Adjuvant chemotherapy with 5-FU, adriamycin, and mitomycin-C (FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma: A Southwest Oncology Group study.

PURPOSE: To evaluate FAM [5-FU (5-fluorouracil), doxorubicin, mitomycin C] chemotherapy as adjuvant therapy for patients with resected TNM stage I, II, or III gastric carcinoma. PATIENTS AND METHODS: One hundred ninety-three eligible patients were accrued from 1978 to 1991 in a phase III trial comparing six cycles (1 year) of postoperative FAM chemotherapy with observation only. RESULTS: The median follow-up on this study was 9.5 years. For all patients, no differences (log-rank analysis) in disease-free survival (p = 0.45) and overall survival (p = 0.57) between FAM therapy (93 cases) and surgery (100 cases) were observed. Quality of surgical resection affected survival irrespective of FAM use. Cases with curative resection, defined in a retrospective review of pathology and surgical reports as cases having no evidence of residual disease in the abdomen and tumor-free margins > 1 cm, had superior survival compared to cases not meeting these requirements (p < 0.001). FAM was well tolerated with 6% (five of 90) of cases demonstrating grade IV hematologic toxicity. There were two drug-related fatalities (one cardiomyopathy, one hematolytic uremic syndrome). CONCLUSION: FAM is not effective adjuvant therapy for TNM stage I, II, and III patients with resected gastric cancer. Future adjuvant studies must emphasize prospective surgical quality control to assure enrollment of appropriately staged and resected cases and wide participation to assure adequate case accrual over a reasonable period.

1988: use of a Bayesian statistical model for risk assessment in coronary artery surgery. Updated in 1995.

A computerized statistical model based on the theorem of Bayes was developed to predict mortality after coronary artery bypass grafting. From January, 1984, to April, 1987, at our hospital, 700 patients underwent isolated coronary artery bypass grafting. The presence or absence of 20 risk factors was determined for each patient. The first 300 patients formed the initial database of the Bayesian predictive model, and the remaining 400 patients were prospectively evaluated in four groups of 100 each. Each group was prospectively evaluated and then incorporated into the database to update the model. There was good agreement between predicted and observed results. Bayesian theory is particularly suited to this task because it (1) accommodates multiple risk factors, (2) is tailored to one's specific practice, (3) determines individual, rather than group, prognosis, and (4) can be updated with time to compensate for a changing patient population. These flexible attributes are especially valuable in light of recent changes in the coronary artery bypass graft patient profile.

Phase II trial of dimethyltriazenoimidazole carboxamide in patients with metastatic carcinoid. A Southwest Oncology Group study.

BACKGROUND: The use of chemotherapy in patients with metastatic carcinoid tumors has been of limited value, and investigation of new agents is necessary. Previous reports have suggested that dimethyltriazenoimidazole carboxamide (DTIC) may have antitumor activity. METHODS: A Phase II trial to investigate the clinical response rate to DTIC in patients with metastatic carcinoid tumors was performed. DTIC was administered at low (650 mg/m2) or high (850 mg/m2) doses every 28 days. RESULTS: Sixty-three patients were entered into the study, and 56 were evaluable for toxicity and response. Toxicity was moderate, with the most common side effect being nausea and vomiting (88%). Nine patients (16%; 95% confidence interval, 8-28%) had partial responses, 5 of 25 receiving 850 mg/m2 and 4 of 31 receiving 650 mg/m2 of DTIC. Median survival time of all patients was 20 months. CONCLUSIONS: DTIC has minimal activity in patients with metastatic carcinoid tumors.

Cooperative games: a way to modify aggressive and cooperative behaviors in young children.

We investigated the effects of competitive and cooperative games on aggressive and cooperative behaviors of 70 children (4 to 5 years old) from four classes in three preschools. The experimental design included both multiple baseline and reversal components. Behaviors were measured during game conditions and in subsequent free-play periods. Results showed that cooperative behavior increased and aggression decreased during cooperative games; conversely, competitive games were followed by increases in aggressive behavior and decreases in cooperative behavior. Similar effects were also found during free-play periods.

Mothers of molested children: some comparisons of personality characteristics.

The Clinical Analysis Questionnaire (CAQ) was used to study the personality characteristics of three groups of mothers: one whose children had been molested by a family member (n = 13), a second group whose children had been molested by a teacher (n = 15), and a group of control mothers whose children had not been molested (n = 12). There were few disparities between the two groups of mothers of molested children. When the molested groups were combined and compared to controls, they differed on only one scale measuring normal personality functioning. Significant differences between mothers of molested children and control mothers were found on 7 of the 12 scales measuring abnormal functioning. In addition, significant correlations were obtained between mother's scores and children's scores on the Adjustment scale of the Personality Inventory for Children (PIC). Results were discussed in terms of the lack of differences between the two molested groups, the role of mothers in sexual abuse, and the relationship of maternal clinical symptoms to child maladjustment.

Use effectiveness of the Cytobrush in the primary care setting.

BACKGROUND: Numerous studies indicate that Papanicolaou smears contain better cellular material when the technique for collecting the sample employs the Zelsmyn Cytobrush. Few studies, however, have examined its ability to increase the percentage of abnormal Papanicolaou smear results in actual clinical practice. METHODS: This study looked at 7999 Papanicolaou smears done by 46 primary care physicians to determine the percentage of abnormal results during two different periods. The Cytobrush technique was then implemented; and after 6029 Papanicolaou smears, the percentage of smears with abnormal findings was recalculated. RESULTS: The proportion of Papanicolaou smears demonstrating significantly abnormal cells remained constant during the three observation periods: 1.81 percent during the first period, 1.96 percent during the second period (before the Cytobrush technique was implemented), and 1.96 percent during the third period (after the Cytobrush technique was implemented). CONCLUSIONS: It seems logical that Papanicolaou smears containing better cellular material from the squamocolumnar junction would increase the yield of Papanicolaou smears with cancerous and precancerous cells. Our study, however, did not confirm this supposition. While evaluation of Papanicolaou smear technique based on quantity and quality of cellular material is important, we believe the effectiveness of any technique must be evaluated from another perspective--the actual practice setting.

Cytogenetic abnormalities in renal oncocytic neoplasms.

We have performed cytogenetic studies on five renal oncocytic neoplasms (three grade 2 tumors and two grade 1 tumors) identified histologically by light microscopy. One grade 1 tumor failed to produce mitotic cells. The other four tumors exhibited both normal and abnormal cell lines. Numerical abnormalities were found in both the single grade 1 and two of the grade 2 tumors whereas structural abnormalities were limited to grade 2 tumors. Aneuploidy of chromosome 12 was observed in both grade 1 and 2 tumors. Grade 2 tumors showed more extensive numerical change than the grade 1 tumors. Abnormalities of chromosome 3 characteristic of renal cell carcinoma were not found in any tumor in this series. A combination of C-banding and HaeIII endonuclease banding was used to identify an ambiguous marker. In our four cases and in the cases previously reported, loss of a sex chromosome, abnormalities of chromosomes 1 and 22, and trisomy 12 are findings most often observed in renal oncocytoma.

Angiocentric immunoproliferative lesion (lymphomatoid granulomatosis). A cytogenetic, immunophenotypic, and genotypic study.

We report the occurrence of a cytogenetically abnormal clone 46,XX,t(1;6)(p35;q23),t(1;9;19)(q23;p24;q13) in the spleen of a 23-year-old woman with a three-year history of angiocentric immunoproliferative lesion (AIL) (lymphomatoid granulomatosis). The skin, lungs, spleen, liver and, focally, bone marrow were involved by atypical lymphohistiocytic infiltrates. Immunophenotypic study of the spleen showed that 46% of the cells displayed a helper/inducer T-cell phenotype. However, analysis of DNA isolated from the spleen failed to show clonal T-cell receptor beta-chain gene, T-cell receptor gamma-chain gene, or immunoglobulin heavy chain gene and light chain gene rearrangements. The finding of a cytogenetically abnormal clone supports the concept that angiocentric immunoproliferative lesion is a neoplastic process.

Perpetrator status and the personality characteristics of molested children.

The personality and intellectual characteristics of three groups of children, one molested by a teacher (n = 16), a second group (n = 16) where the offender was a member of the child's family, and a non-molested control group (n = 16) were contrasted. The children were evaluated using the Personality Inventory for Children (PIC), the Children's Personality Questionnaire (CPQ), and the Wechsler Intelligence Scale for Children (WISC-R). There were few differences between the two molested groups or between boys and girls. However, comparisons of molested and non-molested children showed significant differences on 23 of 34 scales on the PIC and CPQ combined. WISC-R verbal IQs were also lower for the molested groups. While the lack of differences between the two molested groups may have been due to the parent-like relationship between the teacher and the children he molested, the results suggest that a relatively noncoercive style of abuse can still produce significant psychological impairment.

A phase II trial of combination chemotherapy in patients with metastatic carcinoid tumors. A Southwest Oncology Group Study.

A prospective Phase II trial of combination chemotherapy in patients with metastatic carcinoid tumors was conducted by the Southwest Oncology Group. The therapy included 5-fluorouracil, Adriamycin, cyclophosphamide, and streptozotocin (FAC-S) or the same combination without Adriamycin (FC-S) in patients with heart disease. Seventy-four patients were entered and two were ineligible. Sixty-nine of the 72 were histologically reviewed. Six patients were declared ineligible after this review. Fifty-six patients received FAC-S, and nine received FC-S (one patient was inevaluable). The response rates were 31% and 22%, respectively. The median survival of all patients was 10.8 months. The analyses of various clinical and histologic parameters indicated that responses were more common in patients with gastrintestinal carcinoids; there was also a tendency toward shorter survival in patients with tumors that had a higher mitotic rate or the atypical and/or undifferentiated histologic pattern. The FAC-S combination can produce objective responses in patients with metastatic carcinoid tumors, but these are generally partial and brief. It was also concluded that currently available chemotherapy is inadequate.

Primary malignant pulmonary tumors in the older patient.

The incidence of lung cancer, the most common visceral malignancy, is increasing in the elderly patient. Careful preoperative preparation and postoperative care will allow some of these patients to have surgical resections. Radiotherapy and chemotherapy offer benefits for those patients who cannot have a curative surgical resection.

Primary lymphomas of the gastrointestinal tract.

An institutional experience with primary gastrointestinal lymphoma (PGL) is reviewed. Included are 46 cases involving the stomach, 11 involving the small bowel, and two, the large bowel. The clinical, pathologic, and therapeutic aspects of PGL are discussed.

Case report: cystic partially differentiated nephroblastoma (Wilms tumor).

A case of a cystic partially differentiated nephroblastoma treated with combined chemotherapy after removal in a 2-month old newborn is reported. Cystic partially differentiated nephroblastoma is a newly described clinicopathologic entity, involving elements of a nephroblastoma and cystic disease, and it is believed to be a pathologic derivative of the metanephric blastema and not related to renal dysplasia. Cystic partially differentiated nephroblastoma is distinguished from multilocular cysts of the kidney by the presence of partially differentiated renal elements in the septa of cysts. The aggressive appearance of the cells led to the treatment of this tumor as potentially malignant.

A rationale for the treatment of metastatic neuroblastoma.

In developing a chemotherapeutic program for children with disseminated neuroblastoma, we established three human neuroblastoma lines in cell culture to study the effects of dibutyryl cyclic AMP, papaverine, 5-trifluoromethyl-2'-deoxyuridine, and cyclophosphamide on cell growth, biochemical behavior, and morphology. Based upon our studies, a clinical treatment program was designed. We have treated 15 patients with disseminated neuroblastoma and have established the optimum dose range and sequence of these drugs. Early results were promising; plans for continuation of clinical and experimental studies were discussed.

Amino terminal sequence and location of phosphate groups of the major human casein.

The amino acid sequence of the first 28 residues of the major human casein was determined. This protein in multiphosphorylated forms (0 to 5 phosphorous per molecule) was compared to cow beta-casein which is similar in composition but phosphorylated at a constant level. After sequencing the phosphate-free human casein, phosphorylated seryl and threonyl residues were located in three of the other phosphorylated forms by examining the aqueous layer of the phenylthiohydantoin conversion step during automatic liquid phase sequencing. Phosphate groups on specific seryl/threonyl residues suggest a biosynthetic mechanism involving stepwise phosphorylation or dephosphorylation.