Reducing leg edema after groin dissection.
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Biomedical subjects
Publications and source records attributed to L J Humphrey.
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For many years, various melanoma vaccines have been employed. This is a unique melanoma vaccine in that it is a subcellular tumor homogenate and no adjuvants have been added. This vaccine has been given to 129 stage I and 61 stage II melanoma patients. All were followed at least 5 years and had 87.5% and 63.9% 5-year survival rates, respectively. Sixty-four stage I males and 65 stage I females had 84% and 90% 5-year survival rates, respectively. We saw no difference between those with or without lymph node dissection. Thirty-six stage II males and 25 stage II females had 66.7% and 60% 5-year survival rates, respectively. Of stage II patients, 23 had only one positive node, 22 had two to four positive nodes, and 9 had five or more positive nodes with 69%, 63%, and 55% 5-year survival rates, respectively. Large published series were used as historical controls [6,27,28], and significant differences were noted when compared to our stage II patients (P = 0.001)--those with two to four positive nodes (P = 0.03), and those with five or more positive nodes (P = 0.04). We conclude that there is a significant increase in survival for these stage II patients, at high risk of recurrence, receiving a tumor homogenate vaccine. This vaccine warrants further analysis, development, and use in a phase III randomized clinical trial.
With the popularity of breast-conserving treatment plans, the natural history of "breast recurrence" in the ipsilateral breast must be distinguished from local recurrence following modified radical mastectomy. Hence, this study considers those patients who develop skin or chest wall recurrence after modified radical mastectomy, whether as a primary procedure or for patients with "breast recurrence" after partial mastectomy. The incidence of postmastectomy locally recurrent breast cancer following modified radical mastectomy (MRM) and adjuvant immunotherapy (IT) is compared to historical controls. The risk factors and treatment of local recurrence in this program as well as in a larger group of patients who recurred after modified radical mastectomy are reported.
Prevention and early detection of cancer programs can double the survival rate in the next 5 years. For many programs it will cost more dollars than savings realized. Only through education can government, insurance carriers, and individuals realize that the value of these far exceeds cost when compared to cost of so many lifestyle things of temporary value.
Two antigens in specimens of human breast cancer have been identified as autoantigens. One antigen appears to be an IgG Fc fragment; the other, an IgG Fab fragment. Antibodies in sera of cancer patients directed against these antigens have also been identified. These autoantibodies occur in patients with breast cancer as well as other cancers, and rarely in patients with non-cancerous disease or in people screened in a detection center for breast diseases. The breast cancer patient found to have antibody directed against the IgG Fab antigen falls into a group that has improved two-year survival statistics over groups of patients who lack this antibody.
Sequential paired punch biopsy samples were taken from three separate locations on each of four burn patients and were quantitated for the number of viable bacteria per gram of tissue. The range (log10 0.02 to log10 1.51) and the standard deviation (log10 0.67) were determined for each pair. The 95 per cent confidence interval based on any single observation, x, was determined to be x +/- 1.31. It is concluded that the burn wound biopsy is a reliable procedure for quantitating organisms in a burn wound and that changes in sequential samples give an indication of the dynamics of infection in the burn patients.
The study was designed to establish where significant correlations exist in a variety of metabolic substrates and hormone mediators in patients sustaining thermal injury. The factors studied were insulin, human growth hormone, cortisol, glucagon, free fatty acid, triglyceride and glucose. Incorporated into this design was an evaluation of the impact of quantitated severity of injury upon these correlations. In patients sustaining a low severity of injury (Probability of death (p = 2.2 to 33.9) there appeared a loss of glucose regulation in conjunction with insulin resistance without significant interplay of other factors studied. In contrast, patients sustaining high severity injury (p = 46.9 to 100) evidenced correlations between glucagon and glucose (negative), cortisol and free fatty acid indicating a significant role of hyperglucagonemia in these patients. A discriminant function analysis was employed to incorporate all significant variables into a probability model. Only insulin, glucose and glucagon appeared in the optimal classification equation.
Mononuclear and polymorphonuclear cells isolated by Ficoll-hypaque density-gradient sedimentation from peripheral blood of 25 burn patients at 3-to 4-day intervals during hospitalization were subjected to morphologic analysis. The aim was to identify all cells isolated and to examine the cell population characterized as B-lymphocytes. Patterns of response comprised of lymphocytes, monocytes, neutrophils, and precursor cells in varying stages of maturity were delineated. Shortly after thermal trauma, isolated cell pools from all patients contained high proportions of immature cells. In surviving patients during convalescence, the cell pools had increasing proportions of mature cells and corresponding declines in immature cell types. Patients who died did not produce large populations of mature cells at any time during their hospitalization. Cells identified morphologically as lymphocytes were accounted for by E-rosette assay (T-lymphocytes). Cells previously identified as B-lymphocytes appeared morphologically to be monocytes, were positive for Fc and complement receptor activity, and were phagocytically active.
The differing aspects of fibrocystic disease are presented. The various histological components making up the breast account for the variegated presentation of symptoms and findings. Pain, tenderness and nodularity represent the greatest problem with the former two prompting the patient to seek relief. The latter symptom, nodularity, causes concern for patient and physician as such changes must be distinguished from those of carcinoma of the breast. Guidelines for and consideration of premalignant benign changes are briefly presented. Data from a clinical trial of danazol for the patients with fibrocystic disease are presented. The drug was highly effective in affording relief from pain and tenderness. Some diminution in nodularity was also seen. The impact of this drug on the problems associated with fibrocystic disease of the breast is discussed.
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Three human malignant tumors and a rat carcinoma (Walker 256), which all showed strong Fc receptor activity in tests with sheep erythrocytes (E) sensitized with rabbit IgG antibodies (A), were used to study the distribution of the receptor in subcellular fractions isolated by differential centrifugation. Smears of the three crude sediments obtained (nuclei, mitochondria rich and membrane rich) all possessed receptor activity. EA incubated in the suspension of cell fractions did not attach to Fc receptor positive tissue sections or to cells in suspension. Cells from which the surface receptors had been eluted still showed activity in sections of cell pellets. Apparently the Fc activity is connected with both external and internal membranes.
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Recent studies have shown that antibody in the serum of patients with carcinoma of the breast reacts with two distinct antigens obtained from breast cancer tissue. Hence, there are two antibodies. The first antibody reacts against the Fc fragment of immunoglobulin and is also found in the sera of patients with benign breast disease and certain inflammatory lesions and, therefore, does not seem to have any significant meaning for the patient with carcinoma of the breast. The second antibody is directed against the Fab fragment of human immunoglobulin that is found in breast cancer tissue. Recent experiments have shown that in immunodiffusion tests, this autoantibody reacts not with normal IgG(Fab), but rather with heat-aggregated Ig(Fab). It is thought that tumor-associated antibodies react with antigens on the tumor cell surface. Intracellular enzymes then proceed to fragment the attached antibody, leaving the Fab fragments attached on the cell surface. With intact immunosurveillance, the host appreciates this altered immunoglobulin (Fab). It is suggested that the autoantibody then formed against this fragment reacts with the fragment attached to the tumor cell, thereby allowing the tumor cell to be destroyed. Clinical data supporting this hypothesis are derived from the fact that 9 patients having this autoantibody to the Fab fragment are alive at 1 year after their carcinoma of the breast.
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Mammography is of real assistance to the surgeon in evaluating breast problems not associated with a breast mass. Use of mammography in the detection of early breast cancer in breast demonstration projects has brought forth the time honored value judgement of benefit vs risk. This report introduces an additional aspect in the consideration of benefit vs risk, the interval cancer. From the demonstration project at KUMC, 326 biopsies were performed and 65 proved to be cancer. However, 24 additional women developed cancer before their next recommended screening date. This reduces the accuracy of mammography and physical examination by trained nurses in screening for breast cancer to 73%.
Receptor studies on normal and malignant human tissues were carried out. Erythrocyte receptor studies failed to show differences between malignant and normal tissues; both apparently have a receptor for rat erythrocytes, a hemolysin for monkey erythrocytes, and an agglutinin for rabbit erythrocytes. Fc receptors were found in several malignant tissues and only an occasional normal tissue, except for a patient who died of sepsis.