Biomedical subjects
Publications and source records attributed to J S Nystrom.
The finding of a granuloma on a bone marrow biopsy is not common. The etiologic spectrum encompasses a wide variety of disorders. We present the case of a young woman with a bone marrow granuloma and discuss the differential diagnosis, emphasizing the most common causes. This disorder can be associated with serious diseases.
Beginning in 1975, 78 patients with resected stage B and C colorectal carcinoma were randomly assigned (2:1) to receive either levamisole 2.5 mg kg-1 day-1 given for 2 days every week for 18 months or placebo therapy in the same schedule. Pretreatment characteristics (age, gender, disease site, CEA and stage) and the pattern of follow-up were similar in both groups. For the first 5 years following randomisation, relapse-free survival and overall survival were similar in the two treatment groups. Subsequently, excess late mortality was associated with levamisole group assignment. Consequently, overall survival was somewhat greater in the placebo group than in the levamisole group, 68% vs 38% (P < 0.08). For patients surviving 5 years from randomisation, subsequent survival favoured placebo over levamisole (100% vs 57%; P < 0.03). The absolute numbers of deaths were 27 in the levamisole group (19 definitely cancer related) and seven in the group placebo (five definitely cancer related). This long-term result seen with a more intensive adjuvant levamisole dose and schedule suggests: (1) other levamisole adjuvant trials in patients with colorectal cancer should be examined for long-term outcome; (2) future trials utilising the even higher levamisole dosage required for clinical immunomodulation should proceed cautiously.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two hundred sixty-six patients with metastatic nonsquamous carcinoma of unknown origin underwent upper and lower gastrointestinal series, intravenous pyelograms, and chest roentgenograms (CR) for location of a primary cancer site. Of 129 identified cancer sites, only 22 were verified antemortem, whereas necropsy disclosed 25 cases with false-positive examination results. The CR patterns thought typical for lung cancer (eg, single mass lesion and hilar or mediastinal adenopathy) were often shown (43%) to represent metastatic lesions. Because contrast roentgenographic studies are costly, uncomfortable, of low yield, and often misleading, they should be limited to cases with specific organ dysfunction.
The patient with metastatic adeno- or undifferentiated carcinoma who presents with a cryptic primary is subjected to an extensive diagnostic search. These efforts apparently stem from the following assumptions: 1). The ultimately proven primary sites in such patients will occur with the same frequency as the most commonly occurring carcinomas (i.e., lung, breast, colon, prostate, etc.); and 2). Metastatic patterns and histologies seen at diagnosis are the same as for patients presenting with these more common tumors. Our data contradict these assumptions. For example, the most commonly occurring unknown primary was pancreas. Rarely occurring primaries included breast and prostate. Lung cancer was observed frequently, but the presentation was atypical because of the large proportion of female patients. In addition, the metastatic patterns at diagnosis were unusual for many of the ultimately proven primary sites. In an attempt to deal with these contradictions, a method to search for new relationships between primary site and metastatic-histologic presentations was employed. This method succeeded in placing the location of the primary cancer to above or below the diaphragm in 80% of the patients studied retrospectively. Tested prospectively in a small group of patients, the method appears to be clincally useful. Finally, in this study we have made the diagnosis, antemortem, of the primary cancer site (PCS) in only 30 of 264 patients. The failure to find the primary site, dispite extensive radiologic work-up, was disappointing to the authors, and emphasizes the difficulty of finding PCS antemortem. In our study pancreas and lung appear to be most common cryptic primary sites.
Surgical operation remains the most effective method of treatment for patients with cancer of the large bowel. However, innovative surgical techniques have not improved survival rates for colorectal cancer in 25 years. Attempts at increasing survival with chemotherapy as an adjunct to surgical procedures remain inconclusive and controversial. Many adjuvant chemotherapy trials have failed to recognize those prognostic factors-such as nodal involvement, serosal penetration, vascular or perineural invasion, and microscopic invasion at margins of resection-that characterize certain patients at high risk for recurrent cancer. Failure to include only high risk patients in adjuvant chemotherapy is, in part, responsible for the lackluster performance to date. For rectal cancer, preoperative irradiation increases the chances of cure with surgical operation by reduction of pathologic staging, but it has not increased survival in patients with persistent nodal involvement. Immunotherapy is a possibly valuable method of treatment; however, it is clinically untested. An adjuvant immunotherapy protocol for high risk patients is described.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Carcinoembryonic antigen (CEA) has been demonstrated in tumors and body fluids, suggesting that effusion fluid (EF) CEA titer might separate benign and malignant EF. Plasma and EF CEA titers were determined on 141 patients with either benign (86) or malignant (55) EF. Although plasma CEA titers separated patients with either a benign or malignant EF 56% of the time, this separation was better accomplished (90% of the time) using EF CEA (P less than .0001). A malignant EF was associated with an EF CEA titer greater than or equal to ng/ ml or when, in the range 5.0 to 9.9 ng/ml, the EF CEA titer was greater than twice the plasma CEA. Paired plasma and EF CEA titers may aid in determining the benign or malignant origin of an EF.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Streptozotocin (STZ) has shown antitumor activity against various tumors in man, but the clinical usefulness of this drug has been limited, mainly because of renal and gastrointestinal toxicity. Nineteen patients with advanced cancer of various types were given a mean dose of 3.4 g/m2 of STZ by continuous iv infusion over 5-6 days each month for one or two monthly cycles. Basic serum and urine studies were performed immediately before and after each treatment cycle. Following STZ treatment, no significant changes in BUN or creatinine were seen. Four patients in whom initial tests for proteinuria were negative developed grade 1 or 2+ proteinuria after completion of the treatment cycle. No myelosuppression or renal failure was observed. Six patients had no nausea or vomiting, seven patients had nausea only, three patients had nausea and vomiting which were well-controlled with antiemetics, and three patients had uncontrollable nausea and vomiting. Confusion, lethargy, and depression were noted in five patients who had no prior central nervous system abnormalities; these effects appeared during treatment or in the immediate posttreatment period. Two patients with diffuse non-Hodgkin's lymphoma had complete remission, while several other patients had documented improvement. Although central nervous system toxicity may be a limiting factor, prolonged STZ infusions may have significant clinical promise.
Twenty-eight patients with inoperable non-small cell carcinoma of the lung were treated with high-dose methotrexate with citrovorum factor rescue. One patient (4%) responded with a partial regression of the tumor. Three patients had severe or life-threatening complications: acute renal failure, acute shortness of breath, and bone marrow suppression, respectively. There is 98% confidence that the true response rate for this therapy is less than 20%. The results of this study demonstrate that high-dose methotrexate with citrovorum factor rescue, in the schedule utilized, is not effective in the treatment of patients with non-small cell carcinoma of the lung.