Between 1920 and 1970, 13 patients (7 men and 6 women) with cutaneous angiosarcomas of the head or neck were treated at the Mayo Clinic; the mean age of the patients was 66 years. Three clinical patterns were noted: a superficial spreading type, a nodular type, and an ulcerating type. There were no predisposing benign lesions; however, in one patient, angiosarcoma developed in an area of previously irradiated skin. Three modes of therapy were used: surgery alone, radiation alone, and surgery with postoperative irradiation. Of the 13 patients, 2 survived more than 5 years and 2 were alive within 1 year of therapy. Because cervical lymph node spread is common, lymph node clearance is recommended for patients with lateralized lesion or with palpable lymphadenopathy at presentation.
For many years, radiofrequency-generated lesions have been used for the treatment of pain and abnormal movements. However, the reliability of this method has been questioned because of the variation in the size of lesions produced by the electrode at different times and temperatures. A 500-kHz radiofrequency generator with different electrodes was used to determine the size of lesions, using different time and temperature exposures. A computerized feedback mechanism kept the tip temperature constant during the production of the lesion, regardless of varying tissue impedance. Eight electrodes of different size and tip characteristics were evaluated at different temperatures and time settings, both in vitro and in vivo. Graphic display of the curves in time were obtained at 65, 70, 75, 80, 85 and 90°C. The effects of thermocoagulation were studied in vitro in fresh egg whites, using time intervals of 20, 40, 60, 80 and 100 s, and in vivo, in the subcortical white matter of 20 adult New Zealand white rabbits. Animals were sacrificed after 7 days. Lesions were photographed and measured under magnification. In all cases, the coagulated masses were ellipsoid, with regular, well-demarcated borders. A two-way statistical analysis of variance was done. The coagulum size increased with higher temperatures and with larger probes. The increase was significant in both diameter and length (p = 0.001). In contrast, the use of different times at the same level of temperature showed no significant increase in most of the electrodes. There were two statistical significant time effects, for both diameter and length, with the monopolar 2-mm electrode. The use of real-time monitoring with graphic display and the feedback information provided for the computerized control of power and current allows high precision of the temperature at the electrode tip during the production of the lesion.
Cystadenocarcinomas are rare tumors of the'pancreas. They are half as common as their benign counterpart-the cystadenoma. A The first case reported in the American literature was by Lichtenstein in 1934.9 He described a 44-year-old woman who at autopsy had a large papillary cystadenocarcinoma of the pancreatic tail with metastatic liver nodules and peritoneal seeds. Many isolated reports and several reviews appeared during the subsequent three decades after this initial report. Kennard in 19417 reviewed the world literature and added one case of papillary cystadenocarcinoma. At that time, most tumors either were biopsied only or were treated with internal or external drainage procedures or marsupialization. Sawyer and associates in 195212 found reports of only 29 cases of cystadenocarcinoma and added another to the literature. Most reports concerned clarifying the incidence of the tumors and assessing the malignant potential. Information on the natural history, pathogenesis, and prognosis was not forthcoming because no one institution had a
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