Metastatic breast disease 40 years after the initial diagnosis.

This is the case of a patient with metastatic disease diagnosed 40 years after a radical mastectomy which was followed by radiation treatment for breast cancer. The patient had nonspecific symptoms for 3 years, and a lymph node biopsy revealed the underlying cause to be recurrent breast cancer. Excision of the largest metastases combined with chemotherapy resulted in a further 3-year remission.

An unusual cytogenetic abnormality involving chromosomes 1 and 7 in a case of chronic myelomonocytic leukemia.

We report a case of chronic myelomonocytic leukemia in which cytogenetic analysis revealed a 47,XY, +1, +der(7)del(7)(q32q36)ins(7;1)(q32;p36.3p22) chromosomal constitution. This abnormal karyotype, which as a whole is new to any myeloid malignancy, points to a possible pathogenetic role for the oncogenes MET and FGR on the derivative chromosome 7, and for the CSF1 and JUN genes flanking the breakpoint on chromosome 1.

Pancoast's syndrome following an intrapleural rupture of a hepatic echinococcus cyst.

A case of Pancoast's syndrome due to a hydatid cyst is described. The cyst developed secondarily, after intrapleural rupture of an echinococcus cyst situated in the liver. The patient was operated and the cyst excised. After the operation the pain in the shoulder and the arm disappeared immediately. The Horner's syndrome needed longer to subside. Three years after the operation there is still some constriction of the pupil of the right eye. The development of Pancoast's syndrome due to hydatid disease is very rare and this case--caused by a secondary cyst after intrapleural rupture of a similar hepatic echinococcus cyst--is the first described in the literature.

Use of the activated coagulation time in cardiac surgery. Effects on heparin-protamine dosages and bleeding.

A standard heparin-protamine protocol was used for a series of 44 patients. In a second series of 82 patients. Activated Clotting Time (ACT) by the Hemochron method was used to control heparinization and its reversal with protamine. The two groups was similar in regard to surgical procedures, pump-times and perfusion technique. Patients in group II controlled by Hemochron received in average 13% less heparin and 48% less protamine than patients in group 1 (p less than 0.001 Student's t-test). The intra-operative blood loss was on an average 50% less in group II than in group I (p less than 0.001). There was, however, no significant difference in regard to postoperative bleeding. The introduction of the ACT test thus resulted in reduced dosages of heparin and protamine and in a reduction of intra-operative bleeding, while surgical technique seems to be the main factor in the control of postoperative bleeding.

Dumb-bell intrathoracic and intraspinal neurofibroma. Report of a case.

Neurogenic tumors of the posterior mediastinum commonly constitute an extraspinal portion of a dumb-bell tumor affecting the spinal canal. In a 42-year-old man with a history of back pain for more than 6 months and severe lower-limb paralysis and impaired urinary voiding for 20 days, chest radiography showed a posterior mediastinal mass and thoracic myelogram a total extradural defect at the level of T10. A computed tomography scan showed extension of this intrathoracic mass into the intraspinal space through the spinal foramen. In a single-stage operation, posterolateral thoracotomy and laminectomy were performed. This surgical approach avoids complications, notably from traction on the spinal cord.

An automated patient registration and treatment randomization system.

Centralized patient registration and treatment randomization for multicenter clinical trials has many advantages over other approaches. Our Automated Patient Registration and Treatment Randomization system is a fully automated Interactive Voice Response, microcomputer-based application which can operate unattended and is continuously available to provide patient registration and treatment randomization. Several techniques are employed to ensure security of the system and validity and accuracy of the data. Several randomization methods were implemented to support different study designs including balanced block randomization, stratified permuted block scheme, and a sophisticated randomization design based on the minimization method and Zelen's adaptive randomization method for institution balancing.

Delayed sternal closure following cardiac operation.

Reports are presented of five cases in which sternal closure was delayed following surgery with cardiopulmonary bypass. The indications for delayed closure were cardiac distension, particularly of the right ventricle, and intractable bleeding. Four patients survived after delayed sternal closure, but one died of myocardial failure 23 days after the operation. In 3 additional cases (infants with severe congenital heart disease) the sternum was left open for the same reasons, but death from cardiac insufficiency occurred a few hours postoperatively. Delayed closure of the sternum is a useful manoeuvre and its judicious use adds flexibility in the management of selected and difficult cases.

An expert system for assigning patients into clinical trials based on Bayesian networks.

Assigning patients into clinical trials is a knowledge and data intensive task. Eligibility determination for entry into a clinical trial is based upon specific inclusion and exclusion criteria. This paper investigates the use of an excerpt system to assist the physician through this task. This expert system uses Bayesian networks, a probabilistic method that can take advantage of pre-existing statistical knowledge. The paper also describes the feasibility of such a system by presenting the implementation of three clinical protocols. The experimental results reveal that the approach is feasible. The system gives correct eligibility scores when all evidence is available but also predicts eligibility when there is missing evidence. The system directs the physician to the protocols the patient is most eligible for, according to the current evidence. The system has the ability of learning its prior and conditional probabilities (expert knowledge) from training examples.

Recurrent anaphylactic shock as a manifestation of echinococcosis. Report of a case.

Hydatid disease, caused by the cestode Echinococcus granulosus, is common in Mediterranean regions, being highly endemic in Greece. Depending on its size, an intact hydatid cyst may be "silent" or may cause symptoms from compression of adjacent organs. Rupture of a hydatid cyst commonly gives to allergic phenomena, which can include anaphylactic shock. A case is presented in which there was a two-year history of recurrent anaphylactic shock due to small, incomplete ruptures of hydatid cyst. The case emphasizes the potentially life-saving importance of early diagnosis of hydatid cyst.

Experimental acute and chronic vascular access through the femoral vessels: hemodynamic study in dogs.

In a side-to-side fistula between femoral artery and vein, an external "shunt" was created that simultaneously connected the distal femoral vein and the proximal femoral vein in 14 normal dogs with weight ranging from 14 to 28 kg. Blood flow and pressure alterations of different sites of this experimental model of vascular access were studied. The results showed that the degree of blood flow on these two vascular communications depends on the structural integrity of the femoral artery with adequate blood flow and blood pressure. Also, the correct connection of external shunt with the fistula is of equal importance. It is suggested that the blood pressure as well as the blood flow rate of these two vascular communications were adequate to allow performance of acute and chronic hemodialysis.

Paclitaxel (175 mg/m2) plus carboplatin (6 AUC) versus paclitaxel (225 mg/m2) plus carboplatin (6 AUC) in advanced non-small-cell lung cancer (NSCLC): a multicenter randomized trial. Hellenic Cooperative Oncology Group (HeCOG).

PURPOSE: The combination of paclitaxel and carboplatin has become a widely used regimen in NSCLC due to phase II reports of moderate toxicity, reasonable activity and easy outpatient administration. Purpose of our present prospective study was to evaluate the dose response relationship of paclitaxel. PATIENTS AND METHODS: Since July 1996, 198 patients with non-operable NSCLC and measurable disease without previous chemotherapy entered the trial. Ninety nine patients (group A) were randomized to receive paclitaxel 175 mg/m2 in three-hour infusion plus carboplatin dosed to an area under the concentration-time curve of 6 every 3 weeks and 99 (group B) to receive the same regimen with paclitaxel increased to 225 mg/m2. Eligibility criteria included WHO performance status 0-2, documented inoperable stage IIIA and IIIB, IV, no brain metastasis, no prior chemotherapy and adequate renal and hepatic function. Patients in both groups were well-matched with baseline disease characteristics. RESULTS: In group A with 90 evaluable patients, the response rate was 25.6% (6 CR, 17 PR) whereas in group B with 88 evaluable patients, the response rate was 31.8% (3 CR, 25 PR), P = 0.733. Median time to progression favored the high-dose paclitaxel (4.3 vs. 6.4 months, P = 0.044). The median survival was 9.5 months for group A versus 11.4 months for group B (P = 0.16). The one-year survival was 37% for group A and 44% for group B (P = 0.35). The best prognostic factor for one-year survival was the response rate (P < 0.0001). With a relative dose intensity of paclitaxel 0.94 in both groups, neurotoxicity (P = 0.025) and leucopenia (P = 0.038) were more pronounced in group B patients. No toxic death was observed. CONCLUSIONS: Higher dose paclitaxel prolongs the median time to progression but causes more neurotoxicity and leucopenia. The better response rate, the longer overall and better one-year survival seen with the higher dose of paclitaxel are not statistically significant.