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Biomedical subjects

H A Briele

Publications and source records attributed to H A Briele.

At least 19 recordsLinked to original sources
PubMed1990

Results of treatment of stage I-III breast cancer in black Americans. The Cook County Hospital experience, 1973-1987.

Whether the prognosis for black women with breast cancer differs from that of nonblack women remains controversial. The treatment results of 526 black women who received definitive therapy for Stage I-III breast cancer at Cook County Hospital, 1973 through 1987 are presented. The 5-year and 10-year projected survival rates for 272 node-negative patients (83.9% and 76.6%, respectively) and for 72 node-positive nonadjuvant treated patients (58.1% and 35.2%, respectively) are similar to those reported in the literature for nonblack patients. Adjuvant therapy improved the projected relapse-free (P = 0.0744) and overall survival curves (P = 0.0448) for 182 node-positive patients compared with nonadjuvant patients. The greatest benefit was seen for patients greater than 50 years of age with one to three positive nodes. The incidence of estrogen and progesterone receptors was found to be similar to those reported for nonblack patients. Once breast cancer has been diagnosed and appropriately treated, there appear to be few differences in the natural history of breast cancer between black and nonblack patients.

Adenocarcinoma↗
PubMed1990

Malignant melanoma of the female genitalia.

Fifteen women with genital malignant melanoma were studied. Their ages ranged from 19 to 66 years (mean 49.1 years); 12 were white, and three were black. The sites of involvement were the mons pubis (one patient), perineal body (one), labium majus (three), labium minus (three), and vagina (seven). Ten patients (66.6%) died of their disease, one is alive with disease, and four are alive without evidence of disease. For the living patients the duration of follow-up was 20 to 118 months (mean 63.6 months). Of those who died, survival ranged from 3 to 76 months (mean 25.1 months). The predominant type of malignancy was superficial spreading melanoma 50%. Nodular melanoma represented 22%, and the nodular polypoidal variant 14%. Melanoma of the squamous mucosa, also referred to as lentiginous melanoma, constituted 14%. By using Chung's method of determining levels of invasion, we found that no lesion was in situ (level I), two were level II (less than 1.0 mm thick), one was level III (between 1.0 and 2.0 mm) and the remaining 11 patients had lesions that were greater than 2.0 mm (levels IV and V). Because the subcutaneous fat is not consistently present in all sites of the female genitalia, all tumors thicker than 2.0 mm were included in level IV, and no level V tumors were classified in our study. Using Breslow's microstaging method, we found the thickness to range from 0.65 to 9.5 mm (mean 4.75 mm). When we correlated survival with level and thickness of tumor in nine patients who died, one tumor was level III and eight were level IV; thickness ranged from 1.65 to 9.0 mm (mean 5.64 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Soft tissue sarcomas of the adult thoracic wall.

Forty-nine adult patients with soft tissue sarcomas of the thoracic wall have been treated by the Division of Surgical Oncology at the University of Illinois. Fibrosarcoma was the most common histologic type (20%). Patients with dermatofibrosarcoma protuberans had the longest mean overall survival time (150.8 months). The mean overall survival time for all patients was 98.2 months, and the disease-free 2-, 5-, and 10-year survival rates were 68%, 51%, and 34%, respectively. Wide excision was the treatment of choice; selected patients also received adjuvant radiotherapy, chemotherapy, or both. In all 10-year survivors, the sarcomas were low grade and well differentiated, or were less than or equal to 5.0 cm in diameter. Aggressive treatment afforded these patients good long-term results.

Adult↗
PubMed1987

Cutaneous thick melanoma. Prognosis and treatment.

Among proponents of elective lymph node dissection (ELND) for clinical stage I melanoma, controversy exists as to whether there is an upper limit of tumor thickness beyond which ELND should not be considered. We reviewed 169 patients with clinical stage I and II melanoma that was greater than or equal to 3.0 mm thick and who were treated at the University of Illinois Hospital, Chicago. Of 139 patients with clinical stage I disease, 117 underwent ELND. Five- and ten-year survival rates were 55.7% and 48.9%, respectively. Multifactorial analysis demonstrated that anatomical location, level, pathologic stage, and ulceration were the best predictors of survival. Thickness did not emerge as a significant variable. Our findings do not support basing treatment decisions, eg, ELND in this group of patients, solely on the thickness of the primary tumor. We continue to recommend ELND in patients with either intermediate or thick melanomas.

Adult↗
PubMed1987

Thin malignant melanomas with regression and metastases.

The significance of partial regression in thin malignant melanomas (0.76 mm or less) of the skin was evaluated to determine if the regression was associated with the later development of metastases in patients who previously were considered to have a favorable prognosis. Of 575 patients with primary cutaneous melanoma treated and followed up by the Division of Surgical Oncology at the University of Illinois, Chicago, we found that 103 (18%) had tumors that measured less than 0.76 mm. Of these, 30 (29%) showed histologic evidence of partial regression. In six (20%) of the 30 patients, visceral metastases developed and the patients died. All six had more than 77% regression of their primary tumors. Of the remaining 24 patients, only one had regression greater than 77% and she is still alive three years after diagnosis. Most of these 24 (83%) patients had regression of less than 50% (mean, 29.9%). No metastasis occurred in the 73 patients who had thin melanomas without histologic evidence of regression. It is apparent from this study that patients with thin melanomas who show partial regression cannot be included in the "low-risk" group if the extent of regression is 75% to 80% or more.

Aged↗
PubMed1986

Soft tissue sarcomas of the distal extremities.

Multimodality therapy and limb salvage procedures constitute a significant advance in the treatment of soft tissue sarcoma of the extremity. The applicability of these procedures to soft tissue sarcoma of the distal extremities was evaluated in a retrospective study of 159 such cases treated during a 10-year period. Thirty-seven patients were treated by operation alone, 57 had operation and adjuvant chemotherapy, and 65 had multimodal therapy. The distal extremities are unusual sites for soft tissue sarcomas and accounted for only 20% of our patients with sarcoma. The majority of patients were younger than 50 years and the sex distribution was approximately equal. The major histologic types were synovial cell sarcoma (18.2%), fibrosarcoma (15%), liposarcoma (13.8%), and rhabdomyosarcoma (13.8%). The 5-year survival rate was 72% with multimodality therapy, 72% for operation and chemotherapy, and 51% for operation alone. The local recurrence rate was 13% with operation alone, 9% with operation and adjuvant chemotherapy, and 12% with multimodality therapy. Based on our review, wide local excision and adjuvant chemotherapy proved to be as effective as multimodal therapy.

Adult↗
PubMed1985

Soft tissue sarcomas of the adult head and neck.

From 1969 to 1983, 53 adult patients with head and neck soft tissue sarcomas were evaluated and treated by the Division of Surgical Oncology at the University of Illinois. The most common anatomic location was the neck (36%), and these patients had the highest 5-year disease-free survival rate (67%). Fibrosarcoma was the most common histologic type (26%); patients with aggressive fibromatosis had the longest mean survival time (93 months). The mean overall survival time was 58.7 months, and the disease-free 2-year, 5-year, and 10-year survival rates were 68%, 54%, and 28%, respectively. Wide excision was the treatment of choice, with adjuvant radiotherapy or chemotherapy, or both, used in selected patients. In all of the long-term survivors, the tumors were either well-differentiated or less than or equal to 5.0 cm in diameter. It is apparent that aggressive therapy of such tumors can provide good long-term results.

Adolescent↗
PubMed1985

Pelvic exenteration.

Sixty-eight patients at the University of Illinois, Cook County, and the West Side Veterans Administration hospitals underwent pelvic exenteration for advanced pelvic malignancies during the 15-year period from 1969 to 1984. Thirty-two had colorectal cancers, eleven cervical, seven bladder, and six vulvar; in twelve the cancers were in miscellaneous pelvic sites. Forty-five exenterations were done with intent to cure, and twenty-three for palliation of patients with bulky, necrotic tumors that had caused symptomatic fistulae, local sepsis, chronic bleeding, or severe localized pain. The total 30-day postoperative mortality was 4.4% (3/68). The 5-year survival rate of patients who underwent curative exenteration was 33% (median 27 months). Pelvic exenteration appears to be a feasible surgical procedure for a variety of advanced malignancies as well as for palliation of severely symptomatic patients.

Adult↗
PubMed1985

Pharmacokinetics of melphalan in clinical isolation perfusion of the extremities.

The pharmacokinetics of melphalan in clinical hyperthermic isolation perfusion was studied in 16 patients with malignant melanoma. Analysis by computer-generated lines of best fit showed that the loss of melphalan from perfusate conforms best to a biexponential equation. The initial loss with a half-life (t1/2) of approximately 5 to 10 min is interpreted as rapid uptake of melphalan by the tissue of the perfused extremity. The terminal portion of the curve with a half-life of approximately 35 to 50 min is interpreted as due predominantly to the hydrolysis of melphalan, with a lesser component of loss due to absorption of melphalan to the filters and tubing of the perfusion apparatus. Determination of the area under the curve suggests that there is no appreciable uptake of melphalan by the tissue of the perfused extremity after 30 min.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1985

Melanoma of the head and neck.

Cutaneous melanoma of the head and neck accounts for approximately 20 per cent of all melanomas. Variation in the incidence of melanoma by sex and by subsites within the head and neck is related to exposure to sunlight. Study of the precursor skin lesions of individuals and families at high risk for melanoma are providing new insights into the biology of melanoma. The clinical importance of such information is earlier diagnosis and treatment. With microstaging techniques it has become apparent that in many instances the primary tumor can be excised safely with narrower margins than were thought necessary in the past. The role of elective lymph-node dissection remains controversial, but when it is performed a complete dissection is recommended. Improvement in adjunctive methods of treatment is needed, but significant palliation can be achieved, with occasional long-term survival.

Adult↗
PubMed1984

Lymphangiosarcoma in chronic lymphedema that followed dissection of the groin in surgical management of a malignant melanoma.

A 41-year-old white man who had a malignant melanoma in the left lumbar area was treated by wide excision and dissection of the ipsilateral inguinal lymph nodes. Progression and irreversible lymphedema of the left lower extremity developed. Fourteen years after the surgery, numerous purplish plaques and nodules developed on the left leg and thigh. Histologic examination by conventional and electron microscopy yielded the diagnosis of angiosarcoma. The patient died 18 months after the diagnosis was made.

Chronic Disease↗
PubMed1983

Late recurrence of cutaneous melanoma.

Most patients treated for cutaneous melanoma who have recurrent disease do so within the first ten years after primary diagnosis. This report covers seven patients with clinical stage I disease in whom local or regional recurrence developed 11 to 23 years after first treatment. Six of the seven patients were premenopausal at the time for primary diagnosis, suggesting that gonadal steroids may affect the natural history of cutaneous melanoma by lengthening the disease-free interval. The seventh patient was male. All seven of the patients had regional recurrence that was definitively treated by further surgery. Lymph node metastases occurred in six of these seven patients. After surgical retreatment, all patients lived for at least 2.5 years. Four remain alive, three disease free, and one with partially controlled systemic and regional disease free, and one with partially controlled systemic and regional disease. This study underlines the importance of continued long-term follow-up in patients treated for cutaneous melanoma.

Adult↗
PubMed1983

Estradiol and progesterone in human breast cancer cytosols and their relationship to receptor incidence.

Plasma and breast cancer cytosol estradiol and progesterone levels were determined in pre and postmenopausal women and correlated with tumor estrogen and progesterone receptor incidence and content. There was no statistical correlation between plasma estradiol levels and estrogen or progesterone receptor incidence or content in premenopausal patients. Similarly, no correlation was apparent between plasma estradiol and progesterone levels, and tumor cytosol steroid concentration in either pre or postmenopausal women. In contrast to these observations, a significant inverse relationship developed between plasma progesterone levels and progesterone receptor incidence in premenopausal patients. An increase in tumor progesterone concentration in pre and postmenopausal patients was also significantly, and inversely related to receptor incidence. Our observations suggest that an increase in plasma progesterone and a decrease in tumor estrogen: progesterone ratio is significantly correlated with a decrease in estrogen and progesterone receptor incidence in pre- and postmenopausal patients.

Adult↗
PubMed1982

The role of chemotherapy as an adjuvant to surgery in the initial treatment of primary soft tissue sarcomas in adults.

A prospective study was carried out to determine the results of chemotherapy as an adjuvant to surgery in the initial treatment of adult primary soft tissue sarcomas. The results were compared with those in a group of patients with similar histologic types of primary sarcoma treated by surgery alone. The chemotherapy regimen consisted of adriamycin, 60 mg/m2 intravenously on Day 1, and DTIC, 250 mg/m2 on Days 1 through 5. The cycle was repeated every 22 days. The total dose of adriamycin was 500 mg/m2; the DTIC was continued for 1 year. The adjuvant chemotherapy group consisted of 113 patients (group one) and the concurrent surgical resection group consisted of 144 patients (group two). In group one, 53 tumors were T1 and 60 tumors were T2; 67 of the tumors were grade 3 and 46 were grade 4. In group two, 65 had T1 and 79 had T2 tumors; 82 tumors were grade 3 and 62 were grade 4. The anatomic location and histologic types were similar in both groups. Seventy-seven (77%) of the 113 patients in group one lived disease free for 2 years, compared with 59% of the 144 patients treated by resection alone. Of the patients eligible for 5-year survival analysis, 74% were disease free in the adjuvant chemotherapy group, compared to 50% in the surgical group. The incidence of local recurrence was about the same in both groups. From a histologic standpoint, malignant fibrous histiocytomas and myogenic sarcomas appeared to benefit most with use of the use of the two-drug regimen used here, and the least favorable response was in liposarcomas and fibrosarcomas. In other histologic types, the role of adjuvant chemotherapy needs further clarification.

Adult↗