Organization of clinical trial on national scale: management of early cancer of the breast

From a study of the organization of a national clinical trial on the management of early cancer of the breast in women there appear to be overwhelming advantages in studying large numbers of patients. To this end centres abroad have been encouraged to join. All the evidence at present suggests that it is feasible to organize a study on this scale, that the documentation and follow-up are accurate, and that the enthusiasm of the participants can be successfully fostered and maintained.

Regression of axillary lymph-nodes in cancer of the breast

A multicentre, prospective trial on the treatment of Stage-I and Stage-II breast cancer by simple mastectomy plus radiotherapy versus simple mastectomy alone is described. So far 1050 patients have been collected within 2 years. Data on the first 161 patients treated by simple mastectomy alone are analysed. Axillary lymph-nodes have regressed within 3 months of mastectomy in 75 per cent of patients in clinical Stage II. Regression may be due to resolution of reactive changes in lymph-nodes following removal of the primary tumour.

Acute and modified rejection of heterotopic canine cardiac allotransplants studied by serial needle biopsy

Serial histological changes in heterotopic canine cardiac allografts are reported using a percutaneous needle biopsy technique. This procedure can be performed without general anaesthesia or major complications and gives a high success rate (over 98%) with representative sampling of the organ.

A pattern of acute rejection is described and compares well with the findings in other orthotopic and heterotopic studies. Histological differences between a group of untreated dogs and a group receiving azathioprine and hydrocortisone, in amounts that would permit subacute rejection in treated human transplants, suggest that immunotherapy causes greater reduction in local cellular immunological activity than in graft necrosis. It is concluded that although major graft damage in acute and subacute rejection appears to be cell mediated other factors may also be concerned in the pathogenesis of graft necrosis.

Mithramycin treatment of hypercalcaemia and renal failure in a patient with paratesticular embryonic sarcoma

A 17-year-old patient with a small paratesticular embryonic sarcoma presented with symptoms of renal failure, polyuria and widespread bone metastases. Investigation revealed hypercalcaemia and uraemia without any evidence of hyperparathyroidism. The hypercalcaemia responded over a period of weeks to administration of mithramycin with initial improvement in the symptoms and metabolic derangements. Control was lost with the necrosis of intra-abdominal tumour deposits and haemorrhagic polypoid deposits in the alimentary tract. The value and hazards of mithramycin are well demonstrated by these rare complications of this type of tumour.

Oestrogen as a reticuloendothelial stimulant in patients with cancer

Stimulation of reticuloendothelial activity may benefit patients with cancer. Oestrogenic compounds are known to stimulate reticuloendothelial phagocytic activity in animals and a similar effect is demonstrated in patients.The depression of reticuloendothelial phagocytic activity which follows radiotheraphy in the treatment of cancer can be prevented by the simultaneous administration of stilboestrol. Possibly this could be associated with a more favourable response to therapy, and a controlled trial is needed to establish this.

Orthotopic transplantation of the pig heart

Orthotopic transplantation of the pig heart is described, with success in the last 12 of 23 studies, leading to survival until rejection in the last two. The pig heart was found to be easily damaged by cold. In contrast, organ viability was not appreciably affected when the warm ischaemic time was shortened by making the aortic anastomosis the initial manœuvre of implantation. The advantages of the pig as a model for the study of orthotopic cardiac allografts would appear to be its tolerance of long periods of cardiopulmonary bypass, immediate clotting after heparin reversal and ability to maintain the circulation without drug or pacemaker support. These factors have contributed to the relative simplicity of post-operative management.

Effect of alcohol on the acquisition and resistance-to-extinction of avoidance responses in rats

Two experiments were conducted to explore the effects of alcohol on avoidance behavior in rats. In Exp. I, the effect of alcohol on the acquisition of an avoidance response was examined in a 2 × 4 factorial design. Groups of rats were trained to avoid in one of two simple avoidance tasks following the administration of one of four doses of alcohol. Alcohol significantly affected the latency of the first escape trial but did not significantly influence any of the measures of avoidance learning. In Exp. II, a 2 × 3 factorial design was employed to study the effect of alcohol on the resistance-to-extinction of a previously learned avoidance response. Rats were trained to avoid in one of the two tasks and then were given one of three doses of alcohol prior to extinction. Alcohol significantly influenced resistance-to-extinction, with the appropriate dose increasing the persistence of the response. The results of these experiments were taken to indicate that (a) alcohol does not really reduce fear in rats or (b) alcohol reduces fear, but the level of fear does not determine the acquisition or extinction of simple avoidance responses.

Further study into obstructive jaundice and ischaemic renal damage

Renal ischaemia for one hour in two groups of Gunn rats, one with and the other without bile-duct ligation, produced comparable reversible renal tubular lesions in both groups. Since Gunn rats have an unconjugated hyperbilirubinaemia, which is unaffected by bile-duct ligation, it seems likely that the high levels of bilirubin glucuronide are responsible for sensitizing the renal tubules to ischaemia, possibly by depressing cell respiration.