Treatment of liver cancer with regional intraarterial 5-FU infusion.

The results of a retrospective three year study of forty-six patients with cancer of the liver treated with regional intraarterial infusion of 5-FU are reported. No primary mortality was noted. Oblective overall remission rate was 43 per cent. Overall median survival from onset of treatment was six months. The one year survival rate was 33 per cent and the two year survival rate 11 per cent. Patients with an objective response had a significantly prolonged survival as compared with nonresponders, especially in the colorectal group: sixteen months versus four months. Survival was not related to tumor size and involvement of the liver. During treatment 42 per cent of the patients developed extrahepatic metastases. Quality of life was improved in 63 per cent of the patients. The results indicate that infusion therapy induces reasonable response and palliation but is inadequate for the control of extrahepatic tumor growth.     

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.     

Intraarterial infusion chemotherapy (5-fluorouracil) in patients with inextirpable or locally recurrent rectal cancer.

A retrospective analysis of the results of treatment of advanced rectal cancer of the pelvis with regional intraarterial infusion of 5-fluorouracil (5-FU) is reported. A special technic for positioning the catheters selectively in the internal iliac arteries justifies this analysis. Four patients with primary inextirpable rectal cancer and 10 patients with locally recurrent rectal cancer have been treated. No immediate mortality was noted. Relief of pain was noted in two-thirds of the patients. An objective tumor response was noted in three patients with locally recurrent disease. In one patient with primary inoperable cancer it was possible to extirpate the tumor after infusion therapy. An improvement in quality of life during the first 2 months after therapy was achieved in half of the patients as judged by their performance. Complications were not serious. Hematomas with infection were seen in one patient, two patients had septicemia, and three patients had transient oliguria. Transient thrombocytopenia was reported in two patients. The results indicate that infusion therapy produces a reasonable response such as palliation of pain. Only minor complications were seen and easily controlled. The advantages of infusion therapy are that it can be given in a reasonable time with only a short hospital stay.     

Natural history of patients with untreated liver metastases from colorectal cancer

One hundred fifty-five patients, laparotomized because of colorectal cancer, were retrospectively evaluated with special attention given to the natural course of untreated synchronous liver metastases. The median survival time for patients with synchronous liver metastases was 4.5 months. The survival time was mainly influenced by the extent of tumor involvement in the liver. Patients with elevated levels of serum-alkaline phosphatase at the time of operation had a significantly shorter survival time than those with normal values. Serum alkaline phosphatase levels are a good indication of prognosis. The incidence of synchronous liver metastases was 16 percent. This low rate is partly explained by the development of metachronous liver metastases in five patients within 1 year. Comparison with previous reports, often more than 10 years old, revels that the poor prognosis of patients with untreated liver metastases from colorectal cancer has remained unchanged.     

Prophylactic oophorectomy in colorectal carcinoma

It is a well established fact that women with recurrent colorectal carcinoma have a high frequency of ovarian metastases. This study was undertaken to see if microscopic metastases could be found in serial sections of ovaries removed at the time of primary operation. Of 58 patients, 4 had microscopic metastases and an additional 2 patients had macroscopic metastases. This finding, plus the risk of the development of a primary ovarian carcinoma, favors prophylactic oophorectomy in women with colorectal carcinoma.     

Release of acid hydrolases in hemorrhagic shock after pretreatment with hydrocortisone in the pig

An experimental study of the effect of pharmacologic doses of hydrocortisone in hemorrhagic shock in the pig is described. Oligemic hypotension was induced for sixty minutes by maintaining the mean arterial blood pressure at 30 mm Hg. Pretreatment with hydrocortisone (50 mg/kg of body weight) suppressed the plasma activity of the acid hydrolases β-D-glucosidase and β-D-galactosidase compared with that in a control group. In addition, treatment with steroids reduced the degree of metabolic acidosis and hyperpotassemia. After reinfusion of the shed blood the arterial blood pressure was higher in the group treated with steroids.The results of this study indicate that glucocorticoids have a protective effect in hemorrhagic shock in pigs. This action seems to occur primarily at a metabolic level rather than by direct interference with the general circulation.     

Ambulatory inguinal hernia repair compared with short-stay surgery

Two groups of patients operated on for inguinal hernia, one outpatient group and one inpatient group, are compared with respect to subjective distress and immediate postoperative complications. The groups were chosen at random and matched for sex and age. A large number of those who received treatment as outpatients suffered marked distress during the first postoperative days. Some form of intermediary or light nursing should be tried out for the outpatients so that if necessary they can stay the night after operation at the hospital. The number of postoperative complications was equal in the two groups. With suitable patient selection and with a small number of reserve places in a light-care ward, the majority of inguinal hernia operations can be performed on outpatients, resulting in a considerable economic saving and shorter waiting time.     

Changes in blood clotting and fibrinolysis after liver ischemia in pigs

Ten pigs were subjected to fifteen minutes of liver ischemia and four pigs to sixty minutes of liver ischemia. After fifteen minutes of ischemia three of ten animals showed a significant prolongation in the recalcification time. There was no decrease in clotting factors to explain the prolongation. The increase in fibrinolytic activity was similar in the three pigs with and the seven pigs without a prolonged recalcification time. There were no changes in fibrinogen concentration in any of the animals. Dilution tests for determining the circulating anticoagulants strongly indicated the presence of an anticoagulant in the plasma samples with a prolonged recalcification time.All four animals subjected to sixty minutes of liver ischemia showed a moderate prolongation in the recalcification time of longer duration but not of the same magnitude as that of the animals having fifteen minutes of liver ischemia. The prolongation in the recalcification time in this group was probably a result of a decrease in clotting factors.     

Growth quantitation of human mammary carcinoma in organ tissue culture

Organ tissue cultures of human mammary carcinomas were performed for twenty-four, forty-eight, and seventy-two hours. All types of tumor tested produced growth that could be quantitated by labeling with tritiated thymidine. Incorporation was located mainly within epithelial cells as controlled by autoradiography. Two labeling methods were compared, Parker 199 and Trowell's T8 media were tested, and the addition of human albumin or serum was evaluated. The serum factor was important for growth, although no difference between Parker 199 and Trowell's T8 medium could be demonstrated. The data were suitable for statistical evaluation, and variance analysis showed the tumors, culture times, and media to be significant sources of variation. The method is intended for studies of hormonal responsiveness of human mammary carcinomas.     

Herniography in athletes with groin pain

In the years 1974 to 1981, herniography was performed in 78 athletes with groin pain. The investigation comprised 101 painful groin sides in 23 athletes with bilateral symptoms. Before herniography, a hernia was palpated in only eight (7.9 percent) groins with pain. Hernias were found at herniography in 84.2 percent of the symptomatic groin sides and in 49.1 percent of the asymptomatic groin sides. Sixty-three hernia operations were performed. The herniographic and operative diagnoses corresponded well. Direct hernias dominated among the operated athletes, and were found in 55.6 percent of those below 30 years of age. Altogether 69.8 percent of the operated patients were cured by hernia repair and another 20.6 percent were improved. Tenoperiostitis of the adductor muscles was the most frequent diagnosis in those not cured by operation and among the nonoperated patients. Herniography was of great value in selecting those patients who needed a repair. A broad differential diagnostic approach when examining these patients is of the utmost importance.     

Changes in hospital costs for an appendectomy: 1955, 1965, and 1975

A reduction in the number of postoperative bed days for patients who underwent appendectomy led to a study of changes in hospital costs of appendectomies for the years 1955, and 1965, and 1975. No significant changes were found in the total hospital costs. However, the postoperative costs decreased by 36 percent from 1955 to 1975 due to a decrease in the mean duration of hospital stay. During the same period of time, the perioperative costs increased by 90 percent due to increased length of operation time correlated with an increasing proportion of inexperienced operating surgeons. At present, there seem to be few possible ways to increase the cost efficiency of treating appendicitis.     

Role of obstruction in the pathogenesis of acute appendicitis

The role of obstruction in the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix perioperatively in 24 patients operated on with an appendectomy because of suspected acute appendicitis. The technique used involved inserting a fine needle through the apex into the appendix lumen and measuring the hydrostatic pressure required to inject saline solution. In three patients with a gangrenous appendix found at operation, and in two patients with a phlegmonous appendix, there were signs of obstruction of the appendix lumen as revealed by increased pressure within it. In 14 patients with a phlegmonous appendix found at operation, no signs of obstruction were found. These experimental data suggest that obstruction is not an important causative agent of acute appendicitis, but might develop as a result of the inflammatory process.     

Deficient collagen formation by obese mice in a standard wound model.

Poor healing was demonstrated in two different experimental models of diabetes mellitus. In one model, there was an absolute lack of insulin and in the other, a resistance to insulin. A review of the history of the results of surgery in diabetic patients shows that in the clinical situation, wound failure is associated with both a lack of insulin and a resistance to insulin. Thus, the causes of wound failure in diabetic patients include a failure of insulin to perform its normal role in healing. This does not exclude other causes such as "small vessel disease" as etiologic factors, but it does suggest that control of metabolic derangements is beneficial to healing in diabetic patients who undergo operation.     

Development of right inguinal hernia after appendectomy

The incidence of right inguinal hernia is significantly greater in patients who have undergone appendectomy than in the general population. The most likely cause of such hernias is injury to the segmental nerve supply to the inguinal musculature. The choice of incision at appendectomy may therefore be important, and the surgeon should avoid injury to the nerve branches and important structures in the inguinal region, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.     

Hormonal and cholinergic effects on amylase and lysosomal enzyme activities in pancreatic tissue and ascites of rats with acute experimental pancreatitis

The effects of hormonal or cholinergic stimulation on survival and on activities of lysosomal enzymes and amylase in pancreatic tissue and ascites were studied in rats with induced pancreatitis. Pancreatitis per se caused an increase of the activities of cathepsin D, N-acetyl-beta-D-glucosaminidase and amylase, and a decrease of acid phosphatase in pancreatic tissue. Pancreatic protein concentration was not influenced. In pancreatitic rats administration of cerulein or carbachol markedly decreased survival rate. Cerulein increased the activities of cathepsin D and amylase in ascites and cathepsin D and acid phosphatase in pancreatic tissue. Carbachol increased the activities of cathepsin D and amylase in ascites and acid phosphatase in pancreatic tissue. Both cerulein and carbachol decreased the activity of amylase in pancreatic tissue. Administration of secretin or the anticholinergic drug Pro-Banthine did not influence survival rate or the activities of lysosomal enzymes and amylase in ascites. In pancreatic tissue the activity of acid phosphatase was slightly increased by secretin or Pro-Banthine. In conclusion, the results show a nonparallel alteration of lysosomal enzyme activities in pancreatic tissue in rats with pancreatitis. Cerulein and cholinergic stimulation decreased survival rate and brought about a marked increase of cathepsin D activity in ascites and, in the case of cerulein, also in pancreatic tissue. The implication of lysosomes and especially the catheptic proteases in the pathogenesis and outcome of acute pancreatitis deserves further attention.     

Development of portasystemic shunts after subcutaneous transposition of the spleen in the rat

Transposition of the spleen to the abdominal subcutaneous tissue in rats was performed, and the development of collaterals between the portal and systemic venous vessels was studied. The effects of different modifications in operative technic and of the time lapse after transposition on the development of these anastomoses were examined. The capacity of the collaterals was studied by determining survival after acute portal ligation, by recording portal pressure, and by performing angiography. The clinical significance of the method described is still to be demonstrated.     

Disease of the gallbladder in patients with normal cholecystograms

In contrast with what has widely been assumed, disease of the gallbladder sometimes remains undetected by even repeated cholecystography or cholegraphy. Chronic cholecystitis, gallstones, and acalculous cholesterolosis can escape detection by roentgenography of the gallbladder. Of 4,000 patients subjected to cholecystectomy between 1962 and 1973, the cholecystogram had been normal in only two. The range of indications for the operation has since been widened. Patients with typical symptoms of gallbladder disease or recurrent pancreatitis of unknown origin have been operated on despite a normal cholecystogram. Within as short a period as eight months, an additional six patients with a normal cholecystogram have been operated on at our hospitals.Treatment consisted of cholecystectomy also in the four patients in whom no stones could be palpated in the gallbladder. Gross and microscopic examination of the gallbladder in these patients revealed cholesterolosis. When last seen, seven of the eight patients were still symptom-free an average fifteen months after the operation.     

Selective celiac angiography and surgical exploration for suspected liver cancer: A comparative study of 196 patients

In 196 patients subjected to celiac angiography and exploratory laparotomy for suspected liver tumor, 81 per cent of the tumors were diagnosed by angiography, 26 per cent of patients had false-negative angiograms, and 16 per cent had false-positive angiograms. Diagnosis on laparotomy proved correct except in one patient. Of 22 patients with liver tumors not diagnosed on angiography, 10 could be specifically treated and 3 of them have survived more than one year. This gain is discussed in relation to the rather high number of unnecessary laparotomies.