Elective resection for colorectal cancer in vermont: 1971–1975

An analysis of 612 patients undergoing elective resection for colon and rectal cancer in Vermont during the period 1971 to 1975 indicates an increasing incidence of cancers of the cecum and ascending colon, an increased number of Dukes' A cancers, a synchronous cancer rate of 6 percent, an overall operative mortality of 6.5 percent, a wide variance in postoperative stay and a relatively small experience per operating surgeon.Only one third of colorectal cancers can be visualized through the rigid sigmoidoscope. Better screening techniques that are simple, reliable, inexpensive and safe must be developed to locate proximal lesions before they metastasize to lymph nodes and distant sites. Further trials with stool blood testing are recommended.     

Clinical staging of rectal cancer

The gross and microscopic pathologic features of 167 rectal cancers were reviewed and the size, morphology and degree of differentiation correlated with the histologic Dukes' classification. A diagnosis of Dukes' A adenocarcinoma was made in 32 percent of all rectal cancers and in 70 percent of nonulcerated, partly or well differentiated cancers that did not exceed 5 cm in greatest diameter. The incidence of Dukes' A lesions in patients meeting these criteria is similar to the survival rates reported after local excision, electrocoagulation and endorectal radiation. A prospective study comparing the results of local treatment with radical resection in selected patients is recommended.     

Factors influencing perineal wound healing after proctectomy

The hospital and office records of 86 patients who underwent proctectomy for cancer of inflammatory bowel disease with primary closure of the perineal wound were reviewed. Almost one fourth of all patients suffered a significant perineal wound complication, the majority of which were infections. The incidence of postoperative perineal wound complications was comparable in both groups of patients. Urinary retention occurred in 24 percent of patients who underwent abdominoperineal resection or rectal cancer, and half of these patients required transurethral resection which indicates the need for more thorough preoperative assessment of bladder function, especially in older men. The development of leg ischemia that resulted in amputation in two elderly patients who had preoperative evidence of obstructive peripheral vascular disease suggests that a synchronous two-team abdominoperineal resection with the patient in the modified lithotomy position for a prolonged period should be avoided. One third of all patients were discharged less than 10 days after surgery and two thirds within 2 weeks. Prolonged stays were more frequent in cancer patients and appeared to be related to age rather than to the development of postoperative complications. The perineal wound after abdominoperineal resection for cancer healed more rapidly and more completely than did the wound after proctectomy for inflammatory bowel disease. Fourteen percent of the inflammatory bowel disease patients did not have a healed wound 1 year after surgery. The extent of rectal cancer as determined by Duke's classification played no role in healing of the perineal wound, but women with rectal cancer healed at a slower rate than did men. The location of the exit site for wound catheters and the use of cautery and preoperative steroid therapy appeared too have no effect on the healing of the perineal wound.     

Palliative surgery for benign superior vena caval syndrome.

The two cases reported herein bring the total up to four in the literature, so far as we have been able to determine, but even with this insignificant number, it is believed that the feasibility of the procedure and the surprising degree of palliation and rehabilitation that has been obtained and maintained for over four and a half years strongly support the feeling that a reasonable surgical procedure is now available and can be offered with a high degree of optimism for successful palliation of benign superior vena caval syndrome.     

Thyroid irradiation and carcinogenesis: Review with assessment of clinical implications

The dose response relationship of induction of thyroid carcinoma by irradiation is roughly bellshaped. High (ablative) doses of irradiation for the treatment of Grave's disease have not increased the incidence of thyroid carcinoma. Lower doses of irradiation including some diagnostic doses have the potential for inducing carcinoma of the thyroid.     

Increased susceptibility to pulmonary infection in alloxan diabetic mice

Pulmonary infections in diabetics have received little attention clinically or experimentally despite an impression that diabetics are more prone to pulmonary infections and do poorly with these and all infections. In a mouse model, aerosolized pneumococci were used in order to mimic the natural portal of entry of pneumococci, to investigate susceptibility to pneumococcal infection in alloxan diabetic and normal mice, and to test the hypothesis that insulin therapy would have a protective effect. When exposed to an aerosol created from 10⁸ type III Streptococcus pneumoniae (PnIII)/ml, nondiabetic mice had a higher survival rate than uncontrolled diabetic mice (P < 0.001) and insulin-treated diabetic mice (P < 0.001). Insulin-treated diabetic mice had a significantly decreased death rate compared to untreated diabetic mice (P < 0.05). The data show that alloxan diabetic mice are more likely to succumb to infection from aerosolized pneumococci than are normal mice. Insulin therapy appeared to decrease this susceptibility. A possible clinical inference is that insulin therapy is beneficial in diabetic patients with pulmonary infections.     

Legionnaires' disease in renal transplant patients

Legionnaires' disease, which is commonly manifested as pneumonia, was only recently recognized to be a bacterial infection. Diagnosis can be difficult because Gram's stain does not readily stain the bacterium in pulmonary secretions, the organism is not readily cultured, and legionellae is not affected by many commonly used antibiotics. In a retrospective review of all of our transplant patients, we identified 14 cases of Legionnaires' disease after 101 renal transplants. The patients characteristically had high fever, polymorphonuclear leukocytosis, dyspnea and an unproductive cough accompanied by radiographic changes of consolidating pneumonia. Legionnaires' disease can be diagnosed by direct immunofluorescent antibody staining, culture on special media or increases in serum titers of legionella antibodies in surviving patients. Since the recognition of Legionnaires' disease in 1977, we have successfully treated seven renal transplant patients using erythromycin with or without rifampin.     

Core-cutting needle biopsy for the diagnosis of breast cancer

Core-cutting needle biopsy of most palpable breast cancers can be easily performed in the office using local anesthesia and frequently provides unequivocal histologic diagnosis.     

The effect of protein depletion on bone marrow myeloid cell repopulation

We studied the effect of protein depletion on bone marrow recovery after injection of the cytotoxic drug, 5-fluorouracil (5-FU), by using an in vitro quantitative clonal culture technique for femoral marrow granulocyte/macrophage progenitor cells (GM-CFC). Mice were maintained for 7 days on either a regular diet or on a protein-free but isocaloric and otherwise complete diet. Groups of animals were assayed 1–5 and 7 days after 40 mg/kg ip 5-FU. Both regular-diet animals and animals on the protein-free diet had similar GM-CFC toxicity 1 day after 5-FU injection. However, 5 days after 5-FU, protein-depleted animals were significantly different from regular diet animals in the extent of repopulation of the GM-CFC (confidence 95%). Regular diet animals demonstrated a rebound overshoot of the progenitor cells which was not found in protein-depleted animals. The extent of recovery of the GM-CFC at 7 days after 5-FU for the protein-depleted animals still did not equal that of the regular diet animals (90% confidence). Quadratic regression analysis of the recovery curves for both regular diet and protein-free diet animals for Days 1–7 following 5-FU were significantly different (P < 0.01). We conclude that while protein depletion does not alter the acute bone marrow toxicity of 5-FU, protein-depleted animals had an impaired rate and extent of repopulation of the myeloid progenitor cells. These findings may form the basis for a clinical policy of dietary repletion in selected malnourished cancer patients prior to chemotherapeutic treatment.     

Ineffectiveness of methylprednisolone in the treatment of pulmonary dysfunction after cardiopulmonary bypass.

Fifty consecutive adults undergoing elective cardiac surgery with cardiopulmonary bypass received a single dose of methylprednisolone (30 mg/kg) at the time of anesthesia. The results were compared with those in the immediately preceding fifty adult patients who underwent elective cardiac surgery and who did not receive corticosteroids. The age, sex, and weight of the patient, mortality, nature of the lesions treated surgically, bypass time, smoking history, physiologic evidence of preexisting lung disease, preoperative New York Heart Association class, preoperative left ventricular end diastolic pressure, incidence and duration of the postoperative low cardiac output syndrome, postoperative arrhythmias, operative and postoperative blood loss and postoperative hours of respiratory support, dynamic lung-thorax compliance, alveolar arterial oxygen gradient, fraction of wasted ventilation, and incidence of tracheostomy were tabulated and statistically contrasted. The two groups were comparable relative to all preoperative factors, except for a slightly higher end diastolic pressure in the patients who received steroids. Methylprednisolone given at the time of anesthesia was associated with a higher intraoperative blood loss, a higher incidence of low cardiac output syndrome, and an increased requirement for postoperative mechanical ventilation. As bypass time approached three hours, the proportion of patients requiring prolonged support in both groups became similar. It was concluded that pretreatment with methylprednisolone in massive doses had an overall adverse cardiopulmonary effect.     

Percutaneous needle biopsy of pulmonary lesions

Percutaneous needle biopsy of lung lesions has proved useful in the diagnosis of tumors and infectious lesions of the lung. Accurate tissue diagnosis of tumors was obtained in 81 percent of attempts, and an accurate microbiologic diagnosis was obtained in 75 percent of infectious lesions. Eleven percent (23 of 213) of patients biopsied for tumor were spared diagnostic thoracotomy, and only one biopsy gave a false-positive result. There has been no mortality, and the only significant morbidity was a 12 percent incidence of pneumothorax necessitating chest tube insertion. The use of this technique in varied clinical settings has made it a valuable and often primary diagnostic tool for lung lesions.     

A retrospective and prospective study of serial CEA determinations in the early detection of recurrent colon cancer.

The results of the present study emphasize the importance of minimizing the time delay between a significant elevation in CEA and a second-look operation. Equally important are the frequency of serial determinations, a thorough understanding of the limitations of the assay, and careful evaluation of the clinical condition of the patient.     

Relationship between postoperative temperature and survival in patients resected for colorectal cancer

The present study suggests that the prognosis of patients undergoing resection for colorectal carcinoma might be improved if there is an increase in body temperature during the postoperative period.     

Clinical and pathologic evaluation of patients with recurrence of gastric cancer more than five years postoperatively

From the clinical and pathologic findings, the characteristics of recurrence of gastric cancer more than five years postoperatively were evaluated as compared with recurrence of less than five years postoperatively. The late (more than 5 years postoperative) recurrence rate was 2.0 per cent, or 17 of 864 patients who had undergone the so-called radical operation. The duration of disease prior to the first operation was comparatively long in the patients with late recurrence. Late recurrence is characteristic of localized cancer, such as Borrmann's type II, and differentiated adenocarcinoma with nonserosal invasion (pathologic findings of the resected stomach at the first operation) and by a recurrence pattern of hematogenous metastasis, especially liver metastasis.     

Technic of chronic thoracic duct “side fistula” for immunologic evaluation of patients with cancer

A technic suitable for long-term study of the human thoracic duct circulation under physiological conditions is described. The results and observations obtained in ten patients studied for three to twenty-one days are presented.     

Hormone effects on human mammary cancer in organ cultures.

Specimens of human breast cancers and fibrosarcomas were incubated for 4 to 72 hours as organ cultures. The effect of various concentrations of testosterone, progesterone, and 17-beta-estradiol on cell survival and multiplication was measured as changes in incorporation of H3-TdR into DNA. Both types of tumor reacted to the hormones; both stimulations and inhibitions were recorded. Statistical analysis of data demonstrated possible influence of factors other than hormone treatment. The specificity of hormone sensitivity assays in vitro is questioned.