Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer

Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome.Methods: Patients having surgical debulking and IP 5-fluoro-2-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively.Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m² daily for 3 days) and IP leucovorin (240 mg/m²) with a median cycle number of 4 (range, 1–28). The median number of complications was 1 (range, 0–5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0–132 months). The median survival was 34 months (range, 2–132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection.Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.Presented in part at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

Primary sequence, copy number, and distribution of mariner transposons in the honey bee

A single honey bee mariner transposon (TnM1a) was sequenced, revealing a transpositionally non-autonomous element of 937 bp delimited by 30 bp perfect inverted terminal repeats. The element is flanked by the TA duplication typical of mariner elements in general. There are approximately 435 copies of TnM1a homologous elements per haploid genome. These elements appear, by Southern blot analysis, to be dispersed throughout the genome. Thirteen individual genomic clones with an average size of 15 kb, were found to contain only a single element each, which also suggests that the elements are not tightly clustered. Finally, mariner elements are neither inactivated by methylation nor sequestered into a methylated fraction of the genome.     

Effect of mucolytic and bronchodilator aerosol therapy on airway resistance in mechanically ventilated patients

Nebulisation of a 10% solution of Mesna (Mistabron) in 10 postoperatively ventilated patients without preexisting pulmonary disease caused a significant increase in inspiratory resistance. This increase is effectively blocked by addition of a bronchodilator (i.e. Salbutamol) to the aerosol. No significant changes in airway resistance were observed in the 10 patients receiving salbutamol alone or isotonic saline. The expiratory resistance did not change suggesting that only the larger airways are involved in the constrictive effect of the drug. Although no patient showed clinical signs of bronchospasm, it is worth considering that even in patients without history of obstructive pulmonary disease nebulisation of Mesna should be performed in combination with a bronchodilator.     

Complications in surgical patients: A comparison of methods for identifying occurrence

Because reporting of complications by physicians is not reliable, monitoring of the hospital course of surgical patients by nurses can improve effectiveness of identifying complications. Monitoring the course of only those patients who remain in the hospital more than four postoperative days will disclose 90 per cent of complications expected in all patients undergoing operation. Twenty hours per week of a nurse's time is sufficient to monitor 1,300 such patients annually. Identification of patients with large hospital bills will include most patients with complicated hospital courses but does not discriminate them from the large number of uncomplicated courses which also generate large hospital charges.     

Ventricular arrhythmias induced in monkeys by the inhalation of aerosol propellants

After inhaling fluoroalkane gases, which are used as aerosol propellants, some people have died suddently and unexpectedly. Seeking an explanation, we had 14 monkeys inhale these gases. All developed ventricular premature beats, bigeminy, or tachycardia, which began at an average of 39 (SE +/-4.2) sec. Fluoroalkanes were present in blood, but arterial hypoxemia or hypercapnia was absent, and arterial pressure was reduced only slightly. In contrast, without fluoroalkanes, 3 min of asphyxia or anoxia caused arrhythmias in only one monkey whose arterial oxygen tension had fallen to 16 mm Hg. The ventricular arrhythmias caused in well oxygenated monkeys by fluoroalkane gases may either be mediated through beta adrenergic receptors, since propranolol abolished these arrhythmias, or result from a nonadrenergic, direct, toxic effect of these gases on the heart. These results suggest that some deaths after propellant inhalation may be caused by ventricular tachycardia or fibrillation.     

Blood zinc, copper, insulin and glucose levels in carbohydrate-sensitive and normal men given a sucrose or invert sugar tolerance test

Twelve carbohydrate-sensitive and 12 non-carbohydrate sensitive (normal) men were studied. Carbohydrate sensitivity was identified by hyperinsulinemic and normoglycemic responses to a sucrose load. In a blocked split-plot design, fasted subjects were given 2 g/kg body weight of sucrose or invert sugar, and responses of plasma zinc, copper, insulin, and glucose were determined. Erythrocyte zinc and copper also were measured. Blood samples were taken 0, 0.5, 1, 2, and 3 hours after the sugar loads were given. Plasma zinc, copper, insulin, and glucose did not differ significantly between the two sugar loads. Neither did erythrocyte zinc and copper differ significantly between the two load doses. Also, plasma zinc, copper, and glucose, as well as erythrocyte zinc and copper, did not differ significantly between the carbohydrate-sensitive and normal men. Plasma insulin was significantly higher in the carbohydrate-sensitive than the normal men. Plasma zinc did not change significantly between sampling times. Plasma copper declined progressively over the testing period. The greater the elevation of plasma glucose above the fasting level, the greater the plasma copper was depressed. Copper appears to be withdrawn from plasma after sugar loading to facilitate glucose uptake and metabolism.