Elemental profiles in cryosections and frozen-dried bulk specimens of the normal lens

Energy-dispersive X-ray analysis was used to obtain distribution profiles of Na, K, Cl, P and S in rapidly frozen-dried bulk specimens, and in cryosections of the normal rat lens. Na and Cl are highly concentrated in the capsule, and K and P, in the epithelial cells. Profiles of the entire radius of a lens show relatively high concentrations of K and P in the outermost cells of the lens, with decreasing concentrations through the cortex, and a minimum throughout the nuclear region. S, on the other hand, shows increasing concentrations at deeper locations, with maximum values throughout the nuclear region.

Cooperative clinical trials of the National Prostatic Cancer Project: Protocol 900

In May 1978, the National Prostatic Cancer Project Treatment Subgroup activated its first clinical trial evaluating adjuvant chemotherapy (Protocol 900). This protocol is a comparison of long-term adjuvant chemotherapy with cyclophosphamide, estramustine phosphate, or no additional treatment in patients with definitive surgical therapy for adenocarcinoma of the prostate. To date, 128 patients have been entered with an entry rate of approximately 2.2 patients per month. One hundred five patients form the basis of this report, with 96 patients still on active therapy. Estramustine phosphate has been administered at a dose of 600 mg/m2 orally daily in three divided doses. The cyclophosphamide is administered 1 g/m2 intravenously every 3 weeks. Results are still preliminary; only two evaluable patients have died. Approximately two-thirds of patients entered have had negative lymph nodes. Recurrent disease has been documented in 15 patients, including eight receiving cyclophosphamide, three receiving estramustine phosphate, and four on the no-treatment arm. The recurrence rate has been disproportionately high (50%) in patients receiving cryosurgery rather than radical prostatectomy (12%). Maximum survival has reached 241 weeks. Side effects have consisted of leukopenia in patients receiving cyclophosphamide (56%), and nausea and vomiting with cyclophosphamide (85%), and estramustine phosphate (36%). This study continues with patient entries now over one-half of the number anticipated in the original study design.

Immunotherapy of prostate cancer: a review

Tumors are antigenic and patients can mount an immune response against their tumors. Prostate cancer patients are sensitized to their malignancies and immunotherapeutic efforts have been successful. As with other tumors, it is unlikely that immunotherapy alone will be curative, but will play a role in combination therapy along with surgery, radiation, and chemotherapy. But before its rightful place can be delineated, additional clinical and laboratory studies must be completed.

Cryosurgery for life-threatening bleeding hemorrhoids in the elderly

Forty-three elderly patients with massive bleeding of hemorrhoidal varices were treated by cryosurgery at a single outpatient session, using nitrous oxide gas, without premedication or anesthesia. The results were excellent in all but one patient, who had ulcerative colitis and required another session of cryotherapy following a recurrence of bleeding. There was no morbidity and no mortality. The patients have remained free of symptoms over follow-up periods ranging from two to five years. The authors believe that cryosurgery is the treatment of choice and indeed may sometimes be life-saving for elderly, poor-risk patients who are unfit for general anesthesia and surgical hemorrhoidectomy.

Surgical repair of Wolff-Parkinson-White syndrome: a new closed-heart technique

The conventional operation for ablation of accessory pathways in Wolff-Parkinson-White (WPW) syndrome requires an endocardial approach and necessitates cardiopulmonary bypass and hypothermic cardiac arrest. Cryosurgical ablation of these pathways from the epicardial surface has been described but limited to superficial accessory pathways. We report a new closed-heart technique combining dissection of the atrioventricular (AV) pad and cryosurgery. Six patients with WPW syndrome underwent operation for ablation of accessory pathways associated with disabling tachyarrhythmia refractory to medical management. All pathways were located in the left lateral AV sulcus as determined by preoperative and intraoperative electrophysiological assessment. The heart was exposed through a median sternotomy. The AV fat pad and its vascular contents were dissected away from the atrium at the site of the pathway. A small segment of the ventricle adjacent to the sulcus was exposed. The fat pad was retracted to avoid cryoinjury to the coronary vessels. A cryoprobe, 1.5 cm in diameter, was applied to the exposed AV junction (-60 degrees C for 2 minutes) to create transmural fibrosis. After ablation of the pathway was verified, the chest was closed. All 6 patients have remained free from preexcitation during short-term follow-up. This simplified technique is applicable to patients with free wall accessory pathways. This group constitutes the majority of symptomatic patients with WPW syndrome at our institution.

Cryosurgical treatment of dysplastic lentigo of the glans penis

A lesion showing hyperplasia of atypical basal-layer melanocytes on the glans penis was repeatedly frozen with 4-mm margins repeatedly blistering the lesions. Fourteen months after therapy the patient remains free of apparent disease.

Cryotherapy

Since 1969 cryosurgical perineal destruction of the prostate has been developed at the University of Iowa for treatment of patients with prostatic cancer. The technique of this procedure has been the subject of previous reviews. This is a summary of our experience of patient survival and the effect on local prostatic cancer growth in those patients with various stages of the disease subjected to perineal cryosurgical destruction of their cancer. We also report briefly on our experience in the laboratory where the Dunning tumor model is used to study the effect of cryosurgery as well as combinations of immunological modifications.

Treatment of idiopathic exudative retinal detachment

Three patients with idiopathic exudative retinal detachment are presented. Fluorescein angiography and/or angioscopy was used in each case to demonstrate an area of leakage from the choroid into the subretinal space, accounting for the detachment. The leakage sites were treated by cryopexy or photocoagulation, resulting in reattachment of the retina in each case (four eyes). This method of examination and treatment should be considered in all cases of idiopathic exudative retinal detachment.

Cryosurgery of cutaneous carcinomas. An 18-year study of 3,022 patients with 4,228 carcinomas

In the past 18 years, 3,022 patients with a combined total of 4,228 cutaneous carcinomas were subjected to cryosurgery. Proper selection of patients, histologic type of the tumor, and its anatomic site are important considerations to determine the use of cryosurgery as a therapeutic modality. Indications and contraindications are precisely outlined and the importance of monitoring neoplasms during freezing is emphasized. A long period of follow-up in this series is supportive evidence that cryosurgery is a distinct therapeutic tool for the management of skin cancers and attests to its effectiveness, when properly administered by the skilled cryosurgeon.

Na,K-ATPase in simulated eye bank and cryoextracted rabbit lenses, and human eye bank lenses and cataracts

In the rabbit, cryoextraction of the lens and subsequent storage in Tyrode's solution did not alter the Na,K-ATPase activity from that determined in immediately excised rabbit lenses. Similarly, the procedures employed with the rabbit eye to simulate collection and storage of normal human eyes (eye banking) had no effect upon the Na,K-ATPase activity of the lens. These results permitted the investigation of human lenses with the knowledge that measured Na,K-ATPase activity had not been altered grossly by any manipulation procedures. Analysis of Na,K-ATPase activity in 44 eye bank lenses, 14 primary nuclear cataracts, 11 primary cortical cataracts, 18 primary posterior subcapsular cataracts, and 31 mixed cataracts revealed no significant difference in the enzyme activity between these groups. Similarly, there was no correlation between electrolyte levels and Na,K-ATPase in a further 18 mixed cataracts. It is concluded that, despite an often pronounced electrolyte imbalance, human cataract can develop without significant alteration in Na,K-ATPase activity.

Treatment of prurigo nodularis: use of cryosurgery and intralesional steroids plus lidocaine

Two patients with prurigo nodularis resistant to most modalities of therapy were treated successfully with the combined use of cryosurgery and intralesional steroids plus lidocaine. This appears to be a successful treatment regimen for a dermatosis that is often difficult to control.

Basal cell carcinoma--a review of treatment results with special reference to cryotherapy

A retrospective study has been undertaken of all head and neck basal cell cancers treated at the Royal Free Hospital between 1976 and 1980 inclusive. Four methods of treatment were used during the period: simple excision with primary closure (n = 43), skin grafting or trans-position flap (n = 19), radiotherapy (n = 99), and cryosurgical ablation (n = 34). The methods were compared by observing the immediate results, the subsequent tumour recurrence rate and the length of follow-up. Statistical comparison of tumour recurrence rate showed no significant difference between treatment groups. Radiotherapy had the lowest recurrence rate (2%), but required an average of 9 out-patient treatment attendances. Excision with primary closure carried the highest recurrence rate (9.3%), whilst excision with defect closure by flap or graft, which needed a mean in-patient stay of 8.2 days, and cryosurgical treatment had similar recurrence rates of 5 to 6%. Comparing the modes of treatment, cryosurgery was quickest to perform, required no hospitalization and less than 2 out-patient treatment sessions per patient and gave the best cosmetic result. It appears to be a safe technique for treating basal cell cancers and may prove to be the most cost effective method.

Comparison of treatment modalities for epidermal nevus: a case report and review

For the past 2 years, we have been treating a teenage girl for a disfiguring, extensive, inflammatory linear verrucous epidermal nevus (ILVEN). In this one patient, we examined the efficacy of numerous treatment modalities and compared our results with those reported in the literature. In our experience, cryotherapy using liquid nitrogen proved to be the most successful therapy, and we have subsequently used it to treat almost all of this patient's lesions. Although cryotherapy does not provide an easy or dramatic cure, we believe it does produce reasonably good cosmetic results.

[Antitumor immunity in the relatively early period after cryosurgery. Experimental study using rat's metastasizing mammary tumor]

Six-week-old female Sprague-Dawley rats were inoculated with a mammary tumor, MRMT-1. At 2 weeks after inoculation, one of the following 4 treatments was done: surgical tumor excision (SE), cryosurgery (CR), surgical excision plus re-inoculation of freezing-thawing-produced vaccine (FT), and surgical excision plus fasting for 72 hours (FA). In FT and FA groups, incidence of metastatic death were higher than in SE group, while that in CR group was similar as in SE group. Specific footpad reactivity at 2 and 3 weeks after treatment was lower in CR than in SE group. Winn's neutralization assay revealed that antitumor activity of spleen cells at 1 and 3 week(s) after treatment was lower in CR than in SE groups. In vivo observation on effect of inactivated serum at 1 week after treatment showed tumor enhancement in SE group and tumor inhibition in CR group. In conclusion, the observed mild reduction in antitumor immunity in the relatively early period after cryosurgery might not be due to blocking action of superfluous tumor antigens, but probably due to activation of suppressor cells consequent on cryosurgical stress or on slow absorption of tumor antigens.