of the lung were explored at Memorial Hospital and underwent interstitial implantation using encapsulated sources of radon 222 (53 patients) or iodine 125 (52 patients). These lung cancers were considered unresectable because of extension of the disease into the mediastinum with fixation or invasion of the major vessels, trachea, and esophagus or chest wall involvement. No apical lesions, which have a better prognosis, are included in this review. Sixty-nine patients had epidermoid cancer, 24 had adenocarcinoma, and the remaining 12 had various other histological types. All patients were staged according to the criteria proposed by the American Joint Committee using the TNM definitions (standing for tumor, nodes, and metastasis). Local control was obtained in 8 of 10 patients (80% with clinical Stage I and II unresectable cancers of the lung and in 44 of the 95 (46%) with clinical Stage III lung cancer. The two-year survival was 50% for Stages I and II and 7% for Stage III. Five patients have survived for five years or more. The complications, disease-free interval, local recurrences, distant metastases, and survival are presented and indications for this type of therapy outlined.
The treatment of pulmonary metastasis in osteogenic sarcoma.
The survival times in a control series of 145 cases of osteogenic sarcoma without pulmonary resections including records of pulmonary nodules and surgical wedge excisions, suggest that pulmonary resection is a noteworthy adjunct treatment. The 5-year survival of patients subjected to repeated pulmonary surgery is known for 22 patients who were under the age of 21. Where aggressive pulmonary resections were performed, i.e., repeated thoracotomies, and multiple wedge resections of nodules, a 5-year survival rate of 31 per cent (after date of primary amputation) is noted and compared to a previous study of 145 cases, 121 of which had untreated pulmonary metastases, and at 5 years, only 2 per cent of these patients with metastases were still alive. Lung wedge resection survivals are highly significant statistically although survival with residual disease must be considered in part at least, due to aggressive chemotherapy (i.e., high dose methotrexate with citrovorum rescue in combination with other drugs).