[Locoregional chemotherapy of liver metastases of colorectal cancer]

Intraarterial regional chemotherapy for non-resectable, isolated colorectal metastases to the liver was performed in 121 patients via implantable pumps or infuse-a-ports. FUDR alone or in combination with 5-FU and Mitomycin C was administered in different modalities. Partial response rate ranged between 35 and 71%. Median survival since starting chemotherapy was so far 8-16 months. Extrahepatic relapse occurred in 45%, technical complications in 23% (pump) and 46% (infuse a port). Local toxic side effects strongly depended on drug dosage and application modus. These results corresponded with those of 647 German collective cases and 490 cases from American literature.

Failure of platelet markers to evaluate membrane biocompatibility during a combined hemodialysis-hemoperfusion treatment

Plasma levels of the platelet markers beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) are among the most sophisticated indexes of biocompatibility available to evaluate new members for hemodialysis. This investigation was designed to determine the extent of platelet activation by measuring the alpha-granule release products, beta-TG and PF4; anticoagulation and thrombogenesis by monitoring plasma heparin; and fibrinopeptide A (FPA) and thromboxane B2 (TX B2) levels during treatment with a combined hemodialysis-hemoperfusion system. Both in vivo and in vitro results showed that the platelet markers had a pattern different from that generally observed during treatment with hemodialysis alone. This is due to the avidity of charcoal for the markers studied, which therefore cannot be used to evaluate the biocompatibility of the system.

[Status of regional chemotherapy of the liver]

The review of the literature and of own results show, that the local chemotherapy of hepatic only metastasis from colorectal or breast cancer and of primary liver carcinoma may result in a prolongation of life of six to eight months. There are no statistical advantages of different treatment modalities. Metastases from colorectal primaries show complete remission in about 10%. Other tumors are not suitable or need further interest. The advantage of the shown patients has to be bought by additional surgery and occasional local toxicity. The method still can not be seen as standard treatment, but should further be examined and developed by specialized centers. There is no more doubt that the surgical resection of localized tumors is of great value.

[Regional chemotherapy of liver metastases]

Intraarterial regional chemotherapy of the liver by implantable pumps and port-systems is currently applied predominantly in patients with isolated colorectal metastases. Therapy and evaluation of results must consider the following factors: natural course of the disease; classification of tumor extent in the liver; evidence of isolated liver metastases; vascular anatomy, optimal catheter-implantation technique, complete perfusion; choice of drugs and dosage; technical complications; local toxicity, extra-hepatic recurrence, definition of therapeutic success. Our own experiences with regional chemotherapy in 145 patients with metastases to the liver and in 9 patients with hepatocellular carcinoma are reported. Using different therapeutic modalities we found a significantly enlarged response rate and at this time a true prolongation of life of about 8 months. Further prospective studies are necessary. The use of regional chemotherapy for liver metastases seems to be recommended at this time only under study conditions.

Anxiety sensitivity in agoraphobics

This study further validated the "Reiss-Epstein-Gursky Anxiety Sensitivity Index" (ASI) as a measure of the fear of anxiety. Agoraphobics scored high on the ASI before, but not after, behavioral treatment. Residual anxiety sensitivity, however, did not predict resurgence of agoraphobic avoidance at six months follow-up. Indeed, anxiety sensitivity continued to decline during the follow-up period. Multiple regression analyses indicated that the ASI predicted the number of fears in agoraphobics beyond that predicted by the level of general anxiety. This finding supports the hypothesis that high anxiety sensitivity enhances fear acquisition; it also suggests that the ASI measures a construct different from that measured by general anxiety scales. Empirical similarities and differences were found between the ASI and two other "fear of fear" measures: the Agoraphobic Cognitions Questionnaire and the Body Sensations Questionnaire.

Morphological changes after intra-arterial chemotherapy of the liver

The livers of twenty patients given intra-arterial chemotherapy to treat malignant tumors of the liver or liver metastases, were examined histologically. The results show that cytostatic chemotherapy primarily affects tumor cells, but also causes toxic damage to liver tissue. Besides necrosis of single cells or groups of cells and cholestasis in about one-third of the cases sclerosing cholangitis is a major complication. After chemoembolization, which produces a more marked therapeutic effect with regard to tumor necrosis, extensive necrosis of liver tissue, arteries, bile ducts, and nerves is most conspicuous. Nevertheless, in view of the positive therapeutic effects observed, intra-arterial chemotherapy is recommended for palliative therapy.

Biofiltration and calcium-phosphate metabolism

We evaluated the effect of one session of biofiltration on calcium-phosphate metabolism in four uremic patients and compared the results with those of a previous traditional hemodialysis (Cuprophane membrane) session, on the same subjects. The most noteworthy results were: both total and ionized plasma calcium rose less in biofiltration; phosphate clearance and parathyroid hormone clearance were higher in biofiltration; plasma 25-OH D did not change in either dialysis technique.

[Continuous intravenous or intra-arterial administration via a subcutaneous implantable infusion chamber. Preliminary clinical experiences with particular reference to intra-arterial chemotherapy]

An infusion chamber was implanted subcutaneously in 18 patients for intravenous systemic treatment and in 20 for intra-arterial treatment of the liver. Intravenous catheters were introduced via the cephalic vein, intra-arterial ones via the gastroduodenal artery, after exclusion of extrahepatic metastases. Six manageable complications were observed during a total implantation time of 102 months for i.v. treatment and usage over 500 days: three temporary occlusions; one infection; two extravasations. The intra-arterial chemotherapy, largely for hepatic metastases of breast carcinoma, was undertaken according to a modified FAM schema (fluorouracil, adriamycin, mitomycin C): It achieved a high response rate with two full and eleven partial remissions. Complications were rare, except for 4 temporary occlusions. Systemic side effects were almost completely absent, local toxicity was low. One problem was the fixation of the needle which connects to the infusion chamber. This was true for both intravenous and intra-arterial treatment.

[Clinical evaluation of the tumor marker CA 19-9 in comparison with carcinoembryonic antigen (CEA) in surgical pre- and postoperative diagnosis]

A new tumor marker (CA 19-9) was investigated. CA 19-9 is a tumor-associated antigen which is detected by a monoclonal antibody. CA 19-9 (CIS-Centocor) was compared simultaneously with CEA (carcinoembryonic antigen) in 347 patients. 123 patients with gastrointestinal tumors showed a sensitivity of 31% for CA 19-9 (CEA 49%), combination increased sensitivity to 58%. The highest sensitivity was found in pancreas carcinoma (CA 19-9 75%, CEA 66%, combination 92%); it was lower in gastric, colon, and oesophagus carcinomas. In relapsed colorectal carcinomas sensitivity was 53% (CEA 78%, combination 85%). In cases of relapse, tumor markers may become positive even if they were not detectable before resection of the primary tumor. Specificity for CA 19-9 was 100% (CEA 84%) compared to a group of non-malignant diseases including patients with inflammations and patients with nicotin abuse (n = 102). Because of its high specificity and superior sensitivity to CEA in pancreas carcinomas CA 19-9 should be determined in primary and relapse diagnosis in combination with CEA.

Klinische Überprüfung des Tumormarkers CA 19-9 im Vergleich zum karzinoembryonalen Antigen (CEA) in der chirurgischen prä- und postoperativen Diagnostik

Die Wertigkeit eines neuen Tumormarkers (CA 19-9) wurde in einem chirurgisch-onkologischen Krankengut untersucht. Es handelt sich um ein tumorassoziiertes Antigen, das mit Hilfe eines monoklonalen Antikörpers bestimmt wird. Ein Vergleich erfolgte mit einem herkömmlichen CEA-RIA. In Seren von insgesamt 347 Patienten erfolgte simultan die Bestimmung von CEA und CA 19-9. Die Sensitivität von CA 19-9 bei 123 Patienten mit gastrointestinalen Tumoren betrug 31% (CEA 49%). In der Kombination erhöhte sich die Sensitivität auf 58%. Höchste Werte für CA 19-9 fanden wir beim Pankreaskarziom mit 75% (CEA 66%, Kombination 92%). Geringere Sensitivitäten ergaben sich bei Magen-, Kolonund Ösophaguskarzinomen. Melanompatienten waren bis auf eine Ausnahme CA 19-9 seronegativ (CEA 15% positiv). In der Rezidivdiagnostik kolorektaler Tumoren ergab sich für CA 19-9 eine Sensitivität von 53% (CEA 78%, Kombination 85%); bei Rezidiven kann ein Tumormarker positiv werden, der bei Auftreten des Primärtumors negativ war. Die Spezifität betrug, gemessen an einer Gruppe nicht-maligner Erkrankungen, incl. Entzündungen und Patienten mit arterieller Verschlußkrankheit und Niko- tinabusus (n = 102), für CA 19-9 100% sowie für CEA 84%. Aufgrund der hohen Spezifität sowie der CEA übertreffenden Sensitivität beim Pankreaskarziom empfiehlt sich die simultane Bestimmung von CEA und CA 19-9 in der chirurgischen Primärund Rezidivdiagnostik.

Chemonucleolysis for herniated nucleus pulposus in adolescents

Fifty-five adolescents between the ages of thirteen and nineteen years underwent chemonucleolysis for one or more herniated lumbar discs at St. Michael's Hospital, Toronto, Ontario. The surgery was done by the senior one of us (J.M.) between 1972 and 1982. The duration of symptoms ranged from two months to three years. Pain in the lower limb was the predominant symptom in forty-eight patients. Reduction of the amount of straight leg-raising by 50 per cent or more, with or without pain in the ipsilateral hip when the asymptomatic limb was lifted (cross-over pain) and with or without pain radiating up or down the lower limb when the tibial nerve was pressed in the popliteal fossa (bowstring discomfort), was considered evidence of tension on or irritation of the nerve root and was present in all patients. Chemonucleolysis was considered as an alternative to discectomy and was performed only after the patient failed to respond to conservative management. An anaphylactic reaction occurred in one patient and was treated successfully. The most common symptom after injection was increased back pain, and it was controlled with medication. One patient had transient weakness of the extensor hallucis longus after injection. The length of follow-up ranged from two to twelve years (average, four years and six months), excluding one patient who was killed in an accident six months after injection. Chemonucleolysis did not relieve the symptoms in eleven of the fifty-five patients. These eleven patients all subsequently had surgical excision of the disc, and in them the chemonucleolysis was considered to have failed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of local moderate hyperthermia in combination with chemotherapy by N-nitroso-1,3-bis-(2-chloroethyl)urea (BCNU) on the descending colon of the rat with transplanted Yoshida sarcoma. 2. Monochemotherapy in combination with subsequent hyperthermia at various time intervals]

There are numerous reports on in vitro and in vivo investigations of hyperthermia for cytostasis of malignant tumors. Combination of chemotherapy and hyperthermia is to potentiate the therapeutic effect. The time interval between the two types of therapy was the main subject of the present investigation. Local hyperthermia (43 degrees C, 60 min) following BCNU chemotherapy at intervals of 0, 3, 6, 9, 12, and 24 h, respectively, was studied in a colonic Yoshida sarcoma model in Sprague-Dawley rats. No significant increase in the curing rate resulted from hyperthermic treatment. The results suggest that the highly anticipated hyperthermic peritoneal lavages should be investigated in controlled animal experiments prior to clinical use.

[Effect of local moderate hyperthermia in combination with N-nitroso-1,3-bis-(2-chloroethyl)urea (BCNU) and 5-fluoro-(tetrahydro-2-furyl)uracil (ftorafur) on induced autochthonous colonic cancers in the rat. 3: Polychemotherapy in combination with hyperthermia]

The use of hyperthermia for the treatment of tumors has been tested in vitro and in vivo experiments as well as clinically for a long time. Combination of hyperthermia with chemotherapy was reported to result in overadditive cytostatic effects. In a clinically adapted, controlled animal experiment, local moderate hyperthermia (43.5 degrees C, 3 X 60 min) alone and in combination with polychemotherapy (BCNU) and Ftorafur) was used for the treatment of AMMN-(N-nitrosoacetoxymethyl-methylamine) induced autochthonous colonic carcinomas in Sprague-Dawley rats. Diagnosis and follow-up inspections were carried out endoscopically. The applied therapies did not result in prolonged survival times, nor was an additive effect seen after combined hyperthermia and chemotherapy in this "hard", i.e. relatively chemotherapy-resistent, tumor model.

[Effect of moderate local hyperthermia in combination with chemotherapy with cyclophosphamide or N-nitroso- 1,3-bis(2-chloroethyl)urea(BCNU) on Yoshida sarcoma implanted in the descending colon of rats. 1. Repeated hyperthermia within 8 days and combination of chemotherapy followed by hyperthermia 24 h later]

The application of hyperthermia in cytostatic therapy has been discussed for a long time. Recently the question arose whether the chances of therapy might be improved by combining chemotherapy with hyperthermia. We used an inoculated gastrointestinal tumor to verify this hypothesis experimentally. 2 X 10(6) Yoshida sarcoma ascites cells were implanted in the descending colon of 101 Sprague-Dawley rats. A preternatural anus with two lumina was established concomitantly. Chemotherapy started on day 6 after surgery. 24 h later local hyperthermia was applied by means of a silicone tube inserted in the immobilized descending colon. The temperature in the tumor was raised to 43 +/- 0.5 degrees C. No acute toxic effects of hyperthermia were noted. The body temperature was kept from rising above normal by cooling. The differences in survival time between the chemotherapeutically treated groups and the control group were statistically validated. Additional hyperthermia did not result in additive effects. No advantage of hyperthermia alone was noted over the control. The results support scepticism about the therapeutic efficacy of hyperthermia and underline the necessity of further investigations in clinically adapted animal experiments.