Adrenocortical carcinoma is a rare tumor, and only limited information is available about its natural history and the effects of therapy. We studied 105 patients (75 female and 30 male; mean age, 46 years) with adrenocortical carcinoma who were referred to us between 1963 and 1987. The average duration of symptoms before diagnosis was 8.7 months. At the time of diagnosis, 68 percent of the patients had endocrine symptoms, and 30 percent had distant metastases. Hormonal studies showed that 79 percent of the tumors were functional. Eighty patients underwent surgery, and 59 also received the adrenal cytotoxic agent mitotane. The median disease-free interval after surgery was 12.1 months (range, 1 to 175). Tumor dissemination occurred in 82 percent of the patients, most commonly to the lung, liver, and adjacent organs. The median survival time was 14.5 months (range, less than 1 to 175), and the five-year survival was 22 percent. Age over 40 years and the presence of metastases at the time of diagnosis were the only factors recognized as indicating a poor prognosis. Mitotane controlled hormonal secretion in 75 percent of the patients. Eight mitotane-treated patients had partial tumor regression, but the drug did not have a significant effect on survival. We conclude that adrenocortical carcinoma carries a poor prognosis. Mitotane therapy may offer transient benefits, particularly in controlling endocrine symptoms.
A series of Co–Fe bimetallic
catalysts was prepared, characterized,
and studied for the hydrogenation of carbon dioxide. The catalyst
precursors were prepared via an oxalate coprecipitation method. Monometallic
(Co or Fe) and bimetallic (Co–Fe) oxalate precursors were decomposed
under a N2 flow at 400 °C and further pretreated under
a CO flow at 250 °C. The catalysts (before decomposition of the
oxalates or after activation) were characterized by BET, TGA-MS, X-ray
diffraction, CO-TPR, SEM, HR-TEM, and Mössbauer spectroscopy
techniques. The hydrogenation reaction of CO2 was performed
using Co–Fe bimetallic catalysts pretreated in situ in a fixed-bed
catalytic microreactor operating in the temperature range of 200–270
°C and a pressure of 0.92 MPa. With increasing Fe fraction, the
selectivity to C2–C4 for Co–Fe
catalyst increased under all operating conditions. The alcohol selectivity
was found to increase with increasing iron content of the Co–Fe
catalyst up to 50%, but then it dropped with further addition of iron.
Among the three different activation conditions, the CO pretreated
Co–Fe (50Co50Fe) catalyst exhibited a much lower selectivity
for methane. Addition of 1 wt % Na or 1.7 wt % K to 50Co50Fe catalyst
increases its olefinic (C2–C4) and oxygenate
selectivities.
Patients with disseminated intraperitoneal malignant neoplasms were given intra-abdominal photodynamic therapy. Patients received dihematoporphyrin ethers intravenously 48 to 72 hours before laparotomy at doses of 1.5 to 3.0 mg/kg. At operation, as much tumor as possible was resected. Red light (630 nm) was delivered to all peritoneal surfaces from an argon-pumped dye laser at doses ranging from 0.2 to 3.0 J/cm2 in an escalating fashion. Viscera and peritoneal surfaces were anatomically isolated and exposed to light for intervals calculated to deliver the prescribed energy. Light was delivered to mesentery and bowel by a flat-cut optical fiber, while other areas, including diaphragm, viscera, omental bursa, gutters, and pelvis, were delivered light through a diffusing wand. Twenty-three patients (13 with ovarian cancer, eight with sarcoma, and two with pseudomyxoma peritoneii) underwent photodynamic therapy. Five of eight patients cleared positive peritoneal cytologies after treatment. Six patients remained clinically free of disease for up to 18 months, and five patients had treatment-related complications. Intraperitoneal phototherapy is technically feasible and deserving of clinical evaluation.
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