Specialty-oriented internships.

The osteopathic medical rotating internship for many years represented the culmination of the making of an osteopathic physician. The rotating internship has been singularly responsible, in many instances, for our representation as the primary care profession. As recently as 12 years ago, the majority of DOs entered practice directly from the rotating internship. This 1-year exposure from classroom to practice was a trip through a required minimum of five clinical specialties with some typical exposure to radiology, pathology, and anesthesiology. The author proposes a specialty track program as part of a restructured internship.

Multiple primary prostate cancer.

Although increasing reports are noted of apparent endometrial carcinoma of prostatic origin, the controversy is present of the actual existence of such an entity. The association of papillary prostatic cancer (endometrial or ductal) with the typical microacinar variety has also been previously presented. This report is an account of 2 cases of multiple prostatic primary tumors. The first case is the twelfth reported case of endometrial (utricular) carcinoma not only simultaneously associated with microacinar type carcinoma, but also with a previous transitional carcinoma of the urinary bladder. The second case is a papillary carcinoma and associated microacinar type with the papillary component responding dramatically to chemotherapy. Significant aspects of interest in this case include the site of papillary metastasis to the lungs, elevated estrogen levels with normalization after treatment, and finally response to chemotherapy.

Mitomycin C, vincristine, and bleomycin therapy for advanced cervical cancer.

The Southwest Oncology Group has treated 130 patients with advanced disseminated uterine cervical carcinoma no longer amenable to therapy with further radiation or surgery. Patients received one of three different schedules of mitomycin C, vincristine and bleomycin. A twice weekly schedule of bleomycin and vincristine produced response in 60% of patients. An infusion bleomycin schedule produced response in 39% of patients and a once weekly vincristine bleomycin schedule produced a 25% response rate (45% overall). Responding patients lived significantly longer than nonresponders (30 vs 18 weeks). Toxicities encountered included leukopenia, thrombocytopenia, peripheral neuropathy, gastrointestinal upset, dermatitis, and alopecia. We believe two of the schedules utilized represent an improvement in producing tumor remission induction in this previously recognized refractory carcinoma.

Primary pleural melanoma. A first reported case and literature reivew.

Although metastatic pulmonary and pleural melanoma has previously been noted, primary pleural melanoma has not been reported. In addition, an extracutaneous response to Adriamycin chemotherapy for melanoma is documented. The patient demonstrated a continued objective response and remained in remission for 10 months. His death was not related to the tumor, and at autopsy there was no gross or microscopic evidence of other organ involvement or origin. Previously reported unusual primary sites associated with this tumor are reviewed, and the established criteria for determination of a primary site in the lung are reiterated. Possibilities of prior unrecognized presence of a primary site are discussed. After having reviewed pertinent literature regarding this intriguing case, we believe that all necessary criteria for proof of a first report have been met.

Phase II study of mitomycin-C, vincristine, and bleomycin in advanced squamous cell carcinoma of the uterine cervix.

Utilizing the stathmokinetic principle of timed vincristine and bleomycin, we combined these two agents with Mitomycin-C. The dose schedule included vincristine 0.5 mg/m2 intravenously (i.v.) geginning on day 1 and repeated twice weekly for 12 weeks; each injection was followed in 6-12 hours by bleomycin 6 mg/m2 for 12 weeks. Mitomycin-C was administered as a 20 mg/m2 bolus beginning on day 2 and repeated at 6-week intervals. Thirty patients were entered into this study, 27 were fully available for response. Thirteen patients (48%) met criteria of response (greater than 50% reduction in volume of measurable tumor). Significant myelosuppression resulted from this therapy. Median leukopenia nadir was 3.8 X 10(3) cells/mm3 and median thrombocytopenia nadir was 116 X 10(3) cells/mm3. Additional toxic reactions included anemia, lassitude, anorexia, peripheral neuropath fever, and skin rash. Despite significant, but manageable, toxicity, this combination appears to represent an improvement in the chemotherapy of a traditionaly refractory solid tumor.