Integration of full-dose adjuvant chemotherapy with definitive radiotherapy for primary breast cancer: four-year update.

Controversy exists over the effect of definitive radiotherapy on the ability to administer full doses of adjuvant chemotherapy in primary breast cancer. Ninety-six consecutive women with clinical stage I and II breast cancer were treated with radiotherapy plus chemotherapy. Three combinations of drugs were used: cyclophosphamide and 5-fluorouracil (CF); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP). Chemotherapy consisted of two cycles of CF (cyclophosphamide at a dosage of 100 mg/m2 orally on days 1-14+5-fluorouracil at 600 mg/m2 iv on days 1 and 8) during concurrent radiotherapy, followed by six cycles of CMFP (same CF dosages+methotrexate at 40 mg/m2 iv on days 1 and 8+prednisone at 40 mg/m2 orally on days 1-14). The study included 63 premenopausal and 33 postmenopausal patients; 72 had 1-3 positive nodes, had greater than or equal to 4 positive nodes, and 9 had negative nodes and negative estrogen receptors. The mean CF doses delivered during concurrent radiotherapy were 95% of the optimal doses, and the mean CMF doses administered during the six cycles after radiotherapy were 89%. The CMF was delivered at level I (greater than or equal to 85% of optimal doses) to 73% of the patients. With a median follow-up of 36 months, 16 relapses have been observed. Two of these patients had treatment failure only in the breast or axilla and are disease free after mastectomy. Of the 72 patients with 1-3 positive nodes, 10 relapsed in distant sites, while 4 of 15 patients with greater than or equal to 4 positive nodes have had distant failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Asian immigration to Australia: past trends and future prospects.

PIP: Recent trends in immigration trends to Australia from Asia are analyzed, and future prospects are considered. Concerns about the ethnic composition of the population due to different levels of Asian immigration are emphasized, as are the policy options available to affect immigration levels.^ieng

Enterocutaneous fistulae: interventional radiologic management.

Twelve patients with high-output enterocutaneous fistulae were successfully managed by interventional radiologic therapy. Control of the bowel effluent was gained by anchoring a large-bore T tube in the lumen of the bowel and placing sump drains adjacent to the bowel wall. Abscesses communicating with the fistulous tract were also catheterized and drained. This approach afforded control of sepsis and allowed the formation of a mature, fibrous external tract that subsequently underwent spontaneous closure.

Percutaneous transhepatic drainage preoperatively for benign biliary strictures.

In two patients, the value of percutaneous transhepatic decompression in the management of benign biliary strictures is illustrated. The procedure can help provide relief of jaundice, control of infection and improvement of nutritional status. Results of previous experience indicate that these factors play a major role in determining the over-all success rate in the surgical management of these patients.

Choledochocele as a cause of recurrent pancreatitis.

A patient with recurrent episodes of acute pancreatitis found to be caused by the presence of a choledochocele is presented. Transhepatic cinecholangiography revealed a choledochocele receiving the terminations of the common bile duct and pancreatic duct, which emptied via a pinpoint opening into the duodenum. With duodenal peristalsis, the contrast material filling the choledochocele could be seen refluxing into the pancreatic duct. A discussion of the possible etiologies of choledochoceles and a review of the existing literature is presented.

Clinical applications of nonoperative T-tube replacement.

T tubes were successfully reintroduced through previously created drainage tracts in 17 consecutive attempts. The new tubes can re-establish bile flow in a variety of circumstances in avoiding reoperation.

Pancreaticogastrostomy: a further evaluation.

The anastomosis between the remaining pancreas and the intestinal tract after various types of pancreatic resection has been the site of complications responsible for considerable morbidity and mortality. After Whipple resections reestablishment of pancreatic-intestinal continuity has generally been accomplished in some manner between the pancreas and upper jejunum. This suture line has at times failed, often as the result of postoperative pancreatitis, giving rise to hemorrhage, abscess, and fistula formation. Since 1963, 25 patients undergoing pancreaticoduodenal resection have had some portion of their pancreas implanted into the back wall of the stomach. The operations have been done by the resident and senior staff of the Department of Surgery at the University of Pennsylvania. Morbidity has decreased and operative mortality has fallen from 20-30% to 8%. The technique is not difficult and there seems to be less tendency for the anastomosis to leak. Pancreatic function is usually adequate. The procedure is useful after radical resection of the pancreaticoduodenal region or at times after pancreatic trauma.

An analysis of twenty years' experience with operations for carcinoma of the stomach.

We analyzed the records of 242 consecutive patients with adenocarcinoma of the stomach operated on for cure. We correlated survival with several factors, including the type of primary lesion, the operation performed, operative mortality, state of regional lymph nodes, margins of the resected specimens, and duration of preoperative symptoms. Overall survival at 5 years was only 18.6% and at 10 years was 7.1%. Patients with small malignant gastric ulcers, however, enjoyed increased survival at 5 years (53.8%) and at 10 years (15.0%). Overall operative mortality was 7.1%, but was 0% for patients with small malignant gastric ulcers. Even with large or high-lying lesions, radical operation can be accomplished with acceptable mortality and definite chance for cure. Thirteen of 45 five-year survivors had positive lymph nodes, and 7 of the 45 had positive margins of resection. Longer symptomatic preoperative periods, correlated positively with increased survival. Thirty patients with preoperative symptomatic periods exceeding 24 months had a 30.0% 5-year survival. Perhaps some of these lesions underwent malignant change in areas of symptomatic benign disease. We advocate early operation for gastric ulcers which do not heal promptly and stay healed.