Technique of exploratory laparotomy and staging in Hodgkin's disease

Exploratory laparotomy, splenectomy, liver biopsy, multiple lymph node biopsy, and bone biopsy have been successfully carried out in 76 patients with Hodgkin's disease. The superiority of these procedures for accurate determination of extent of abdominal disease is clear. A surgical technique of staging is described that has, to date, no mortality and insignificant morbidity.     

Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease

Those who provide care at home for a spouse with Alzheimer's disease (AD) endure considerable challenges, including social isolation and increasing caregiving responsibilities. We examine the extent to which an intervention that helps spouse-caregivers mobilize their social support network, helps them better adapt to the caregiving role. We used detailed social support information collected from 200 spouse-caregivers participating in a randomized, controlled trial of enhanced social support services in the USA. Using random effects regression models, we found that individuals in the intervention group reported higher levels of satisfaction with their social support network over the first 5 years of the intervention than those in the support group. Higher levels of emotional support, more visits, and having more network members to whom they felt close were all individually predictive of longitudinal changes in social support network satisfaction. We conclude with a discussion of the importance of having psychological respite when caregivers spend their days in the home and are isolated.     

Protective effect of prostaglandin E2 receptors EP2 and EP4 in alloimmune response in vivo

Prostaglandin E2 (PGE2) is produced during inflammatory responses mediating a variety of both innate and adaptive immune responses through 4 distinct receptors: EP1 to EP4. The use of gene-targeted mice and selective agonists/antagonists responsible for each receptor has gradually revealed that each receptor plays a unique and important role in various disease conditions. In addition, PGE2 is known to have some immunosuppressive properties. In this study, we investigated the role of PGE2 receptors by examining the therapeutic efficacy of highly selective receptor agonists on the alloimmune response in vivo. We used a fully major histocompatibility complex (MHC)-mismatched murine cardiac transplantation model. C57BL/6 cardiac allografts were heterotopically transplanted into BALB/c recipients. We treated mice with a highly selective agonist for each EP receptor. EP2 and EP4 agonists significantly prolonged allograft survival compared with controls. In particular, the EP4 agonist was more effective than the EP2 agonist in the inhibition of acute allograft rejection. In conclusion, PGE2 receptors merit further study as novel therapeutics for clinical transplantation.     

Pelvic and perineal recurrences after abdominoperineal resection for adenocarcinoma of the rectum

Pelvic and perineal recurrences were evaluated in 48 patients who underwent abdominoperineal resection at Roswell Park Memorial Institute for adenocarcinoma of the rectum. The duration of follow-up of these patients was at least 5 years or until death. There were 26 male and 22 female patients with a median age of 60 years. In 40 patients, the abdominoperineal resection was considered to be curative and in the remaining 8 patients, palliative abdominoperineal resection was performed. Only 2 of the 48 patients had a pelvic recurrence and in none of these patients was this recurrence the first site of relapse. One of the 48 patients had a local perineal recurrence; however, this was treated successfully with surgery. This represents a total of three pelvic or perineal recurrences in 48 patients, for a recurrence rate of 6 percent.     

Splenectomy for palliation of chronic myelocytic leukemia.

Sixty patients with chronic myelocytic leukemia (CML) (most, in the "terminal phase" of the disease) were subjected to splenectomy because of symptomatic splenomegaly, thrombocytopenia or anemia for which they required frequent transfusions. Surgical morbidity and mortality were high when the procedure was performed on a "casual" basis, but both were reduced sharply after care of these patients was restricted to a single medical-surgical-nursing team and improved technics of surgery and perioperative management were developed. Significant hematologic and clinical benefit was achieved in half of the patients and temporary arrest of the disease was often observed, but in most patients, the basic evolution of CML was not greatly altered. In eight patients, however, long-lasting improvement (one to nine years) was recorded. Measurement of the doubling time of circulating leukemic cells and other observations were consistent with the hypothesis that, in some patients, the spleen contains a more rapidly proliferating and "more malignant" population of leukemic cells than the marrow. We conclude that splenectomy is often a useful palliative procedure in advanced stages of CML, and that it may be strikingly beneficial in 10 to 15 per cent of such cases.