Evaluation of subclasses for T4-classified squamous cell carcinoma of the external auditory canal.

BACKGROUND: T4-classified squamous cell carcinoma (SCC) of external auditory canal (EAC) can potentially involve different anatomical structures, which could translate into different treatment strategies and survival outcomes within one classification. Our aim is to evaluate the clinical added value of T4-subclasses proposed by Lavieille and by Zanoletti. METHODS: Retrospective data, including patients with primary operated cT4-classified EAC SCC, was obtained from 12 international hospitals. We subclassified according to the T4-subclasses. The treatment strategies, disease-free survival (DFS) and overall survival per subclass were calculated. RESULTS: A total of 130 T4-classified EAC SCC were included. We found commonly used treatment strategies per subclass according to Lavieille and the DFS seems also to differ per subclass. Subclass according to Zanoletti showed comparable treatment strategies and survival outcomes per subclass. CONCLUSION: Our study suggests that the subclass according Lavieille might have added value in clinical practice to improve care of T4-classified EAC SCC.

Neuroendocrine neoplasms of the middle ear: Unpredictable tumor behavior and tendency for recurrence.

BACKGROUND: Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare temporal bone tumors. This study evaluates its clinical behavior and therapy outcome. METHOD: Retrospective case review in a tertiary referral center evaluating histopathology, immunohistochemistry, treatment, and outcome. RESULTS: Nine patients were diagnosed with MEANT. One patient presented with locally invasive tumor and underwent extensive en-bloc tumor resection with adjuvant radiotherapy. Seven of eight patients with locally non-aggressive tumor confined to the tympanomastoid space underwent tumor resection. Two patients were disease-free, five presented recurrence, even after apparent successful surgery. All tumors showed neuroendocrine features. Histopathology and immunohistochemistry did not yield prognostic tumor characteristics. CONCLUSION: MEANTs are rare tumors with uncertain biological behavior and subsequent unpredictable clinical course. The preferred treatment is complete surgical tumor resection. They have a high tendency for recurrence, irrespective of negative intermediary surgery. As of yet, there are no prognostic biomarkers, including histopathology and immunohistochemistry.

Evaluation of the modified Pittsburgh classification for predicting the disease-free survival outcome of squamous cell carcinoma of the external auditory canal.

BACKGROUND: Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is a rare disease, which is commonly classified with the modified Pittsburgh classification. Our aim was to evaluate the predictive performance of this classification in relation to disease-free survival (DFS). METHODS: We examined retrospective data from a nationwide Dutch cohort study including patients with primary EAC SCC. These data were combined with individual patient data from the literature. Using the combined data, the predictive performances were calculated using the c-index. RESULTS: A total of 381 patients were included, 294 for clinical and 281 for the pathological classification analyses. The c-indices of the clinical and the pathological modified Pittsburgh classification predicting DFS were 0.725 (0.668-0.782) and 0.729 (0.672-0.786), respectively. CONCLUSION: The predictive performance of the modified Pittsburgh classification system as such appears to be acceptable to predict the DFS of EAC SCC. Other factors need to be added to a future model to improve the predicted performance.

Clarifying question meaning in a household telephone survey.

This study contrasts two interviewing techniques that reflect different tacit assumptions about communication. In one, strictly standardized interviewing, interviewers leave the interpretation of questions up to respondents. In the other, conversational interviewing, interviewers say whatever it takes to make sure that questions are interpreted uniformly and as intended. Respondents from a national sample were interviewed twice. Each time they were asked the same factual questions from ongoing government surveys, five about housing and five about recent purchases. The first interview was strictly standardized; the second was standardized for half the respondents and conversational for the others. Respondents in a second conversational interview answered differently than in the first interview more often, and for reasons that conformed more closely to official definitions, than respondents in a second standardized interview. This suggests that conversational interviewing improved comprehension, although it also lengthened interviews. We conclude that respondents in a national sample may misinterpret certain questions frequently enough to compromise data quality and that such misunderstandings cannot easily be eliminated by pretesting and rewording questions alone. More standardized comprehension may require less standardized interviewer behavior.

Strategies for estimating behavioural frequency in survey interviews.

When people answer survey questions of the form "During the past month, how many times did you...?" their responses provide valuable data for researchers and policy makers. Yet the way respondents produce their answers to these "behavioural frequency questions" is not well understood. This article demonstrates that survey respondents can use an array of distinct estimation strategies, depending on what information is available in their memories. The kind of event information that people use is related to factors such as the regularity of occurrence, similarity of one episode to the next, and frequency. In a study conducted as a telephone survey, respondents' verbal reports and response-time patterns indicate that they usually answer behavioural frequency questions by either retrieving and counting episodes, retrieving or estimating rates of occurrence, or converting a general impression of frequency into a numerical quantity. The third strategy should be of particular concern to survey researchers because respondents provide a quantitative estimate without any relevant numerical knowledge. The set of strategies and the factors that influence their use are integrated into a statistical model that could help survey practitioners to improve data quality and memory researchers to broaden their perspective.

Adjuvant treatment of recalcitrant genitoanal warts with systemic recombinant interferon-alpha-2c.

Seventeen male patients with recalcitrant genitoanal warts, who had been unsuccessfully treated with classical destructive modalities for 16 months on average, were included in an open uncontrolled trial. The treatment regimen consisted of caustic and/or surgical measures as judged optimally suited in the individual cases, combined with an intermittent systemic low-dose adjuvant interferon-alpha-2c regimen (3 or 6 5-day-courses with intervals of 2 weeks) followed by a 1-year-observation period. At the end of interferon treatment, no patient had clinically visible warts but 10 still had subclinical acetic acid positive lesions. At the end of the 1-year-observation period, clearance of both warts and acetowhite lesions was observed in 4 patients (23.5%), whereas acetowhite lesions persisted in 4 others (23.5%). Recurrence of clinically visible lesions, always within the acetowhite areas, was observed in 9 (53%) patients. Interferon may thus have been effective in suppressing clinical recurrences of genitoanal warts, but its potency to eradicate subclinical papillomavirus infection was disappointing.

Parts of activities: reply to Fellbaum and Miller (1990).

If people believe that one activity is a kind of another, they also tend to believe that the second activity is a part of the first. For example, they assert that deciding is a kind of thinking and that thinking is a part of deciding. Fellbaum and Miller's (1990) explanation for this phenomenon is based on the idea that people interpret part of in the domain of verbs as a type of logical entailment. Their explanation, however, suffers from at least 2 deficiencies. First, it fails to account for parallel effects with nouns (e.g., a contest is a kind of an activity, and an activity is a part of a contest). Second, it contains a flaw that incorrectly predicts many activities to be parts of each other (e.g., coming is part of going and going part of coming). However, a hypothesis Rips and Conrad (1989) originally proposed for the kind-part reciprocal effect avoids both of these difficulties.

Folk psychology of mental activities.

A central aspect of people's beliefs about the mind is that mental activities--for example, thinking, reasoning, and problem solving-- are interrelated, with some activities being kinds or parts of others. In common-sense psychology, reasoning is a kind of thinking and reasoning is part of problem solving. People's conceptions of these mental kinds and parts can furnish clues to the ordinary meaning of these terms and to the differences between folk and scientific psychology. In this article, we use a new technique for deriving partial orders to analyze subjects' decisions about whether one mental activity is a kind or part of another. The resulting taxonomies and partonomies differ from those of common object categories in exhibiting a converse relation in this domain: One mental activity is a part of another if the second is a kind of the first. The derived taxonomies and partonomies also allow us to predict results from further experiments that examine subjects' memory for these activities, their ratings of the activities' importance, and their judgements about whether there could be "possible minds" that possess some of the activities but not others.

Stage III nodular lymphomas. Preliminary results of a combined chemotherapy/radiotherapy program.

Since 1975, all histologic subtypes of Stage III and IIIE nodular lymphoma patients were treated with a combination of radiotherapy and multiple-agent chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Fifty-eight patients were treated through 1979. Treatment consisted of two cycles of CHOP-Bleo alternating with sequential radiotherapy to clinically involved regions, and further CHOP-Bleo to a total of ten cycles. Radiotherapy doses ranged between 3000 and 4000 rad delivered in three to four weeks. Forty-six patients completed treatment. In the other 12 patients, treatment was interrupted because of progressive disease in seven, and myelosuppression in five. Overall five-year survival and disease-free survival results were 82% and 47%, respectively. Survival for those patients who completed therapy was 93%. By histopathology, survivals for all patients were: poorly differentiated lymphocytic, 100%; mixed cell, 80%; and histiocytic, 39%. Disease-free figures for all 58 patients were: poorly differentiated lymphocytic, 44%; mixed cell, 65%; and histiocytic, 35%. The extent of abdominal disease influenced five-year survival as follows: 100% for those who had only occult disease at staging laparotomy; 88% for those who were Stage III on the basis of a positive lymphangiogram; and 50% for those who had a palpable mass or required an exploratory laparotomy for symptoms. Five of seven patients with progression during protocol therapy have died. No patients died as a result of myelosuppression. A number of patients developed complications during treatment, none of which were fatal. Eight patients developed herpes zoster, four patients developed transient radiation hepatitis, and four patients had miscellaneous complications.

The roles of staging laparotomy, chemotherapy, and radiotherapy in the management of localized diffuse large cell lymphoma: a study of 75 patients.

A retrospective study of 75 laparotomy-studied Stage I and II patients with diffuse large cell (histiocytic) lymphoma was conducted to determine the relative contributions of laparotomy, radiotherapy, and combination chemotherapy to their management. The treatment programs were radiotherapy alone, radiotherapy followed by adjuvant chemotherapy, and alternating chemotherapy-radiotherapy. Treatment selection was based on disease presentation, with limited therapy used for favorable patterns and intensive therapy used in prognostically unfavorable settings. Disease-free survival was best in those treated with initial chemotherapy, even though these patients comprised the least favorable prognostic group. A select subset of patients, those with extranodal head and neck disease, obtained good results with radiotherapy alone, but for other presentations this was not a successful approach. Differences in results for the three treatment programs are discussed in relation to future treatment decisions.

Treatment of stage I and II mediastinal Hodgkin disease. A comparison of involved fields, extended fields, and involved fields followed by MOPP in patients staged by laparotomy.

Three treatment programs for Stage I and II mediastinal Hodgkin disease (established by laparotomy) were compared. Involved-field radiotherapy + MOPP gave a disease-free survival rate of 97%, significantly different from 62% and 55% for involved and extended fields, respectively. Corresponding survival figures of 97%, 88%, and 84% were not significantly different statistically due to salvage with radiotherapy and/or chemotherapy. Among patients given radiotherapy alone, the survival figure of 94% for limited mediastinal disease was significantly better than 63% for extensive mediastinal and hilar disease; corresponding disease-free figures of 72% and 35% were also significantly different. Constitutional symptoms were an important prognostic factor in disease-free survival following the use of involved fields; hilar disease was important only with large mediastinal masses. Most relapses were intrathoracic; MOPP alone salvaged only 47%. Treatment of Stage I and II Hodgkin disease should be based on symptoms, extent of mediastinal disease, and hilar involvement.

Reassessment of prognostic factors in stage IIIA and IIIB Hodgkin's disease treated with MOPP and radiotherapy.

Prognostic factors have been re-evaluated for 88 patients with Stage III Hodgkin's disease to see if they have remained significant on a long-term basis. Treatment had consisted of two cycles of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis; all patients had achieved complete remission. Case material was grouped according to the presence of absence of mediastinal disease. Five-year survivals for Stage IIIA and IIIB patients were 85 and 80%; corresponding disease-free survivals were 76 and 73%. Significant prognostic factors include age, histopathology, and extent of abdominal disease, but the relative importance of these factors differs for the mediastinal and nonmediastinal patients. Modifications of current treatment policy for both mediastinal and nonmediastinal patients are discussed in relation to the prognostic factors.