Early detection and treatment of spinal epidural metastases: the role of myelography.

Spinal epidural metastases were detected in 75 of 140 cancer patients with back pain who were evaluated prospectively by clinical criteria, spine roentgenography, and bone scan. Fifty-five of the 75 patients with epidural metastases had no evidence of myelopathy when diagnosed. Of the patients diagnosed and treated while still ambulatory, more than 90% remained so. Myelograms were performed in 127 patients to diagnose the 75 with epidural disease. To try to reduce the number of myelograms needed, we attempted to design radiotherapy ports based on clinical symptoms and the plain spine films alone. A port could not be designed for 64 of the 127 patients, either because of diffuse vertebral metastases or a normal plain roentgenogram. A port could be designed for 63 patients, and all epidural disease would have been encompassed in 50 of the 54 patients who had spinal epidural metastases (93%). Most patients with cancer and back pain require myelography for accurate treatment planning. There are, however, situations in which treatment can be determined based on symptoms and plain films alone, with a low risk of missing epidural cancer.

Early recurrence following induction chemotherapy for stage IV head and neck cancers: rationale for additional therapy.

Twenty patients with Stage IV neoplasms of the head and neck were treated with two induction cycles of cis-platinum, bleomycin and methotrexate. Eight of eleven operable patients and five of nine inoperable patients responded prior to surgery and/or radiation, including three CRs. Toxicity was mild. There were two early local recurrences but no systemic metastases among the resectable patients. Perhaps initial therapy should be used to select patients with chemoresponsive tumors who might benefit from additional chemotherapy after surgery.

A growth and development course for allied health majors.

This article describes an interdisciplinary course in growth and development for allied health students. The course focuses on physical, nutritional, and psychosocial aspects of development and views the individual from the time of conception through adulthood. For each developmental stage, professors integrate course material and class activities for students so that a composite picture of the individual is presented. Students also complete a developmental study on a preschool child and compare their assigned child to normative expectations. The course has been successful during the past five years, and it is anticipated that students from other major fields will elect to take this course.