Kinetics, quantitative analysis and radioimmunolocalization using indium-111-HMFG1 monoclonal antibody in patients with breast cancer

HMFG1 tumour associated monoclonal antibody IgG1 and F(ab')2 fragments were radiolabelled with indium-111 and used to study patients with breast cancer. In vitro and in vivo stability of the radiolabelled antibodies was shown to be satisfactory. Thirty patients with primary breast cancer underwent tumour resection and quantitative evaluation of the radioactivity in the tumour and normal tissues following administration of specific and non-specific antibodies. The mean tumour uptake of HMFG1 F(ab')2 fragments at 24 h was significantly higher (P less than 0.05) than the intact IgG but at 48 h there was no difference. The mean tumour uptake with the specific antibody was higher than the non-specific antibody of the same subclass (P less than 0.05). Lymph node metastases showed higher antibody uptake than the corresponding primary tumours (P less than 0.05). Fifteen patients with primary or metastatic breast cancer were investigated by external body scintigraphy using HMFG1 F(ab')2 fragments. Successful localisation was observed in approximately 50% of the primary and metastatic lesions with no false positive results. All the patients had observable concentration of 111In in the liver (20% of the injected dose), the kidneys and the spleen. Following i.v. administration, F(ab')2 fragments cleared from the blood more rapidly than the intact IgG. We conclude that HMFG1 F(ab')2 fragments can localise specifically and faster than intact IgG in breast cancer but the sensitivity of the radioimmunoscintigraphy is relatively low. This method needs further improvement before becoming clinically useful for detecting and staging breast cancer.

Treatment of colorectal cancer and other malignancies with continuous infusion of 5-fluorouracil

Twenty-six consecutive patients with gastrointestinal and other epithelial origin neoplasms were treated with continuous intravenous infusion of 5-Fluorouracil using a portable pump. Out of twenty-four evaluable patients, four achieved complete remission, four a partial response while in twelve patients the disease remained stable. The overall response rate was 33%. Twenty out of the 24 patients achieved significant improvement in their performance status and quality of life. The median survival was 9.5 months. The two more frequently observed toxicities were stomatitis (19.5%) and hand-foot syndrome (15.3%). Our study shows that long-term continuous infusion of 5-Fluorouracil is of palliative value in patients with gastrointestinal and other neoplasma of epithelial origin. The use of portable pumps makes this a practical and cost effective outpatient form of treatment.

Management of the obstructed left colon by the one-stage intracolonic bypass procedure

Six patients with left-sided colonic obstruction were treated by immediate resection and anastomosis using the intraluminal bypass procedure. There was no mortality or clinical anastomotic leakage. The technique provides an alternative to staged management of left-sided colonic obstruction.

Ulcerative colitis and polyposis coli. Surgical options

Until a medical cure for ulcerative colitis is available, it is up to the surgeon to provide a solution. With the wealth of experience now available, the operation of ileal pouch with anal anastomosis must be considered as an option in treating the young or well-motivated patient. Screening of families in whom polyposis coli has been found can prevent colon cancer developing. For this group of patients, who may be totally asymptomatic, to be able to offer a reconstructive operation may make it easier for such patients to accept colectomy. The value of consultation between medical and surgical gastroenterologists in order to time surgery is vital, and an exact histologic diagnosis in inflammatory bowel disease may prevent the potential disaster of constructing an ileal pouch in a patient with Crohn's disease. The construction of a pouch is not difficult, being made up of several familiar surgical steps in an unfamiliar setting. However, it is a long operation, frequently taking more than 4 hours, and mucosal protectomy can be rather awkward. For these reasons and the problems with patient counseling, we believe ileal pouch with anal anastomosis operations should be performed at referral centers. We still have to decide on the best type of pouch to use, but it is encouraging that better antibiotics, safer anesthesia, and new techniques such as the intraluminal bypass tube and rectal sleeve dissection have helped to make this operation more successful for a greater number of patients.

Cystic pneumatosis in coeliac disease

This report presents a patient with proximal small bowel cystic pneumatosis associated with poorly controlled coeliac disease and pseudo-obstruction. Cystic pneumatosis is rare in the proximal small bowel and we can find no report of its occurrence in association with coeliac disease.

The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure

The one-stage intracolonic bypass procedure prevents gastrointestinal secretions and fecal content from coming in contact with an anastomotic site without interrupting the intraluminal continuity of the fecal flow from proximal to distal colon. This can be achieved by the intraluminal implantation of a soft, pliable tube above the anastomotic site. Previous clinical and experimental data have indicated that the intracolonic bypass procedure can protect an anastomosis in the presence of maximal colonic loading, gross dehiscences, or fecal peritonitis. This report presents 28 patients with perforated diverticulitis, all of whom were treated by one-stage intracolonic bypass procedures. Ten of the 28 patients had peritonitis, and 18 had pericolic abscesses. Results indicate no deaths and no anastomotic leakages. Three patients (10.7%) had a complicated postoperative course. One patient with fecal peritonitis had prolonged ileus and a pulmonary effusion, and one had a myocardial infarction. Both of these patients responded to medical therapy. Another patient had a wound infection. The hospital stay ranged from 10 to 18 postoperative days. All patients passed the tubes spontaneously 2 to 3 weeks after operation. The one-stage intracolonic bypass procedure can be recommended as a viable alternative to the two- or three-stage procedures commonly used for perforated diverticulitis.