1-phenylalanine mustard (L-PAM) in the management of premenopausal patients with primary breast cancer: lack of association of disease-free survival with depression of ovarian function. National Surgical Adjuvant Project for Breast and Bowel Cancers

Breast cancer patients participating in a prospective randomized clinical trial who were less than or equal to 49 years of age, had positive axillary nodes, and who received prolonged 1-phenylalanine mustard (L-PAM) as an adjuvant to mastectomy continue (after 4 years) to demonstrate a significantly greater disease-free survival (p = .007) than do patients who received placebo. Benefit was achieved in patients who were less than or equal to 39 years as well as those who were 40-49 years of age. Those in the younger age group showed a greater improvement in disease-free survival at 4 years relative to their controls (32% vs. 69%; p = .01) than did those in the older age group (48% vs. 61%; p = .09). When patients were examined relative to their nodal status, a highly favorable effect was found to have been achieved with L-PAM in those with 1-3 positive nodes (54% vs. 86%; p = .006). Results indicate that both age groups were benefited. When considered over time, they demonstrate that a relatively greater effect was achieved in the younger women. While L-PAM failed to significantly alter the disease-free survival of those with greater than or equal to 4 positive nodes a slightly better effect was achieved in the group less than or equal to 39 years. Since adjuvant chemotherapy has been found to be more effective in premenopausal than postmenopausal women, it has been presumed that decreased ovarian function, as a result of the chemotherapy, is responsible for the findings. To support or repudiate that concept, information regarding serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), as well as menstrual function, has been obtained from women receiving L-PAM or L-PAM plus 5-FU therapy. In contrast to findings relative to disease-free survival, ovarian function and menses were most affected in patients 40-49 years of age. Amenorrhea occurred in 73% of patients in that age group and in only 22% of those less than or equal to 39 years (p less than .001). Similarly, a significant increase in LH and FSH and a decrease in E2, all indicative of ovarian suppression, was observed only in the older group of patients. Thus, it is concluded that while ovarian suppression may account for some of the adjuvant chemotherapeutic effect in premenopausal women, the dichotomy of findings in younger and older premenopausal women relative to therapeutic response and ovarian function indicates that other factors could be responsible.

Effect of Corynebacterium parvum in prevention and reversal of atrophy of the liver following portacaval shunt

Since it has been demonstrated that the administration of Corynebacterium parvum is associated with increased hepatocyte proliferation in both normal and regenerating livers, it seemed appropriate to determine whether the use of this agent would affect the hepatic atrophy which occurs following end-to-side portacaval shunts. When administered at shunting, liver weight and liver deoxyribonucleic acid failed to decrease to the same extent as that occurring in untreated, shunted rats. An increase in liver deoxyribonucleic acid synthesis was observed following portacaval shunt only in treated rats. Corynebacterium parvum administration to portacaval shunt rats with livers demonstrating marked atrophy 15 to 18 days following shunting resulted in the reversal of such atrophy. There was an increase in liver weight and deoxyribonuclei acid to the extent that those values were equal to, or greater than, those of livers from nonshunted rats. By increasing the number of cells within liver, Corynebacterium parvum administration prevents or reverses the decrease in liver size, that is, atrophy, which occurs after portacaval shunts were performed.

Benign prostatic hyperplasia in an XX man

A sixty-nine-year-old white phenotypic male who was being investigated for a myeloproliferative disorder, was found to have an XX karyotype in all cells examined in bone marrow, lymphocytes, and skin fibroblast cultures. Despite essentially no testosterone in the plasma, he also suffered from severe prostatic hyperplasia, a finding not reported previously in patients with this genotype. While endocrine studies showed normal follicle-stimulating hormone, the luteinizing hormone level was twice the upper limit of normal and estrogens were in the normal female range. Except for complete absence of Leydig cells, testicular histology resembled that usually found in Klinefelter syndrome. The patient died of the combined effects of the myeloproliferative disease and urinary tract obstruction. The mechanism of occurrence of the sex chromosome anomaly as well as the cause and implication of the unusual finding of prostatic hyperplasia are discussed.

Further observations on the inhibition of tumor growth by C. parvum with cyclophosphamide. VII. Effect of treatment prior to primary tumor removal on the growth of distant tumor

The present investigations were directed toward determining whether primary tumor manipulation prior to its removal is advantageous for the control of metastases and survival. Studies were carried out to ascertain whether 1) there is justification for delaying surgical removal of a primary tumor to permit preoperative administration of cyclophosphamide (CY) and/or C. parvum (CP) and 2) there is an advantage to administering the immunotherapy directly into a primary tumor. After operation, in all investigations, systemic CP and CY was used. Despite the putative similarity of animals, tumors and treatment regimens there was marked variation in response of tumors to therapy. No benefit was derived from administering preoperative immunotherapy alone. When operation was delayed to employ systemic immuno-chemotherapy, a slight improvement in the control of distant tumor was noted. The employment of preoperative intratumor immunotherapy led to a greater prolongation of survival and more inhibition of distant tumor growth than did immediate primary tumor removal or the use of preoperative systemic immunotherapy. The results suggest that there may be an advantage to delaying removal of a primary tumor so that it may be employed in therapeutic strategies directed toward control of metastatic disease.

Group therapy training in psychiatric residency programs: a national survey

The authors used a questionnaire sent to the directors of the 256 approved American psychiatric residency programs to examine the availability, content, and orientations of group therapy training. They found that 78% of the responding programs offered group therapy training, a substantial increase from earlier estimates; that an approach incorporating didactic courses, observation and leadership of groups, supervision, and participation in an experiential group was gaining increased acceptance; that most of the programs provided a variety of arrangements for supervision of group training; that the theoretical orientations mirrored the field of group therapy itself; and, finally, that associated disciplines were gaining increasing acceptance.

Variation of macrophage migration by a factor from regional lymph node cells of breast cancer patients

Using a standard heterologous assay in which lymphokines alter guinea pig peritoneal macrophage migration, it was found that regional lymph node cells (RLNCs) from patients with primary breast cancer elaborate soluble factors which variably affect such migration. Variation of migration resulted when soluble factors employed were obtained from different nodes in the same patient as well as from nodes from different patients. Some nodes from a patient elaborated migration inhibition factors (MIF) and other migration enhancing factors (MEF). The findings are in keeping with others obtained by us relative to the variation in lymphocyte transformation and thymidine uptake by RLNCs and further emphasize that all RLNs in patients with breast cancer are not biologically similar. They lend support to our previous hypothesis that the reason why some RLNs contain metastases and others do not is more likely due to biological differences than because of anatomical happenstance, i.e., transport of tumor cells to some nodes and not to others.

Comparative effects of Corynebacterium parvum, Brucella abortus extract, Bacillus Calmette-Guérin, glucan, levamisole, and tilorone with or without cyclophosphamide on tumor growth, macrophage production, and macrophage cytotoxicity in a murine mammary tumor model

In this laboratory, it has been repeatedly demonstrated (using a murine mammary tumor model) that the combination of cyclophosphamide (CY) and Corynebacterium parvum (CP) is more effective than either agent alone in the control of tumor growth. This paper presents information obtained in our model comparing findings on the effects of CP with a Brucella abortus extract (Bru-Pel; BP) and glucan (GL) on tumor growth. In addition, the influence of those agents as well as bacillus Calmette-Guérin, tilorone, and levamisole on bone marrow macrophage colony production and cytotoxicity is presented. None of the nonspecific stimulating agents (NSSAs) inhibited tumor growth when administered systemically without CY, confirming our previous contention that such immunotherapy alone is likely to be an ineffectual form of treatment. Whereas tumor regression was observed following intratumor CP, neither GL nor BP had such an effect. When used with CY, neither BP nor GL administered ip or intratumorally inhibited tumor growth as effectively as did CP and CY. Inhibition of the growth of a distant tumor as well as the treated tumor occurred following intratumor CP and CY but not following intratumor BP and CY. All of the microbial NSSAs increased macrophage colony production to varying degrees in both normal and tumor-bearing mice. In the latter mice, CP had the most prolonged effect. Levamisole and tilorone failed to increase colony production in normal mice while in tumor-bearing mice the effect was inversely proportional to the amount of agent administered. To some extent, the stimulation of colony production by the NSSAs paralled the degree of tumor inhibition observed when those agents were combined with CY. The cytotoxicity of cultured macrophages could not be related to tumor growth inhibition.

Detection and significance of occult axillary node metastases in patients with invasive breast cancer

Blocks of axillary lymph nodes from 78 patients with invasive breast cancer, which after "routine" pathological examination were regarded as negative for metastases, were step-sectioned at 20 u intervals. Occult metastases were detected in 24% of the cases. A significant association between such metastases and a lack of or slight degree of an intraductal carcinomatous component of the dominant cancer was noted. There was no relationship between occult metastases and 15 other histopathological and 3 clinical features investigated, including an average 5 year survival rate. Similarly there was no correlation between any of the possible discriminants investigated in the 24% of patients who have died of their diseases or are living with recurrence regardless of the presence of occult metastases. Factors accounting for the lack of universal survival in patients with Stage I (and those with occult metastases that might be designated as stage 11/2) remain enigmatic. It is concluded that attempts to detect occult metastases by extending histopathological methods may be more academic than practical or therapeutically significant.

Outbreak of Mycoplasma pneumoniae infection among hospital personnel

An outbreak of illness due to Mycoplasma pneumoniae occurred among employees of a large hospital. The spectrum of disease ranged from severe upper respiratory infection to multilobed pneumonia. No unusual increase in the incidence of respiratory illness due to this organism was observed in the surrounding community during the period under investigation. It was not possible to identify any single area of the hospital frequented by enough of the involved personnel to explain the spread of the infection among the hospital's employees. This is the first outbreak of M pneumoniae disease to be reported among hospital personnel.

Correlation of antitumor chemoimmunotherapy with serum inhibition of tumor cell destruction

The administration of cyclophosphamide and Corynebacterium parvum in combination results in tumor growth inhibition greater than that resulting from the use of either agent alone. The precise mechanism(s) by which this chemoimmunotherapy combination results in a synergistic inhibiting effect is not known. The possibility was entertained that the tumor effect might be related to a greater decrease in serum-mediated interference with cellular cytotoxicity, i.e., "blocking" activity, by both agents in combination rather than by either alone. The present findings fail to support such an explanation. C. parvum by itself failed to decrease serum inhibition and in conjunction with cyclophosphamide resulted in an effect that was no greater than that produced by cyclophosphamide alone.