The role of radiotherapy after chemotherapy in the management of persistent para-aortic nodal disease in non-seminomatous germ cell tumours

In the years 1979-1982, 83 patients with malignant teratoma of the testis who had retroperitoneal adenopathy at presentation or after a period of surveillance were treated. Complete radiological resolution of disease was obtained in 34 patients and a residual mass remained in 26, the remainder having progression of the para-aortic or other metastatic disease. There was no para-aortic relapse in 47 patients receiving radiotherapy post-chemotherapy whereas 2/11 who did not receive radiotherapy or an immediate retroperitoneal node dissection relapsed. Morbidity from radiotherapy was minimal apart from subcutaneous fibrosis in the irradiated area of 6 patients. It is concluded that radiotherapy is effective in sterilising minimal residual tumour post-chemotherapy and may be considered as an alternative to surgery.

A randomised comparison of photons and 15 MeV neutrons for the treatment of carcinoma of the bladder

108 patients with T2 or T3 carcinoma of the bladder were randomised to receive either photon therapy or low- or high-dose 15 MeV neutrons. Fifty-nine patients received photon treatment, 20 low-dose neutrons (LDN) and 20 high-dose neutrons (HDN). Eight patients received a combination of photon and neutron therapy, due to machine breakdown, and one patient received only one exposure, due to intercurrent illness. The three-year survival for all groups was 43% but there was no difference in survival between the treatment groups. The complication rate in the photon group was low--minor 3%, major 5%. The complication rates in the neutron groups were higher--LDN 30% and 15% respectively, HDN 15% and 10% and combined 25% and 37%. Only six patients died of complications related to therapy--photons 2, LDN 1, HDN 1, combined 2. No therapeutic gain for neutron therapy has been found in this study.

The treatment of ependymoma of the brain or spinal canal by radiotherapy: a report of 79 cases

Seventy-nine patients (54 adults, 25 children) with ependymomas of the brain or spinal canal were treated by radiotherapy between 1956 and 1980. The survival was 50% at 5 years and 40% at 15 years and was significantly better in adults than in children. Survival did not depend upon the extent of surgical removal, site of tumour or histological grade. Cranio-spinal radiation may improve survival in children.

Prospective study of follow up alone in stage I teratoma of the testis

In a prospective surveillance study of 45 patients with stage I teratoma of the testis 34 (76%) required no further treatment. Eleven patients relapsed but were salvaged by chemotherapy and radiotherapy. Seven patients relapsed within three months of the initial assessment and only one after more than 12 months. These preliminary results suggest that a follow up policy in stage I teratoma of the testis is possible but only in a regional centre with facilities for close monitoring of patients.

Radiotherapy in seminoma of the testis

Five hundred and forty-seven patients with histologically proven seminoma of the testis were treated by radiotherapy between 1960 and 1978 using a standard method. Of these, 448 patients had 'early' disease and a life-table survival of 94% at 5 years was achieved. Survival was significantly improved in patients treated in later time periods. Survival in more advanced disease was less good (62% in Stage IIB, 51% in Stage III and 13% in Stage IV at 5 years). The radiotherapeutic management of this tumour is discussed.

Role of pulmonary function tests in the prevention of bleomycin pulmonary toxicity during chemotherapy for metastatic testicular teratoma

Thirty-eight men were treated for metastatic teratoma with up to four courses of chemotherapy, each containing 90 mg bleomycin. Routine pulmonary function tests (PFTs) were performed before each course to assess their value in detecting bleomycin pulmonary toxicity. PFTs were repeated 2-5 yr after completion of chemotherapy in 10 disease-free survivors. Analysis of changes in individual PFT values showed a fall in the carbon monoxide diffusing capacity (DLco) after 90 mg bleomycin (P less than 0.005). The DLco remained depressed with subsequent doses of bleomycin, but there was no further statistically significant fall. There was no significant change in any other PFT. Similarly, late PFT values showed no significant change. There was no correlation between changes in the visible extent of metastases as assessed from the chest radiography and changes in serial PFTs. It is concluded that routine PFTs are unnecessary if the total bleomycin dose in less than or equal to 360 mg, unless there are particular risk factors. Late drug-induced pulmonary damage is unlikely to develop after treatment withdrawal.

Lymphomas of the testis-results of treatment 1960-77

Fifty-one patients with malignant lymphoma presenting in the testis are reported. The tumours were all diffuse non-Hodgkin's lymphoma. Eight patients had bilateral involvement. Fifty-three per cent of patients had evidence of spread beyond the testis at presentation and 75% at some time. The actuarial survival for all patients was 20% and for patients with disease apparently confined to the testis 40%. There was a survival advantage for patients with right sided tumours and lymphocytic histology. Chemotherapy using the VAP regime followed by radiotherapy to sites of bulky disease is recommended for patients with evidence of spread at presentation. For patients with disease apparently confined to the testis it is suggested that consideration should be given to adjuvant chemotherapy following radiotherapy to the abdominal nodes and scrotum.

Signet ring cell lymphoma: a rare variant of follicular lymphoma

A case of signet ring cell lymphoma, the eighth in published reports is recorded. This rare tumour is a variant of follicular lymphoma which may be mistaken for metastatic carcinoma. The case has been studied by light microscopy, immunohistochemistry and electron microscopy and confirms that this sub-group has rather uniform characteristics. Observations on the possible origins of the vacuoles are presented.

The treatment of supradiaphragmatic metastatic seminoma

Forty-four patients with supradiaphragmatic metastases from seminoma of the testis treated between 1960 and 1973 were studied. Nine patients had metastases at presentation, the remainder developed following abdominal irradiation. Only six patients were long-term survivors, five having nodal disease and one pulmonary parenchymal involvment. Thirty-three patients were treated by whole lung irradiation. The complete remission rate in these cases was poor (55%) despite the use of a dose which gave an appreciable incidence of pulmonary radiation damage. The results are in contrast to the excellent response to treatment obtained with subdiaphragmatic disease.

The activities of 2-oxoglutarate dehydrogenase and pyruvate dehydrogenase in hearts and mammary glands from ruminants and non-ruminants

1. The activities of 2-oxoglutarate dehydrogenase (EC 1.2.4.2) were measured in hearts and mammary glands of rats, mice, rabbits, guinea pigs, cows, sheep, goats and in the flight muscles of several Hymenoptera. 2. The activity of 2-oxoglutarate dehydrogenase was similar to the maximum flux through the tricarboxylic acid cycle in vivo. Therefore measuring the activity of this enzyme may provide a simple method for estimating the maximum flux through the cycle for comparative investigations. 3. The activities of pyruvate dehydrogenase (EC 1.2.4.1) in mammalian hearts were similar to those of 2-oxoglutarate dehydrogenase, suggesting that in these tissues the tricarboxylic acid cycle can be supplied (under some conditions) by acetyl-CoA derived from pyruvate alone. 4. In the lactating mammary glands of the rat and mouse, the activities of pyruvate dehydrogenase exceeded those of 2-oxoglutarate dehydrogenase, reflecting a flux of pyruvate to acetyl-CoA for fatty acid synthesis in addition to that of oxidation via the tricarboxylic acid cycle. In ruminant mammary glands the activities of pyruvate dehydrogenase were similar to those of 2-oxoglutarate dehydrogenase, reflecting the absence of a significant flux of pyruvate to fatty acids in these tissues.

Pancreatitis--a retrospective study

A retrospective study has been made of all adult patients admitted to Manchester Royal Infirmary with exocrine pancreatic disease between 1968 and 1974, in order to define the factors which influence the variable mortality and morbidity rates in published accounts of patients with acute pancreatitis. The most plausible explanation is that some series with low mortality rates include a variable number of patients with relapsing acute pancreatitis and acute exacerbations of chronic pancreatitis. Both these pathological entities have a negligible mortality and morbidity rate compared with single attacks of acute pancreatitis. The difficulties encountered by the clinician in determining the prognosis of acute pancreatitis at the time of admission to hospital are discussed. Attention is drawn to the differing role of alcohol as an aetiological factor in relapsing chronic pancreatitis and acute pancreatitis.

Experimental induction and treatment of toad poisoning in the dog

Toad poisoning was studied in awake and anesthetized dogs. The intoxication was defined with respect to clinical signs, blood changes, and alterations in electrocardiogram, blood pressure, and respiratory rate. The efficacy of propranolol hydrochloride as an antidote was evaluated.

Quinone epoxides. V. The biosynthesis of terreic acid

Tracer studies using the 14C-labeled salts of acetic acid, 6-methylsalicylic acid, and orsellinic acid demonstrate that the carbon skeleton of terreic acid (3,4-epoxy-6-hydroxy-2,5-toluquinone), a metabolite of Aspergillus terreus, is biosynthesized by the acetate–malonate pathway and that 6-methylsalicylic acid is an intermediate in this process. Orsellinic acid does not appear to be involved. Molecular 18O is incorporated into the metabolite, and distinction can be made between incorporation at the epoxide oxygen and the three remaining oxygens on the basis of exchange rates. By this method the epoxide oxygen is shown to originate from atmospheric oxygen. The overall biosynthetic pathway is discussed.

Caerulomycin, a new antibiotic from Streptomyces caeruleus Baldacci. II. Structure

The antibiotic caerulomycin is shown to be 4-methoxy-2,2′-dipyridyl-6-syn-aldoxime (I) by chemical and spectroscopic studies.

Studies on the biosynthesis of volucrisporin. II. Metabolism of some phenylpropanoid compounds by Volucrispora aurantiaca Haskins

DL-Phenyllactic acid-α-14C, DL-phenylserine-α-14C, L-phenylalanine-carboxyl-14C, and shikimic acid-U-14C were incorporated into phenylalanine and tyrosine isolated from mycelial hydrolysates of Volucrispora aurantiaca as well as into volucrisporin. DL-m-Tyrosine-carboxyl-14C was incorporated into volucrisporin but not into the aromatic amino acids. L-Tyrosine-β-14C, cinnamic acid-α-14C, and m-hydroxycinnamic acid-α-14C were metabolized by the fungus but did not serve as precursors of volucrisporin or of mycelial phenylalanine. The results are consistent with the concept of a biosynthetic pathway to volucrisporin via phenylpyruvic and m-hydroxyphenylpyruvic acids. Substantial amounts of each radioactive substrate fed to V. aurantiaca PRL 1952 were incorporated into a brown melanoid pigment.

Dealkylation studies on inhibited acetylcholinesterase

1. A rapid method for measuring the rate of dealkylation of organophosporus-inhibited enzymes is described. 2. The dealkylation rates have been measured for acetylcholinesterase inhibited by isopropyl, sec.-butyl, 1,2-dimethylpropyl, 1,2,2-trimethylpropyl and cyclohexyl methylphosphonofluoridate, and by di-isopropyl phosphorofluoridate; they are first-order under the conditions used.

BIOGENETIC STUDIES ON VOLUCRISPORIN

In experiments with C14-labelled compounds, shikimic acid, phenylalanine, phenyllactic acid, and metatyrosine were found to be precursors of the terphenylquinone pigment volucrisporin. It is suggested that the pigment is biosynthesized by the self-condensation of two molecules of an unbranched phenylpropanoid intermediate, and that hydroxylation of the phenyl rings in the meta position occurs before the condensation step.