The radiation therapy oncology group, a 36-member national study group, has collected, by means of a registry, 234 patients treated with primary irradiation for UICC Stage I and II adenocarcinoma of the breast. Analysis of these patients has revealed a 5-year actuarial survival rate of 83% for Stage I and 68% for Stage II. The local-regional failure rate for all 234 patients was 8.5% (20/234), and 16.6% (17/102) for those patients followed for a minimum of 3 years. The local failure rate for T1 tumors was negligible, being 1.7% (2/117), regardless of whether or not complete excision of tumor was performed prior to irradiation. For T2 tumors, the local failure rate was 9.7% (9/93) if there was preirradiation tumor excision, but increased to 29.2% (7/24) if the preirradiation surgery was limited to incisional or needle biopsy only. There were six severe complications (2.6%), and all of these were cases of breast fibrosis. There were 14 other complications but these were judged to be of only mild to moderate severity. Eighty-four percent of the patients had an acceptable cosmetic result with either no difference or only a mild to moderate difference between the treated and untreated breast.

Adenocarcinoma↗

PubMed1980

Porphyria variegata.

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5-Aminolevulinate Synthetase↗

PubMed1979

Long term follow-up of combination chemotherapy-radiotherapy of stage III Hodgkin's disease: a Cancer and Acute Leukemia Group B study.

The Cancer and Acute Leukemia Group B studied the effect of combination chemotherapy-radiotherapy on Stage III Hodgkin's disease. Chemotherapy consisting of 4 weekly doses of vinblastine and one dose of mechlorethamine hydrochloride was followed by no therapy (CT), radiation to involved fields (CTIF) or total nodal radiation (CTTN). Two other treatment arms included total nodal radiation alone (TN) or total nodal radiation followed by chemotherapy (TNCT). Maximum follow-up is ten years. Complete remission percentages were 36 (8/22) for CT, 71 (17/24) for CTIF, 100 (21/21) for CTTN, 86 (19/22) for TNCT and 89 (16/18) for TN. Disease-free survival in patients receiving radiation +/- chemotherapy is 23% (19/73) at 5 years, but even after 9 years relapses were observed in two patients. Forty-one percent of all patients are alive and 32% have survived for five years. Ability to administer adequate therapy was the main determined for response duration and survival. Factors influencing the outcome of the disease include histology, age, splenectomy, initial white blood cell count and performance status, whereas symptomatology, initial absolute lymphocyte count and sex played no role on survival.

Adult↗

PubMed1979

Reduced ferrochelatase activity in fibroblasts from patients with porphyria variegata.

Ferrochelatase deficiency has been shown in both porphyria variegata (PV) and erythropoietic protoporphyria (EPP). It has been suggested that in PV there is a decrease in the enzyme, whereas in EPP the enzyme is unstable. In the present study ferrochelatase activity was measured in skin fibroblasts from three patients with PV and three normal subjects. The enzymatic activity in the patients with PV (17.5 +/- 4.5 pmoles heme formed per 10(7) fibroblasts per hour) was 50% of that of the control group (31.0 +/- 3.2 pmoles heme formed per 10(7) fibroblasts per hour). This supports the contention that the enzyme is deficient in PV and that an inactive ferrochelatase is the primary deficiency in this type of porphyria.

Fibroblasts↗

PubMed1979

Carcinoma of the uterine cervix: the Patterns of Care Study process survey.

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Decision Making↗

PubMed1979

Optimum fractionation for irradiation of carcinoma of the bladder. Experiments based on one case.

A patient with multiple metastases of transitional cell carcinoma of the bladder to the skin and subcutaneous tissues proved a model where most of the biologic and host-related factors were constant. The effects of varying the physical factors of radiation dose and time were observed. The results indicate that fractionated irradiation at intervals of 48 h was more effective than at intervals of 24 h and that superfractionation (intervals of 5 h) was not an effective method for the treatment of this tumor. The possible reasons for this effect and the implication for the treatment of bladder carcinoma are discussed.

Carcinoma, Transitional Cell↗

PubMed1979

The technical significance and application of Mahler's separation-individuation theory.

Greater knowledge and integration of developmental concepts and of the frame of reference of separation-individuation, add to the analyst's richer insights and to his more complete interpretations and reconstructions. Freud recognized the complexity of preoedipal development and the importance of the object and of object relations. Contemporary contributions have enabled us to proceed beyond the preoedipal conceptualizations of and since Freud, to better understand ego- and drive regression and evidence of fixations or ego distortions which may appear parallel to "normal neurotic" findings. I question whether we encounter different patients today and suggest that we understand our patients better, thus making our analytic assessments and practices so different from 50 years ago. Separation-individuation theory encompasses and organizes findings from many sources, research and clinical, and permits us to perceive and process material in a multifaceted way. It must affect the timing and content of interpretations and reconstruction, and has a profound influence upon the understanding of psychopathology as well as normal development.

Adult↗

PubMed1979

Measuring the quality of medical care: a beginning.

Quality of medical care is fundamental; however, the recognition of quality is a complex task. The Patterns of Care Study is examining radiotherapeutic care in cancer throughout the United States, using a new methodology which can be applied to other medical disciplines. The system is described and illustrated as applied to the management of carcinoma of the cervix. Considerable variations in treatment have been identified. These variations can be studied and, where necessary, modified by appropriate educational programs; thus, the quality of medical care can be improved.

Decision Making↗

PubMed1978

Porphyria variegata--studies of an affected couple and their children.

Porphyria variegata affects approximately 1 in 200 Afrikaans-speaking people in South Africa. This paper reports the first case of a marriage between 2 people with porphyria variegata and describes investigations carried out on their 2 children, who do not exhibit any signs of the disease. The wife had suffered 1 miscarriage at 4 months' gestation.

Adult↗

PubMed1978

Fanconi's anaemia, with special reference to erythrokinetic features.

Serial haematological investigations were carried out in 5 patients with Fanconi's anaemia over periods of 6 months--11 years. All the patients were pancytopenic with a depression of the granulocytic and megakaryocytic elements of the bone marrow throughout the greater part of their illnesses. Erythropoietic acitvity was variable. The initial bone marrow examination revealed depressed erythroid function in 3 patients. The erythroid hypoplasia persisted in 2 of them, while in the third, erythroid activity increased with time, possibly as the result of therapy with oxymetholone. Erythroid hyperplasia was present in the remaining 2 patients, both at presentation and throughout the course of the illness. This could not be attributed to treatment in either patient. Six erythrokinetic studies were carried out in the 5 patients at variable intervals after the diagnosis had been made. In 2 studies erythroid activity was unequivocally depressed, while in a further 3 a significant, though probably suboptimal, erythroid marrow response was present. In the final study erythropoiesis was increased but was markedly ineffective in terms of the delivery of viable red cells into the circulation. In vivo counting suggested that some degree of ineffective erythropoiesis was also present in the other patients and studies with 51Cr indicated a shortened red cell survival in all subjects studied. In 2 of them significant splenic sequestration was present. Leukaemic transformation occurred in 2 patients. In 1 of them its development was heralded by the appearance of micromegakaryocytes in the bone marrow.

Adolescent↗