Patients In Good Physical Condition Research Articles

Combined esophageal and duodenal atresia: A review of the literature from 1950 to 2020

The combination of duodenal atresia (DA) and esophageal atresia (EA) is very rare. With improvements in prenatal sonography and the use of fetal magnetic resonance imaging (MRI), these malformations can be diagnosed in a more accurate and timely manner; polyhydramnios remains the most common sign despite having a low specificity. The high rate of associated anomalies (in 85% of cases) can also impact neonatal management and increase the morbidity rate; thus, it is of paramount importance to look for every possible associated malformation, such as VACTERL and chromosomic anomalies. The surgical management of this combination of atresias is not well defined and changes according to the patient's clinical status, the type of EA, and the other associated malformations. Management ranges from a primary approach for one of the atresias with delayed correction of the other (56.8%) to a simultaneous repair of both atresias (33.8%) with or without gastrostomy, or total abstention (9.4%). We suggest that a simultaneous approach can be safely performed on patients in good physical condition, with a birth weight over 1500 g, and with no major respiratory distress; this method begins by closing the tracheoesophageal fistula to protect the lung and then repairing the DA. The mortality rate has decreased over the years, dropping from 71% before 1980 to 24% after 2001. In this review, we present the available evidence on these conditions, focusing mostly on the epidemiology, prenatal diagnosis, neonatal management strategies, and outcome, with the aim of determining how the different clinical features and surgical approaches may impact on morbidity and mortality.

Abstract OT1-21-01: Preoperative radiotherapy and systemic therapy following surgery in ‘de novo’ metastatic breast cancer (Protocol MF22-01; Intervention Systemic Treatment METastasis-ISTMET)

Abstract Background Five to eight percent of breast cancer (BC) patients present with distant metastasis at diagnosis, known as ‘de Novo’ metastatic breast cancer (dnMBC). Recent data showed that approximately 40% of dnMBC patients undergo locoregional treatment (LRT). LRT treatment modalities for metastasis and primary tumor benefit a subset of patients with oligometastatic disease. Our study group has recently demonstrated two prospective studies regarding this topic with favorable outcomes. MF07-01 IMET study, one of the first clinical randomized trials, showed that the patients with the diagnosis of dnMBC undergoing LRT followed by systemic therapy had an additional 14% OS benefit by the end of the 10-year follow-up when compared with others who received only systemic therapy. A prospective multicenter registry study MF14-01 BOMET also presented LRT prolonged survival and decreased locoregional recurrence in a prospective registry study with a median follow-up of 3 years. Timing of primary breast surgery either at diagnosis or after systemic treatment provided a survival benefit similar to systemic therapy alone in bone-only dnMBC patients. Although, the optimal timing of concurrent endocrine therapy, radiotherapy, and/or sequential surgery remains unclear. Hypothesis We hypothesize that in the era of modern radiotherapy and endocrine therapy, concurrent radiation and endocrine therapy will be non-inferior to sequential treatment modalities in terms of locoregional and systemic disease control in dnMBC. ER/PR (+), Her2 neu (-) oligometastatic dnMBC patients are potentially curable with multimodality treatments. Objectives The primary objective is to perform a Phase I study to evaluate the feasibility of this curative intent treatment approach for patients with oligometastatic disease. Secondary objectives are to present the treatment response evaluating with CTC and/or ctDNA, and IHC and marker changes with multimodality treatments Methods Postmenopausal ER/PR (+) and Her2 neu (-), oligometastatic dnMBC patients will be enrolled in the study. Inclusion criteria: Primary breast tumor amenable for complete surgical resection, patients in good physical condition for receiving protocol-driven locoregional and systemic treatments and radiotherapy; Bone-only oligometastatic disease (5 or less metastasis); Primary tumor biopsy, metastatic site biopsy (ER/PR, Her2, Ki67). Exclusion criteria: Primary tumor not amenable for complete resection; primary tumor with extended infection, bleeding, or necrosis; patients with poor physical condition which prevents the patient from receiving protocol-driven locoregional and systemic treatment; synchronous primary cancer at the contralateral breast; clinically involved contralateral axillary nodes; patients not suitable for adequate follow-up, and failure to give informed consent. Study Design: • RT to the primary tumor (Hypo fractionated) + AI concurrent, Collect CTC and/or ctDNA • Add CDK4/6i to AI 2-4 weeks after RT + (6 months) • RT to bone metastasis (if still visible), Collect CTC and/or ctDNA + (12 months) • Primary Breast Surgery, Collect CTC and/orctDNA, ER/PR/Her 2 in the final specimen + • CDK4/6i +AI until progression and/or unmanageable toxicity Conclusion We hypothesize that in the era of modern radiotherapy and endocrine therapy, concurrent radiation and endocrine therapy will be non-inferior to sequential treatment modalities in terms of locoregional and systemic disease control in dnMBC. ER/PR (+), Her2 neu (-) oligometastatic dnMBC patients are potentially curable with multimodality treatments. Citation Format: Atilla Soran, Serdar Ozbas, Lutfi Dogan, Kamuran İbis, Mutlu Dogan, M Selam, Kazim Senol, Secil Ak Aksoy, Mine Ozsen, Sibel Cetintas, Turkkan Evrensel, Efe Sezgin. Preoperative radiotherapy and systemic therapy following surgery in ‘de novo’ metastatic breast cancer (Protocol MF22-01; Intervention Systemic Treatment METastasis-ISTMET) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-21-01.

ECOG score as a barrier for clinical trial eligibility in the patient population with genitourinary cancer: Is it time to adapt this criterion to real-world data?

78 Background: ECOG score is a common eligibility criteria used in clinical trials (CT). Many CT recruit only patients in good physical condition (ie. minimal comorbidities and good performance status), which may misrepresent the real-world cancer population.This gap may result in safety and effectiveness data that may not be applicable to the real-world patient population. Furthermore, applying strict eligibility criteria augment a barrier for patient accrual to CT. In this study we analyzed the impact of ECOG performance status on Genitourinary (GU) oncology trials eligibility of patients who used the Trialjectory web-based platform. Methods: Trialjectory is an AI- based platform that matches cancer patients to CT based on a patient reported questionnaire that translates to an individual clinical profile. The profile includes disease status and stage, biomarkers, treatment history and comorbidities and demographics. Data from patients with prostate and urinary bladder cancer was analyzed. The number of matched trials per patient was determined based on the patient’s profile, location and travel preference. To assess the impact of ECOG score, we edited the data set to reflect a better performance status per patient. We used a paired samples Wilcoxon test to assess the association between decreasing the ECOG threshold and the number of matched CT. Results: Between May 2021 and August 2022 we analyzed 153 bladder cancer profiles with ECOG=2 and 71 with ECOG=3, and 90 and 27 prostate cancer profiles with ECOG=2 and ECOG=3, respectively. In a multiple regression analysis, high ECOG score was inversely and significantly associated with the number of matched trials per patient in prostate cancer (p=0.009), independent of cancer stage, patient ethnicity and gender; and in urinary bladder cancer (p=0.003), after adjustment for cancer stage, gender and ethnicity. Editing ECOG score from 2 to 1 resulted in a profound increase (233% for prostate cancer patients and 300% for urinary bladder cancer patients respectively) in the number of matched trials per patient, from a median of 3 trials to 7 and from 2 to 6 trials per patient respectively (V = 426, p-value <0.0001 and V = 14, p-value = 0.0002 respectively). Among Bladder Cancer patients, editing the ECOG score from 3 to 2 resulted in an increase of 200%, from a median 1 to 2 matched CT (V = 291, p-value = 0.0002). Conclusions: The results reflect a high magnitude reduction in eligibility for patients with higher ECOG scores. Excluding these patients may result in skewed reporting on effectiveness-toxicity of drugs that may not be applicable for the real-world patient population augmenting a significant barrier for CT accrual amongst the proactive population who seek it.

Concurrent docetaxel and S-1 compared with oxaliplatin and s-1 as first-line therapy for advanced gastric adenocarcinoma: A retrospective study.

e16540 Background: The aim of this study was to compare the efficacy and safety between docetaxel plus S-1 with oxaliplatin plus S-1 therapy as first-line treatment for advanced gastric adenocarcinoma. Methods: Patients, who had received docetaxel plus S-1 or oxaliplatin plus S-1 as first-line chemotherapy for advanced gastric adenocarcinoma, were retrospectively reviewed. Kaplan–Meier curve and log-rank test were used to analyze the survival. Prognostic factors were estimated by Cox regression. Adverse events (AEs) were evaluated using CTCAE 4.0. Results: One hundred and twenty-nine patients received concurrent docetaxel plus S-1, whereas 130 received oxaliplatin plus S-1. The median progression-free survival (PFS) and overall survival (OS) in docetaxel and oxaliplatin groups were 6.0 and 8.2 months ( P= 0.025), 14.7 and 15.7 months ( P= 0.697), respectively. Multivariate Cox regression suggested that chemotherapy regimen (docetaxel vs oxaliplatin; HR = 1.535, 95% CI:1.092-2.156, P = 0.014), Eastern Cooperative Oncology Group performance status (ECOG PS 3-4 vs 0-2; HR = 4.213, 95% CI: 2.246–7.903, P< 0.001), Lauren type (Intestinal vs Diffuse, HR = 0.471, 95% CI: 0.307–0.725, P= 0.001, Mixed vs Diffuse, HR = 0.649, 95% CI: 0.442–0.953, P= 0.028), and number of metastases (HR = 2.097, 95% CI: 1.421–3.095, P< 0.001) had significant effects on PFS. Multivariate Cox regression suggested that pathologic types (signet-ring cell carcinoma vs adenocarcinoma; HR = 1.688, 95% CI:1.152-2.472, P = 0.007), Lauren type (Intestinal vs Diffuse, HR = 0.637, 95% CI: 0.414–0.982, P= 0.041), number of metastases (HR = 1.7, 95% CI: 1.154–2.504, P= 0.007) had significant effects on OS.The most common grade 3-4 adverse events were leukopenia (3.1% vs 7.8%), neutropenia (7.7 vs 12.3%), anemia (13.2% vs 14.6%), thrombocytopenia (2.3% vs 10.8%), peripheral neuropathy(0.8% vs 7.8%)and Nausea/vomiting/ anorexia (1.6% vs 3.8%). Conclusions: Concurrent oxaliplatin plus S-1 therapy appears to be effective as first-line treatment in advanced gastric and has an acceptable safety profile. For patients in good physical condition, we prefer to recommend oxaliplatin combined with S-1 for treatment.

Percutaneous Vascular Interventions Versus Bypass Surgeries in Patients With Critical Limb Ischemia: A Comprehensive Meta-analysis.

The aim of our study was to compare percutaneous vascular interventions (PVI) versus bypass surgeries (BSX) in patients with critical limb ischemia (CLI). Previous relevant reviews with limited numbers of included studies did not strictly confine the inclusion criteria to CLI, also involving patients with severe claudication, which may introduce bias in the decision-making of CLI revascularization. Current treatment strategies for CLI still remain controversial. We performed a meta-analysis of all available randomized controlled trials and observational clinical studies comparing PVI with BSX in CLI patients. Primary endpoints included overall survival, amputation-free survival, 30-day mortality, and major adverse cardiovascular and cerebrovascular events. We identified 45 cohorts and 1 RCT in over 20,903 patients. In overall population, PVI reduced the risks of 30-day mortality [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.51-0.95), major adverse cardiovascular and cerebrovascular events (OR 0.42, 95% CI 0.29-0.61), and surgical site infection (OR 0.31, 95% CI 0.19-0.51), but increased the risks of long-term all-cause mortality [hazard ratio (HR) 1.16, 95% CI 1.05-1.27) and primary patency failure (HR 1.31, 95% CI 1.08-1.58). When compared with autogenous BSX, PVI was also associated with additional increased risks of long-term death or amputation (HR 1.41, 95% CI 1.02-1.94) and secondary patency failure (HR 1.51, 95% CI 1.17-1.95). In patients with infrapopliteal lesions, we found PVI had inferior primary patency (HR 1.39, 95% CI 1.10-1.75) compared with BSX. For patients in good physical condition with long life-expectancy, BSX may represent a better choice compared with PVI, particularly when autogenous bypass is available. While enhanced perioperative care for cardiovascular events and surgical site should be considered in patients underwent BSX to achieve comparable short-term outcomes provided by PVI.

Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter?

BackgroundPrompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai.Methodology/Principal findingsBetween 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38–4.13%) and 0.35% (95% CI: 0.06–1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia.Conclusions/SignificanceBenzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.

Perineal Colostomy Post Amputation of Rectum

The operation described by Miles in 1908, an effective method in the radical treatment of tumors of the anus and lower rectum [1], and with better survival, leaves the stigma of the definitive iliac colostomy that leads to various psychosocial disorders [2]. Seeking to reduce social and family rejection, in addition to gas elimination and lack of control of the stools by the absence of sphincter, several methods of stools retention have been described [3-6]. Dr. Lázaro Da Silva, in Brazil, made the first perineal valve colostomy in 1991, when performing 2 to 3 extra-mucosal circular seromiotomies with invaginating seromuscular synthesis, with the meso-redundant occupying the pelvis, the distal valve stayed extra peritoneal and the proximal fixed to the promontory, this prevents or delays the excretion of stools directly [7]. It is indicated in patients proposed for abdominoperineal resection post-neoadjuvant, benign lesions with extensive sphincter involvement, extensive or intractable stenosis after perineal radiotherapy. This procedure is reserved for young or older patients in good physical condition, good cognitive level and without indication of postoperative radiotherapy [8].

Monoclonal Antibodies in the Treatment of Chronic Lymphocytic Leukemia in 2015

Chemotherapy combinations with monoclonal antibodies are now the basis for treatment of chronic lymphocytic leukemia. Rituximab, the most widely used anti-CD20 antibody in routine clinical practice, led not only to improvement of progression-free survival, but also to improvement of overall survival in previously untreated patients with good performance status in combination with fludarabine and cyclophosphamide. This regimen has become the standard treatment for patients in good physical condition. Rituximab and the newest anti-CD20 antibody obinutuzumab in combination with chlorambucil, as compared with chlorambucil alone, prolonged overall survival in previously untreated patients with significant comorbidities, and the combination of anti-CD20 antibody with chlorambucil has become the standard regimen in this group of patients. Alemtuzumab and ofatumumab improved treatment results in refractory chronic lymphocytic leukemia. Targeted therapy with combination chemotherapy and monoclonal antibody in patients with chronic lymphocytic leukemia represents a significant advance in the treatment of this disease.

The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study

In the last three years, all elective neurosurgical cases were performed by a single surgeon at Nara Medical University. For the last year and a half, all patients were transferred to a newly created neurosurgical intensive care unit. The purpose of this study was to evaluate the impact of admission to an intensive care unit after elective neurosurgery. This study was conducted as a retrospective clinical chart review. Institutional ethics approval was waived, and we reviewed the charts of 296 neurosurgical patients who were American Society of Anesthesiologists' physical status I-II. To avoid channelling bias, propensity score analysis was used to generate a set of matched cases (patients transferred to the intensive care unit [ICU]) and controls (patients transferred to the neurosurgical ward). This process resulted in 104 matched pairs of elective surgical patients who did or did not have an ICU admission after surgery. Glasgow outcome scale (GOS) at discharge or at three months after the operation was compared as the primary outcome measure. As secondary outcome measures, we also compared rates of severe early complications and patient satisfaction regarding perioperative patient care. With an unmatched population, poor GOS tended to occur more often in the non-ICU group than in the ICU group (6.5% vs 2.3%, respectively). Mortality rates and severe early complication rates also tended to be higher in the non-ICU group than in the ICU group (2.4% and 5.3%, respectively, non-ICU group vs 0.8% and 2.3%, respectively, ICU group). However, after propensity score matching, there was no difference regarding the GOS between groups. Both groups showed very high good outcome percentages (98.1% ICU vs 97.1% non-ICU). With regard to mortality rates and severe early complications, both groups showed low mortality (0.96% vs 0.96%) and complication rates (2.89% ICU vs 3.85% non-ICU). Patient care in the ICU failed to increase patient satisfaction regarding the overall hospital care. The results of this analysis suggest that admission to an ICU after elective neurosurgery has little impact on outcomes.

Salvage chemotherapy for hormone-refractory prostate cancer: Association of Adriamycin and ifosfamide

Prostate carcinoma is the most common cancer in men. Hormone-resistance is the natural history of this metastatic disease and requires the use of docetaxel as the standard chemotherapy. At present, there is no approved second-line treatment. Here, we report a combination of treatment with Adriamycin and ifosfamide in a series of 7 relatively young patients with an average age of 57 years at the time of diagnosis. Chemotherapy was administered over 3 days with the following schedule: 20 mg/m(2) Adriamycin per day and 1-1.5 mg/m(2) ifosfamide per day, in association with Uromitexan. Treatment was repeated every 3 weeks. Three biological responses, one CT scan response, one bone scan response and two CT scan stabilizations, were obtained. Mean survival following this combination was 6.6 months, and over 26 months after first-line chemotherapy. Tolerance was good with the use of granulocyte-colony stimulating factors. Our observations clearly show that the use of this type of salvage therapy for relatively young patients in good physical condition should be further assessed in a clinical trial, particularly when different lines of chemotherapy are required.

Extensive Unilateral Iliofemoral Occlusions: Durability of Four Techniques of Arterial Reconstructions

In patients with long unilateral iliofemoral occlusive disease unfit for percutaneous transluminal angioplasty (PTA), most surgeons would choose some type of prosthetic bypass (aortounifemoral, iliofemoral or cross over). All these bypasses would provide excellent early results, but some may not be sufficient in patients with a good life expectancy who also need durable patency. The purpose of the study was to compare the long-term results of four types of arterial reconstructions. Over 20 years, 468 unilateral iliofemoral occlusions were treated primarily by one of the following techniques: aortounifemoral bypass (group 1, n = 108), iliofemoral bypass (group 2, n = 144), crossover bypass (group 3, n = 108), and iliofemoral endarterectomy (group 4, n = 108). Patients in group 3 presented with more severe comorbidities, and patients in group 4 had more superficial femoral artery occlusions. All data were prospectively registered after discharge and during the survey. Patency was assessed with duplex ultrasonography on a yearly basis. Perioperative complications and death rates were similar in all groups. The standard error was less than 10% for a period of over 10 years in all groups, except for group 3, in which it was more than 10% after 8 years. At 8 years, primary patency rates in groups 1, 2, 3, and 4 were 79%, 66%, 74%, and 89%, respectively. The difference was significant between group 4 and group 2 (p < .02) and group 3 (p < .01). Secondary patency and limb salvage rates were not significantly different. In this study, for an equal perioperative risk, the primary patency rates of iliac endarterectomies were superior to those of the other techniques, suggesting that these procedures should be the first choice in patients in good physical condition. Iliofemoral bypasses and crossover bypasses needed much more redo surgery. A crossover bypass should be reserved for patients who are unfit for an abdominal approach or who have a short life expectancy.

A structural model of the relationships among self-efficacy, psychological adjustment, and physical condition in Japanese advanced cancer patients.

We made detailed research for relationships among physical condition, self-efficacy and psychological adjustment of patients with advanced cancer in Japan. The sample consisted of 85 (42 males and 43 females) advanced cancer patients. Interviews were conducted with some measurement scales including the Self-efficacy scale for Advanced Cancer (SEAC), and the Hospital Anxiety and Depression Scale (HADS). Karnofsky Performance Status (KPS) and medication status were also recorded from the evaluation by physicians. We used structural equation modeling (SEM) for statistical analysis. The analysis revealed that the model, including three self-efficacy subscales, depression, anxiety, KPS, meal-, liquid-intake, prognosis and three latent variables: 'Self-efficacy', 'Emotional Distress', and 'Physical Condition,' fit the data (chi-square(24)=28.67, p=0.23; GFI=0.93; CFI=0.98; RMSEA=0.05). In this model, self-efficacy accounted for 71% of the variance in emotional distress and physical condition accounted for 8% of the variance in self-efficacy. Overall, our findings suggest clearly that close relationships existed among physical condition, self-efficacy and emotional distress. That is, patients in good physical condition had a high self-efficacy, and patients with high self-efficacy were less emotionally distressed. These results imply that psychological intervention which emphasizes self-efficacy would be effective for advanced cancer patients.

Physical condition and activity of daily living among HIV patients infected through blood products in Japan.

To examine the present status and trends in physical condition and activity of daily living (ADL) among patients infected HIV by blood products in Japan. Data from a survey of 605 HIV patients infected through blood products were available quarterly between April 1997 and March 2000. Physical condition (summary index of 13 symptoms) and ADL in the first quarter of 2000 were assessed by comparing proportions of patients in good physical condition and having good ADL according to the level of CD4 counts and the use of antiretroviral treatments. Trends in those proportions during the study period were investigated, and these trends were also assessed by the changes in CD4 counts and antiretroviral treatments. The proportion of patients in good physical condition was 70.6% and having good ADL was 65.7% in the first quarter of 2000, which was associated with the CD4 counts and antiretroviral therapy. The proportion of patients in good physical condition decreased from 79.2% to 66.2%, and ADL also decreased from 72.1% to 61.3% during the study period. These declines were presumably associated with the changes in CD4 counts and antiretroviral treatments.

Should tamoxifen be a primary treatment choice for elderly breast cancer patients with locoregional disease?

To determine the efficacy of tamoxifen as primary treatment for elderly breast cancer patients with locoregional disease, the medical records of 85 patients of 75 years and older were reviewed. The median follow-up was 28 months (range 3-97 mo). Complete remission occurred in twelve (14.1%) patients. All of these patients remained in remission until death or closing date of the study. Twenty (23.5%) patients responded with a partial remission; 5 of them subsequently developed tumor progression. Thirteen (15.3%) patients developed initial tumor progression and 39 (45.9%) had disease stabilisation. Nineteen of this latter group subsequently developed tumor progression. Out of 37 (43.5%) patients with tumor progression, 14 patients were salvaged by surgery (n = 13) or radiotherapy (n = 1). Until the closing date of the study, disease could not be controlled by secondary treatment in 12 patients who subsequently died of breast cancer. Twenty-two of the 37 patients were unfit for surgical treatment at progression, of whom 14 were operable at diagnosis. The actuarial 5-year observed survival rate was 40% for the whole patient group. Although some patients (14.1%) managed to maintain a long lasting complete remission, caution should be preserved in using tamoxifen as first-line treatment, because of the high risk of treatment failures. As long as factors can not be identified to predict which subgroups of patients will respond to tamoxifen with a remission lasting for their life-time, tamoxifen may only provide an acceptable alternative for elderly breast cancer patients who are too frail or are unwilling to undergo surgery or radiotherapy. For elderly patients in good physical condition, primary treatment by (ABSTRACT TRUNCATED AT 250 WORDS)

Metastatic leiomyosarcoma of the skull--case report.

A 65-year-old female presented with a rare intestinal leiomyosarcoma metastasis to the skull manifesting as a mass beneath the scalp. She was free of neurological and physical symptoms on admission. The tumor was totally removed with normal surrounding bone and dura. The histological diagnosis was leiomyosarcoma. Ultrastructural and immunohistochemical studies demonstrated the smooth muscle origin of the tumor. Such patients in good physical condition should be immediately treated surgically to achieve the best chance of survival.

Carcinoma of the lung: Duration of life of individuals not treated surgically.

Summary A group of 443 patients with histologically proved bronchiogenic carcinoma, not treated surgically, was studied with respect to several factors which may have a bearing on duration of life. The following were the pertinent findings: 1) Of the 443 patients, 373 (84.2 per cent) died within two years of the onset of striking symptoms. The remaining 70 (15.8 per cent) lived from two as long as seven-and-a-half years. This group included 18 who lived three to five years and seven who lived five years or longer. The history is cited of one patient (not included in the statistics) who lived more than 17 years from the time the diagnosis of carcinoma was made. 2) Histological study of material of 320 patients examined at autopsy showed that the type of tumor has an important bearing on duration of life. Patients with epidermoid carcinoma lived the longest; those with anaplastic carcinoma, the shortest; those with adenocarcinoma occupied an intermediate position. 3) As a clinical corollary of this study, as well as on the basis of an analysis of the results of surgical treatment reported from 10 large centers of the United States and the Continent, it is concluded that resectional surgery should be restricted to patients in good physical condition in whom the disease is discovered in a relatively early stage. Surgery, we believe, is contraindicated in patients with advanced bronchiogenic carcinoma because of the considerable operative risk and the discouragingly poor results. Certainly, such patients should not be subjected to operation on the principle that nothing is lost by the attempt since death is a matter of a few months in any event. Our study reveals an appreciable number of patients with bronchiogenic carcinoma who lived two years or longer without surgery.