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Biomedical subjects

M Merson

Publications and source records attributed to M Merson.

28 records · Page 2Linked to original sources

A reappraisal of oophorectomy in carcinoma of the breast.

Bilateral oophorectomy was used to treat 601 patients with disseminated breast carcinoma from 1974-1984. The total response rate was 31.2%. Complete regression occurred in 10.5% of patients and partial regression occurred in 20.8%, whereas 28.3% of patients showed no change and the disease progressed in 36.9% of patients. The patients who had a total regression had good survival rates (60.8% at 5 years and 47.3% at 7 years). No significant differences were found in the various age groups or with different types of dissemination. Patients with syncronous primary carcinoma and distant metastases had a high rate of regression as did patients with slow-growing carcinomas that metastasized many years after primary treatment. Estrogen receptor (ER) rates were good indicators of response only when determined on metastatic tissue at the time of oophorectomy. The value of ER determined on the primary tumor was of limited predictivity of response. A total of 220 patients received chemotherapy before oophorectomy. In this group the response rate was 22.3%, lower than that observed in patients who did not receive chemotherapy (36.6%). No important differences in total response rates were found among patients with amenorrhea and without amenorrhea although total regressions were more frequent in the latter patients than in the former patients.

Adult↗

Serologic differentiation between antitoxin responses to infection with Vibrio cholerae and enterotoxin-producing Escherichia coli.

A ganglioside enzyme-linked immunosorbent assay (ELISA) was used to study and attempt to differentiate between antitoxin responses in persons infected with either Vibrio cholerae or Escherichia coli producing heat-labile enterotoxin. In most cases (69%-94%), experimentally infected North Americans and naturally infected Bangladeshis responded to either infection with significant (greater than twofold) increases in serum antibody titer to both heat-labile enterotoxin and cholera toxin. In all but one instance, the response was higher to the homologous than to the heterologous toxin, and for the Americans the homologous antitoxin titers remained significantly higher for at least one year. Determination of levels of antibodies to purified subunits A and B of cholera toxin by an ELISA showed that V. cholerae infection in most instances induced a significant response to subunit B but rarely to subunit A. E. coli infection, on the other hand, induced only slight increases in antibody titer to either subunit.

Adolescent↗

Lymphnodal metastases from unknown primary tumors.

Prognosis and adequate therapy of lymphnodal metastases from unknown tumors are still uncertain. At the Milan Cancer Institute 71 patients with neoplastic adenopathies of unknown origin were hospitalized between 1965 and 1979. Men were 45 and women 26 with a M/F ratio of 1.7: 1. Most of patients were aged 51-70 years. Laterocervical adenopathies were the more frequent, followed by supraclavicular, axillary, inguinal, submandibular and retroperitoneal ones. In 11 cases the primary tumor was subsequently found (3 cases in tongue, 3 in rhinopharynx. 2 in lung. 2 in breast and 1 in thyroid). Of the remaining 60 cases, only histologic diagnosis of the metastasis was available and the primary tumor has never been found. Squamous cell carcinoma was the most frequent histologic type, followed by adenocarcinoma, undifferentiated carcinoma and malignant melanoma. No significant relationship between histologic types and lymphnodal sites could be demonstrated. In different cases treated with all possible combined therapies (surgery, chemotherapy and radiotherapy), no correlation between survival and therapy was possible. 35 patients (58.3%) were dead 18 months after diagnosis. No significant correlation between survival and histology was either shown. The natural history of these tumors remains unclear and any specific therapy cannot be proposed to be scheduled in such cases.

Adult↗

Unexpected breast cancer detection after outpatient biopsy for benign lesion.

At the Istituto Nazionale Tumori of Milan, in its Outpatient Department, 1302 breast surgical biopsies were carried out in 1978. Fibroadenomas occurred in 44.2% and benign dysplasias in 39.3%. Sixty-two cancers (4.8%) and 23 atypical hyperplasias (1.8%) were unexpected findings, with an increasing incidence in women over 50. Seventy-nine duct resections were performed for significant nipple discharge and revealed 5 unexpected carcinomas and 28 papillomas or papillomatosis. In our opinion and experience, this procedure of performing breast biopsy in the presence of a solid lump in women over 30 without hospitalization improves early detection of cancer, lowers costs, cuts down admission waiting lists and increases the number of women who better accept a surgical diagnosis and treatment.

Adenocarcinoma↗

Prognostic significance of the growth rate of breast cancer: preliminary evaluation on the follow-up of 196 breast cancers.

The doubling time (DT) of 196 consecutive breast cancers was studied by means of a double mammographic examination (average time between the 2 mammographies, 30 days) and calculated with the formula of exponential growth. On the basis of DT values the case series was divided into 3 groups of growth: fast (DT from 1 to 30 days), 31 cases (15.8%), intermediate (DT from 31 to 90 days), 84 cases (42.9%), slow (DT more than 90 days), 81 cases (41.3%). No relationship was found between growth rate and size of tumor, or menopausal status of the patient. After mastectomy fast and slow cases were equally distributed in the N- and N+ groups, whereas for the intermediate cases the N- : N+ ratio was 1 : 2. One hundred and thirty-four cases were followed for a period of 12 to 52 months. Evaluation was done on the basis of the subdivision into N- 2nd N+, and the latter group into N+ (1-3) and N+ (greater than 3). For N- tumors the course of the disease was apparently not affected by the growth rate. However, the case of fast growing tumors showed a higher proportion of recurrences with respect to N+ slow growing tumors. This difference was even more noticeable the higher the number of involved lymph nodes, but not statistically significant. The course of slow growing tumors was identical in the N- and N+ groups, but all the N+ tumors were subjected to adjuvant chemotherapy.

Adult↗