Sorption and transport characteristics of europium on sandy soils.

Radioactive europium can be released as a fission product during nuclear incidents and pose a threat to the human and surrounding environment because of its biological activity and long decay half-lives. For safe design issues and human health protection demands in construction of the planned nuclear power plants (NPPs) at Al-Dabaa site, it is necessary to study the sorption and transport of different radionuclides as europium within the selected area for predicting their fate at any crisis. Many soil samples were collected from different locations at the area selected along the northwestern coast of Egypt. The samples were transported to the laboratory, preserved, and characterized using X-Ray fluorescence (XRF), Fourier transform infrared spectroscopy (FT-IR), and X-Ray diffraction (XRD). Experiments were performed to study the sorption and transport kinetics of Eu(III) ions on two sandy soil samples from the collected ones. The effect of different parameters (e.g. contact time, pH, initial europium concentration, and temperature) on the sorption behavior europium was explored in a static condition. The maximum sorption capacity was determined and found to be 3.4 and 7.0 mg g-1 for sorption of Eu(III) ions onto soil-1 and soil-2, respectively. Different models were applied to assess the sorption of europium onto the surface of the investigated soils. Data confirmed that Eu retention was attained through a chemisorption process. Further, the thermodynamic parameters were determined and their values confirmed the endothermic nature of the sorption process. The transport of europium radionuclides, with groundwater, through homogeneous porous media with uniform one-dimensional flow in the geosphere was processed and the relative migration velocity was determined in presence of both distilled and seawater media. The transport of Eu(III) radionuclides was higher in presence of seawater than that in presence of distilled water by about two order of magnitude. This obviously clarified the effect of seawater in accelerating the transport of radionuclides with groundwater in the geosphere of studied area. The role of different competing ions have various valances on the relative migration velocity was explored. Further, the time required for studied radionuclides to reach Mediterranean Sea was determined.

The relevance of internal mammary lymphoscintigraphy in the management of breast carcinoma.

The incidence, implications, and significance of an abnormal internal mammary lymphoscintigram (IML) in 981 breast carcinoma patients without histologic or clinical evidence of axillary metastases is reported. A 13%-16% incidence of parasternal abnormality in patients with early, operable disease correlates well with clinical data. The statistically significant increase, with P consistently less than or equal to 0.005, in incidence of local or distant relapse associated with an abnormal IML when compared to the normal IML emphasizes the value of the procedure as a marker. These results indicate that patients with negative axillae but an abnormal IML should be considered to have stage II disease and should be offered adjuvant therapy. The significance of the IML in determining the true extent of disease in patients with apparent local relapse as well as the prognostic implications of an abnormal IML in 311 patients seen initially with recurrent breast carcinoma is also reported.

A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma.

We determined the therapeutic effect of fluorouracil (5-FU) in combination with folinic acid (FA) in patients with measurable recurrent or metastatic carcinoma of the colon or rectum by comparing it to standard 5-FU therapy in a prospective randomized controlled trial. Patients were randomized to receive either FA, 200 mg/m2/d for five consecutive days, or nothing. All patients received 5-FU, 370 mg/m2/d for five days on the first course, with subsequent dose modifications to maintain equal toxicity in the two arms. One hundred thirty patients were entered on trial and only five were excluded from the analysis because they did not meet the eligibility criteria or they refused therapy after randomization. The two treatment arms were balanced for 11 clinical characteristics. Patients were evaluated for response at the end of every two treatment courses and toxicity after every course of therapy. Median follow-up was 1.45 years. Dose-limiting toxicity was mucositis and diarrhea on this treatment schedule, although neutropenia was apparent. The response rate was 33% (21 of 63 patients) in the 5-FU and FA arm and was 7% (four of 61 patients) in the 5-FU arm (P less than .0005). Time to disease progression was significantly different in the combination arm as compared with the single-agent arm (P = .023). Overall survival was significantly longer for patients treated with 5-FU and FA as compared with those receiving 5-FU alone (P = .05). The median survival was 12.6 months for patients receiving the combination, and 9.6 months for those receiving 5-FU alone. Our results indicate that the combination of 5-FU and FA is effective treatment for patients with metastatic or recurrent carcinoma of the rectum and colon who have not received prior chemotherapy.

Male breast cancer: a 13-year review of 89 patients.

A retrospective chart review was conducted of men with the diagnosis of carcinoma of the breast seen at this institution between January 1967 and March 1981. Eighty-nine patients were available for analysis. These cases were evaluated to determine whether the natural history of this disease was similar to that of women with carcinoma of the breast and to identify prognostic variables in carcinoma of the male breast. The results of this review would suggest that many similarities exist between breast cancer in women and in men. The most common presenting symptom is a lump, the patterns of recurrence are similar for both men and women, and survival is determined by initial T stage and the presence or absence of nodes. Local postoperative radiotherapy does not influence overall survival in male breast cancer but does decrease the incidence of chest wall recurrence. Survival after recurrence is short and is similar to that observed for women with recurrent carcinoma of the breast. The differences observed in the present series were that the median age at presentation of 63.6 years is somewhat greater than that usually observed in women; no cases of lobular carcinoma were observed; and in the 44 patients who developed recurrences to date, none had evidence of liver metastases as the initial site of recurrence. In most respects the natural history of male breast cancer is similar to that of carcinoma of the breast in women. Since carcinoma of the male breast is a relatively rare malignancy. it is reasonable to recommend management of this disease be based on the greater base of knowledge available for carcinoma of the female breast.

Contributions of host- and disease-related attributes to the outcome of patients with acute myelogenous leukemia.

Three sequential trials of treatment for acute myelogenous leukemia (AML) involving 173 patients were analyzed to identify clinical and myeloblast-cell progenitor properties in culture related to outcome. The latter, including self-renewal capacity expressed as plating efficiency (PE2) and drug sensitivity, were determined for a representative group of 45 patients. Despite increasingly intensive remission induction therapy, similar response rates were achieved in the three trials and no increase in the duration of survival was observed. Clinical attributes at presentation by multivariate analyses were not consistently predictable of outcome. Of the blast cell attributes, only PE2 was predictive of duration of survival (p less than 10(-6)). For patients in remission the relapse rate during the first year was 0.63 compared with 0.15 in subsequent years. The percentage marrow myeloblasts at presentation, a measure of disease activity, was significantly higher for the patients having remissions lasting less than one year. These studies demonstrate the importance of disease-related attributes on the outcome of patients with AML.

Varicella-zoster infection in adult cancer patients. A population study.

In a retrospective review of varicella-zoster (V-Z) Infections in adult cancer patients, 766 episodes of V-Z Infection were studied among 740 patients seen at a large comprehensive cancer center from 1972 to 1980. The highest risk of infection was present among patients with lymphoma and leukemia. The risk of dissemination of V-Z Infection was significantly associated with the presence of active tumor at the time of Infection. The site of the primary tumor correlated with the site of subsequent zoster Infection among patients with breast cancer, cancer of the respiratory tract, and gynecologic cancer. Pain attributable to V-Z Infection was present in a large majority of episodes. The median time from the completion of therapy to the onset of Infection was seven months for patients receiving radiotherapy and less than one month for those receiving chemotherapy. Various attributes of this study group were compared with those of previously studied cancer and noncancer populations.

Complications associated with Ommaya reservoirs in patients with cancer. The Princess Margaret Hospital experience and a review of the literature.

The complications associated with the use of Ommaya reservoirs in 106 patients with meningeal involvement due to malignant disease are reviewed. Twenty-seven patients had acute lymphoblastic leukemia, 12 acute myelogenous leukemia, 3 chronic lymphocytic leukemia, 34 lymphoma, 29 carcinoma, and 1 chronic myelocytic leukemia. There were 11 technical complications, including 1 death due to misplacement of the catheter, 2 mild intraventricular hemorrhages, and 5 malfunctioning reservoirs; 3 required craniotomies (1 for subdural hematoma and 2 for subdural hygroma); 13 cases of bacterial meningitis occurred in 10 patients. One patient died of Staphylococcus aureus meningitis. The organisms causing the other infections were mainly coagulase-negative staphylococci (8 cases) or Propionibacterium acnes (2 cases). The projected infection rate for all patients (by Kaplan-Meier analysis) during the first year following insertion of a reservoir was 15%. Successful use of Ommaya reservoirs requires expert surgical implantation and meticulous care during accessing to minimize complications.

External irradiation for squamous cell carcinoma of the nasal vestibule.

A retrospective analysis of 56 patients who underwent primary external irradiation for squamous cell carcinoma of the nasal vestibule between 1958 and 1983 is presented. The overall 5 year actuarial survival and cause specific survival rates were 64 and 87%, respectively. The 5-year local relapse-free rate after primary irradiation was 80%. Prognostic factors which lowered the local control rate after irradiation included a primary tumor size of 2 cm or more, or involvement of the skin of the ala nasi, columella, lip, cartilage, or bone. Local control was improved in patients who received a tumor dose equivalent to, or greater than, 5500 cGy/25 fractions/5 weeks. Only two patients in whom the primary tumor was controlled developed regional nodal metastases, and elective regional nodal irradiation is not recommended. Four patients (9%) developed significant late morbidity after irradiation. External irradiation is effective treatment for squamous cell carcinoma of the nasal vestibule, and produces high local control and cure rates and good cosmetic results.

Supraglottic laryngeal carcinoma: an analysis of dose-time-volume factors in 410 patients.

Four hundred and ten patients with supraglottic laryngeal carcinoma treated with moderate dose radical radiotherapy with surgery for salvage (RRSS) were analyzed in detail to determine optimal dose-time-volume parameters to be used in the treatment of each stage of supraglottic carcinoma. In the RRSS group 41% are alive and well at 5 years, 38% died of their tumor and 21% of intercurrent disease. Presence or absence of nodal disease has a major impact on survival. Local control is approximately 70% in T1, T2N0 patients and approximately 50% in T3 and T4N0 patients. Seventeen percent of T1 and T2N0 patients failed in the initially negative neck. Ten major complications (2.4%) have been seen. Local control by irradiation was not influenced by dose or field size. Regional control in the initially negative neck was markedly increased with the use of larger irradiation field sizes. Field sizes of less than 7 X 7 cm resulted in an 18% neck failure rate as compared to 3% with larger field sizes (p = 0.00005). This particularly applied to early stage disease. As a result of the use of larger irradiation field sizes giving reduced neck failure rates, improvement in survival has been seen in early stage supraglottic patients. The results are compared with published results. There is no statistically significant dose response curve in any stage of supraglottic cancer over the dose range 1650-2300 ret. Optimal treatment factors for supraglottic cancer are discussed.

Radical radiation therapy with 5-fluorouracil infusion and mitomycin C for oesophageal squamous carcinoma.

Thirty-five patients with clinically staged non-metastatic squamous carcinoma of the oesophagus were treated with radiation combined with mitomycin C, and 5-fluorouracil (5-FUra) infusion. Twenty patients were planned for a split course regimen 2250-2500 cGy in 10 fractions and chemotherapy. This dose of radiation to be repeated with another course of chemotherapy after 4 weeks rest. Fifteen patients were planned for a single course 4500-5000 cGy in 20 fractions and a single course of chemotherapy. Thirty-one patients are available for a minimum follow-up of one year, 26 patients for a minimum follow-up of 2 years. All 35 patients are included in the survival and local relapse-free analysis. Survival at one year is 47% and at 2 years 28%. The local relapse-free rate at both one and 2 years is 48%. There was an improvement in survival and local relapse-free rate for the single course regimen compared to the split course; 2 years survival 48% versus 12% (p = 0.24) local relapse-free rate 79% versus 27% (p = 0.07). All patients receiving radiation and chemotherapy were compared with historical controls treated by radiation alone. This matching procedure was done independent of knowledge of outcome (two controls were matched/case). Patients were matched for age, sex. TNM stage, and total radiation dose. There was a significant difference in survival p = 0.004 and local relapse-free rate p = 0.05 for patients receiving radiation and chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma pharmacokinetics of 5-FU given by continuous infusion with allopurinol.

We determined the steady-state plasma levels of 5-FU when the drug was administered by continuous infusion for 5 days during 21 courses in patients with metastatic colorectal carcinoma receiving concomitant oral allopurinol given at a dose of 300 mg orally three times/day. The steady-state plasma level increased from 3.37 to 7.49 microM with dose increases from 1.25 to 2.25 g/m2/day. Clearance ranged from 1.79 to 2.41 L/min/m2. Although we observed a large day-to-day variation and a large patient-to-patient variation in plasma 5-FU levels at any given dose level, these were not significant. The plasma level of 5-FU increased linearly with dose. The difference between 5-FU plasma levels with dose was significant (P = 0.002). When the levels were adjusted for patient-to-patient and day-to-day variation the difference remained significant (P = 0.02). The results indicate that: (a) plasma levels of 5-FU may show large but insignificant variation from patient to patient and from day to day; and (b) steady-state plasma levels and 5-FU increased linearly with dose.

Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases.

Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.

Risk factors for varicella zoster disseminated infection among adult cancer patients with localized zoster.

Varicella zoster (VZ) infection can be a highly morbid and potentially fatal disease among immunocompromised patients; 811 episodes of VZ infection among adult cancer patients seen at the Princess Margaret Hospital from 1970 to 1980, were identified. Seven hundred twelve patients with first episodes of localized VZ infection (zoster) were analyzed for potential risk factors for dissemination. Significant risk factors after univariate analysis included the diagnosis of Hodgkin's disease, decreasing age, chemotherapy within 6 months of VZ infection, and extensive tumor at initial tumor diagnosis. Complete tumor remission at the time of infection, previous radiotherapy, and breast or gynecologic cancer were associated with reduced risk in this analysis. After multivariate analysis the following factors were independently associated with increased risk: Hodgkin's disease (P less than 0.001), non-Hodgkin's lymphoma (P = 0.016), and head and neck cancer (P = 0.043). Complete tumor remission and previous radiotherapy were again related to a reduced risk of infection. This study identifies risk factors that define specific subgroups of adult cancer patients with zoster infections who are at increased risk for VZ dissemination. These factors may be useful in prospectively defining high-risk groups in the design of antiviral therapy trials and may have a role in deciding which cancer patients with zoster will benefit most from receiving antiviral therapy to prevent dissemination.

Weight gain during adjuvant chemotherapy for breast cancer.

Weight gain during adjuvant chemotherapy has been reported by several authors. Because increased body weight at diagnosis is associated with an increased risk of disease recurrence, we have assessed the prevalence of weight gain in a series of patients receiving adjuvant treatment, as well as the association of weight gain with type of treatment and risk of recurrence. We first assembled an inception cohort of 237 patients who had all undergone pretreatment evaluation and treatment at one institution, and had already been followed for at least 12 months. Body weight at the start and completion of treatment was recorded, as was type of treatment and status at last followup. Ninety-six percent of patients gained weight during treatment and none lost weight (mean increase 4.3 kg). Weight gain was strongly associated with treatment, and was least in patients receiving single agent chemotherapy, greatest in patients treated with ovarian ablation and prednisone, and intermediate in those receiving combination chemotherapy. There was no association between weight gain and disease recurrence.

A pilot study of mitomycin-C/5-fluorouracil infusion combined with split course radiation therapy for carcinomas of the larynx and hypopharynx.

Fifty-seven patients with advanced squamous carcinoma of the larynx and hypopharynx were entered on a pilot study of initial therapy using split course radiation therapy combined with simultaneous chemotherapy using mitomycin-C and 5-fluorouracil. The treatment was well tolerated with 90% of patients completing their planned radiation treatment. Seventy percent of this group completed their planned chemotherapy. Significant hematological toxicity was not observed. Survival and loco regional control at one and two years of follow-up were considered at least comparable to that achieved with conventional single-course radical radiation therapy as primary treatment. Based on these results a randomized trial of this radiation-chemotherapy regimen compared to radiation therapy alone as initial therapy is in progress.