Localized well-differentiated thyroid carcinoma: survival analysis of prognostic factors and (131)I therapy.

BACKGROUND: Recommendations regarding therapeutic use of (131)I for patients with well-differentiated thyroid cancer remain controversial. Between 1969 and 1993, 1171 patients with papillary (including mixed) or follicular thyroid cancer were reported to the New Mexico Tumor Registry. Of these, 1075 cases (77.6% female, median age 41 years) were available for analysis of survival plots and previously recognized risk factors. Extent of operation was documented for 344 patients. METHODS: One hundred twenty-seven (37%) patients underwent postoperative (131)I ablation. Median follow-up was 99 months. A proportional hazards model was constructed using age, gender, stage, histology, and use of radioiodine. The same variables plus extent of operation were examined in the smaller group. RESULTS: Kaplan-Meier survival estimates at 12 years were 96.2% for patients younger than 45 years and 68.6% for those older than 45 years. Age, gender, and histology, but not stage, were important survival variables (P <.05). Adjusting for other risk factors, there was no apparent survival benefit associated with radioiodine following clinically appropriate thyroidectomy. Findings from the small group mirrored those of the large group. CONCLUSIONS: (131)I may not be as efficacious as previously believed for patients with well-differentiated thyroid cancer confined to the neck.

Electrochemical modification of tumor growth in mice.

We evaluated the effect of direct electrical current on large tumors in mice. Lewis lung carcinoma greater than 1 cm in the shortest dimension was treated percutaneously with 20 mA for 15 min. Separate groups were given one or more than one (two or three) percutaneous electrical treatments (PET). A third group was given sham electrical treatment, and a fourth group had surgical excision of the tumor. Animals in both PET groups survived longer and had smaller primary tumors at death compared with the sham group. PET did not alter the systemic course of the disease, judged by lung and spleen weights and by histological observation of the extent of metastatic burden in the lung. Surgery resulted in long-term survival of 17% and an increase in average survival time compared with both PET and sham treatment. PET produced rapid and polarity-dependent alterations in physiological solutions in vitro, and it is likely that similar electrochemical processes mediated the observed reduction in tumor growth. PET is potentially useful as an adjuvant modality because it reduces local tumor mass but does not alter the extent of metastasis.

The response to further chemotherapy in patients with carcinoma of the breast who progressed while receiving adjuvant therapy.

The effect of known chemotherapeutic programs in patients with breast cancer who developed metastasis during or after adjuvant chemotherapy with L-PAM plus 5-FU (PF) were studied. Thirteen patients failed while receiving adjuvant therapy at 3-22 months from the time therapy started. Three patients failed 6-28 months after 2 years of therapy. Thirteen patients received PF followed by cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) at the time of progression on PF. Of these, ten received Adriamycin and vincristine (AV) at the time of progression on CMF. The response to CMF was 7%. No patient responded to AV after progression on CMF. Two of three patients treated with AV after failure on PF did respond, but both for only 6 months. This suggests that adjuvant therapy may render the tumor less responsive to further chemotherapy. Since most patients failed while on adjuvant therapy, this may indicate a poor prognosis regardless of the agents used.

Hypnoanesthesia in the morbidly obese.

The advent of chemical anesthesia relegated hypnosis to an adjunctive role in patients requiring major operations. Anesthesia can be utilized with acceptable risk in the great majority of patients encountered in modern practice. But an occasional patient will present--such as one with morbid obesity--who needs a surgical procedure and who cannot be safely managed by conventional anesthetic techniques. This report describes our experience with such a patient and illustrates some of the advantages and disadvantages of hypnoanesthesia. The greatest disadvantage is that it is unpredictable. Close cooperation between the patient, hypnotist, anesthesiologist, and surgeon is critical. However, the technique may be utilized to remove very large lesions in selected patients. Hypnoanesthesia is an important alternative for some patients who cannot and should not be managed with conventional anesthetic techniques.

Screening for occult blood in selected patients. The potential for false-negatives.

Seventy-one patients presenting for elective hernia repair without gastrointestinal symptoms were screened for occult blood in their stools. All patients had stools negative for occult blood and were studied with proctosigmoidoscopy and barium enema. Polyps were found in 10% of the study population. The potential for missing polyps definitely exists if patients are selected for further studies only on the basis of tests for occult stool blood.