Nuclear protein changes following N,N-dimethylformamide (DMF)-induced maturation

A human colonic carcinoma cell line was exposed to a nontoxic concentration of N,N-dimethylformamide (DMF) for 2 wk. Nuclear proteins were isolated from control and treated cells and compared by sodium dodecyl sulfate (SDS) electrophoresis. Qualitative and quantitative differences were observed. Metabolic labeling with tritiated leucine demonstrated qualitative variation between control and treated cells.

Internal radiotherapy for hepatic metastases II: The blood supply to hepatic metastases

Given that metastatic hepatic malignancy remains as a significant cause of death, with a median survival after diagnosis of only 7 months despite treatment, there exists a need for some effective treatment modality. Internal radiotherapy in the form of yttrium-90 microspheres infused into the hepatic artery appears to be a promising method of therapy. One criterion required for the success of this treatment is that of a differentially greater arterial supply to tumor as opposed to liver tissue. This arterial hypervascularity of tumor has been demonstrated before. However, some conflict has been reported as to the maintenance of this state as tumor size increases. Using 15 micrometers Cobalt-57 microspheres for studying salivary adenocarcinoma implants in DA rat livers, these experiments have demonstrated a constant blood flow in the tumor periphery of 3.9 times that within the normal hepatic parenchyma, regardless of tumor size. Also demonstrated is a progressive decrease in central tumor arterial blood flow after a tumor diameter of 6 mm has been exceeded. Arterial hypervascularity of liver tissue adjacent to the tumor has been demonstrated while an intermediate zone of liver tissue appeared hypovascular, suggesting the presence of shunting. In three humans with metastatic liver disease, hepatic artery infusion of particulate radiotracer has demonstrated the peripheral tumor hypervascularity and relative central tumor hypovascularity with good correlation obtained with the images of the metastases on conventional colloidal hepatic scintigraphy. This method allows assessment of the patient's suitability for internal radiotherapy by enabling assessment of the tumor vascularity and the degree of potentially dangerous extrahepatic irradiation.

Extensive resections of isolated metastasis from carcinoma of the colon and rectum

The results of this study show that hepatic resection for metastatic carcinoma of the colon and rectum is an effective treatment modality. The duration and quality of survival are better than those achieved by an other treatment modalities. The results of this study also show that hepatic resection is a safe procedure; however, a 50 per cent, two of four, mortality rate in patients undergoing a trisegmentectomy for metastatic disease points toward a need for better selection of patients. Adjuvant chemotherapy following hepatic resection has not been shown to be of any benefit in this series.

An assessment of ultrasound scanning in the recognition of colorectal liver metastases

The preoperative detection of visible liver metastases in patients with colorectal cancer is important in determining a rational treatment policy. The accuracy of haptic ultrasound scanning was assessed in 100 patients with primary colorectal cancer. Each patient had a 99mTc-sulphur colloid scan, ultrasound scan, and liver function test. All patients came to laparotomy and the liver was carefully palpated. With very few exceptions the combination of isotope and ultrasound scanning gave accurate information on the state of the liver in all patients in this series. Alkaline phosphatase was the only enzyme whose serum activity was consistently elevated in the presence of liver metastases. Ultrasound scanning of the liver is a simple, safe, accurate, and non-invasive method for preoperative assessment of the state of the liver in patients with primary colorectal cancer.

A transmembrane precursor of secretory component. The receptor for transcellular transport of polymeric immunoglobulins

Secretory component (SC), a glycoprotein associated with polymeric IgA and IgM in external secretions, is produced by certain epithelial cells and is thought to be the receptor mediating the transepithelial transport of these immunoglobulins. We studied the biosynthesis of human SC in a cloned cell line (HT29.E10) derived from a colon adenocarcinoma. In both cell-free translations and pulse labeling of cells, SC is made as a larger precursor (Mr = 95,000). This precursor is a transmembrane protein, as a large fragment (Mr = 80,000), is protected by the membrane from proteolytic digestion. Both this membrane-protected fragment and the undigested precursor have the same NH2-terminal sequence as mature SC. These data indicate that SC is proteolytically cleaved from the NH2-terminal, ectoplasmic (noncytoplasmic) domain of the precursor. This conclusion is supported by pulse-chase experiments. The Mr = 95,000 form is first converted to a Mr = 100,000 form by addition of peripheral sugars. The Mr = 100,000 form is then slowly cleaved to a Mr = 80,000 form which is gradually released into the medium. We propose that the transmembrane precursor of SC is the receptor involved in transepithelial transport of polymeric immunoglobulins.

Therapy of liver tumors metastatic from colorectal cancer with whole-liver radiation combined with 5-FU, adriamycin, and methotrexate

Twenty-seven patients with liver metastasis from colorectal cancer were treated with intrahepatic arterial chemotherapy and external radiotherapy consisting of 5-fluorouracil (5-FU) (10 mg/kg/day for 8 days), adriamycin (5 mg/m2/day for 7 days) and methotrexate (MTX) (240 mg/m2/X1), combined with 2,100 rads of whole liver irradiation. Twenty of these patients (74%) had previously received systemic chemotherapy. Of the 21 patients who could be fully evaluated, seven (33%) had an objective partial response and another 10 (48%) had stable disease following treatment. The median duration of survival for all patients after initiation of treatment was 6.5 months. Those patients responding to therapy survived longer (12.7 months) than those who had stable disease (5.5 months) or disease progression (2.5 months). The response rate was not affected by previous chemotherapy. Additionally, of the 14 patients with symptoms related to the disease, nine (64%) experienced substantial relief of these symptoms. Toxicity with the therapy used in this study was generally moderate. The median nadiR WBC was 3,500 cells/mm3; the median nadir platelet count, 121,000 cells/mm3. There was, however, one treatment-associated fatality from sepsis in a patient whose WBC was 900 cells/mm3.

Serial CEA assays and liver scintigraphy for the detection of hepatic metastases from colorectal carcinoma

Of 340 patients with histologically proven colorectal carcinoma, hepatic metastases were diagnosed in 90 (26 per cent), in 50 at the time of initial surgery (synchronously) and in 40 during the post-operative follow-up (metachronously). At the time of initial surgery, plasma carcinoembryonic antigen (CEA) levels were markedly elevated in patients with synchronous metastases and normal or only moderately elevated in those with metachronous metastases. During follow-up, CEA levels in the entire group of patients with metastases remained normal in 8 per cent and rose in the remainder: very quickly in 85 per cent and slowly in 15 per cent. Hepatic metastases were diagnosed by strict scintigraphic criteria in 70 per cent of patients and were suggested by liberal criteria in the remainder. During follow-up, hepatic metastases progressed in the scintigraphic image from those defined by liberal to those diagnosed by strict criteria. In two-thirds of the patients, liver scintigraphy proved to be superior to the CEA test in diagnosing hepatic metastases by strict criteria; in the majority of the remainder of patients, the CEA test, particularly in cases with a pattern of fast increase of CEA in plasma, suggested metastases before a definite diagnosis could be made by liver scintigraphy. In only 3 per cent of the patients neither liver scintigraphy nor the CEA test were indicative of metastases. Thus, the two diagnostic modalities, when combined, could attain a sensitivity of 97 per cent, when patients with persistently rising CEA levels and concomitant liver lesions defined by the liberal criteria were grouped with those for whom scintigraphy was unequivocal.

[Comparative study of ultrasonography and scintigraphy in liver metastases detection in cases of colorectal carcinoma (author's transl)]

A comparative study has been realized to test the accuracy of ultrasonography and scintigraphy for detecting the presence of liver metastases in 305 patients with colorectal carcinomas. Presence or absence of hepatic metastases has been affirmed by laparotomy and biopsy. In the 47 cases with metastases, the sensitivity of ultrasonography was 93%, that of scintigraphy being 76%. In 258 cases without metastases the specificity of ultrasonography was 97%, that of scintigraphy being 92%. These results, confirmed by report in the published literature, show that ultrasonography should be the first examination for suspected hepatic metastases.

Results of pulmonary resection for metastatic lesions

We reviewed the role pulmonary resection for metastatic pulmonary lesions in our institution. Over a 22 year period, 142 patients underwent 153 thoracotomies. The operative mortality was 0.7%. Complete follow-up was obtained on 140 hospital survivors (99.3%). The actuarial 5 year survival rate for carcinoma was 24% (70% confidence limit 0% to 52%) and for sarcoma was 29% (70% confidence limit 0% to 61%). The survival rate to the end of the follow-up for patients with short disease-free intervals (less than 3 months) was 30%; with free intervals of 3 to 30 months, the survival rate was 27%; with long intervals (greater than 30 months), it was 24% (p = 0.8). Six of 29 lobectomy or pneumonectomy specimens has secondary metastases in the regional nodes, but actuarial 5 year survival rates following lobectomy, pneumonectomy, or segmental or wedge excision were not statistically different. Long-term follow-up revealed an overall survival rate of 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, we continue to advocate conservative excision of pulmonary metastases when the primary tumor is controlled and other organ systems are not involved, regardless of the tumor histology or the disease-free interval.