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Biomedical subjects

D J Pritchard

Publications and source records attributed to D J Pritchard.

At least 19 recordsLinked to original sources
PubMed1979

Immune responsiveness in patients with choroidal malignant melanoma.

We studied selective in vivo and in vitro immunologic factors of 25 patients with choroidal malignant melanoma. Immune profile factors did not show consistent differences between patients with melanoma and an age-matched control population. The studies were also non-contributory in delineating variations in immunocompetence with respect to melanoma cell types. Serial immune profiles failed to identify a change when clinical evidence of metastasis developed. When tested as a group, patients with melanoma in whom metastatic disease developed during the study showed significant depression of initial mitogen-induced lymphocyte blastogenesis. This depression was noted in advance of clinically recognized metastatic disease. This group had a wide range of responses that overlapped those of control patients, thus making the usefulness of these testing factors questionable for individual prognosis or for clinical monitoring.

Adult↗
PubMed1979

An amputee visitor program as an adjunct to rehabilitation of the lower limb amputee.

Based on evaluation of the rehabilitative needs of patients who have had a leg amputated because of cancer, an amputee visitor program was developed. The visitor is a cancer amputee who has successfully completed rehabilitation. About 5 days after a patient's amputation, the visitor sees the patient, telling of personal experiences, answering the patient's questions, and showing the prosthesis. The visitor later evaluates the visit on a data collection sheet. From 1 to 6 months after the visit, the patient and, if possible, a relative are interviewed to determine their long-term reaction to the program. During a 30-month period, 65 new patients were seen and evaluated by two visitors. Sixty (92%) responded favorably to the visit. In follow-up interviews with 36 patients, 33 (92%) said the visit substantially improved their outlook. In summary, our data indicate that the amputee visitor contributes significantly to rehabilitation.

Amputation, Surgical↗
PubMed1979

Total joint arthroplasty. Applications in the management of bone tumors.

Limb-saving resection has become a valid alternative to amputation in carefully selected patients with bone tumors. As interest grows in this technique, efforts continue to improve our methods of bone and joint reconstruction to restore a functional extremity. Previously there was little interest in this form of treatment despite a limb-saving potential, because of inadequate methods of skeletal reconstruction. The purpose of this paper is to review these previous methods and to outline our present approach to the problem.

Adolescent↗
PubMed1978

A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Preliminary results.

To determine whether immediate or delayed lymphadenectomy is more beneficial than none in cases of localized (stage I) melanoma, we undertook in 1972 a prospective randomized study. Patients with midline trunk lesions were excluded as well as patients with lesions situated directly over the node-bearing area. In addition, because of the low risk of metastasis, the protocol was changed to exclude level 2 lesions. Of the 173 patients studied, 63 were randomized to no lymphadenectomy, 56 to delayed (3 months) lymphadenectomy, and 54 to immediate lymphadenectomy. None of these regimens differed significantly from the others in its effect on length of survival or interval to metastasis. And of the 110 patients who underwent elective lymphadenectomy, 103 were without nodal involvement. Our preliminary conclusion is that elective node dissection is not beneficial in management of melanoma. However, disease progression was advanced significantly by age of the patient (greater than 60 years) and by invasiveness (level 4 or 5) and thickness (greater than 1.5 mm) of the melanoma.

Adult↗
PubMed1978

A prospective study of immune responsiveness in human melanoma. I. Assessment of initial pretreatment status with stage of disease.

The clinical findings in 262 patients with melanoma were correlated with an assessment of their cellular-mediated immunity by delayed-type hypersensitivity (DTH) skin tests, by lymphocyte blastogenesis, and by leukocyte enumerations. Patients with systemic metastases (stage IV) and those with evidence of tumor burden had fewer positive DTH reactions for recall antigens than did patients with localized disease (stage I), patients with no evidence of tumor burden, and 227 normal controls. However, no differences were found in the magnitude of response among patients with melanoma or when compared with controls. Patients with melanoma had fewer responses to dinitrochlorobenzene (40% than did controls (98%), but there were no differences by stage or tumor burden. Similarly, blastogenesis in the presence of PHA, Con A, and PWM was depressed when compared with controls, but there was no meaningful correlation with the clinical status. Leukocyte, T cell, or B cell counts revealed no alteration from normal for the patients with melanoma. The usefulness of these studies for routine clinical monitoring is questioned.

Dinitrochlorobenzene↗
PubMed1978

Adjuvant radiation therapy for regional nodal metastases from malignant melanoma: a randomized, prospective study.

After nodal metastasis from malignant melanoma, approximately 80% of patients die from disseminated disease. To clarify the role of radiation therapy (XRT) following node dissection. 56 patients with biopsy-proven nodal metastasis participated in a randomized, prospective clinical trial which compares radiation therapy to the regional lymph node area following lymphadenectomy (27 patients) with lymphadenectomy alone (29 patients). Interesting differences in the survival curves (p = 0.09) and in the disease-free interval curves (p = 0.08) for the two treatment groups proved to be attributable to imbalances in the age and nodal distributions in the treatment groups. Covariate analysis identified age and sex as the factors having the most significant (p less than 0.04) effect on survival and identified the number of positive nodes as the covariate having the most significant (p less than 0.02) effect on disease-free interval. Treatment did not have a significant effect upon survival or disease-free interval.

Clinical Trials as Topic↗
PubMed1978

Surgical treatment of osteogenic sarcoma at the Mayo clinic.

Osteogenic sarcoma continues to present a tremendous therapeutic challenge. Until recently, treatment has continued at a relatively unsophisticated level. Although amputation, usually at a cross-bone level with a safe margin above the lesion, continues to be the treatment of choice, increased interest is being demonstrated in radical en bloc limb-saving resections. Modern joint implants are proving effective in restoring the osseous integrity and joint function after the resection.

Amputation, Surgical↗
PubMed1978

Resection of pulmonary metastatic osteogenic sarcoma in children.

Over a three year period, 28 children or young adults up to 20 years of age underwent 60 thoracotomies for pulmonary metastatic osteogenic sarcoma. These patients also received adjuvant chemotherapy. Sixteen of the 28 patients are currently alive and 13 of these are free of disease. The patients have been followed for 6 to 48 months after the initial thoracotomy; median survival is 25 months. Actuarial survival curves produced a 4 year survival of 57%. Although a tumor-free interval of more than 1 year greatly enhanced survival, three patients survived with tumor-free interval of 6 months or less. Patients with disease confined to one lobe at the initial thoracotomy did very well, and yet survivors were seen when disease involved more than one lobe or was bilateral. An aggressive surgical approach toward the pulmonary metastases thus appears to be justified.

Adolescent↗
PubMed1978

Trends and variability in survival from osteosarcoma.

Survival of patients with primary osteosarcoma who received traditional surgical management has been very poor. Several studies have reported the percentage of patients alive 3 years after first treatment to be between 20 and 25%. In a study of such patients first treated at the Mayo Clinic between Jan. 1, 1963, and July 1, 1974, the survival noted in the first few years was typical of that of other reports, about 25%. However, by 1972 through mid-1974, the 3-year survival had become 50%. This improvement was not the result of adjuvant treatment or any basic change in type of patient treated, yet it is similar to that reported in connection with some of the new adjuvant therapies used in trials depending on historical controls. Our results cast doubt on findings made in the absence of concurrent, randomly selected controls.

Adolescent↗
PubMed1978

Adjuvant therapy for nonmetastatic osteogenic sarcoma: an evaluation of transfer factor versus combination chemotherapy.

A randomized study compared the effects of combination chemotherapy (high-dose methotrexate, adriamycin, and vincristine) with immunotherapy in the form of transfer factor in the adjuvant treatment of patients with nonmetastatic osteogenic sarcoma after apparent complete surgical ablation of the primary tumor. Thirty-two patients were evaluated. Of 22 patients who received chemotherapy, three died of drug-related complications and six were alive without disease recurrence between 260 and 673 days after operation. Ten patients in the transfer factor group converted their markers, and of these, five were alive without recurrence 420--753 days after operation. Neither treatment program was considered superior with respect to disease-free survival.

Bone Neoplasms↗
PubMed1978

'Transdifferentiation' of chicken neural retina into lens and pigment epithelium in culture: controlling influences.

The in vitro transdifferentiation of chicken embryo neural retina into pigment epithelium and lens cells was investigated under a variety of experimental conditions. Our findings suggest that some aspects of the phenomena are a function of medium composition and volume, whereas others depend upon conditions which develop during culture growth. Before melanin is visible, potential pigment cells are recognized as foci within epithelial sheets which remain in contact with the dish. The final area occupied by colonies of potential pigment cells is directly proportional to bicarbonate concentration. Low total medium volume also favours formation of potential pigment cells. In contrast the extent of cells other than potential pigment cells is not related to bicarbonate and is favoured when the volume of medium is large. Accumulation of melanin within the potential pigment cell colonies is suppressed when cells are crowded together. Lentoid bodies are formed from cells which are distinct from potential pigment cells and arise in crowded situations, in association with multilayering. Another type of structure superficially resembling a lentoid is derived from cell aggregates formed during the initial establishment of cultures. The survival of these 'aggregate bodies' is inversely related to bicarbonate concentration. Crystallin content is unrelated to lentoid numbers. The results provide the basis for a new hypothesis concerning cytodifferentiation in this system.

Animals↗
PubMed1977

Thymus-dependent and nonthymus-dependent lymphocytes in patients with sarcomas.

Several measurements indicate that cellular and humoral immunity is depressed in patients with sarcoma; but whether such observations reflect diminished numbers of lymphocytes and their subpopulations is not known. We determined the numbers of peripheral leukocytes, lymphocytes, rosette-forming thymus-dependent cells (T cells), and nonthymus-dependent SmIg-bearing cells in 134 patients with various mesenchymal sarcoma and in 47 normal controls. In all of these determinations, patients and controls gave similar values. Furthermore, values for patients with or without tumor, with or without metastasis, and with bone or soft-tissue sarcomas were similar. All 134 patients were studied prospectively, and the 84 who remained free of disease after 6 months had virtually identical values to the 50 who showed disease progression.

B-Lymphocytes↗
PubMed1977

Intraosseous well-differentiated osteosarcoma.

A series of 27 patients with intramedullary osteogenic sarcomas that were so well-differentiated histologically as to be confused with benign lesions was studied. Of the 27 patients, 14 were females and 13 were males, and most were adults. The tibia and femur were involved commonly. Roentgenographically, the tumors showed a mixture of sclerosis and lysis with poor margination. However, they lacked the highly destructive appearance of high-grade osteosarcomas. Histologically, spindle cells with minimal cytologic atypia were arranged in interlacing bundles. Mitotic figures were scarce. The amount of osteoid was variable, commonly being abundant. With recurrence, three tumors became highly anaplastic. Excision of tumor almost invariably led to recurrences. Resection or amputation has led to good results in seven patients. Only three of the 27 patients died with metastatic tumor; one patient is alive with metastasis. Central low-grade osteosarcomas have been misdiagnosed frequently and hence treated inadequately. Careful roentgenographic and histologic correlation is required to make the diagnosis.

Adolescent↗
PubMed1977

Fibrosarcoma in infants and children: a review of 110 cases.

This retrospective study summarizes the clinicopathologic findings in 110 children with fibrosarcoma. Seventy cases were selected from previous reports and 40 were from our files. The histologic criteria used for diagnosis are the same as those used for adults. Sixty-eight patients were in the first quinquennium of life, 13 in the second, and 29 in the third. Eleven patients died of their tumor, three in the first quinquennium and eight in ght third. Our findings indicate that children who are less than 5 years old have a 7.3% chance of developing metastatic spread even though the local recurrence rate is 43%. Children who are 10 years old or older had a metastatic rate of 50% at 5-year follow-up, a figure closely approximating that for adults. We believe that infants and children less than 5 years old may be treated initially by local excision of the lesion, without sacrificing significant function of the part. Recurrent tumor does not seem to predispose to metastatic disease.

Adolescent↗