A multifactorial analysis was used to identify the dominant prognostic variables affecting survival from a computerized data base of 339 melanoma patients treated at this institution during the past ...17 years. Five of the 13 parameters examined simultaneously were found to independently influence five year survival rates: 1) pathological stage (I vs II, p = 0.0014), 2) lesion ulceration (present vs absent, p = 0.006), 3) surgical treatment (wide excision vs wide excision plus lymphadenectomy, p = 0.024), 4) melanoma thickness (p = 0.032), and 5) location (upper extremity vs lower extremity vs trunk vs head and neck, p = 0.038). Additional factors considered that had either indirect or no influence on survival rates were clinical stage of disease, age, sex, level of invasion, pigmentation, lymphocyte infiltration, growth pattern, and regression. Most of these latter variables derived their prognostic value from correlation with melanoma thickness, except sex which correlated with location (extremity lesions were more frequent on females, trunk lesions on males). This statistical analysis enabled us to derive a mathematical equation for predicting an individual patient's probability of five year survival. Three categories of risk were delineated by measuring tumor thickness (Breslow microstaging) in Stage I patients: 1) thin melanomas (<0.76 mm) were associated with localized disease and a 100% cure rate: 2) intermediate thickness melanomas (0.76-4.00 mm) had an increasing risk (up to 80%) of harboring regional and/or distant metastases and 3) thick melanomas (>/=4.00 mm) had a 80% risk of occult distant metastases at the time of initial presentation. The level of invasion (Clark's microstaging) correlated with survival, but was less predictive than measuring tumor thickness. Within each of Clark's Level II, III and IV groups, there were gradations of thickness with statistically different survival rates. Both microstaging methods (Breslow and Clark) were less predictive factors in patients with lymph node or distant metastases. Clinical trials evaluating alternative surgical treatments or adjunctive therapy modalities for melanoma patients should incorporate these parameters into their assessment, especially in Stage I (localized) disease where tumor thickness and the anatomical site of the primary melanoma are dominant prognostic factors.
The therapeutic efficacy of isolated limb perfusion in patients with localized melanoma of the extremity remains controversial. We compared patients treated at the University of Texas M.D. Anderson ...Cancer Center, Houston, with wide local excision and isolated limb perfusion using either melphalan or imidazole carboxamide with a group matched for prognostic factors from the University of Alabama at Birmingham and the University of Sydney (Australia) who were treated with wide local excision alone. No significant difference in disease-free or overall survival rates was found between patients treated with wide local excision with adjuvant isolated limb perfusion or wide local excision alone. However, a subset of patients with thicker lesions (greater than 2.0 mm) treated with wide local excision and isolated limb perfusion using melphalan had a significant improvement in both disease-free and overall survival rates. These data suggest that isolated limb perfusion using melphalan may improve survival rates in selected patients with localized melanoma of the extremity who are at increased risk for local and regional micrometastases, and justifies the continued study of this treatment approach in prospective clinical trials.
The anatomic, colposcopic, cytologic, and histologic findings of the cervix in 300 women exposed to diethylstilbestrol (DES) in utero are reported. Structural cervical abnormalities were found in ...51.7% of these patients and an abnormal colposcopic examination was present in 50.6%. The initial interpretation of the pathologic specimens revealed that 26.6% of patients had cytologic or histologic evidence of cervical dysplasia. A uniform pathologic review demonstrated that 10.8% of the cytologic specimens and 37.5% of the histologic specimens had been overread by the initial pathologist. A correlation of the review cytology and histology revealed that the Papanicolaou smear sensitivity for the prediction of abnormal histology was 83.9% and specificity was 86.3%. The probability of an atypical cytologic finding predicting an abnormal histologic pattern was highly significant (P less than .00001). Colposcopic and structural cervical abnormalities were not predictive of an abnormal histologic diagnosis. Of the 18 patients (6%) with histologic evidence of mild-moderate dysplasia, 12 have been followed with no treatment, and cytologic and colposcopic examination has been normal. Marked dysplasia-carcinoma in situ was found in 14 patients (4.7%). Their therapy is summarized. These data strongly suggest that women exposed to DES may be followed safely with Papanicolaou smears and colposcopic examinations provided that both cytopathologists and colposcopists are cognizant of the metaplastic changes in the DES progeny that distinguish them from patients with cervical intraepithelial neoplasia (CIN) who were not exposed to DES. Biopsy should be performed only if indicated by cytologic atypia, colposcopic evidence of advanced CIN, or the presence of an invasive lesion.
13 human lymphoid cell lines previously characterized in terms of their intrinsic Epstein-Barr virus (EBV) genome content were infected or superinfected with EBV from the supernatant of P3HR-1 cells. ...The cell lines included 2 lymphoma cell lines that contain no detectable EBV genomes and 11 cell lines containing intrinsic EBV genomes. All the cell lines responded to EBV infection by expressing early antigen (EA). The number of EA-positive cells in the cultures was proportional to the viral concentration used for infection or superinfection. However, cell lines containing multiple intrinsic EBV genomes expressed higher amounts of EA-positive cells. Evaluation of EA expression versus the number of intrinsic EBV genome copies per cell in each line revealed EA to increase as the intrinsic EBV genome content of the cell lines increased in a nonlinear curve that was described by an exponential logistic function. The coefficient of determination R2 for this curve was greater than 0.9 for multiple experiments. The data suggest that 80-90% of the virus in P3HR-1 is defective and requires intrinsic viral genomes for expression of EA. Transactivation or complementation between intrinsic EBV genomes and infecting virus is supported by these observations.
Characteristics of subjective symptomatology of asthma were examined within a group of 132 adult asthma patients receiving medical care in a university-based, ambulatory clinic setting. Patients ...responded to 36 symptom descriptions or adjectives associated with asthma which were included in a modified version of the Asthma Symptoms Checklist (ASC). A principal components exploratory factor analysis was conducted and five factors were identified. The five factors measured 1) panic-fear, 2) airways obstruction, 3) hyperventilation, 4) fatigue, and 5) irritability. Psychometric properties of the factor scores were satisfactory. The reliabilities were high, standard deviations were large, and differences in factor mean scores conformed to clinical experience. Correlational analyses support the construct validity of the ASC, especially the panic-fear factor. An important outcome of this study was to verify the ASC factor structure in an outpatient setting. The ASC was confirmed as a valuable instrument for use in self-management programs for adults with asthma. The five ASC factors represent highly stable components of subjective symptomatology of asthma among diverse adult patient populations and geographical settings.
Alkaline phosphatase was monitored in 17 mice with s.c.-implanted tumors to relate the total circulating alkaline phosphatase to the total number of tumor cells in each mouse. There was a ...semilogarithmic relationship between the alkaline phosphatase units and the number of tumor cells. A time-independent standard plot of alkaline phosphatase and the number of tumor cells was used to estimate the size of disseminated and localized tumors. In animals treated with cyclophosphamide, the alkaline phosphatase marker was used to monitor the regression and recurrence of the neoplasm in vivo.
To contribute more comprehensive information about the characteristics of asthma, this article analyzed patients served by the University of Alabama at Birmingham Comprehensive Asthma Program. Their ...physicians rated one fifth of these patients as having “severe” asthma with the remainder about equally divided between “moderate” and “mild.” One in two first received a diagnosis of asthma ten or more years previously. Common comorbidities were hypertension, obesity, rhinitis, bronchitis, sinusitis, and arthritis. One half had visited an emergency room or been hospitalized for asthma in the past year. Inhaled bronchodilators and continuous theophylline were the most commonly prescribed medications. Side effects, especially tachycardia and insomnia, were common and almost exclusively associated with theophylline or corticosteroid therapy. Spirometric assessment showed chronic airflow obstruction in those with more severe asthma. Prevalence of respiratory symptoms, intensity of medication regimen, incidence of side effects, and health care utilization increased as asthma severity increased.
UAB-University of Alabama at Birmingham
Controversy exists as to the influence of age on the prognosis of patients with carcinoma of the cervix. We present a series of patients with International Federation of Gynecology and Obstetrics ...(FIGO) stage I squamous cell carcinoma of the cervix, who were treated at a single institution with uniform radiation technics or radical surgery. A multifactorial analysis showed that age above or below 40 was not of prognostic significance after adjusting for race, substage, and treatment. Equal five-year survival was obtained by either radiation therapy or radical surgery. Complications in patients treated with radiation therapy appeared to be more serious than those in the surgical group. Theoretical reasons are advanced to favor surgical management in younger patients.
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