- Email: [email protected]
Computed Tomography and Radiotherapy in the Treatment of Cancer
TRAUMA
varied considerably, depending on the type of cancer and pain threshold of a given patient. N. J. 1 table, 7 references Computed Tomography and Radiotherapy in the Treatment of Cancer
B.
JOSE, A. M. CHU, S. C. SHARMA, D. A. TOBIN AND R. M. SCOTT, Department of Radiation Oncology, University of
Louisville, James Graham Brown Cancer Center, Louisville, Kentucky J. Surg. Oncol., 23: 83-92 (June) 1983 The authors used computerized tomography (CT) to plan and to simulate radiotherapy in cancer patients. The planning included 4 steps: 1) anatomic cross-sections of estimated tumor volume, 2) computerized plan for treatment, 3) use of an optimal treatment plan and 4) daily reproductions of the CT image for optimal treatment. Several specific cases are presented, and the various technical problems and solutions are discussed. The simulator and x-ray unit with fluoroscopy used to prepare patients for appropriate radiotherapy also are described. N. J. 8 figures, 9 references A Rationale for Surgical Detection of Cancer Without Hospitalization A. AzzARELLI, V. QUAGLIUOLO, V. MENOTTI AND S. DI PIETRO, Institute Nazionale per lo Studio e la Cura dei
Tumori, Milano, Italy J. Surg. Oncol., 22: 179-183 (Mar.) 1983 Of 20,143 patients who presented to the outpatient department in 1 year 2,499 with lesions of the breast, skin, oral cavity, lymph nodes and soft tissues were operated upon on an outpatient basis. The main purpose of this plan of management was to detect unexpected malignant disease without hospitalization, thus, containing the cost. Breast operations were performed on 1,266 patients with a variety of lesions, mostly benign. Of these patients 99 (7.8 per cent) had unexpected carcinoma and 67 (5.3 per cent) had precancerous lesions. Of 1,048 patients with lesions of the skin and oral cavity who were managed on an outpatient basis 261 (24.9 per cent) had squamous or basal cell carcinoma and most were cured. Unsuspected malignant melanoma was found in 20 of 149 patients (13.4 per cent) who underwent biopsy of nevi. Of 185 patients who underwent operations for lymph node and soft tissue lesions 44 had lymphomas (31 unexpected) and 6 had sarcomas (5 unexpected). Based upon these data the authors conclude that outpatient surgical diagnostic procedures have an important role in the early detection of malignancies of the breast, skin, oral cavity, lymph nodes and soft tissues. N. S. D. 7 tables, 14 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOVASCULAR SURGERY Lasting Antihypertensive Effect of Percutaneous Transluminal Angioplasty of Renal Artery Stenoses in a Child R. GHISLA, F. MAHLER, M. HAERTEL, A. KRNETA, 0.
OETLIKER AND E. Bern, Switzerland
185 ROSSI,
Inselspital and University of Bern,
Amer. J. Dis. Child., 137: 600-601 (June) 1983 Long-term success in control of hypertension after percutaneous transluminal renal angioplasty in adults is well documented. In contrast, the authors note that the long-term efficacy of this procedure in children has not been shown. A 4.5year-old boy with left main renal artery stenosis and right segmental renal arterial stenosis is reported. Pre-treatment blood pressure was 180/130. Systemic renin activity was elevated (40 ng./ml. per hour). Bilateral percutaneous transluminal renal angioplasty was done in 1980. Blood pressure, renin levels and angiograms have remained normal during 3 years of followup. The authors believe that percutaneous transluminal renal angioplasty offers potential long-term relief of renal hypertension owing to fibromuscular hyperplasia in children. J. H. N. 2 figures, 6 references
Editorial comments. This is another example of a percutaneous technique replacing a moderately complex operative procedure. L. R. K. The authors report remedy of hypertension in a 4.5-year-old boy. The hypertension was caused by renal artery stenosis, presumably fibromuscular dysplasia. This useful clinical experience suggests exciting possibilities that extend percutaneous techniques used in adults to the treatment of renovascular disease in children. However, the use of the term angioplasty may be misleading, since no plastic repair of the stenosis is performed. Perhaps a more appropriate designation for the procedure would be angiodilation. M. M. Beta Blocking Agents in the Treatment of Hypertension
Department of Medicine, New York Medical College, Valhalla, New York
M. MOSER,
N. Y. State J. Med., 83: 941-945 (June) 1983 Treatment with {3 blocking agents has become established as an effective approach in the management of hypertension. Although some investigators suggest the use of these agents as step 1 therapy, the Joint National Committee Reports on Detection, Evaluation and Treatment recommend diuretics as initial treatment in the majority of patients. The availability of {3 blocking drugs represents an advance in the therapy of hypertension. These drugs are effective as monotherapy but no more effective in the majority of patients than a diuretic. The drugs may be used as monotherapy in some young patients with the so-called hyperkinetic syndrome but in the majority of patients they should remain as step 2 agents. In combination with a diuretic, they are as effective as reserpine but more effective than any of the step 2 drugs (/3methyldopa, clonidine, guanabenz and prazosin). This is an excellent clinical review of the state of the art in {3 blocking agents and their physiologic effects. The agents available currently are described and their cardioprotective actions are presented. W. W. H. 3 tables, 21 references
TRAUMA The Etiology, Diagnosis, and Treatment of Bladder Trauma
varied considerably, depending on the type of cancer and pain threshold of a given patient. N. J. 1 table, 7 references Computed Tomography and Radiotherapy in the Treatment of Cancer
B.
JOSE, A. M. CHU, S. C. SHARMA, D. A. TOBIN AND R. M. SCOTT, Department of Radiation Oncology, University of
Louisville, James Graham Brown Cancer Center, Louisville, Kentucky J. Surg. Oncol., 23: 83-92 (June) 1983 The authors used computerized tomography (CT) to plan and to simulate radiotherapy in cancer patients. The planning included 4 steps: 1) anatomic cross-sections of estimated tumor volume, 2) computerized plan for treatment, 3) use of an optimal treatment plan and 4) daily reproductions of the CT image for optimal treatment. Several specific cases are presented, and the various technical problems and solutions are discussed. The simulator and x-ray unit with fluoroscopy used to prepare patients for appropriate radiotherapy also are described. N. J. 8 figures, 9 references A Rationale for Surgical Detection of Cancer Without Hospitalization A. AzzARELLI, V. QUAGLIUOLO, V. MENOTTI AND S. DI PIETRO, Institute Nazionale per lo Studio e la Cura dei
Tumori, Milano, Italy J. Surg. Oncol., 22: 179-183 (Mar.) 1983 Of 20,143 patients who presented to the outpatient department in 1 year 2,499 with lesions of the breast, skin, oral cavity, lymph nodes and soft tissues were operated upon on an outpatient basis. The main purpose of this plan of management was to detect unexpected malignant disease without hospitalization, thus, containing the cost. Breast operations were performed on 1,266 patients with a variety of lesions, mostly benign. Of these patients 99 (7.8 per cent) had unexpected carcinoma and 67 (5.3 per cent) had precancerous lesions. Of 1,048 patients with lesions of the skin and oral cavity who were managed on an outpatient basis 261 (24.9 per cent) had squamous or basal cell carcinoma and most were cured. Unsuspected malignant melanoma was found in 20 of 149 patients (13.4 per cent) who underwent biopsy of nevi. Of 185 patients who underwent operations for lymph node and soft tissue lesions 44 had lymphomas (31 unexpected) and 6 had sarcomas (5 unexpected). Based upon these data the authors conclude that outpatient surgical diagnostic procedures have an important role in the early detection of malignancies of the breast, skin, oral cavity, lymph nodes and soft tissues. N. S. D. 7 tables, 14 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOVASCULAR SURGERY Lasting Antihypertensive Effect of Percutaneous Transluminal Angioplasty of Renal Artery Stenoses in a Child R. GHISLA, F. MAHLER, M. HAERTEL, A. KRNETA, 0.
OETLIKER AND E. Bern, Switzerland
185 ROSSI,
Inselspital and University of Bern,
Amer. J. Dis. Child., 137: 600-601 (June) 1983 Long-term success in control of hypertension after percutaneous transluminal renal angioplasty in adults is well documented. In contrast, the authors note that the long-term efficacy of this procedure in children has not been shown. A 4.5year-old boy with left main renal artery stenosis and right segmental renal arterial stenosis is reported. Pre-treatment blood pressure was 180/130. Systemic renin activity was elevated (40 ng./ml. per hour). Bilateral percutaneous transluminal renal angioplasty was done in 1980. Blood pressure, renin levels and angiograms have remained normal during 3 years of followup. The authors believe that percutaneous transluminal renal angioplasty offers potential long-term relief of renal hypertension owing to fibromuscular hyperplasia in children. J. H. N. 2 figures, 6 references
Editorial comments. This is another example of a percutaneous technique replacing a moderately complex operative procedure. L. R. K. The authors report remedy of hypertension in a 4.5-year-old boy. The hypertension was caused by renal artery stenosis, presumably fibromuscular dysplasia. This useful clinical experience suggests exciting possibilities that extend percutaneous techniques used in adults to the treatment of renovascular disease in children. However, the use of the term angioplasty may be misleading, since no plastic repair of the stenosis is performed. Perhaps a more appropriate designation for the procedure would be angiodilation. M. M. Beta Blocking Agents in the Treatment of Hypertension
Department of Medicine, New York Medical College, Valhalla, New York
M. MOSER,
N. Y. State J. Med., 83: 941-945 (June) 1983 Treatment with {3 blocking agents has become established as an effective approach in the management of hypertension. Although some investigators suggest the use of these agents as step 1 therapy, the Joint National Committee Reports on Detection, Evaluation and Treatment recommend diuretics as initial treatment in the majority of patients. The availability of {3 blocking drugs represents an advance in the therapy of hypertension. These drugs are effective as monotherapy but no more effective in the majority of patients than a diuretic. The drugs may be used as monotherapy in some young patients with the so-called hyperkinetic syndrome but in the majority of patients they should remain as step 2 agents. In combination with a diuretic, they are as effective as reserpine but more effective than any of the step 2 drugs (/3methyldopa, clonidine, guanabenz and prazosin). This is an excellent clinical review of the state of the art in {3 blocking agents and their physiologic effects. The agents available currently are described and their cardioprotective actions are presented. W. W. H. 3 tables, 21 references
TRAUMA The Etiology, Diagnosis, and Treatment of Bladder Trauma