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.

Successful praziquantel treatment of paragonimiasis following bithionol failure. A case report

A patient from Southeast Asia with cough and hemoptysis was documented to have pulmonary paragonimiasis. Initial treatment with bithionol failed. The patient was then treated with praziquantel 75 mg/kg body weight a day for 2 days under an investigational protocol. Subsequent follow-up studies showed clinical improvement and indicated parasitologic cure. A concurrent asymptomatic Clonorchis infection was also cured following praziquantel treatment. Side effects were minor.

Association between the mammalian 110,000-dalton heat-shock protein and nucleoli

A rabbit antiserum has been prepared using as antigen the 110,000-dalton mammalian heat-shock protein. This protein was purified for injection by two-dimensional PAGE of heat-shocked Chinese hamster ovary cells. Characterization by immunoautoradiography and immunoprecipitation reveals that the antiserum is specific for the 110,000-dalton protein. Both techniques also reveal that the protein against which the antiserum is directed is induced by heat shock. Indirect immunofluorescence shows that the antigen is primarily localized at or near the nucleolus in cultured cells and numerous murine tissues. Treatment of cultured cells with deoxyribonuclease destroys the organization of staining within the nucleus while ribonuclease appears to completely release the antigen from the nucleus. A binding of the antiserum to cytoplasmic structures is also observed by immunofluorescence. This association with nucleoli may have implications in the regulatory aspects of the heat-shock response.

Loss of vascular fibrinolytic activity following irradiation of the liver--an aspect of late radiation damage

The vascular fibrinolytic activity, known to originate from the endothelium, was studied histochemically by fibrinolysis autography in liver samples from beagles exposed to radiation treatment. Eighteen to thirty months prior to sacrifice, six dogs received X irradiation (4600 rad in 5 weeks) and three dogs received X irradiation plus aspirin (1 g/kg). Two dogs served as untreated controls. Control livers showed extensive fibrinolytic activity related to large and small vascular structures. The vascular fibrinolytic activity had been lost from all vessels except the major portal branches in five irradiated livers and was severely diminished in three. One irradiated liver appeared to possess normal fibrinolytic activity.

Energy metabolism of groups of broiler breeders in open-circuit respiration chambers

Energy metabolism of broiler breeders housed in groups was measured in large open-circuit respiration chambers. The design, function and calibration of the chambers are described. Each of the three chambers has a capacity for 24 pullets or adult layers, or 16 adult broiler breeders. Control of ventilation rate is by calibrated choked-flow nozzles. Before experiments were started the system was assessed by CO2 infusion and recovery and ethanol combustion studies. Percentage CO2 recoveries were greater than 98 of infused and the mean (+/- SD) quotient of CO2 produced to O2 consumed from the combusion of ethanol was 0.67 (+/- 0.02). Forty-eight broiler breeder hens in lay were placed in the respiration chambers (16 per chamber) and fed at different rates from around maintenance to about twice this value. The energy required for maintenance (MEm) was 365 kJ/kgW0.75 d and the efficiency of utilisation of metabolisable energy (ME) for production (kp) was 0.70. Starvation heat production was about 350 kJ/kgW0.75 d and was shown to affect the derived values of the energetic parameters when included in the relationship between retained energy and metabolisable energy intake. Published results were recalculated and found to support this.

Paragonimiasis in Indochinese refugees. Roentgenographic findings with clinical correlations

Twenty-five Indochinese refugees with paragonimiasis were reviewed. Thirteen patients were diagnosed by ova identification in sputum specimens, but 12 patients were diagnosed by an elevated complement fixation titer in conjunction with clinical and epidemiologic criteria. Roentgenographic lesions included diffuse (44%) and segmental (24%) infiltrates, nodules (20%), and cavities (20%). The classic ring shadow was present in only 8%. Of note was the frequency of pleural effusions (48%), which were massive in 6 patients and the sole manifestation in 5. Although tuberculosis should always be excluded, work-up of pulmonary effusions and infiltrates in immigrants from Southeast Asia should include a serologic and microbiologic search for paragonimiasis.

Hyperthermia in combination with radiotherapy: a review of five years experience in the treatment of superficial tumors

Facilities for regional tumor hyperthermia has been in use at RPMI since 1976, and have been routinely used to treat patients according to protocol since 1977. Hyperthermia delivery has been exclusively by microwave using 434 MHz, 915 MHz and 2450 MHz. Greatest success at reaching tumor temperatures of 43-44 degrees C with minimal skin heating was obtained using 915 MHz. The majority of the patients were treated with this frequency. Approximately 125 patients have been treated and 70 have achieved completion of therapy and follow-up. Follow-up has been at least one month and several patients have been followed for one to two years. Initially, for entry into the hyperthermia protocol, patients were required to have three or more lesions. One lesion on each patient was treated with 800 rad fractions repeated three times on a 72 hour schedule. The second lesion was treated with 700 rad fractions and the third with 500 rad plus hyperthermia on the same schedule. Twelve patients with multiple melanoma lesions completed this study. One of 12 patients showed no response to the combination of hyperthermia plus radiotherapy, while four showed no response to radiotherapy alone. Of eight patients who survived three months, all lesions treated by hyperthermia plus radiotherapy responded completely, while only five lesions treated by radiotherapy alone so responded. In a second study, 58 patients with superficial tumors were treated by a protocol where hyperthermia was added to optimal conventional radiotherapy. Of the total, 43 patients had complete tumor response at follow-up varying from one month to 18 months. A subgroup of 24 of these patients had two lesions, one of which was treated with hyperthermia in addition to radiotherapy while the other served as control, receiving radiotherapy only. Nineteen lesions demonstrated complete response to hyperthermia plus radiotherapy, while only 14 of the controls had complete response. None of the lesions treated with hyperthermia responded less well than those treated by radiotherapy alone. Morbidity, as measured by skin reaction, was rarely increased in the heated field.

Prognostic factors in locally recurrent rectal carcinoma treated by radiotherapy

An analysis has been made of the symptomatic response and survival of 143 patients following radiotherapy for locally recurrent rectal cancer. Computerized tomography (CAT) was performed on 45 patients. Of 119 evaluable patients, 54 had a good response to radiotherapy, 29 a moderate response and 36 no apparent response. Median response was 9 and 3 months respectively in the good and moderate groups. Median survival was 15, 9 and 5 months for the three groups. Latent interval between surgery and radiotherapy appeared to be of prognostic importance. When this exceeded 2 yr median survival was 12 months compared with 7 months for patients with a latent interval of less than 2 yr. Tumour volume measured by computed tomography may have prognostic importance. Radiotherapy should be considered for most patients with symptomatic recurrence. Surgery might be combined with radiotherapy for selected groups of patients with good prognosis.

Radiation therapy and hyperthermia in the treatment of superficial lesions: preliminary analysis: treatment efficacy, and reaction of skin, tissues subcutaneous

Superficial and measurable tumors were treated with hyperthermia and radiation therapy according to RTOG protocol 78-06. This study focuses on a subset of patients who were heated with microwaves. Eighty patients representing 88 lesions were treated between 1978 and 1981 with a schedule which allowed 48-96 hours to elapse between treatment sessions. The mean value of the average temperatures for individual lesions was 42.3 degrees C. The mean total radiation dose was 33.95 Gy. Skin reaction was examined in terms of the maximum score reported, using a modified Fowler scale. Erythema, the most common finding, was reported as the maximum skin reaction in 24% of the cases. Ulcerations and blisters occurred with frequencies of 18% and 7%, respectively. No reaction or desquamation was reported in 19% and 17% of the cases. Complete regression was noted in 48% of the treated lesions, partial regression in 17%, and no change in 24%. Twenty-five percent of the patients enjoyed sustained response for greater than 180 days. Refinement of hyperthermia treatment equipment and technique may result in less normal tissue reaction and improved clinical responses. In view of the encouraging initial results, we recommend aggressive pursuit of hyperthermia as a new treatment modality.

Preliminary report on phase III RTOG studies of extended-field irradiation in carcinoma of the prostate

The radiation therapy oncology group (RTOG) has conducted two studies testing the value of extended-versus limited-fields in carcinoma of the prostate. RTOG protocol 75-06 tests the value of paraaortic irradiation in patients with locally advanced tumors limited to the pelvis. RTOG protocol 77-06 tests the value of pelvic irradiation in patients with tumors limited to the prostate. Two hundred sixty-eight evaluable patients have been entered on RTOG 75-06, and 219 on RTOG 77-06 prior to 1981. This is a preliminary report on treatment-related morbidity in patients followed for a minimum of 1 year. Treatment-related morbidity has been classified according to a five-grade severity classification schema and correlated with the protocol option assignment in order to determine whether the use of extended fields had an effect on the incidence of side effects. Thirty-one percent of 268 patients on RTOG 75-06 and 34% of 219 patients on RTOG 77-06 had some form of treatment side effects. The majority (over 80%) of these were mild (grade 1 and 2) and by definition did not interfere with the patients' performance (life style). Only three patients on RTOG 75-06 and one on RTOG 77-06 had grade 4 complications (by definition requiring a surgical intervention). No fatal (grade 5) complications have been recorded so far. The use of paraaortic fields in RTOG 75-06 and pelvic fields in RTOG 77-06 have not resulted in a significant increase of GI or GU morbidity at this time. The only statistically significant trend was the incidence of postirradiation genital and lower extremity edema which strongly correlated with the extent of staging lymphadenectomy.

Monoclonal antibody against a differentiation antigen on human leukemia cells: cross-reactivity with rat leukemia and suppression of rat leukemia in vivo

We produced a McAb against a normal differentiation antigen on human ANLL that cross-reacts with a rat ANLL. The McAb reacted with all ANLL cells tested as well as normal undifferentiated myelomonocytic cells. This McAb, of the IgM isotype, in the presence of C mediated lysis of human and rat leukemic cells in vitro. In addition, it mediated complete tumor suppression in rats engrafted with 10(2) to 10(3) rat leukemic cells in vivo. No significant side effects were observed in McAb-treated rats. McAb of this type may be useful in the treatment of human ANLL after conventional therapy, which often eliminates most leukemic cells, leaving a small number of residual cells. The ultimate utility of this McAb for human therapy or McAb directed against the same or other differentiation antigens remains to be determined.

Monoclonal antibody against a differentiation antigen on human leukemia cells: cross-reactivity with rat leukemia and suppression of rat leukemia in vivo

We produced a McAb against a normal differentiation antigen on human ANLL that cross-reacts with a rat ANLL. The McAb reacted with all ANLL cells tested as well as normal undifferentiated myelomonocytic cells. This McAb, of the IgM isotype, in the presence of C mediated lysis of human and rat leukemic cells in vitro. In addition, it mediated complete tumor suppression in rats engrafted with 10(2) to 10(3) rat leukemic cells in vivo. No significant side effects were observed in McAb-treated rats. McAb of this type may be useful in the treatment of human ANLL after conventional therapy, which often eliminates most leukemic cells, leaving a small number of residual cells. The ultimate utility of this McAb for human therapy or McAb directed against the same or other differentiation antigens remains to be determined.

Abdomino-pelvic computed tomography in the management of ovarian carcinoma

121 CT scans were obtained in 75 women with ovarian cancer, including 108 scans of the abdomen and pelvis and 13 of the pelvis alone. 70 patients had epithelial carcinoma. In 48 cases, pelvic CT was performed within 3 weeks after surgery, confirming the operative findings in all but 6. In the abdomen, CT identified intrahepatic deposits and minimal ascites not seen at surgery; however, small peritoneal deposits not usually shown by CT were readily found at surgery. CT was superior to clinical examination, detecting unsuspected disease and delineating areas of known disease more accurately. It was also helpful in assessing suitability for repeat laparotomy. In 7 cases, CT demonstrated an operable lesion which had been thought to be inoperable. In 65 cases (59%), CT contributed additional information which was helpful in management, proving it to be an important noninvasive investigation in patients with ovarian carcinoma.

The anterior cruciate ligament problem

The management of the acutely injured anterior cruciate ligament (ACL) was evaluated by a survey of 58 orthopedic surgeons in North America. The ACL is the most frequently totally torn ligament in the knee. Diagnosis may be made with a combination of tests: anterior drawer, Lachman, and pivot shift. If the patient is unable to relax because of pain or fear, examination under anesthesia, and possibly arthroscopy, should be performed. The manner in which the patient is treated for the ligamentous deficiency depends on the physician's perception of the natural history of the ACL deficient knees, the biomechanical necessity of the ligament, and the physician's ability to repair or reconstruct the ligament. Treatment can be surgical or nonsurgical. The method depends on the patient and his or her life-style. Since the ACL is vital to normal knee function, surgical intervention is advisable in the majority of cases of acute disruption in patients less than 40 years of age. Patients with chronic instability of the ligament, should be treated initially with a program of rehabilitation and, possibly, a reconstruction if the knee has not responded after at least six months. All knee surgeons should continuously review the literature and, as necessary, revise the treatment regimens for their patients.

Behavioural and ultrastructural studies of desmethylmisonidazole-induced neurotoxicity in mice

The hypoxic cell radiosensitiser desmethylmisonidazole (DMM, Ro-05-9963) was administered orally to C3Hf female mice at three different dose levels (1.4, 1.6 and 1.8 mg g-1 day-1). Behavioural and morphological end-points were used to evaluate the neurotoxicity of this compound at these doses. The behavioural changes present at all three dose levels appeared when the total dose approached approximately 19 mg g-1. The behavioural changes initially appeared and developed to a severe state rapidly (24 to 48 h). A pattern of haemorrhagic necrosis was observed in the brain stem and cerebellum, but no pathology was observed in the cerebrum. Peripheral nerve degeneration was also evident and appeared concurrent with the central pathology. DMM appears to affect both the central and peripheral nervous systems at the same time at these dose levels. This is in some degree different from previous experience with misonidazole where peripheral damage distinctly precedes central effects. The development of the disorder appeared to be more rapid and severe when compared with earlier experience with misonidazole.

Adult respiratory distress syndrome following thrombolytic therapy for pulmonary embolism

Pulmonary edema is rare in patients with pulmonary embolism and to our knowledge has not been described in association with thrombolytic therapy. We describe a patient with massive pulmonary embolism in whom the adult respiratory distress syndrome (ARDS) developed shortly after a course of streptokinase therapy. The possible association between streptokinase therapy or pulmonary embolism and ARDS should be recognized as streptokinase gains wider clinical use.

Computed tomography in adrenal disease

Ninety-eight patients with suspected adrenal disease were examined by computed tomography (CT). In 73 patients adrenal disease was confirmed on biochemical and other grounds (Cushing's syndrome (38), primary aldosteronism (8), phaeochromocytoma (12), androgen excess (7), Addison's disease (1) and non-functioning adrenal masses (7)). The CT appearances of hyperplasia and benign and malignant adrenal tumours are described in detail. Ninety-six per cent of the adrenal glands were identified, and all but one of the 39 adrenal mass lesions were correctly identified and localised by CT. The failure to identify some adrenal glands and one adrenal tumour was related to a paucity of intra-abdominal fat. Two abdominal ectopic phaeochromocytoma were not identified (in one patient because the appropriate area was not scanned). The 25 patients examined with unproven adrenal disease had normal glands on CT. That some hyperplastic glands appear normal on CT precludes its use as a screening procedure for biochemically unproven adrenal disease. Computed tomography allows the differentiation of adrenal hyperplasia from functioning adrenal tumours, and the differentiation of benign from malignant lesions with a high degree of certainty; it is the method of choice for the identification and localisation of adrenal tumours.

Pulmonary vascular and alveolar development in tetralogy of Fallot: a recommendation for early correction

Using quantitative morphometric techniques, we analysed pulmonary arterial and alveolar development in the lungs of seven children aged 1.2-12 years who died during or soon after repair of tetralogy of Fallot. One child had a residual ventricular septal defect and survived for five months. One other child had had a previous Waterston-Cooley anastomosis (Waterston shunt). Postmortem lung volume in relation to body surface area was generally below normal for age, the alveoli were small, and the total alveolar number was below normal in five of the seven cases. Microscopically, airway and alveolar structure appeared normal. The preacinar arteries were larger and the intra-acinar arteries were smaller than normal for age. The preacinar elastic pulmonary arteries appeared to contain less elastin and in both preacinar and intra-acinar muscular arteries the media was thinner than normal, although muscle was normally distributed along the arterial pathway. Eccentric areas of intimal fibrosis were small and uncommon. The bronchial arteries were generally more prominent than usual both macroscopically and microscopically, but no abnormal bronchopulmonary connections were present. After corrective surgery a residual ventricular septal defect and pulmonary hypertension were associated with arterial medial hypertrophy, and this change was also found in the right lung of a normotensive patient who had had a Waterston shunt. This group probably represents the most favourable clinical picture of tetralogy in patients who usually survive but, even so, pulmonary arterial and alveolar development was abnormal. The structural findings are discussed in relation to the functional outcome in patients with tetralogy who have survived. Repair of the abnormality during the first two to three years of life is recommended.

Heat shock proteins and thermotolerance; a comparison of induction kinetics

The hypothesis that the expression of heat shock proteins following a preliminary hyperthermic treatment is responsible for subsequent thermotolerance to a second heat treatment is examined. CHO cells were given a 12 min, 45 degrees C pretreatment and then incubated for varying intervals at 37 degrees C. The synthesis of certain intracellular proteins was monitored as a function of time post-incubation by using 35S-methionine incorporation as determined in SDS polyacrylamide gel electrophoresis. Cell survival was concurrently measured by challenging the cells with a second heat treatment (45 degrees C/27 min). Major heat shock proteins were observed at 68 000, 89 000 and 110 000 daltons. The synthesis of these proteins was significantly reduced in the presence of cyclohexamide. The total 35S-methionine incorporation into these proteins correlated well with the induction of survival resistance (thermotolerance). An approximate exponential relationship between survival and the amount of each of these proteins may occur. These and other heat shock proteins were also present, in a significantly reduced degree, in control (non-heat shocked) cells maintained under normal culture conditions at 37 degrees C. It is possible that heat shock proteins are responsible for the phenomenon of thermotolerance.