Biomedical subjects
Publications and source records attributed to J Zidan.
Primary malignant melanoma of the rectum is a very aggressive tumor with a 5-year survival rate of 6%. Most reports include cases of both anal and of rectal melanoma together. We report 2 women with primary melanoma of the rectum, aged 67 and 72 years, who underwent abdominoperineal resection and survived 5 and 7 months respectively.
A 42-year-old woman with liver metastasis from adrenal cortical carcinoma was treated with mitotane (o,p'DDD) for 11 months with a minimal response. Mitotane was stopped because of severe adverse effects. Thereafter a combination of cisplatin and etoposide was given every 3 weeks. A partial response was achieved after five chemotherapy courses. Following this chemotherapy, the patient had a surgical excision of the liver metastasis and entered into a complete remission for 17 months. Etoposide plus cisplatin may be an active combination for the treatment of adrenal cortical carcinoma.
The ultrastructural effects of gentamicin on the stria vascularis of the inner ear of guinea pigs were studied by transmission electron microscopy. In a single specimen of an isolated, inner ear we found an unexpected variation in the structure of the stria vascularis in a normal, pigmented, guinea pig not treated with ototoxic drugs. There were prominent, wide protrusions from the apical surfaces of marginal cells into the endolymphatic space. This finding has not been previously reported and was seen in only 1 of 7 animals studied. It may be considered a normal structural variation, and is not pathological change in the stria vascularis due to ototoxic drugs.
2 cases of infants who refused to nurse from a breast with a cancerous tumor are reported. The first 6 cases of this nature were described 28 years ago. Though this sign could lead to earlier detection of breast cancer in lactating women, it has not been accepted as such by the medical profession. Had the milk-rejection sign been recognized in our cases, breast cancer could have been diagnosed months earlier. We suggest that lactating women should be asked about the nursing habits of their babies and if there is milk-rejection, the breasts should be examined with special care.
500 surviving Arab cancer patients in follow-up were interviewed with regard to other cases of cancer in their families. Among 73 who had breast cancer, in 15 (20.3%) there was another case of breast cancer among first-degree relatives. The incidence of both primary and familial breast cancer was higher among Christian than among Moslem women. We conclude that Arab women with breast cancer in their families are at high risk for developing breast cancer themselves.
The toxic effects on the stria vascularis of treatment with cisplatin alone and combined with the aminoglycoside antibiotic, gentamicin, were studied in guinea pigs. The toxicity induced in albino and pigmented guinea pigs was investigated morphologically with light and transmission electron microscopy, and functionally by brainstem-evoked response audiometry. The results of hearing thresholds were variable, ranging from no change in one ear in some of the animals to a hearing loss of 20 dB in one or both ears when treated with low-dose cisplatin alone or in combination with gentamicin. Bilateral deafness resulted from high-dose cisplatin combined with gentamicin. The combined treatment produced prominent structural damage in the stria vascularis. The results should be considered when aminoglycoside therapy is required in conjunction with cisplatin.
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The toxic effects of cisplatin (cis-diamminedichloroplatinum [II]) on the organ of Corti are well established. Few and conflicting data on this drug's effects on the stria vascularis exist. The present study presents animal experiments on the toxic effects of cisplatin in the stria vascularis and in the organ of Corti. Cisplatin-induced toxicity in albino and pigmented guinea pigs was evaluated morphologically and functionally, using light and transmission electron microscopy as well as auditory brainstem-evoked potentials on the organ of Corti and the stria vascularis. The results showed variability in hearing thresholds, ranging from no change to hearing loss of 30 dB, and prominent damage in the organ of Corti and in the stria vascularis. The toxic effects to both the organ of Corti and the stria vascularis should be considered when cisplatin is used in chemotherapy.
Thirty-one patients with Stage III-IV head and neck squamous cell cancer were treated by three courses of combination chemotherapy using bleomycin, methotrexate, and cisplatin followed by a radical course of radiation and in two cases by surgery. Of 29 evaluable patients, 4 (14%) achieved complete remission (CR) with chemotherapy and 13 (45%) had a partial response (PR). With the addition of radiotherapy and surgery, the CR rate increased to 72%. At 30 months the actuarial survival of all evaluable patients was 61% and of complete responders, 76%. Patients with nasopharyngeal cancer had an actuarial survival of 80% at 30 months, whereas patients with squamous malignancies at other sites in the head and neck region had an actuarial survival of only 37%. Side effects were tolerable. It is concluded that complete responders to combination chemotherapy and radiotherapy have a survival benefit at 30 months. The combined approach is most effective in nasopharyngeal cancer.
In a study of 445 patients with colorectal cancer referred to our center during a 3-yr period, we investigated the following parameters and their interrelationships: sex, marital status, ethnic origin, place of residence, stage of disease, delay in diagnosis and factors responsible for delay. Localized disease was found in 52% of the patients, regional disease in 29% and metastatic disease in 19%. The incidence of colorectal cancer was significantly higher in Jews of European (occidental) descent than in Jews of Asian or North African (oriental) descent or in Arabs. The median and mean ages were significantly higher in the occidental than in the oriental Jewish group and significantly lower in the Arabs than in the oriental Jews. Diagnosis was delayed for more than 6 weeks in 52% of the patients. Responsibility for the delay could be attributed to the patient in 54% of these cases and to the physician in 47%. Administrative factors were responsible for the delay in 26%. (In 27% of the above delayers there was more than one agent responsible for the delay.) On average, patients in whom diagnosis was delayed had more advanced disease than those without delay. Also, patients with advanced disease had a longer delay on average than those with localized disease. The stage of disease at diagnosis was more advanced in the oriental than in the occidental Jews. No correlations were found between delay in diagnosis and either age or sex. There were more widowers with delay (21%) than with no delay (16%). In patients living outside Haifa delay was more prolonged than in those residing in the city. Educational programs aimed at the population at risk of developing neoplasm and especially at those likely to undergo delay in diagnosis are recommended. Postgraduate courses should be designed to instruct physicians on how to minimize delay in diagnosis.
A total of 2299 new cancer patients were referred to the Northern Israel Oncology Center in 1974 and in 1980. The stage of disease, delay in diagnosis, the responsibility for the delay, and the survival of those referred in 1974 were investigated. At the time of diagnosis, 39% of the patients had localized disease, 34% had locally advanced disease, and 23% had metastatic disease. In 52% of the patients there was no delay in diagnosis. No correlation was found in the group as a whole between the stage of disease and delay in diagnosis. Only in the breast cancer group without delay in diagnosis, however, were there significantly more patients at an early stage than at an advanced stage of disease. At each stage of disease, responsibility for the delay was shared about equally between the patients and the physicians, except in advanced breast cancer, where the patients were more often responsible for the delay. The survival rate was higher in patients in whom the disease was diagnosed earlier. It was also higher at each clinical stage (Stages I and II) in patients who had no delay than in those with delay in diagnosis. The survival rate was higher in patients who were themselves responsible for the delay in diagnosis than in patients whose physicians were responsible for the delay. In 1980, less diagnosis were delayed in fewer patients than in 1974 (42% versus 65%). Responsibility for the delay in 1980 lay equally with the patients and with the physicians, but when compared to 1974, the physicians' responsibility and administrative delay were less. Campaigns for early diagnosis are advocated.
Twenty-two patients with advanced cancer of the head and neck where treated with a combination of bleomycin, methotrexate, and cisplatin. In ten previously untreated patients, a complete response (CR) rate of 20%, a partial response rate of 50%, and a no change rate of 30% were observed. With the addition of radiotherapy, the local CR rate in this group of patients increased to 60%. In 12 patients with recurrent disease after surgery and/or radiotherapy, the CR rate was 25%, the partial response rate was 16.7%, and the no change rate was 58.3%. Toxic effects were acceptable, with no fatalities. These short-term results encourage accrual of more patients in the study and further follow-up to determine whether the cure rate can be increased by using cisplatin and radiotherapy in patients with advanced previously untreated head and neck cancer. More energetic treatment should be investigated in patients having disease recurrence after radiotherapy.
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205 patients with solid cancer, underwent bone marrow biopsy using a Jamshidi needle, regular type. 32 (16%) biopsies were positive for bone marrow metastases. Results were correlated with those of skeletal radioisotope scans, X-ray films and the complaint of bone pain, alone or combined. 27 of 131 (17.5%) patients with positive X-ray film and 31 of 110 patients (28.1%) who complained of bone pain had a positive bone marrow biopsy. 17 of 46 (36.9%) patients with 3 positive parameters had a positive bone marrow biopsy as compared with none of 18 patients whose these 3 parameters were negative. Average values of Hb, WBC, serum alkaline phosphatase and calcium did not differ between patients with positive or negative bone marrow biopsy. 86 patients were diagnosed to have bone metastases and 35 more patients were diagnosed within a year following the biopsy. Of these 121 patients, 46 of 46 with positive scan, X-ray and pain were diagnosed to have bone metastases as compared to 27 of 30 patients with a positive scan with pain but negative X-ray film. Only 1 of 18 patients with negative parameters was diagnosed as having bone metastases within a year from biopsy. In our experience, it is of no value (unlike in malignant lymphoma and oat cell carcinoma of lung) to obtain a bone marrow biopsy for the detection of bone marrow micrometastases in asymptomatic cancer patients with negative skeletal radioisotope scan and negative bone X-ray films.
Over the past 22 years, 16 children with thyroid carcinoma were referred to the Northern Israel Oncology Center. All patients had undergone surgical procedures, either total or subtotal thyroidectomy, and 7 patients had undergone cervical lymph node dissections. Postoperatively, 5 patients underwent thyroid ablation with radioactive 131I as first treatment. Two patients received postoperative external radiation therapy to a field encompassing the cervical region, superior mediastinum, and both supraclavicular grooves. After a median follow-up of 60 months (range, 5-169 months), all patients are alive with no evidence of recurrent disease. Two patients who had recurrences, one in the submaxillary lymph nodes and one in the lungs, were salvaged successfully with retreatment with 131I therapy. No severe acute or long-term side effects were exhibited. The long-term results of treatment of pediatric thyroid carcinoma are excellent, but there remains disagreement over the extent of surgical and postsurgical treatment required.
AIMS AND BACKGROUND: To document the clinicopathologic features and treatment modalities of primary malignant parotid gland lymphoma, based on three cases diagnosed and treated at Oldchurch Hospital, Romford, UK. METHODS: Three patients, two with stage II and one with stage IV disease, received primary treatment consisting of chemotherapy following surgical biopsy. RESULTS: All three patients obtained rapid complete remission during their scheduled chemotherapy. One patient is alive without evidence of disease 12 months from the end of treatment. One patient, a frail, elderly gentleman, died due to massive pneumonia while in complete remission for two months. The third patient, who developed local recurrences in both parotid glands without transformation of his low-grade histology, achieved a second complete remission following chemo- and radiotherapy. All side effects were of a mild nature. CONCLUSION: Malignant lymphoma of the parotid gland is a chemo- and radiosensitive disease.
The drugs cisplatin and gentamicin are used for treatment of various cancer patients suffering from infection. The authors report a detailed electron microscopic study of blood vessels in stria vascularis of guinea pigs after treatment with cisplatin alone and in combination with gentamicin. The most distinctive features expressing endothelial cellular injury were mitochondrial, including occasional paracrystalline inclusions; electron-lucent foci with depleted organelles; intracytoplasmic vacuole formations; lipid bodies; cytoplasmic extrusions located on the luminal surface; and severe luminal constriction of part of the vessels from animals treated with the combined drugs. The study suggests that the damage to strial capillaries due to treatment with cisplatin alone and in combination with gentamicin may contribute to the injurious effects of these drugs on the strial tissue. Furthermore, the results of this study may enlarge the awareness of the potential vascular damage and vascular complications in additional body systems after medical use of cisplatin alone or in combination with gentamicin.