Charles M. Bagley

Ovarian carcinoma metastatic to the diaphragm—frequently undiagnosed at laparotomy

Peritoneoscopy was performed four weeks after diagnostic laparotorny in 14 patients with ovarian carcinoma. In 11 of these patients, diaphragmatic metastases were found, and in seven it was the only site of upper abdominal metastasis. One of the patients with diaphragmatic metastases had been thought to have had completely resected Stage IA disease, prior to peritoneoscopy. In patients with ovarian carcinoma, physicians should search carefully for diaphragmatic metastases, by direct visualization of the diaphragm. A high incidence of diaphragmatic metastasis is a possible explanation for the frequent failure of radiotherapy to cure ovarian carcinoma, and shielding of the liver during radiotherapy may be detrimental.

Treatment of ovarian carcinoma: possibilities for progress.

OVARIAN carcinoma is the fourth most frequent cause of death from cancer among women.1 Approximately 14,000 new cases are diagnosed each year, of which 10,000 will eventually be fatal.1 In about 1/...

Diagnosis of liver involvement by lymphoma: Results in 96 consecutive peritoneoscopies

Percutaneous liver biopsy and multiple needle biopsies at peritoneoscopy were done in 47 patients with untreated Hodgkins disease and 46 patients with untreated non‐Hodgkins lymphoma to determine whether hepatic involvement was present. In patients with Hodgkins disease, grouped homogenously by extent of nodal disease, hepatic involvement was proven by these biopsy methods with the same frequency as has been reported for wedge biopsy at laparotomy. With lymphocytic lymphomas, percutaneous biopsy was positive in 40% of cases, but peritoneoscopy gave frequent false‐negative results in the remaining cases. The presence of hepatomegaly was valuable in predicting positive biopsies with lymphocytic lymphoma but was of no use with Hodgkins disease or other lymphomas. Liver function tests were not of value. With Hodgkins disease, the presence of symptoms and the classification in the Lukes‐Butler categories did not help in predicting positive biopsies. The gross appearance of early lymphomatous involvement of the liver is described. Peritoneoscopy is useful in the staging of Hodgkins disease and in the post‐therapy follow‐up of patients with Hodgkins disease and non‐Hodgkins lymphomas. There is minimal morbidity, even with multiple liver biopsies, and peritoneoscopy may be done repeatedly on the same patient, if necessary.

Salvage therapy with whole‐abdominal irradiation in patients with advanced carcinoma of the ovary previously treated by combination chemotherapy

Whole‐abdominal irradiation was delivered to 22 patients with epithelial carcinoma of the ovary who had persistent disease after chemotherapy. Seventeen patients were treated with an open whole‐abdominal field and 5 with the moving‐field technique. Eleven of the 22 also received a pelvic boost. Two of nine patients with microscopic disease at second look are alive and disease‐free at 34 and 52 months, respectively. There were no salvages among the patient with macroscopic disease. Major complications included bowel obstruction in three patients and radiation enteritis in one patient. Whole‐abdominal irradiation is not an effective salvage regimen after multiagent chemotherapy.

Liver-spleen scan in Hodgkin's disease.

The liver‐spleen scans were reviewed from 108 patients with Hodgkins disease, including 71 not previously treated. The results were correlated with clinical and pathologic findings in 122 liver biopsies and 50 spleens. Splenomegaly on scan was associated with advancing stage and tumor involvement of the spleen and liver. All 13 spleens measuring over 15 cm on scan and all 7 with filling defects were positive for tumor. In combination with the physical examination and lymphangiogram, the scan enabled accurate prediction of splenic tumor in 43% of the cases. Mean size of the right and left hepatic lobes was greatest in patients with tumor in the liver, but this finding was attributable to the advanced stage of these cases. Filling defects were not a reliable sign of liver involvement. The combination of the lymphangiogram, physical examination, and liver scan proved useful in selecting groups with very high and very low probability of liver involvement.

CA-125: Use as a tumor marker with mixed mesodermal tumors of the female genital tract

CA‐125 levels were determined in seven patients with a mixed mesodermal tumor of the ovary or endometrium. An elevated level was detected in five of six patients with metastatic or recurrent disease. Chemotherapy with cisplatin and Adriamycin (doxorubicin) resulted in a response in four patients, and the CA‐125 level correlated well with the clinical status of the disease. Cisplatin/Adriamycin is an active combination in mixed mesodermal tumors and CA‐125 appears to be a useful marker for following therapy.

THE EFFECT OF CHEMOTHERAPY ON THE GROWTH OF LEUKEMIA L1210 II. PERSISTENCE OF A NITROSOUREA‐INDUCED CHANGE IN THE GROWTH CHARACTERISTICS OF TRANSPLANT GENERATIONS

A strain of murine leukemia L1210 was treated with subcurative doses of 1,3 bis‐(2‐chloroethyl)‐1‐nitrosourea. When the leukemia cells repopulated the abdominal cavity, aliquots were transplanted to other animals and the growth characteristics measured.