Biomedical subjects
Publications and source records attributed to J Tonak.
According to our experience the lumbar sympathectomy is not indicated for the treatment in clinical stage II. The best results for lumbar sympathectomy are to be expected in clinical stage III. We consider the protective sympathectomy combined with reconstructive arterial surgery indicate only in individual cases.
Among 250 cases of perforation of the large and small bowel during the past 5 years there were 11 patients in whom the cause of the perforation was not clear at first and which were labeled spontaneous. After thorough investigation a satisfactory explanation for the perforation of the apparently normal bowel could be given for all patients. The most frequent causes were distention of the bowel wall, particularly of the cecum, and ischemic enterocolitis. We consider the incidence of really spontaneous bowel perforations very unlikely.
The uncorrected cumulative five-year survival rate ("actuarial method") among 195 patients with infiltrative malignant melanoma of the skin was 58% (160 cases) in clinical stage I, 26% (35 cases) in clinical stage II. In addition to clinical staging, microstaging - i.e. the histologically determined depth of invasion of the primary tumour - is of great prognostic significance. In microstages 2 and 3 with the largest vertical tumour diameter below 0.76 mm, five-year survival rate was 100% while in microstage 3 with greater vertical tumour diameter it was 66% in microstage 4 55% and microstage 5 31%. Results of treatment can be reliably interpreted only if they are divided according to microstage. Propylactic dissection of the regional lymph-nodes (dissection in clinical stage I) need not be undertaken in microstages 2 and 3 with vertical tumours diameter below 0.76 mm. Whether prophylactic dissection was done in one or two sessions has apprarently no significant influence on survival rate. A single X-radiation dose to the primary tumour of 4 000 -6000 R immediately before excision of the tumour did not significantly increase the results. The results were particularly bad when the primary tumour was removed after inadequate manipulation.
INTRODUCTION: In classifying a malignant melanoma Clark et al. (1969) have suggested histologic typing (lentigo maligna-melanoma, superficial spreading melanoma, nodular melanoma) as well as the determination of the depth of invasion. The experiences made so far need further confirmation through respective research in additional material. This applies to the frequency of histologic types of melanoma and the microstages and primarily to the prognostic significance. There appear to be correlations whether the depth of invasion or the type of melanoma is decisive for prognosis or whether both have to be considered. MATERIAL AND METHODS: Between 1967 and 1974 the depth of invasion and the type of melanoma were determined according to Clark et al. (1969) in 139 invasive malignant melanomas. This classification has been carried out routinely following the excision of the tumor since Jan 1st, 1973; in previously operated tumors it was carried out in retrospect without knowledge of the follow-up. Without exception multiple sections of several blocks were used. Uncorrected survival curves and survival rates were drawn up using the acturaial method. Results 1. Of 139 malignant melanomas 3 (2%) were found to be in microstage 2, 50 (36%) in microstage 3, 71 (51%) in microstage 4 and is (11%) in microstage 5. 2. The type of 2 melanomas could not be defined. Among the remaining invasive malignant melanomas 17 (12%) were lentigo maligna melanomas, 48 (35%) were superficial spreading melanomas and 72 (53%) nodular melanomas. 3. Of the 72 nodular melanomas 53 (74%) were found in microstage 4 or 5; of the 65 other melanomas (lentigo maligna melanomas or superficial spreading melanomas), however, only 34 (52%) p less than 0,001) were in this stage. 4. The uncorrected 5-year survival rate was 100% in microstage 2 and 3 and in tumours diameter of 0.76 mm or more, 55% in microstage 4 and 31% in microstage 5. 5. At equal depth of invasion there are no significant prognostic differences between the various types of melanomas. DISCUSSION: It was possible to reproduce the type classification of melanomas as introduced by Clark et al. (1969) in our own material from 139 patients. Tumors of microstage 2 were less frequent in our material (2%) than in American and Australian series (17-28%). As far as the frequency of the types of melanoma and the correlation between the type of melanoma and depth of invasion are concerned, the Erlangen material does not show considerable deviation from the reports in the literature on the subject. Among tumors of equal depth of invasion the type of melanoma has little prognostic impact. The depth of invasion is decisive for the prognosis. It can be determined with little effort to a high degree of reliability.
The following lung tissue concentrations of cefoperazone were found in 20 patients after a 2 g single dose: 45.3-113.3 mg/kg after one hour and 20.5-68.1 mg/kg after two hours. The respective serum levels were measured in parallel determinations for comparison purposes. All determinations were carried out by means of high pressure liquid chromatography. The results suggest that cefoperazone has a rapid and sustained concentration ability in the lung tissue. The drug is therefore suitable for perioperative prophylaxis in lung surgery.