Chlorine and survival of "rugose" Vibrio cholerae.
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Animals↗
Biomedical subjects
R M Clark
Publications and source records attributed to R M Clark.
Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer.
BACKGROUND: Although the conservation management of breast cancer has become a routine method of treatment in most centers, there is still considerable controversy surrounding the ultimate minimum treatment required for node-negative breast cancer to achieve adequate local control. PURPOSE: Our purpose was to assess the value of breast irradiation in reducing breast relapse following conservation surgery for node-negative breast cancer. We attempted to define low-risk groups of women for breast and distant site relapse (i.e., recurrence outside the breast) who might be spared breast irradiation or adjuvant systemic therapy. METHODS: Eight hundred thirty-seven patients were randomly assigned to receive radiation therapy or no radiation therapy following lumpectomy and axillary dissection for node-negative breast cancer. RESULTS: Breast irradiation reduced relapse in the breast from 25.7% in the controls to 5.5% in the irradiated patients. There was no difference in survival between the two groups (median follow-up, 43 months). A low-risk group (less than 5% chance of relapse in the breast without irradiation) could not be defined. Tumor size (greater than 2 cm), age (less than 40 years), and poor nuclear grade were important predictors for breast relapse. Age (less than 50 years) and poor nuclear grade were important predictors for mortality. The presence of ductal carcinoma in situ did not predict breast relapse. CONCLUSIONS: Breast irradiation significantly reduces breast relapse, but it does not influence survival. Important predictors of breast relapse are age, tumor size, and nuclear grade, but not the presence of ductal carcinoma in situ. Age and, in particular, nuclear grade predict survival. IMPLICATIONS: Further follow-up may define an acceptable low-risk group for breast relapse. Until then, we recommend that all patients receive breast irradiation. Systemic adjuvant therapy should be considered for patients with poor nuclear grade tumors.
Age Factors↗
Localized extradural lymphoma: survival, relapse pattern and functional outcome. The Princess Margaret Hospital Lymphoma Group.
Between 1967 and 1988, 22 patients were treated at The Princess Margaret Hospital (PMH) for localized (stage IE) non-Hodgkin's lymphoma (NHL) presenting with spinal extradural compression. The median age of the patients was 55 years (range 18-76). Back pain (20 patients) and leg weakness (18 patients) were the commonest complaints at presentation. Seven patients (30%) were non-ambulatory (paraplegic or severely paretic) and four had imparied sphincter function. Diffuse histiocytic lymphoma (12 cases) was the commonest histology. All patients initially had laminectomy decompression and were referred to PMH post-operatively. One patient (with coincident metastatic carcinoma of the breast) was treated palliatively. The remaining 21 patients received radical post-operative treatment: radiation therapy (XRT) alone in 12 cases (25-45 Gy), radiation therapy plus systemic combination chemotherapy (combined modality therapy, CMT) in 9 cases. The overall actuarial survival for the radically treated patients was 55% at 10 years and there was a significant difference (p = 0.037) between those treated by XRT alone (33%) and those who received CMT (86%). Only one patient from each treatment group failed locally but the distant recurrence-free survival for the XRT group was 32% compared to 100% for the CMT group (p = 0.017). One patient developed primary central nervous system (CNS) relapse. The functional results of treatment were excellent: 19 of the 21 radically treated patients regained or retained normal ambulatory status and the remaining two patients had only minor disability. Decompressive surgery and radiotherapy for localized extradural lymphoma ensures a high rate of local control and functional recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
Antineoplastic Combined Chemotherapy Protocols↗
Analysis of supradiaphragmatic clinical stage I and II Hodgkin's disease treated with radiation alone.
Patients with clinical Stage I and II Hodgkin's disease have been managed at the Princess Margaret Hospital for over 20 years, without the use of routine staging laparotomy. Our experience identified as adverse prognostic factors presence of a large mediastinal mass, B symptoms, and advanced age in presence of unfavorable histology (20). We had suggested previously that the use of extended field radiation therapy (XRT) was associated with a lower risk of relapse than involved field XRT or mantle XRT. There has been a trend over the past decade to select those patients with favorable prognostic factors for treatment with XRT alone and to use mantle plus upper abdominal XRT (extended field XRT) to treat them. A retrospective study of patients with clinical Stage I and II Hodgkin's disease treated at the Princess Margaret Hospital between 1978 and 1986 was conducted to determine the impact of patient selection and extended field radiation on outcome. The study involved 250 patients with supradiaphragmatic disease selected for treatment with radiation alone on the absence of adverse prognostic factors. Radiation techniques included involved field radiation in selected patients (those with upper neck involvement), mantle radiation in the earlier years, and mantle plus upper abdominal radiation in the later years of the study. Actuarial survival was 83.3% at 8 years; cause-specific survival was 90.1% and the relapse-free rate 71.6%. Local tumor control was 94.6%; only two patients had true infield failure. Multivariate analysis showed that significant prognostic factors included age, histology, and erythrocyte sedimentation rate. Extent of the radiation treatment volume was significant and influenced the risk of relapse, particularly out-of-field relapse, independently of other factors. A dose of 35 Gy was found to be sufficient for control of clinical disease. This study validated a previously developed model for the selection of clinically staged patients with Stage I and II Hodgkin's disease for treatment with radiation alone. Careful selection of these patients can yield excellent results without requiring that staging laparotomy be routinely performed or the use of systemic chemotherapy as the initial treatment.
Adolescent↗
Localised lymphoma of bone: prognostic factors and treatment recommendations. The Princess Margaret Hospital Lymphoma Group.
Twenty seven adult patients with newly diagnosed non-Hodgkin's lymphoma localised to either bone (Stage IE) or bone and regional lymph nodes (Stage IIE) were treated between 1967 and 1988. Median age was 53 years and the commonest histology (21 patients) was diffuse histiocytic lymphoma. Twenty-four patients were treated radically: 15 with radiation therapy (XRT) alone and nine with chemotherapy plus radiation therapy (CMT). The cause specific survival for these patients was 56% at 5 years and 40% at 10 years. Survival was significantly better for patients treated by CMT (88% at 5 years) as compared to XRT alone (40% at 5 years, P = 0.03) and for age less than 60 (72% at 5 years) compared to greater than or equal to 60 (30% at 5 years, P = 0.018). Relapse-free rate was 27% at 5 years with XRT alone and 89% with CMT (P = 0.01). Risk factors for loco-regional relapse (seven cases) included: large tumour bulk, treatment by XRT alone and use of 'limited' radiation fields. No radiation dose-response relationship could be identified in this study. Long term local control and survival for localised lymphoma of bone were excellent after treatment by CMT but XRT alone was associated with unacceptably high local and distant failure rates.
Adult↗
Benign and malignant breast pathology.
Research is focused on defining high-risk factors associated with the development of breast cancer and occult metastatic disease in node-negative patients. The interaction between hormones and growth factors is being diligently investigated, both in the genesis of breast cancer and in metastases. The effect of oral contraceptives on breast pathology remains under close scrutiny. Screening mammography for young women is proving to be of doubtful value.
Age Factors↗
Prognosis of breast cancer associated with pregnancy.
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Breast Neoplasms↗
Effects of fetal insulin deficiency on growth in fetal lambs.
Insulin may be an important regulator of growth in late fetal life. To assess the importance of endogenous insulin release in regulation of normal fetal growth, eight fetal lamb pairs were given either an intravenous injection of streptozocin (STZ), a nitrosourea that selectively damages pancreatic beta-cells, or buffer infusion (controls). In six preparations, twins were used, and in two cases, triplets, thus allowing for comparison between treated and control fetuses residing in the same intrauterine environment. Fetal STZ injection was associated with relative fetal hyperglycemia, hypoinsulinemia, and a decrease in the fetal plasma insulin-glucose ratio. Fetal lambs exposed to STZ also developed a mild nonprogressive metabolic acidosis compared with controls. Fetal body weight was depressed by 21% overall, the magnitude of reduction related to length of time in utero after STZ injection. Similar reductions in organ weights (liver, heart, and kidney) were also observed in STZ-administered fetuses compared with controls. Protein accretion in carcass, liver, and kidney after STZ was also depressed, but no significant changes in fetal lipid accretion were observed. Skeletal growth, as measured by tail and tibial lengths, was also depressed after STZ but to a lesser extent than body weight or protein accretion. Thus, in a stable maternal environment, isolated fetal insulin deficiency is associated with significant retardation of somatic and skeletal growth and protein deposition.
Animals↗
Antibody to hepatitis C is common among patients with alcoholic liver disease with and without risk factors.
Thirty-seven patients with clinically suspected alcoholic liver disease were retrospectively studied for the prevalence of antibody to hepatitis C virus (HCV) by enzyme-linked immunosorbent assay (ELISA) and immunoblot assay. Twenty-four had biopsy-proven cirrhosis. Nineteen had identifiable risk factors for non-A, non-B viral hepatitis, and 18 did not. Five of 19 high-risk (26%) and 6 of 18 low-risk (33%) patients had positive antibody, compared with two of 179 healthy blood donors (p less than 0.01 for either group of alcoholics compared with blood donors). Nine of 11 ELISA-positive patients were also either positive or indeterminable by immunoblot testing. Histologic scores for parameters commonly associated with chronic viral hepatitis were numerically worse among anti-HCV-positive patients, but none reached statistical significance. Clinically, seven of 11 (64%) of anti-HCV-positive patients versus 14 of 26 (54%) anti-HCV-negative patients were Child's class C. Among the 21 Child's class C patients, seven (33%) were anti-HCV-positive versus four of 16 (25%) of Child's class A/B patients. A weak correlation between IgG and ELISA optical density was observed (r = 0.52). We conclude that antibody to hepatitis C by ELISA and immunoblot is common among alcoholics with liver disease even in the absence of known or suspected risk factors for viral hepatitis. Although hepatitis C-positive patients tended to have more severe histologic disease, neither histologic parameters nor clinical findings were adequate to predict antibody seropositivity.
Adult↗
Outcome analysis of localized gastrointestinal lymphoma treated with surgery and postoperative irradiation.
One hundred thirteen patients with localized gastrointestinal lymphoma treated by surgery and postoperative irradiation between 1967 and 1985 were reviewed. At 15 years, actuarial survival of this group was 40.6%, with a cause-specific survival of 69.2% and a relapse-free rate of 64%. Two-thirds of relapses occurred at distant sites. In Stage IA and IIA patients with no residuum or with positive resection margins, (N = 90) only site of involvement and stage predicted for relapse. Age, histologic subtype group, and depth of bowel wall invasion did not affect relapse risk. In the very favorable group (Stage IA, IIA, no residuum or microscopic residuum), 8.4% of patients with stomach lymphoma relapsed compared to 25% of patients with small bowel lymphoma. The risk of early relapse was higher in those with Stage IIA small bowel lymphoma than those with Stage IA small bowel lymphoma. We continue to recommend adjuvant abdominal irradiation for patients with Stage IA, IIA completely resected stomach lymphoma and Stage IA completely resected small bowel lymphoma. We recommend combined modality therapy for patients with completely resected Stage IIA small bowel lymphoma and all other localized gastrointestinal lymphoma where visible residual disease is present.
Adolescent↗
Gas chromatographic procedure for measuring total lipid in breast milk.
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Chromatography, Gas↗
Breast cancer and pregnancy: the ultimate challenge.
An update on a series of 413 patients with carcinoma of the breast associated with pregnancy and referred to The Princess Margaret Hospital between 1931 and 1985 is presented. Coincident pregnancy is seriously detrimental to survival and, to a lesser degree, lactation. Subsequent pregnancies do not affect survival provided the pregnancy occurs at least one year after treatment for breast cancer, and preferably two years. Subsequent pregnancy may confer an improved prognosis. Interference in terms of a therapeutic abortion in breast cancer with coincident, lactational and subsequent pregnancies, is associated with decreased survival and ovarian ablation confers no benefit. Investigation and local treatment for coincident pregnancies should be limited to the absolute minimum necessary to achieve local control. Aggressive management should be reserved for acute life-threatening situations and then only after frank discussion with the patient. Adjuvant therapy is recommended after delivery and for lactational presentations, even if nodes are negative, due to the poor prognosis.
Adult↗
The effect of short-term refrigeration of milk and addition of breast milk fortifier on the delivery of lipids during tube feeding.
Both storage of breast milk for 3 days at 4 degrees C and the addition of breast milk fortifier containing lipid improved the delivery of lipids during continuous pump infusion. The percentage of the original lipid delivered after 8 h of pumping was 9, 25, 58, and 66% from the freshly collected milk, stored milk, freshly collected milk mixed with fortifier, and stored milk mixed with fortifier, respectively. Phospholipid and cholesterol levels also were measured. Their loss during delivery through the tube was similar to the loss of total lipid. While storage improved the delivery of lipids from breast milk, the additional lipid delivered from milk mixed with fortifier was primarily due to lipids from the fortifier.
Dietary Fats↗
Changes in cholesteryl esters of human milk with total milk lipid.
Twenty-five milk samples with a wide range of total lipid and degree of fatty acid saturation were chosen for this study. The milk samples were analyzed for total lipid, total cholesterol, and free cholesterol. The cholesteryl esters and triacylglycerols in these samples also were isolated and the fatty acids associated with each lipid class determined. Total cholesterol averaged 13.5 +/- 3.1 mg/dl of milk and was significantly correlated (r = 0.60, p less than 0.05) with total lipid. Free cholesterol averaged 10.9 +/- 2.3 mg/dl of milk and also was significantly correlated (r = 0.72, p less than 0.05) with total lipid. As total milk lipid increased, the fatty acids in cholesteryl esters became more saturated. The fatty acids most affected were 18:2 and 20:4. Total milk lipid and 18:2 in cholesteryl esters were inversely related (r = -0.49, p less than 0.05). There was also a negative correlation (r = -0.51, p less than 0.05) between 20:4 in cholesteryl esters and total lipid. The fatty acids in triacylglycerol were not correlated with total lipid. From these results it appears that the fatty acids esterified to cholesterol and triacylglycerol in milk may be drawn from different substrate pools.
Cholesterol↗
Experience with endomyocardial biopsy in 23 patients with heart transplants.
In the 33-month period April 1985 to December 1987, endomyocardial biopsy was performed 314 times in 23 patients with orthotopic (21) or heterotopic (2) heart transplants at Baptist Medical Center. The technique is described. Adequate tissue was obtained in 99% of cases and there was only one complication from the procedure. Mild to severe acute rejection was seen in 105 specimens (33%). The histopathological interpretation has proved invaluable in the care of patients with heart transplants.
Biopsy↗
Patients versus surrogates: whose opinion counts on ethics review panels?
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Adult↗
Embryonal rhabdomyosarcoma: presentation as a parotid gland mass.
Solid tumors occur infrequently during childhood. Rhabdomyosarcoma is the most common soft tissue sarcoma occurring in children. Therapeutic advances during the last 15 years have lead to a vast improvement in cosmetic and functional results and in overall survival. A case report of rhabdomyosarcoma of the parotid gland and a review of the literature are presented to highlight these advances.
Adenoma, Pleomorphic↗