The role of partial cystectomy in the treatment of recurrent invasive bladder cancer following radiotherapy.

Seventeen patients with recurrent invasive bladder cancer following radical radiotherapy were treated by partial cystectomy. Thirteen patients required augmentation enterocystoplasty, using an ileal patch in 10 patients and large bowel in the others. After 4 years' follow-up, eight patients are alive and disease-free with good bladder function. Of the nine patients who died, six died from bladder cancer and three of these suffered local recurrences. Responsiveness to radiotherapy or tumour stage were not helpful in predicting local recurrences, but all patients who had this complication had anaplastic tumours. In selected patients this procedure offers an alternative to salvage cystectomy, especially where a urinary diversion may be inappropriate.

Renovascular hypertension following radiotherapy and chemotherapy treated by transluminal angioplasty.

A man aged 33 with poorly controlled hypertension who had been treated with radiotherapy and combination chemotherapy for testicular teratoma 8 years earlier was found on arteriography to have 75% stenosis of the left renal artery and occlusion of the right renal artery. The stenosis was dilated by transluminal angioplasty and the hypertension adequately controlled. Patients who develop high blood pressure after abdominal radiotherapy with or without chemotherapy should be investigated for renal artery stenosis.

Adriamycin alone or combined with vincristine in the treatment of advanced breast cancer.

One hundred and nineteen women with advanced breast cancer treated previously by endocrine therapy but no prior chemotherapy were given adriamycin 70 mg/m2 i.v. on day 1 of a 3-weekly cycle for 8 courses, followed by a regimen of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) until relapse. They were allocated randomly to receive either no treatment (group A) or vincristine 1.4 mg/m2 i.v. on days 1 and 8 during treatment with adriamycin (group AV). In 107 evaluable patients objective responses were seen in 30/53 patients (57%) in group A and in 28/54 patients (52%) in group AV. The projected dose of adriamycin received was 78% in group A and 75% in group AV; and 60% for vincristine in group AV. The subjective and haematological toxicity for adriamycin was similar in both groups, but 65% of patients treated with vincristine developed neurotoxicity. The median duration of objective regressions was the same for both groups (7 months), and the median time to failure was 5 months for group A and 6 months for group AV respectively. The median survival of the responders tended to be longer in group AV (17.5 months) than in group A (13 months), but this difference was not statistically significant (P = 0.112). It is concluded that there is no advantage therapeutically in combining vincristine and adriamycin in patients with advanced breast cancer.

Contribution of prednisolone to the primary endocrine treatment of advanced breast cancer.

Two hundred and four patients with progressive locally advanced or metastatic breast cancer not controllable by local therapy alone, and who had had no prior systemic therapy for advanced disease, were treated by primary endocrine therapy according to menopausal status. Premenopausal patients received ovarian irradiation (O) whilst postmenopausal patients received tamoxifen 10 mg b.d. (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg b.d. (P). In 180 evaluable patients, T + P induced significantly more responses than T alone (26/73 vs 9/72, P less than 0.01) and the addition of P to O in premenopausal patients also induced more responses than O alone (7/16 vs 4/19), but this difference was not significant and accrual of premenopausal patients continues. There was a trend for patients receiving T + P to have a longer survival than those receiving T alone (median 25 vs 16 months). These trends occurred in patients with tumours positive for oestrogen receptors and when receptor status was unknown; patients with receptor-negative tumours had a negligible response to endocrine treatment. P mitigated the occurrence of hypercalcaemia and tumour flare sometimes seen with T alone.

Corticosteroids for elderly patients with breast cancer.

Ninety-one assessable elderly women (greater than 65 years) with advanced breast cancer were treated with prednisolone 15 mg (or cortisone 75 mg) daily after primary endocrine treatment (estrogens, androgens or tamoxifen). Thirteen (14%) achieved an objective regression, and 19 (21%) others showed no change for greater than or equal to six months. Hence, 32 patients (35%) had control of disease for about one year. Responses were mainly in soft tissue and skeletal lesions and were independent of response to prior endocrine treatment. Toxicity was low. Low-dose corticosteroid treatment is of value in controlling advanced breast cancer in elderly women.

In vitro investigation of the origin of echoes with biliary sludge.

To investigate the origin of echoes from "biliary sludge," concentrated bile and bile from 5 patients with ultrasound findings of biliary sludge were examined in a tissue-equivalent phantom before and after filtration through progressively smaller pore sizes. Filtration converted echogenic bile to echo-free bile. Examination of the filtration residue by light microscopy established that the source of echoes in biliary sludge was particles, predominantly pigment granules, with lesser amounts of cholesterol crystals. Partial chemical characterization by determination of vulnerability to different solvents verified that the sludge was mainly calcium bilirubinate.

Oestrogen receptors and response to cytotoxic chemotherapy in advanced breast cancer.

Of 54 patients with advanced breast cancer, 21/37 (57%) with oestrogen receptor-positive (ER+) tumours and 11/17 (65%) with oestrogen receptor-negative (ER-) tumours responded to cytotoxic chemotherapy. These data and a survey of the literature indicate that oestrogen receptor status is not a determinant of response to chemotherapy. However, ER+ tumours seem to grow more slowly than ER- ones and the response to chemotherapy tends to be longer in ER+ patients.

Characterization of biological fluids by ultrasound and computed tomography.

Blood and blood products, and solutions of albumin and chondroitin sulfate of varying concentrations were imaged by ultrasound and computed tomography in a phantom having ultrasonic and CT characteristics of liver tissue. Measurements of CT number, ultrasonic absorption, and viscosity were obtained for selected fluids. All fluids, including concentrated solutions of albumin and chondroitin sulfate having high viscosity, were detectable as echofree regions on ultrasound scans. Acoustical enhancement distal to fluids was noted to decrease in prominence with increasing sound absorption in the fluid. On CT scans, fluids with CT numbers close to those of their surroundings were poorly detected.

Acoustic shadowing due to refractive and reflective effects.

Acoustic shadowing may be seen distal to the margins of rounded structures having different acoustic velocities from the surrounding tissue. Refractive and reflective mechanisms for such shadowing are reviewed and in vitro demonstrations of such shadowing are presented. Clinical examples of refractive and reflective shadows are given, and their importance is discussed.

The simultaneous presentation of Hodgkin's disease of myeloma.

The simultaneous presentation of Hodgkin's disease and multiple myeloma is described. This is rare as only one previous case appears to have been documented. Speculations as to the aetiology are discussed as well as the significance of the presentation.