Multimodality treatment in the management of esophageal cancer: neoadjuvant chemoradiotherapy followed by transhiatal esophagectomy.

Esophageal cancer, although not one of the more common malignancies in the United States, remains a significant problem. Nearly as many patients as are diagnosed die in the same year, regardless of the treatment employed. Surgery is considered the mainstay of therapy. Esophagectomy with the use of the stomach as a substitute is preferred. Radical procedures have not proven more effective in extending survival. Because of the poor five-year survival rate, multimodality therapy with preoperative chemoradiotherapy (neoadjuvant therapy) followed by esophagectomy has shown encouraging results. Two illustrative cases are presented, one with adenocarcinoma and one with a squamous cell carcinoma, that were treated in this manner.

Colposcopically directed biopsy and loop excision of the transformation zone. Comparison of histologic findings.

We performed a retrospective comparison between the findings from colposcopically directed biopsies and those from loop excision of the transformation zone (LETZ) specimens. The correlation was satisfactory. When a low grade squamous intraepithelial lesion (SIL) was predicted on a cytologic smear and biopsy specimen, no cases of invasive carcinoma were found. In two (0.8%) cases in which a high grade SIL was predicted on the cervical smear and biopsy, microinvasive carcinoma was found in the LETZ specimen.

Endocervical brush cytology. An alternative to endocervical curettage?

The usefulness of an endocervical brush for cytologic sampling was studied in 288 consecutive women attending a colposcopy clinic. One hundred sixty had initial colposcopic examinations with directed biopsies and endocervical curettage (ECC). One hundred twenty-eight had follow-up examinations that included Papanicolaou smears and ECC some time after evaluation and/or treatment for cervical dysplasia. Within an established protocol for the evaluation and management of abnormal Papanicolaou smears, the endocervical brush was compared to ECC. When the combination of colposcopy and cervical conization showed that dysplasia was confined to the endocervix, the endocervical brush was significantly more sensitive than ECC in detecting this endocervical disease (P less than .05). In follow-up evaluations and in patients with unsatisfactory colposcopic examinations, endocervical brush cytology could replace ECC without affecting clinical management. In patients with a satisfactory colposcopic examination, ECC may be required only when endocervical brush cytology is abnormal. Endocervical brush cytology is less costly and painful and could prove to be a reasonable alternative to ECC for the initial evaluation of the endocervix. Endocervical brush cytology shows promise as a safe adjunct to the colposcopic evaluation of pregnant women, whereas ECC is contraindicated in such women.

Upper genital tract changes and infertility in diethylstilbestrol-exposed women.

A possible relationship of upper genital tract abnormalities in the diethylstilbestrol-exposed woman and infertility was studied. Six hundred thirty-two women had roentgenography performed. Three hundred sixty-seven of these women were not using contraception and were actively trying to become pregnant. One hundred thirty-four (36%) of these women reported difficulties conceiving for a period of 1 or more years. Seventy-three percent of these women had abnormal hysterosalpingograms. The frequency of abnormal x-ray films in the women who did conceive within 1 year was essentially the same (74%). Furthermore, a similar number of women with normal x-ray films (37%) had difficulty conceiving as did women with abnormal x-ray films (36%). When specific hysterosalpingographic abnormalities were related to the presence or absence of infertility, it was observed that the presence of a constriction of the upper uterine cavity resulted in a 2.26-times greater likelihood that a woman would not be able to conceive. If a T-shaped uterus was found in association with constriction of the upper uterine cavity, the odds ratio for inability to conceive was found to be 2.63.

Ultrasound prediction of fetal lung maturity.

Amniocentesis for determination of fetal lung maturity and ultrasonographic (US) evaluation of the biparietal diameter (BPD) and placental grade were performed simultaneously in 261 nondiabetic pregnant women. A BPD of at least 9.3 cm and a grade 3 placenta were evaluated as predictors of fetal lung maturity using amniotic fluid phospholipids as indicators of a mature lung profile. The ability of the sonographic parameters to predict fetal lung maturity was closely related to menstrual age. Before 37 weeks, the false-positive prediction rate using a grade 3 placenta was 100%, and the false-positive prediction using the BPD was 85.6%. After 37 weeks, the false-positive rate using a grade 3 placenta was 5.9%, and the false-positive rate using the BPD was 9.5%. Thus menstrual age, and not these two US parameters, dictated fetal lung maturity. The authors conclude that the best use of US for predicting fetal lung maturity is in establishing menstrual age early in pregnancy.

An improved method for the preparation of intermediate-purity antihemophilic factor concentrate for therapeutic usage.

An improved method involving pH changes in the process for the preparation of intermediate-purity antihemophilic concentrate offers several advantages over the standard method. Antihemophilic concentrates thus prepared are more soluble, more purified and more stable than the standard antihemophilic concentrates. High-potency antihemophilic concentrates with good solubility may be obtained by concentrating the [in-process] solution before lyophilization.