Lymphatic mapping in breast cancer: combination technique.

The current standard of care for patients with invasive breast cancer is complete removal of the tumor by mastectomy or lumpectomy, with documentation of negative margins, followed by complete axillary dissection. Our group has examined the efficacy of lymphatic mapping of the sentinel node via the combination technique in 594 patients with breast cancer. A radiocolloid was injected at six intraparenchymal locations surrounding the tumor 2 hours prior to the operation.

The role of lymphoscintigraphy in the management of the patient with breast cancer.

Introduction: Regional nodal status is the most powerful predictor of recurrence and survival in women with breast cancer. Lymphatic mapping and sentinel lymph node (SLN) biopsy have been found to accurately predict the regional nodal status. Preoperative lymphoscintigraphy has been used in melanoma patients to identify the basins at risk for metastases when primary sites are located in watershed areas of the body.

Impact of clinical trials on the cost of cancer care.

Background: Empirical evidence on the economic impact of cancer clinical trials is in short supply, but it is widely assumed that clinical trials add at least 10% to overall costs.

Objectives: To estimate how much, if at all, trial enrollment increases the use of scarce resources in treating breast, lung, lymphoma, and ovarian cancer patients.

Research Design: A profile of the cumulative charges for all inpatient and outpatient hospital care received by a sample of patients over an observation period beginning at diagnosis and continuing for upwards of 44 months postdiagnosis.

Captopril-associated cholestasis complicating the management of pancreatic cancer.

Cholestatic jaundice is a rare complication associated with the use of the angiotensin -converting enzyme inhibitor captopril. The severity of the disease may range from cholestasis on liver histology to overt fulminant hepatic failure. This diagnosis is seldom considered in patients with pancreatic or biliary tract malignancy.

Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients.

Objective: To provide clinicians who practice in the stem cell transplantation (SCT) setting with practical guidelines for the use of lipid-based amphotericin B (AmB) formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections.

Data Sources: Recommendations are based on the results of a two-day consensus meeting that convened clinicians versed in the management of infectious complications in patients undergoing SCT. This meeting, which was held October 21-23, 1998, in Orlando, Florida, was sponsored by an educational grant from The Liposome Company.

Surgical management of primary melanoma.

A significant proportion of the general population is diagnosed with malignant melanoma each year, and more people die of melanoma now than at any time in the past. Consequently, treatment of melanoma at all stages of development is an important clinical issue. A variety of management options are discussed here, including biopsy techniques and treatment of the primary melanoma.

Chronic esophagitis dissecans presenting with esophageal strictures: a case report.

Chronic esophagitis dissecans superficialis is a rare form of chronic esophagitis producing esophageal cast. Its clinical and histopathologic features have recently been defined. We present a 78-year-old patient with chronic esophagitis dissecans associated with esophageal strictures.

Geriatric oncology: challenges for the new century.

The management of cancer in the older aged person represents one of the major immediate challenges of medicine. The response to this challenge involves answers to the following questions: I. Who is old? Currently.

Evidentiary challenges to evidence-based medicine.

The evidence-based medicine (EBM) movement has exerted a strong influence on contemporary medicine. It has been used to define the hierarchy of knowledge in clinical medicine by classifying clinical findings according to the perceived relevance and validity of the respective methodologies of studies from which evidence was collected. In the spectrum of theories of knowledge, EBM predominantly relies on findings obtained from population-derived clinical research.

Human bone marrow stromal cell: coexpression of markers specific for multiple mesenchymal cell lineages.

The role of hematopoietic stem cells in blood cell development is reasonably understood, whereas the identity and the function of bone marrow stromal cells are much less clear. Using stromal cells in bone marrow cultures of the Dexter type, a favorite medium for the study of hematopoiesis, we show that stromal cells actually represent a unique cell type. Conventional wisdom has held that stromal cells in Dexter cultures comprise a mixture of macrophages, hematopoietic cells, adipocytes, osteoblasts, fibroblasts, muscle cells, and endothelial cells.

Android obesity at diagnosis and breast carcinoma survival: Evaluation of the effects of anthropometric variables at diagnosis, including body composition and body fat distribution and weight gain during life span,and survival from breast carcinoma.

Background: Although a large body of research exists concerning pathologic prognostic indicators of the rate of incidence and survival from breast carcinoma, to the authors' knowledge very few studies have examined the effects of anthropometric variables such as height, obesity, weight gain in adulthood, timing of weight gain, and body composition to survival, although these variables are related to the incidence rate.

Methods: The survival status of 166 patients diagnosed with primary breast carcinoma and followed for at least 10 years was obtained from the Cancer Center's registry, and significant anthropometric and other known prognostic indicators regarding survival after diagnosis were determined by Cox proportional hazards analysis.

Results: Eighty-three of 166 breast carcinoma patients (50%) with up to 10 years of follow-up died of disease.

Postoperative adjuvant therapy for patients with resected non-small cell lung cancer: still controversial after all these years.

Patients with clinical stage I and II non-small cell lung cancer (NSCLC) generally are considered candidates for surgical resection, with cure rates as high as 80% reported for some subsets. Locoregional and systemic adjuvant therapies have been evaluated in patients with lymph node involvement or pathologic T3 status, although considerable controversy regarding an appropriate standard of care continues to exist. Several trials have evaluated postoperative radiation therapy, the majority of which suggest that overall survival may be only minimally improved with this adjuvant therapy, but local failure is probably reduced.

Positron emission tomography in initial staging and diagnosis of persistent or recurrent disease.

Positron emission tomography (PET) constitutes a major advance in the diagnosis, staging, prognostic assessment, and follow-up of lung cancer. However, it is not a magic bullet that can solve all of the uncertainties that beguile the imaging of this disease. Small lesions, particularly those in the brain, may often be missed with PET, and three-dimensional localization of suspected sites may also be unreliable.

Advances in sputum analysis for screening and early detection of lung cancer.

Background: Screening for lung cancer using currently available techniques is not effective in reducing mortality from the disease.

Methods: Archived sputum specimens and clinical data linking specimens to lung cancer outcomes from prior screening programs have been reexamined to evaluate altered gene expressing, including specific oncogene activation and tumor suppressor gene deletion, as well as genomic instability and abnormal methylation.

Results: Several of these tests allow determination of a molecular diagnosis of cancer years before clinical presentation.

Bax degradation by the ubiquitin/proteasome-dependent pathway: involvement in tumor survival and progression.

Previously we reported that proteasome inhibitors were able to overcome Bcl-2-mediated protection from apoptosis. Here we show that inhibition of the proteasome activity in Bcl-2-overexpressing cells accumulates the proapoptotic Bax protein to mitochondria/cytoplasm, where it interacts to Bcl-2 protein. This event was followed by release of mitochondrial cytochrome c into the cytosol and activation of caspase-mediated apoptosis.

A new program to compute and evaluate continuously monitored stopping boundaries for clinical trials.

We present code for the calculation and evaluation of continuously monitored stopping boundaries for use in one-arm and two-arm clinical trials. These designs were first developed for one-arm trials by Thall, Simon and Estey (TSE) (P.F.

Sentinel node biopsy in ductal carcinoma in situ patients.

Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes.

Differential expression of thyroid transcription factor 1 in small cell lung carcinoma and Merkel cell tumor.

The distinction between metastatic small cell lung carcinoma (SCLC) and Merkel cell tumor is difficult by routine histology, prompting the search for specific markers that could separate these neoplasms. Thyroid transcription factor 1 (TFF-1) is a homeodomain containing transcription factor expressed in the normal airway epithelium. The expression of TTF-1 has also been shown in adenocarcinomas and small cell carcinomas of the lung.

Measuring hospital efficiency: a comparison of two approaches.

Objective: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR).

Study Setting: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993.

Study Design: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each.