John W. Raker

Patient delay in cancer.

Abstract Analysis was made of psychosocial factors influencing the amount of elapsed time between the first sign or symptom of cancer and the search for medical help in 563 patients. Delay remained...

Prognostic Factors for Patients with Clinical Stage I Melanoma of Intermediate Thickness (1.51–3.99 mm)* A Conceptual Model for Tumor Growth and Metastasis

Fourteen variables were tested for their ability to predict visceral or bony metastases in 177 patients with clinical Stage I melanoma of intermediate thickness (1.51–3.99 mm). A Cox multivariate analysis yielded a combination of four variables that best predicted bony or visceral metastases for these patients: 1) mitoses > 6/mm2 (p = 0.0007), 2) location other than the forearm or leg) p = 0.009), 3) ulceration width > 3 mm (p = 0.04), and 4) microscopic satellites (p = 0.05). The overall prognostic model chi square was 32.40 with 4° of freedom (p < 10-5). Combinations of the above variables were used to separate these patients into at least two risk groups. The high risk patients had at least a 35% or greater chance of developing visceral metastases within five years, while the low risk group had greater than an 85% chance of being disease free at five years. Criteria for the high risk group were as follows: 1) mitoses > 6/mm2 in at least one area of the tumor, irrespective of primary tumor location, or 2) a melanoma located at some site other than the forearm or leg and histologic evidence in the primary tumor of either ulceration > 3 mm wide or microscopic satellites. The low risk group was defined as follows: 1) mitoses ≤ 6/mm2 and a location on the leg or forearm, or 2) mitoses ≤ 6/mm2 and the absence in histologic sections of the primary tumor of both microscopic satellites and ulceration ≥ 3 mm wide. The number of patients in this series who did not undergo elective regional node dissection (N = 47) was probably too small to detect any benefit from this procedure. Based on survival rates from this and other studies, it is estimated that approximately 1500 patients with clinical Stage I melanoma of intermediate thickness in each arm of a randomized clinical trial would be needed to detect an increase in survival rates from elective regional node dissection.

Surgical experience with the treatment of hypertension of cushing's syndrome

Abstract 1. 1. An analysis of sixty-three patients with Cushings syndrome is presented. 2. 2. Eighty-one per cent of these patients had hypertension at some time in the course of their illness. In six patients, hypertension was the immediate cause of hospital admission. 3. 3. When the stigmas of Cushings syndrome are not flagrantly apparent, the disease may masquerade as essential hypertension. The use of appropriate screening tests may prove the masked presence of Cushings syndrome. 4. 4. Relief of hypertension of Cushings syndrome can be accomplished frequently by surgical means when surgery can control the underlying disease. The results of surgical therapy of benign cortical adenomas are particularly good, and the recent results of subtotal adrenalectomy for adrenocortical hyperplasia are encouraging.

Significance of megakaryocytes in the search for tumor cells in the peripheral blood.

BECAUSE of the frequency of lung and liver metastasis in the spread of certain malignant tumors it has long been accepted that malignant tumors may invade blood vessels, particularly veins, and cre...

Human carcinoma of the breast, in vitro: The effect of hormones. A preliminary report

Cortisol, estradiol‐17B, progesterone, testosterone, and human chorionic gonadotropin altered 3H‐thymidine uptake in tissue culture suspensions of human breast carcinoma in 10 of 20 tumors studied. In 6 patients where there was an opportunity to observe the clinical response to hormonal therapy, an apparent correlation was present between the in vitro data and clinical course. This correlation suggests that this in vitro assay may be useful in selecting patients for hormonal therapy.

A preliminary study of intralesional, intralymph node, intravenous and intraperitoneal Corynebacterium parvum treatments in patients with advanced cancer.

Twenty‐one patients with squamous cell carcinoma of oral cavity and/or cervical lymph node and four patients with soft tissue sarcomas were given intralesional (2–4 mg/m2) and intralymph node (2–4 mg/m2) C. parvum injections followed by 5 intravenous (2–4 mg/m2) C. parvum treatments and conventional therapies. Seven patients with Stage III ovarian carcinomas were given intraperitoneal (2–4 mg/m2) C. parvum injections followed by conventional therapies. The local and systemic effects of the C. parvum treatments were described and the anti‐tumor effects were evaluated in this series of patients. Cancer 42:1912–1915, 1978.

Case 39-1962

Presentation of Case A forty-three-year-old man was referred to the hospital because of pain in the abdomen. Five days previously the patient suddenly experienced severe, generalized abdominal pain...