Eighty-four potential second-look operations based on sequential carcinoembryonic antigen determinations and clinical investigations in patients with recurrent gastrointestinal cancer

In our study of patients with resected primary gastrointestinal cancer, slope analysis of the post-operatively increasing carcinoembryonic antigen time courses signaled relapse in about 80 percent of the patients up to 12 months before positive clinical diagnosis. In 29 patients, clinical confirmation of the relapse could be obtained only after second-look surgery. Slope analysis generally differentiated localized from metastatic disease and therefore also predicted the site of relapse. A first evaluation of 84 patients with potential cases of second-look operations provided evidence for a significant increase in survival. Recently, the evaluation of individual carcinoembryonic antigen doubling times was used to derive an individual prognosis since doubling times strongly correlated with the survival of untreated patients. On this basis, it was clearly possible to show the benefit of second-look operation, since patients with resectable recurrences exhibited longer survival times compared with patients with similar carcinoembryonic antigen doubling times without treatment. Moreover, the introduction of monoclonal antibodies with increased specificity for malignant states, has facilitated the selection of patients for second-look operation because unspecific carcinoembryonic antigen elevations are less frequent and recurrent disease can be predicted more reliably due to the higher carcinoembryonic antigen increments associated with malignant growth.     

Phagocytic activity of granulocytes and alveolar macrophages after burn injury measured by chemiluminescence

Despite substantial progress in handling the acute phase, about 50 per cent of all severely burned patients are still subject to lethal infections during the later stages of the burn disease. Such patients frequently succumb to infections by opportunistic bacteria and viruses of normally low virulence indicating that the antiinfectious host defences are severely compromised. The present study was conducted in order to evaluate the effects of severe thermal injury on the two major categories of phagocytic cells, the circulating phagocytes of the blood and the alveolar macrophages as one population of the fixed phagocytes of the reticulo-endothelial system. The cells were isolated from burned and unburned rats. For quantitative assessment of the phagocytic function the chemiluminescence associated with the phagocytosis of opsonized zymosan particles was measured, using luminol as a chemiluminigenic probe. It turned out that as a consequence of the thermal trauma the phagocytic activity as measured by chemiluminescence is reduced in granulocytes as well as in alveolar macrophages.     

Choledochofiberoscopy in the postoperative management of intrahepatic stones

We prefer a nonaggressive approach to the treatment of high risk patients with intrahepatic stones. We perform extensive choledochotomy, remove all accessible intrahepatic stones, use bouginage of all stenotic segments and maintain patency with a T-tube stent. Postoperatively, we extract the remaining intrahepatic stones mainly with the choledochofiberscope and various types of forceps. The combined use of the Burhenne catheter and Dormia basket and the different types of curved forceps, scoops and Bakes' dilator has improved the success rate of removal. Thirty patients have thus far been treated in this manner with encouraging results.     

Endoscopic pancreatography: its value in preoperative and postoperative assessment of pancreatic disease.

Examples of the use of endoscopic pancreatography in the preoperative evaluation and postoperative follow-up study of patients with pancreatic disease are presented and discussed. Six cases selected from a total experience of forty-eight patients have been summarized. The direct role of pancreatography in the management of these cases is cited. There is a small but definite risk to the procedure. With increased use of endoscopic pancreatography, it is hoped that earlier diagnoses of a variety of pancreatic diseases will be obtained which will permit more accurate medical and surgical therapy.     

Serum 5'-nucleotide phosphodiesterase as a predictor of hepatic metastases in gastrointestinal cancer.

Isoenzyme V of 5'-nucleotide phosphodiesterase (5'-NPD-V) is present in the peripheral sera of patients with hepatic metastases. A total of 122 patients underwent prospective serologic analysis followed by operation for primary tumors of the gastrointestinal tract and careful evaluation of the liver. A positive 5'-NPD-V assay was found in fifty-nine of sixty patients with liver metastases. A negative 5'-NPD-V assay was found in forty-three of sixty-two patients with no evidence of hepatic metastases. The accuracy of the test was 84 per cent, and the predictive value was 75 per cent. Serum 5'-NPD-V was abnormal significantly more frequently in patients with metastatic liver disease than were liver scans or carcinoembryonic antigen (CEA), alpha fetoprotein, serum glutamic oxalacetic transaminase (SGOT), and total serum bilirubin or serum alkaline phosphatase levels.     

Angiography in the diagnosis and management of bleeding stress ulcers and gastritis

Eighteen patients with upper gastrointestinal hemorrhage from erosive gastritis or stress ulcers were studied by selective visceral arteriography.Thirteen patients had positive results on arteriography. Vasopressin (Pituitrin) was administered intra-arterially to six patients. Bleeding was controlled completely in four patients and partially in one patient. There was no control in one patient in whom the left gastric artery was not selectively infused.     

Marginal resection of the mandible in the management of squamous cancer of the floor of the mouth

Over a fifteen year period, marginal resection of the mandible was used as all or part of the initial treatment of twenty-three selected patients with squamous cancer of the floor of the mouth. All patients were classified as T₁ or T₂ on the basis of the extent of the primary tumor. The lesions were lying in the gingivolingual gutter close to the lingual surface of the mandible. Local control rates were obtained that were comparable to the local control rates obtained with other surgical procedures including wider bone excision and with irradiation for patients of the same T classification.     

Sensitivity and specificity of serum ribonuclease in the diagnosis of pancreatic cancer

The serum levels of a poly-[C]-specific acid ribonuclease (RNase) found in the pancreas was measured in 40 normal persons and 137 patients with pancreatic cancer, other cancers, obstructive jaundice, acute pancreatitis or chronic pancreatitis. Serum RNase increased by as much as 800 percent above normal in 69 percent of patients with pancreatic cancer. Analysis of the serum isoenzymes of RNase by isoelectric focusing did not reveal any unique RNases produced by the tumors. In contrast, serum RNase rose in only 8 percent of patients with other cancers, 11 percent of other patients with obstructive jaundice and in no patients with chronic pancreatitis. These data suggest that the finding of increased serum RNase is of adjunctive value in the diagnosis of pancreatic carcinoma and may be particularly helpful in distinguishing it from other causes of biliary obstruction and from chronic pancreatitis.     

New tube for the diagnosis and treatment of upper gastrointestinal hemorrhage

The design, use, and applications of a new tube for the treatment and diagnosis of upper gastrointestinal hemorrhage are presented. The tube incorporates suction, air sump, and irrigating components in a triple-lumen construction. The tube allows constant irrigation of the bleeding stomach with large quantities of irrigant that may contain antacids, vasoconstrictors, or both. The efficient evacuation of the stomach may result in more productive gastroscopy and upper gastrointestinal roentgenographic examinations. The tube can provide early warning of rebleeding as well as perhaps providing definitive or temporizing therapy in some cases of bleeding.     

Metastatic cancer of the liver resulting in obstruction of the extrahepatic bile duct

A case is described of a sixty-five year old man with metastatic cancer of the liver originating in cancer of the colon. The flow of necrotic tissue into the bile duct resulted in obstructive jaundice.     

Selective visceral angiography in the diagnosis and treatment of gastrointestinal hemorrhage

Visceral angiography has been proved to be a valuable addition to the diagnostic armamentarium for acute and chronic gastrointestinal bleeding. Selective visceral arterial infusion of Pitressin is helpful in the control of acute gastrointestinal bleeding. In those patients who received Pitressin, 67 per cent had control of bleeding and in nine of eighteen (50 per cent) surgery was avoided. In patients whose bleeding was controlled by Pitressin there were no deaths resulting from recurrent bleeding of the original lesion.The use of Pitressin seems especially indicated in the management of acute gastrointestinal bleeding in a patient who is a poor surgical risk because of systemic disease, abdominal wall or intraperitoneal sepsis, stress ulcer syndrome, hemorrhagic gastritis, esophagogastric varices, and colonic lesions such as diverticulosis.