Experimental Study About Removal of the Implanted Tined Polyurethane Ventricular Lead by Radiofrequency Waves Through the Lead

Polyurethane pacemaker leads are widely used nowadays. However, only a few studies have been done to investigate the fixation mechanism of polyurethane leads. To elucidate how pacemaker leads are fixed at the early phase after implantation, polyurethane-insulated tined ventricular leads were implanted in seven mongrel dogs. One to 4 months later, tips of the leads were anchored among the trabeculae and the distal part of the leads were encapsulated by whitish fibrous tissue. It was found that not organized thrombi, but cell reaction with various stages of inflammatory cells was responsible for forming the fibrous tissue. We attempted to remove the lead by delivering radiofrequency wave through the lead. However, no lead could be removed.     

Accidental transmission of HCV and treatment with interferon

Accidental transmission of contagious pathogens, especially hepatitis C virus (HCV), by needlestick or other means as an occupational hazard for medical staff is of concern. We retrospectively analysed cases of work-related accidental injury with pathogens such as hepatitis B virus (HBV), HCV, syphilis and human immunode?ciency virus (HIV) reported to the centres for disease control at 15 hospitals (total 5776 beds) in the Gunma prefecture, Japan, from December 1990 to August 1993 (24.7 months). There were 416 such cases (16.8 cases/month), with an incidence of 0.2–3.5 accidents per month per hospital. Such accidents occurred in 297 (71.2%) nurses, 98 (23.5%) medical doctors, 13 (3%) laboratory technicians, four (1.0%) hospital maintenance workers, one (0.2%) assistant nurse, one secretary and two others. There were 323 (77.6%) injuries caused by needlestick, 42 (10.1%) from suture needles or surgical knife cuts, 17 (4.1%) from blood splatters from patients into the eyes or mouth, 10 (2.4%) from contact with injured skin and 24 (5.8%) simple skin contacts. Of the pathogens, 60.3% were HCV, 22.6% HBV, 5.8% syphilis, 0.7% HIV and 10.6% were of unknown origin. Four cases (1.6%) of HCV infection were found and treated with one or two courses of interferon therapy, and HCV was subsequently cleared. All four patients were cured with interferon therapy. None of the HBV-injured cases resulted in infection, possibly because of prophylaxis with HB immunoglobulin and HB vaccine. No HIV or syphilis infection was contracted. In summary, chronic HCV infection acquired as an occupational hazard can be cured by appropriate treatment, such as with interferon, after early detection of the infection.     

Oil-Depot Type Bleomycin in the Treatment of Malignant Lymphoma in Comparison with Regular Bleomycin

Oil-depot type bleomycin was originally intended to take advantageof not only concentration-dependent action, but also the time-dependentaction of bleomycin to obtain more efficient tumor cell kill.In this study, the effects of oil-depot type bleomycin and regularbleomycin on 81 patients with malignant lymphoma were compared.Both oil-depot type bleomycin and regular bleomycin were equallyeffective against Hodgkin's disease, with a complete remissionrate of 60% (6/10) and 54.5% (6/11), respectively. Non-Hodgkin's lymphoma in advanced stages responded better tooil-depot type bleomycin [complete remission (CR); 35.2% (6/17)]than to regular bleomycin [CR: 10.5% (2/19)]. In addition, thepatients were more responsive to smaller doses of oil-depottype bleomycin than regular bleomycin. Eleven out of 12 (91.6%)patients who responded to oil-depot type bleomycin, went intocomplete remission before receiving 45 mg in total dosage ofbleomycin, while five out of 10 (50%) patients who respondedto regular bleomycin reached complete remission after 60 mgin total dosage was administered. The toxic manifestations of oil-depot type bleomycin were almostthe same in quality and quantity as regular bleomycin. However,the average total dose of oil-depot type bleomycin used wasalmost half of that of regular bleomycin. ^* Present address: Cancer Chemotherapy Center, Cancer ResearchInstitute, Tokyo, Japan. ^** Present address: National Nagoya Hospital, Nagoya, Japan.     

Prognostic Factors and Therapeutic Results in Multiple Myeloma

Prognostic factors in 68 consecutive patients with myeloma treatedat the National Cancer Center Hospital from 1962 to 1984 wereanalyzed. Median survival time from onset was 100 months forstage I, 72 months for stage II, and 26 months for stage IIIof the Durie and Salmon's clinical staging system. It was 55months in patients with normal renal function and 18 monthsin those with abnormal renal function. All early deaths occurredin patients with stage III disease. Hemoglobin level, bone lyticlegions and presence of Bence Jones protein were also significantprognostic factors. On the other hand, heavy chain as well aslight chain subtypes of monoclonal immunoglobulin (M-component)and M-component production rate did not influence the survivalof myeloma patients. The analysis of chemotherapeutic responsesand survival curves according to the chemotherapy used in thisstudy (alkylating agent vs Vinca-alkaloid plus alkylating agent)did not disclose any significant difference between the twogroups. The overall response rate was 67%. The survival timefrom the initial chemotherapy of responding patients was significantlylonger than that of nonresponders.     

Second Primary Malignancies in Lymphoma Patients

We evaluated the occurrence and the type of second malignanciesamong 74 patients with Hodgkin's disease (HD) and 407 patientswith non-Hodgkin's lymphoma (NHL) who were treated at the NationalCancer Center Hospital for more than one year. Fifteen patients developed a second malignancy. In 10 of thesepatients the second cancer was gastric cancer, but no casesof acute nonlymphocytic leukemia were encountered. The observed number of second cancers in females among the HDpatients was significantly (p < 0.005) greater than the expectedincidence based upon the number of age-adjusted person-yearsboth for all cancers and for stomach cancer. However, no significantdifferences between males and females in the NHL patients werefound. Furthermore, no significant differences were seen inany of the groups between the observed and expected numbersof second malignancies according to the treatment.     

Five Cases of Malignant Lymphoma Associated With Early Gastric Cancer

Five cases of malignant lymphoma associated with early gastriccancer were reported. Two of them were diffuse large lymphoidtypes (DLL) of malignant lymphoma and the rest were Hodgkin'sdisease (HD). Malignant lymphomas were antecedent or coincidentalin all four cases except for one case of DLL. Histological diagnosisof the early gastric cancer was well differentiated adenocarcinomain three cases and mucocellular adenocarcinoma in two cases.All three cases of HD and one case of DLL were over 60 yearsold. The response to purified protein derivative (PPD) was negativein three out of four cases examined. Malignant tumors were foundin relatives of three patients.     

Effects of Granulocyte Transfusion and Combination Antibiotic Therapy on Documented Septicemia in Patients with Acute Leukemia

A total of 30 episodes of documented septicemia in 25 patientswith acute leukemia have been analysed to evaluate the efficacyof granulocyte transfusion therapy. Almost 90% of the septicemiawas caused by gram-negative bacteria such as Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae. The results showedthat in six out of 23 episodes (26.0%) patients treated withcombination antibiotic therapy alone responded, whereas in sixout of seven episodes (85.7%) patients given granulocyte transfusionplus combination antibiotic therapy responded. The differencewas statistically significant (p < 0.05). Granulocyte transfusionwas most effective in patients with aplastic or hypoplasticmarrows who failed to recover. The infecting organisms thatdemonstrated in vitro sensitivity to none or only one of theoriginal antibiotics were not eliminated by the antibiotic therapy,while 50% of the patients who were treated with more than twoantibiotics to which the infecting organisms were sensitivewere cured. More responses were observed in the transfusiongroup. Bone marrow status, appropriate antimicrobial agents,and early initiation of transfusion appear to be very importantin producing a beneficial clinical response.