Racial differences in the incidence of gliomas: a retrospective study from Memphis, Tennessee.

This study records the incidence of glioblastoma multiforme, astrocytoma and oligodendroglioma in the white and Black patients in the Memphis Statistical Metropolitan Area (MSMA) during a 10.5-year period from 1 January 1984 through 30 June 1994. During this time, only six hospitals performed craniotomy and computer tomography (CT) scanning was routine in each of the hospitals. A total of 824 histologically confirmed first diagnoses were made at these six area hospitals. Based on the zip code listed as the home address, we determined patient's locale and identified 373 patients (232 glioblastoma multiforme, 106 astrocytomas and 35 oligodendroglioma) who resided in the area during the study interval. There were 50 black and 323 white patients. The background population for the area was obtained from the US Census Bureau's statistics for the year 1990. These statistics indicated that 40.5% of the population identified themselves as black and 57.9% as white. Age adjusted incidence rates were 1.550 (p < 0.001) for other astrocytomas, and 0.106 and 0.461 (p = 0.003) in the black and white populations, respectively. There was no significant difference in survival between the two populations. This study confirms a significant disparity in incidence rates for the three most common gliomas between the black and white populations and this disparity is higher than predicted by previous reports.

Prostaglandin production after experimental discectomy.

STUDY DESIGN: This study ascertained the effects of discectomy on prostaglandin synthesis. OBJECTIVES: The purpose of these novel experiments was to measure the levels of two prostaglandins in lumbar epidural fluid obtained from an area subjected to discectomy. For comparison, lumbar epidural fluid from a site not disturbed by discectomy and fluid from a subcutaneous site were analyzed for the prostaglandins. SUMMARY OF BACKGROUND DATA: Previous studies have shown that nuclear material obtained from degenerative discs manifests an extraordinarily high level of phospholipase A2 activity. Others have hypothesized that the known inflammatory effects of phospholipase A2 are due to the release of arachidonic acid, which is converted to various eicosanoids, including several algesic prostaglandins (PGI2 and PGE2). No previous study has continuously measured prostaglandin levels in epidural fluid or assessed the effect of discectomy on prostaglandin production. METHODS: An ultrafiltrate of lumbar epidural fluid of dogs was obtained from indwelling catheters located adjacent to spinal areas that were and were not subjected to discectomy as well as from subcutaneous tissue. The fluid was collected daily for 14 days and analyzed for PGE2 and 6-keto PGF1(alpha) (the stable metabolite of PGI2) by radioimmunoassay. RESULTS: The concentration of 6-keto PGF1(alpha) and PGE2 in fluid collected during the first 24 hours was significantly higher in the area of discectomy than in the epidural region that was not subjected to discectomy and significantly higher than in fluid obtained from the subcutaneous site. The high level of these prostaglandins at the discectomy site fell rapidly, so that by the end of 48 hours the differences in values between spinal fluid from the discectomy and nondiscectomy regions were not statistically significant. The concentration of the prostaglandins in epidural fluid decreased with time and became minimal within the second week. CONCLUSION: The removal of normal discs is accompanied for 24 hours by a marked rise in the synthesis of two prostaglandins known to produce pain. Because the concentration of prostaglandins in epidural fluid decreased rapidly thereafter, the initial surge obtained appears to be associated more with chemical factors such as phospholipase A2 than with wound healing.

The validity and significance of substages of advanced ovarian cancer.

No studies to date have evaluated the validity of the new FIGO substaging of advanced epithelial ovarian cancer nor assessed the importance of substage in relation to other elements such as age at diagnosis, debulking surgery, and second-look laparotomy. The purpose of this study was to determine the significance of these factors. One hundred sixty-seven patients with Stage III ovarian cancer were restaged according to the 1988 FIGO criteria (6% Stage IIIa, 15.6% Stage IIIb, and 78.4% Stage IIIc). The mean age at diagnosis was 40.5 for Stage IIIa, 51 for Stage IIIb, and 62 for Stage IIIc (P = 0.0001). Median survival was 2.5 years for patients age < 60 and 1.4 years for those age > or = 60 (P = 0.0001). Median survival for patients undergoing TAH/BSO was 2.06 years, bowel resection 1.39 years, and biopsy only 1.38 years (P = 0.0003). Only 61 of 131 Stage IIIc patients underwent second-look laparotomy. Seven of nine Stage IIIa, 6 of 17 Stage IIIb, and 14 of 61 Stage IIIc patients had negative second-look laparotomies (P = 0.004). Only 4 of the 14 patients with Stage IIIc and 8 of 13 Stage IIIa/b patients are alive after negative second look (P = 0.37). Median survival for Stage IIIa patients has not been reached and for Stages IIIb and IIIc was 2.29 years and 1.33 years, respectively (P = 0.0001). These data confirm the prognostic validity of FIGO substages for Stage III. The age differential by substages suggests that the natural history of Stage III disease is progressive over several decades. The appropriateness of aggressive cytoreductive surgery and second-look laparotomy must be reevaluated using the new FIGO staging system.