Solcoderm as alternative conservative treatment for acute anal fissure: a controlled clinical study

Acute anal fissure is a common malady that results in morbidity. If a patient is not responsive to conservative treatment, the current recommended treatments are either anal dilatation or lateral internal sphincterotomy. Both operations promise relatively good results, but the recurrence rates are about 16 per cent and 7 per cent, respectively. This fact, together with possible postoperative complications and costs, justifies trying conservative treatment before referring patients for surgery. The authors treated a study group of 25 patients with a topical application of Solcoderm. Another group of 25 patients concurrently treated with the usual conservative treatment served as the control group. Analysis of the early and late results proved Solcoderm to be simple to use, safe, without systemic side effects, cost-effective, and with statistically significant better outcome. Consequently, the authors believe that this method of treatment is justified in cases of acute and fissure and should be attempted before operation.

[Surgery for complete rectal prolapse in adults]

Surgery for complete rectal prolapse was performed in 17 women and 3 men between November 1986 and April 1991. An abdominal approach with posterior rectopexy was used in 17. The Thiersch procedure of anal narrowing was performed in 3 high risk patients. All recovered without major complications. Urinary tract infection developed in 15% and postoperative fecal impaction in 10%. Anal continence improved in 70% of those previously incontinent. There was no recurrence of complete rectal prolapse during follow-up. All patients rated the operative results as either good or very good.

Differential metastatic capacity of three AKR lymphoma variants

The comprehension of tumour progression has advanced due to the use of various models, the most rewarding being probably the study of malignancy variants derived from the same tumour. In the present study the biological behaviours of three AKR lymphoma variants were compared. The three variants, TAU-33, TAU-38 and TAU-39, differed markedly in biological behaviour. The TAU-39 variant formed very large 'primary tumours', TAU-33 produced local growths of intermediate size, and TAU-38 formed small s.c. tumours. However, the metastatic potentials of the variants were inversely related to their ability to produce local tumours. According to various parameters (spread to organs, cachexia and mice mortality rate), the variant of highest metastatic potential was TAU-38, the one of intermediate ability TAU-33 and the TAU-39 had the least aggressive behaviour. A lack of difference in invasive capacity as well as a similar ranking of malignancy by both s.c. and i.v. inoculation indicate a differential behaviour in late metastasis phase. Tumour progression models may contribute to a better understanding of this threatening process and to testing of new treatment modalities suitable for cancer at different stages.

Effect of a membrane-active agent on uptake of adriamycin in Lewis lung carcinoma cells derived from 'primary' and 'metastatic' growths

The treatment of metastatic growth still constitutes a challenge for cancer research. Tumor progression is often accompanied by a loss in sensitivity to previously efficient drugs. Decreased intracellular accumulation of cytotoxic agents is probably the major reason for drug resistance, although other mechanisms have also been described. Properties of the cell membrane have been shown to determine the metastatic phenotype. This cellular organelle is also responsible for the multiple drug resistance phenomenon. Membrane-active agents may increase cell permeability to drugs, counteracting thereby drug resistance. In the present study the effect of the nonionic detergent Tween 80 on sensitivity to adriamycin (ADR) of cells derived from Lewis lung carcinoma 'primary tumors' (PT)-the local growth following subcutaneous inoculation - and 'metastatic tumors' (MT) - lung tumors which develop following intravenous injection - was compared. Flow cytometry analysis demonstrated several differences between cells derived from the PT and the MT: (1) single ADR treatment showed that MT cells possessed a lower percentage of a high ADR permeability subpopulation than PT cells; (2) a dose-dependent shift to a higher ADR accumulating population was seen in the presence of Tween 80 for both cell types. However, the increase in percentage of high ADR permeability cells was more pronounced in MT (up to x4.7) than in PT (up to x1.3) cells. This differential effect of the membrane-acting agent was evident at various ADR (10-50 micrograms) and Tween 80 (0.1-0.4%) concentrations. The present results corroborate previous data obtained in our group in another tumor progression model, AKR lymphoma.

Differential sensitivity to hyperthermia of the F1 and F10 B16 melanoma variants

The currently available antitumoral therapeutic modalities are most often inefficient against metastatic disease. The metastatic phenotype has been shown to be largely determined by cell membrane properties. The cell membrane could therefore be considered as a possible target for antimetastatic drugs. In the present study we examined the effect of hyperthermia (the antitumoral effect of which is based, at least partly, on an action on the cell membrane) on the F1 and F10 variants of B16 melanoma. Cells of the more malignant variant, F10, were found to be markedly more sensitive to hyperthermic treatment than those of the less malignant one, F1. One hour in-vitro treatment by supranormal temperatures (ranging from 40 to 46 degrees C) resulted in a differential effect with regard to both proliferating capacity of the cells in vitro and tumorigenic ability following inoculation to mice. Our present results in the B16 melanoma corroborate data obtained by us in another tumour system, the AKR lymphoma. Study of the effect of membrane-acting agents on tumour variants differing in degree of malignancy might result in the finding of antitumoral agents efficient against advanced cancer.

AKR lymphoma malignancy variants differing at late phase of metastasis

The biological behavior of two AKR lymphoma variants, the TAU-39 and TAU-38, of low (LM) and high (HM) malignancy, respectively, has previously been described. In the present study an attempt was made to determine the phase in the metastatic process in which these variants differ. Two types of findings suggest that the two variants differ in the late phase of the process; (a) no difference in the degree of invasiveness of the primary tumor to the surrounding tissues has been found between the two variants, both being highly invasive; (b) comparison of malignant behavior in the "spontaneous metastasis" versus the "experimental metastasis" tests showed a similar ranking of malignancy of the two variants.

Sensitivity to thermochemotherapy of AKR lymphoma and B16 melanoma variants of malignancy

Drug resistance, which so often accompanies tumor progression, has been shown to be related to changes in membrane properties which may result in decreased drug accumulation in the tumor cell. A correlation between sensitivity to thermochemotherapy and degree of malignancy was found in the AKR lymphoma system. Hyperthermia increased adriamycin (ADR) uptake and concomitantly its cytotoxicity to AKR lymphoma cells. Moreover, these effects were more pronounced on a variant of high malignancy (HM) than on a low malignancy (LM) one. Fluorescent microscopy, as well as cytofluorometry, indicated that lymphoma cells treated by ADR at 43 degrees C were more permeable to the cytotoxic agent than those exposed to the chemotherapeutic substance at 37 degrees C. Cytofluorometry indicated the presence of a minor cell subpopulation with low ADR uptake in the HM variant, not found in the LM one. Fluorocytometry also showed that the temperature-dependent increased ADR uptake was more marked in the HM than in the LM variant, explaining the differential effect of thermochemotherapy on the two lymphoma variants. However, correlation between degree of malignancy and sensitivity to thermochemotherapy is not a general feature. In contrast to the results obtained in the AKR lymphoma system, in the B16 melanoma the low malignancy variant, F1, was more markedly affected by the combined treatment than the F10 variant. The increased cytotoxic effect of ADR by supranormal temperatures in the F1 variant was shown to be due to an augmented drug uptake. The results suggest that drug resistance in late stages of tumor progression can be overcome by an agent acting on the cell membrane. However, the data also indicate the necessity of assaying cancer treatment modalities, including those designed to circumvent drug resistance, on various tumor system models.

Brown-bowel syndrome

Extensive brownish discoloration of the small bowel is rare and has been described mainly in association with malabsorption disorders. It is related to deficiency of the fat soluble vitamin E. Vitamin E is an antioxidant substance that prevents peroxidation of unsaturated fatty acids. Vitamin E deficiency may result in oxidized lipids, which when polymerized with polysaccharides form the brown, PAS-positive pigment termed ceroid or lipofuscin. The deposition of pigmented granules in the effected tissues accounts for the brownish discoloration. We present three patients ultimately found to have "brown bowel syndrome (BBS)," in which the symptoms, preoperative findings, and respective diagnoses were different. In all three patients, serum Vitamin E levels were found to be extremely low.

Abdominal operations without nasogastric tube decompression of the gastrointestinal tract

The routine use of nasogastric (NG) drainage during and after abdominal surgery was examined. One hundred and fifty patients who underwent various abdominal operations with a Levine tube served as a control group (retrospective group). The tubeless study group (prospective group) of 150 patients was randomly and blindly divided into three equal subgroups. Subgroup A patients were operated on without any NG tube. The tube in subgroup B patients was inserted after induction of anesthesia and removed one hour after the operation. The tube in subgroup C was inserted as in subgroup B, but was taken out 12 hours after the operation. The total number of complications in the intubated group was significantly higher than in the tubeless group (P less than 0.01). High temperature, atelectasis and miscellaneous complications were more frequent in the control group than in the study group (P less than 0.01). Other complications such as nausea, vomiting, bronchopneumonia, and gastric dilatation, as well as the resolution of the postoperative ileus and hospital stay, were not of statistical significance. Fewer miscellaneous complications (P less than 0.05) and less patient discomfort were found in subgroup A than in the other tubeless subgroups. Complications in the study group were easily controlled by conservative treatment and no serious complications resulted. Therefore, the routine use of NG suction as adjunctive therapy following abdominal operations is not advocated by this study.

Conservative surgery in Zollinger-Ellison syndrome: report of a case with an eight-year follow-up

The patient described here, with malignant non-beta islet cell tumor of the head of the pancreas, was treated by resection of the tumor and metastases. Additional pathology of perforated duodenal ulcer and pyloric stenosis required vagotomy and pyloroplasty. The maintenance of normal gastrin levels after the operation indicates a good prognosis. We believe that the low-risk Zollinger-Ellison patient should be treated surgically and the tumor removed. When no tumor can be detected, parietal cell vagotomy should be performed to assist the pharmacological control of the gastric acid hypersecretion. Extensive surgery, such as total gastrectomy, is no longer the treatment of choice and is reserved for the so-called "cimetidine failure."

Relationship of nuclear appearance to stromal invasion in human breast cancer

Two biopsies of intraductal and invasive lobular carcinoma of the breast and 11 biopsies of intraductal and invasive carcinoma of the breast were examined by automated micromensurative techniques for mean nuclear area of carcinoma cells in intraductal and in invasive compartments. The nuclei of invasive carcinoma cells tended to be smaller when they invaded stroma as single cells or as "thin strands" than when they invaded as part of large sheets of cells. Cells in direct apposition with the stroma usually had smaller nuclei than cells which were found centrally in large confluent sheets of cells. Intraduct carcinoma cells approached, in size, invasive cells which formed confluent sheets, rather than cancer cells which invaded as single cells. The nuclei of cells which invaded in small groups were usually darker than those of cells in confluent sheets, which were usually more vesicular.

Effect of splenectomy on treatment of Lewis lung carcinoma by an immunomodulatory polysaccharide and a cytotoxic agent

The effect of the spleen on the efficiency of chemotherapy (cyclophosphamide) and immunotherapy (the polysaccharide levan) of C57BL mice bearing the Lewis lung carcinoma was studied. The development of Lewis lung carcinoma caused a gradual splenomegaly in the C57BL mice. Splenectomy did not, however, affect tumor growth in the nontreated host. Levan induced a pronounced splenomegaly. Splenectomy reduced markedly the antitumoral effect of the polysaccharide. These results indicate that spleen elements participate in the inhibitory activity of levan. By contrast, splenectomy had no effect on the efficiency of treatment of cyclophosphamide.

Acute myocardial infarction in a young woman taking oral contraceptives. A case report

Acute myocardial infarction occurred in a 25-year-old woman. Coronary angiography performed one month after the acute illness was normal. An ergonovine test was negative. The patient's acute myocardial infarction most probably was induced by the use of oral contraceptives in combination with heavy smoking. Oral contraceptives, with their known influence on the blood coagulation system, must be considered a risk factor in precipitating coronary artery disease.

A model for cancer treatment in advanced compared to early cancer

Loss of sensitivity to drugs following tumor progression constitutes the main reason for failure of treatment in advanced cancer. In view of the dynamic nature of neoplasms, models of tumor progression should be used for the testing of drugs. In the present study, two variants of malignancy of AKR lymphoma were used as a model of tumor progression to test various treatment modalities. The two variants, TAU-39 (of low-malignancy) and TAU-38 (of high-malignancy) differed in the pattern of local tumor growth as well as in the rate of metastatic spread and mice killing capacity. The efficiency of chemotherapy, immunotherapy and hyperthermia on the two variants was compared. The low-malignancy tumor was more sensitive to adriamycin than the high-malignancy one. Administration of levan-activated macrophages at the tumor site inhibited the growth of TAU-39. However, growth of the high-malignancy variant was stimulated by macrophages. Hyperthermic treatment was, in contrast to the other treatments, more effective against the high - than against the low-malignancy tumor. Models of tumor progression used in tests for antitumoral drugs may help in the discovery of treatment modalities effective also for advanced stages of cancer.

Spontaneous rupture of the normal stomach after sodium bicarbonate ingestion

Spontaneous rupture of the normal stomach is an unusual and highly lethal event. We present a case of spontaneous rupture of a normal stomach after ingestion of sodium bicarbonate, and review the seven similar cases previously reported.

Primary inflammatory malignant fibrous histiocytoma of the colon

A unique case of inflammatory malignant fibrous histiocytoma of the large bowel is presented. This lesion occurred in the colon of an elderly man suffering from weakness, anemia, anorexia, and weight loss. A right hemicolectomy was performed, and six months later, on follow-up, he was found to be well. The literature on visceral involvement by malignant fibrohistiocytic tumors is reviewed.

Endobronchial metastasis of renal cell carcinoma

Endobronchial metastasis from nonpulmonary carcinoma is rare. A case of metastatic renal cell carcinoma is presented and the literature reviewed. Severe haemoptysis was the initial symptom leading to the finding of a bronchial polypoid mass.

Computed tomographic air enema technique to demonstrate colonic neoplasms

The use of intravenous glucagon and the judicious introduction of air into a clean colon offer additional help in the confirmation of the larger intracolonic tumors on computed tomographic examination. The procedure is simple and may aid in the differentiation of an intrinsic colonic tumor from other pathologic conditions, particularly those that are extracolonic in origin.

Bilateral breast cancer

Between the years 1972 and 1982, 1,880 women were treated for breast cancer at the Tel-Aviv Medical Center. One thousand two hundred fifteen detailed charts are included in our study. Sixty-six patients (5.4%) were diagnosed as having bilateral breast cancer. The mean age at first tumor diagnosis was 55.1 years. Bilateral breast cancer appears to be more common in nulligravidas and women who have delivered up to two children. In patients where the first tumor was greater than 4 cm in diameter, there was a higher incidence of a second tumor. A total of 65.2% of all patients who developed a second breast tumor had no axillary lymph node metastasis at the time the first breast tumor was diagnosed. There was no correlation between the histological types of the first and second tumors. The longer the woman survived after the first cancer diagnosis, the greater the likelihood of her developing a second tumor; the longer the interval between the diagnosis of the two cancers, the better the survival rate.

Lipoma of the colon. A report of 22 cases

A series of 22 cases of lipomas of the colon is presented. Fourteen patients had small (mean size, 12.5 mm), asymptomatic colon lipomas which were diagnosed incidently. In four of these patients, more than one lipoma was found. Eight patients had one larger (mean size, 70.5 mm) symptomatic lipoma. The symptomatic patients were older (mean age, 64.3 years) than the asymptomatic patients (mean age, 54.7 years). While small lipomas do not generally give symptoms, it seems that the symptoms of larger lipomas are mainly due to mechanical interference in colonic passage or ulceration of the mucosa that covers the lipoma.

Granulosa-theca cell tumor in a one-year-old infant

A case is presented of a 12-month-old female infant, with sexual precocity due to a Granulosa-Theca cell tumor which presented with vaginal bleeding, breast development and public hair growth. The 17 beta-estradiol levels prior to operation were 300 pg/ml. Levels of gonadotropins were undetectable. Postoperative estradiol levels were measured and found to be 10 pg/ml. This tumor is very rate in infants, and there have been only four previously reported cases in children under 2 years of age.

Effect of splenectomy on the efficiency of chemo-immunotherapy of melanoma-bearing mice

Determination by the immune system of chemo- and immunotherapy of a murine tumor was investigated. The effect of cyclophosphamide and levan (polyfructose) in single and combined treatment on the growth of the F10 variant of B16 melanoma was tested in splenectomized and non-splenectomized mice. Splenectomy was found to increase markedly the efficiency of all treatments, particularly the combined treatment, as judged by the delay of appearance and size of the subcutaneous tumors at the site of inoculation. Nevertheless, mortality rate was not always in correlation with the rate of local tumor evolution: some of the treated splenectomized mice died earlier than expected, with relatively small local tumors, due to enhanced metastasis. The results indicate that elements in the spleen of C57BL mice decrease the therapeutic efficiency of the drugs tested. It can be deduced that splenectomy must not be considered to increase the risk of a tumor-bearing host in all cases. On the contrary, it may improve the efficiency of cancer treatment in certain tumor-host systems.

Streptococcus bovis subacute bacterial endocarditis as a presenting symptom of occult double carcinoma of the colon

A case of double carcinoma of the colon is presented in association with subacute bacterial endocarditis due to Streptococcus bovis. The presence of Streptococcus bovis septicemia is a strong pointer in favour of associated colon carcinoma even in the absence of gastrointestinal symptomatology.