William F. Carr

The management of ovarian-cancer-caused bowel obstruction

Abstract The records of 518 patients with ovarian cancer between 1969 and 1977 were retrospectively analyzed. During the course of their disease, 127 patients developed intestinal obstruction. Obstructions occurred in 17 (13.9%) of stage I patients, 17 (16.8%) of stage II patients, 72 (30.0%) of stage III patients, 20 (36.4%) of stage IV patients, and in 1 of the 3 patients whose initial staging was unknown. At advanced stages, patients developed intestinal obstruction more quickly. Patients deemed terminal and thus inoperable survived an average of 2 months. Those treated surgically for these obstructions survived an average of 7 months. Colostomy patients lived for 6.6 months. The degree of obstruction, partial or complete, was not significantly related to survival. The median time of survival for all patients with obstruction was 112 days.

The Relationship of Reactions to Complications in the Radiation Therapy of Cancer of the Cervix

A review was made of the reactions and complications associated with high-dose radiation therapy of invasive carcinoma of the cervix in 410 patients. In all patients a combination of intracavitary and external therapy had been given. Either a bowel or urinary tract reaction or both developed in 133 of the 410 patients; one or more complications occurred in 94. As the severity of bowel reactions increased, the subsequent complication rate increased significantly, but 39% of those with bowel complications and 88% of those with urinary tract complications had no warning reaction.

Estrogen use — Risk of endometrial carcinoma

Abstract A retrospective analysis was carried out to determine the prior usage rate of exogenous estrogens in all patients treated for adenocarcinoma of the endometrium in our institution from 1960 to 1974, and in a series of matched controls. Hospital records were reviewed, and patients were matched with controls who had a different gynecologic malignancy. The crude usage rate for all patients with endometrial carcinoma was 18.4% compared with 9.2% of controls yielding a relative risk of 2.2. There was a statistically significant increase in estrogen exposure since 1970, but the risk did not change. Hypertension, diabetes mellitus, and obesity were significant risk factors by themselves, but estrogen exposure in these patients did not appear to put them at further increased risk. There was no significant difference between the exposed and nonexposed groups in respect to grade or stage. In spite of a low exposure rate in this area, the relative risk for estrogen exposure was significant, independent of other variables.

Radiation reactions in cervical cancer therapy

Abstract Between 1961 and 1969, there were 410 patients treated for invasive squamous cell carcinoma of the cervix with either intracavitary therapy alone or in combination with external radiation. This group of patients was reviewed for reactions occurring during treatment as well as one month after completion of treatment. The reactions were subdivided into mild, moderate, and severe. As the gastrointestinal reactions became more severe, the chance for a subsequent complication increased significantly. Though patients had no problems during the course of radiation therapy, it appears a certain per cent will still develop complications later. The same relationship was not observed for the genitourinary system. The majority of patients developing a genitourinary complication had no significant symptoms during the reaction period.

Treatment of recurrent carcinoma of the vulva

Abstract From 1960 to 1976, 29 patients out of a total 164 were evaluated at the University of Wisconsin Center for Health Sciences for recurrent squamous cell carcinoma of the vulva. Additional surgery or irradiation was administered to 93%. The majority of patients (18) presented with recurrent disease involving only the perineum. The average survival following surgery was 43 months, or after irradiation, 26 months. Many of these patients (73%) obtained local control of their disease. Recurrent tumor involved the groins or pelvis in the remaining patients (9). Seven of these patients obtained good palliation and/or local control following surgery or irradiation. The average survival for the entire group was 24 months with 2 patients NED at 4 and 13 years.

Intracavitary dosimetry for carcinoma of the cervix and subsequent complications

Abstract The isodose curves from 464 patients treated for invasive carcinoma of the uterine cervix were reviewed for any relationship to subsequent complications. If intracavitary radiation was emphasized, the amount and arrangement of the radioactive sources in a specified volume were more significant than just the range of milligram hours or rads to Point A when the bowel complications were reviewed. When external irradiation to the whole pelvis was the main portion of the treatment plan, the range of rads to Point A from the intracavitary radium insertion related to subsequent bowel problems. Those patients having a central stem for the intracavitary had more bowel complications than when tandem and ovoids were used.

THE APPOINTMENT OF STATE BOARDS OF MEDICAL AND DENTAL EXAMINERS.

Not many years ago it seemed to the majority, as it now seems to some of those interested in the advancement of medical and dental education, that diplomas from chartered colleges or schools gave sufficient assurance that their possessors were qualified to practice in the general or special fields of medicine in which degrees had been conferred upon them, and that the diplomas granted served as an adequate standard for license. This view assumed that instruction in such schools was faithfully given, by competent teachers, during a period of sufficient length to qualify students for the commencement of their careers, and also assumed that diplomas were conferred only upon those who, at the completion of such a period of study, had demonstrated, upon examination, their qualifications. It also assumed that charters would not be recklessly granted to professional schools, and that such charters would be revoked upon proof of their