Arthur B. Abt

Analysis of factors contributing to treatment failures in Stages IB and IIA carcinoma of the cervix

Between April, 1971, and September, 1977, 98 patients with Stages IB and IIA cervical cancer who underwent surgical exploration prior to treatment at Hershey Medical Center were studied. Those who had bulky primary tumor (greater than or equal to 4 cm) had a higher incidence of nodal metastases (80% vs. 16%), local recurrences (40% vs. 5%), and distant metastases (40% vs. 1%). Patients who had positive nodes had more local recurrences (24% vs. 6%) and distant metastases (28% vs. 0%). Those with grossly positive nodes had more distant metastases (60% vs. 7%) than those with microscopically positive nodes. Those who had positive nodes, vascular invasion, and/or deep invasion of the cervix (greater than or equal to 70% of thickness) in the radical hysterectomy specimen had more nodal metastases and local recurrences. Postoperative radiation seemed to prevent local recurrences (40% vs. 6%) and improve the 2-year tumor-free survival rate (94% vs. 55%). Patients who had bulky primary tumors and/or grossly positive nodes at laparatomy may require systemic therapy in view of the high incidence of distant failures.

Vascular Anastomoses in Growing Vessels: The Use of Absorbable Sutures

Primary end-to-end infrarenal aortic anastomoses were performed in 36 piglets using two synthetic absorbable suture materials: polydioxanone and coated polyglactin. Animals were killed at 1, 4, and 11 weeks and 6 months following operation. Each aorta was removed, burst-tested to 300 mm Hg, radiographed, and examined histologically. All anastomoses were patent, and no burst-test failures occurred. Stenosis occurred in 14 of 17 animals at 1 and 4 weeks, respectively. One of 5 animals exhibited stenosis at 11 weeks, and none of the 14 animals had stenosis 6 months postoperatively. Histological examination revealed fibrosis replacing areas of disrupted elastica at 6 months in both suture groups. This study suggests that absorbable suture material, in particular polydioxanone, because of its excellent handling characteristics and prolonged tensile strength retention, will be useful for the repair of vascular and cardiac anomalies where growth of the suture line is required.

Hepatic pathology associated with Hodgkin's disease

Liver biopsies obtained during staging laparotomy for Hodgkins disease from 103 untreated and 25 previously treated patients were reviewed. No significant differences were noted between the two groups as to the incidence of Hodgkins disease, epithelioid cell granulomata, and non‐specific inflammation. There appeared to be some increase (not statistically significant) in fatty infiltration and hemosiderosis in the treated patients. Patients with elevated alkaline phosphatase demonstrated Hodgkins disease, non‐specific hepatic lesions, or no pathologic findings. Biopsies from 5 Hodgkins disease patients with hepatitis‐associated antigen revealed varied hepatic pathologic findings. In 70 patients with both wedge and deep needle biopsies, the needle biopsy did not demonstrate additional lesions than those observed in the wedge specimen. The importance of careful examination of the liver surface during laparotomy was emphasized. Cancer 33:1564–1571, 1974.

Thin basement membrane disease and acute renal failure secondary to gross hematuria and tubular necrosis

A patient with thin basement membrane disease (TBMD), macroscopic hematuria, and acute renal failure is described. A renal biopsy showed massive occlusion of renal tubules by red blood cells and casts. This was accompanied by tubular cell damage consistent with acute tubular necrosis. The patient was receiving warfarin because of a history of deep venous thrombosis at the time he developed the acute renal failure. The possible relationship of the warfarin therapy to the TBMD, intratubular hemorrhage, and acute renal failure are discussed.

Small cell undifferentiated carcinoma of the larynx.

A patient with a small cell, undifferentiated carcinoma of the larynx is described. The tumor appeared to arise in close association with subglottic minor salivary glands. Ultrastructural study of the tumor cells showed neurosecretory granules similar to those seen in normal Kulchitsky cells and pulmonary oat cell carcinomas. Bronchogenic oat cell carcinoma and small cell undifferentiated carcinoma of minor salivary gland tissue probably originate from the same cell type. The aggressive behavior of this tumor suggests the need for early systemic treatment including combination chemotherapy.

Renal failure after anti-D globulin treatment of idiopathic thrombocytopenic purpura

Abstract Idiopathic thrombocytopenic purpura (ITP) is a disorder of rapid destruction of antibody-coated platelets. Anti-D immune globulin has been used for treatment of ITP in the United States since 1995. Initial studies identified no significant side effects of treatment. However, a recent report highlighted occasional episodes of intravascular hemolysis after anti-D immune globulin. We describe two children with ITP who developed acute renal failure (ARF) after treatment with anti-D immune globulin and also analyze ten additional cases of ARF reported to the manufacturer, Cangene Corporation, through postmarketing surveillance. All episodes of ARF were associated with intravascular hemolysis. Four patients required dialysis. Patient age ranged from 1 to 82 years, but those requiring dialysis were all under age 15 years. Several patients with ARF had preexisting creatinine elevation. Three of the patients with ARF had serologic evidence of acute Epstein-Barr virus (EBV) infection. Renal biopsy in one patient showed acute tubular necrosis, with findings consistent with pigment nephropathy. Anti-D immune globulin, used to treat ITP, may be associated with intravascular hemolysis and resultant ARF. Renal function should be monitored in patients with evidence of intravascular hemolysis. Children and adolescents may have increased risk of ARF requiring dialysis.

Fetal Rhabdomyoma and Nevoid Basal Cell Carcinoma Syndrome

A 6-year-old white female presented with a fetal rhabdomyoma of the posterior mediastinum and retroperitoneum. Radiologic evaluation and family history revealed features of the nevoid basal cell carcinoma syndrome (NBS). Literature review disclosed two other children with NBS and fetal rhabdomyoma, which should be regarded as one of the soft tissue tumors associated with NBS.

Staging laparotomy in Hodgkin's disease: Further evidence in support of its clinical utility

Abstract Records of 99 consecutive previously untreated patients with Hodgkins disease subjected to laparotomy at our institution were reviewed in order to assess the frequency with which inadequate or inappropriate therapy might have been administered on the basis of clinical staging alone. Of the 86 patients judged to be candidates for aggressive radiation therapy prior to laparotomy (clinical stage less than IIIB) unsuspected disease was found in the porta hepatis lateral to the margin of the usual para-aortic radiation field in 4, and occult liver involvement in an additional 2. On the other hand, 2 patients with clinically suspected hepatic involvement were found to be free of parenchymal disease and therefore candidates for aggressive radiotherapy. Of particular interest was the discovery of occult abdominal disease outside conventional extended field radiation ports in 3 patients with clinical stage IIA disease. It was not possible to reliably exclude the presence of occult disease outside standard abdominal radiation ports by previously published guidelines outlining indications for staging laparotomy.

VCN-Releasable sialic acid and gangliosides in human neuroblastomas

The ganglioside pattern and VCN-releasable sialic acid residues of six human neuroblastomas were studied. There was no correlation between VCN-releasable sialic acid and prognosis. The ganglioside patterns were more complex in those cases with an expected good prognosis as reflected by the presence of trisialoganglioside. The complexity of the ganglioside pattern did not always correlate with the histologic grade of the tumor. These results suggest the ganglioside pattern may serve as a chemical marker for predicting the prognosis in patients with neuroblastomas.

A patient with multiple, malignant melanomas of the lower genital tract

Malignant melanomas of the female genital tract are uncommon lesions. A patient with multiple cutaneous, vulvar melanomas and a subsequent malignant melanoma of the cervix is described.