Differential permeability of lymphatic and blood vessels in determining the route of metastasis as demonstrated by indirect lymphography

Indirect mammo-lymphography with serial radiograms was made on rats bearing three established rat mammary carcinomas (SMT-2A, TMT-50, MT-W9B), with the water-soluble contrast medium, Iotasul. In the lymphogenously metastasizing SMT-2A, fine lymphatic sprouts from the tumor were seen converging into an afferent lymph vessel that was extending toward a metastatic regional lymph node, in 15-30 min. For 45 min, the dye remained localized in the primary tumor with no other vascular structures or viscera visible until it emerged in the urinary bladder, indicating that Iotasul was absorbed slowly into the systemic circulation via lymphatics and diluted beyond recognition by lymph and blood, and then reconcentrated in urine. In contrast, in the hematogenously metastasizing TMT-50, Iotasul was rapidly diffused into the blood stream, revealing the inferior caval vein within 5 min, and by 15 min the heart, aorta, common carotid arteries, kidney and ureter were all clearly revealed. In the non-metastasizing MT-W9B host, several small vascular markings around the tumor were seen by 10 min and the outline of kidneys and urinary bladder in 15 min, suggesting that the dye was also absorbed through blood capillaries but somewhat slowly. Thus, the differential vascular permeability in rat mammary tumors revealed by Iotasul has not only helped to distinguish lymphatics from blood vessels, but also to correlate it with their metastatic potential.

IgA nephropathy in Korea: a morphological and clinical study

IgA nephropathy (IgA N) is the most common type of primary glomerulonephritis (27.5%) in South Korea and leads to renal failure in a significant number of cases. To evaluate the possible prognosticators of this disease, renal biopsy material from 142 Korean patients with IgA N was studied by light-, electron- and immunofluorescent microscopy, and a clinicopathologic correlation was made. Modified classification of Meadow et al. [1972] for Henoch-Schoenlein nephritis was adopted for the histologic grading of glomerular lesions. Twenty-three biopsies (16.2%) exhibited histologic grades IV and V lesions in association with high levels of proteinuria, serum creatinine and blood pressure and a low frequency of gross hematuria when compared to the remaining 119 biopsies with histologic grades I to III lesions. Ninety-one patients were followed for one to 6.5 years (mean, 3.4 years). Seventeen patients (18.7%) had chronic renal insufficiency, of whom eleven eventually showed endstage renal failure. More than 70% of the patients with histologic grades IV and V exhibited progressive renal disease, whereas patients with grades I to III lesions had a benign course (p less than 0.0005). These results suggest that histologic grading may be the best index to predict the present state or the subsequent progression of the lesion in IgA N.

The material properties of bone-particle impregnated PMMA

The elastic Young's modulus and shear modulus of bone-particle impregnated polymethylmethacrylate (PMMA) has been measured experimentally at room temperature as a function of bone particle concentration. It was found that the moduli increased with increasing bone particle content. This increase was less than the stiffness increase predicted by higher-order composite theory [1, 2] under the assumption of perfect bonding between particles and matrix. It was concluded that a bond existed but that it was not a perfect bond.

Cosserat micromechanics of human bone: strain redistribution by a hydration sensitive constituent

Experimental determination of the strain distribution in prismatic, square cross-section bars of human compact bone in torsion disclosed nonclassical effects associated with the microstructure. Specifically, in wet bone at small strain, significant deviations from the classically predicted strain distribution were observed. The measured strain distribution in wet bone followed predictions based on Cosserat (micropolar) elasticity. In dry bone, the strain distribution was very close to the prediction of classical elasticity. The interaction between Haversian osteons and the cement substance between them was hypothesized to be the principal mechanism for the phenomena. To evaluate this hypothesis, additional specimens were subjected to prolonged torsional load and the cement lines were observed by reflected light microscopy. Localized deformation at the cement lines was observed, but it was less than values reported earlier for bovine plexiform bone.

Pelvic intra-arterial mitomycin C infusion in previously treated patients with metastatic, unresectable, pelvic colorectal cancer and angiographic determination of tumor vascularity

Thirty patients with unresectable pelvic tumors from recurrent or metastatic colorectal cancer, after failing all conventional chemotherapy or radiotherapy, were treated with mitomycin C (MMC) regional intra-arterial (IA) infusion. MMC at a dose of 20 mg/m2 in 100 mL of 5% dextrose in water was infused for a one-hour period through the regional artery (eg, hypogastric, gluteal) approached percutaneously via the femoral artery. This treatment was repeated every four to eight weeks. Of the 26 patients who could be evaluated, three had objective responses, 14 had tumor stabilization, and nine had no response. Median survival time for the responders (Rs) was 435 days, for stabilized patients (Ss) was 263 days, and for nonresponders (NRs) was 195 days, giving an overall survival time of 239 days. Fourteen patients (2 Rs, 8 Ss, and 4 NRs) had good relief of pain after the IA infusion. Thirty-three pelvic arteriograms (including three patients who had never received IA infusion) showed an avascular tumor of grade 0 in eight patients, a hypovascular tumor of grades 1 and 2 in 16 patients, and a vascular tumor of grade 3 in nine patients. Neovasculatures were mainly derived from the hypogastric artery or its branches (eg, gluteal, obturator, and pudendal artery), and occasionally were found to be derived from the superior hemorrhoidal, lumbar, and sacral arteries. The major side effect after the pelvic infusion was necrotizing cellulitis occurring in the buttock. Myelosuppression was manageable and other toxic effects were mild. Metastatic colorectal cancer occurring in the pelvis was basically a vascular-deficient tumor. Regional IA MMC infusion given intermittently was found effective in palliating pelvic pain and improving the quality of these patients' lives.

A sensitive liquid chromatographic procedure for the analysis of camphor in equine urine and plasma

A sensitive method was required to analyze low levels of camphor in equine urine and plasma. Camphorated oil (20% w/w camphor) was administered topically (6 g) and intratracheally (1 g) to standardbred mares. The drug was extracted from urine and plasma by diethyl ether and analyzed as its 2,4-dinitrophenylhydrazone derivative by reverse phase HPLC with UV detection. The UV detector was set at 368.5 nm and the samples were eluted from the C18 column by 82% acetonitrile in water. The detection limit achieved was about 10 ng/mL urine and about 20 ng/mL plasma. After topical administration, only trace amounts of camphor were found in urine, whereas in plasma detectable quantities appeared from 20 min to 12 hrs post-administration. After intratracheal administration, camphor appeared immediately in both urine and plasma and occurred in higher concentrations. The concentrations of camphor ranged from 11.4 to 21.6 ng/mL urine during 2 hrs post-administration and from 46.7 to 1650 ng/mL plasma during 1 hr. All traces of camphor disappeared from urine after 4 hrs and from plasma after 12 hrs. A GC/MS analysis of hydrolyzed urine extracts indicated two metabolites of camphor: trans-isoketopinic acid and an as yet uncharacterized hydroxycamphor.

Tourniquet infusion versus hyperthermic perfusion

The tourniquet infusion method was compared with hyperthermic perfusion in canine limbs by using Adriamycin, actinomycin-D, and melphalan. Tourniquet infusion provided comparable tissue levels with Adriamycin and significantly higher levels with actinomycin-D and melphalan in the treated extremity than hyperthermic perfusion with the same drugs and dosages. Higher systemic leak was observed, more so with melphalan, with the tourniquet infusion method. Tourniquet infusion has caused complete regression of four malignant tumors involving extremities (one malignant melanoma, two Kaposi's sarcomas, one squamous cell carcinoma) and partial greater than 50% regression of nine tumors (three malignant melanomas, three squamous cell carcinomas, one malignant schwannoma, one malignant fibrohistiocytoma, one liposarcoma) followed by excision of residual tumor. Five patients with extremity sarcomas precluding adequate surgical margins were treated preoperatively with the this method. Longer follow-up is needed, as is a larger number of patients for a valid comparison of tourniquet infusion with hyperthermic perfusion.

Combination chemotherapy (CYVADIC) in metastatic soft tissue sarcomas

Forty-one patients with metastatic sarcoma were treated with Adriamycin, 50 mg/m2 i.v. on day 1, Cyclophosphamide, 500 mg/m2 i.v. on day 1, Vincristine, 1 mg/m2 i.v. on days 1 and 5, and Dacarbazine (DTIC), 250 mg/m2 i.v. on days 1-5 (CYVADIC). Three patients had a complete regression, while 8 patients had a partial regression of greater than 50%. The combined response rate was 27%. Eight additional patients showed stabilization of disease for an average of 5 months while 22 patients progressed on CYVADIC. Ultimately, 7 patients with initial tumor regression had progression of their disease. Four patients with partial regression had excision of the regressed nodules of tumor and continued on chemotherapy for a year. They remain alive at a median follow-up of 24.5 months, suggesting that removal of partially regressed nodules may improve results.

Phase II study--intra-arterial BCNU therapy for metastatic brain tumors

Thirty-one patients with metastatic brain tumors (MBT) from lung cancer and ten patients with MBT from melanoma received BCNU, 100 mg/m2, every four weeks by intracarotid and/or vertebral artery infusion into each involved site. Twenty-five patients with lung cancer and all melanoma patients are currently evaluable. Twelve patients with lung cancer had complete and partial responses lasting from 1 to 14 months. Four of them with the histologic diagnosis of small cell carcinoma, one with large cell carcinoma and one with squamous cell carcinoma showed complete response. None of the patients with melanoma MBT experienced any response. All of the patients had periorbital erythralgia and/or occipital pain during the infusion. Four patients manifested mild focal seizures during the infusion or 6 to 24 hours after the treatment. Transient confusion with disorientation was observed in two patients 4 and 24 hours, respectively, after a BCNU infusion. Two patients developed reversible thrombocytopenia after the fifth course of the IA chemotherapy. Median survival of patients with MBT from lung carcinoma was 4 months, with two of them still alive at 10 and 14 months, respectively. Only one patients of the 25 with lung carcinoma died from MBT. Failure to control the primary disease resulted in the deaths of a vast majority of the patients.

Regional chemotherapy via the pulmonary artery for pulmonary metastases

Regional chemotherapy with Adriamycin via the pulmonary artery produces significantly higher tissue levels in the infused canine lobe than systemic administration. Seven patients with soft tissue sarcomas who had received the maximum dose of Adriamycin and had shown metastatic tumor recurrence to the lungs, received small doses of 10 to 20 mg of Adriamycin in the lobar arteries supplying areas with tumor via a Swan-Ganz catheter, temporarily occluding with its inflated balloon the infused artery. One partial objective regression was noted. A total of 56 injections of Adriamycin was given through individual lobar arteries in the seven patients. This preliminary experience indicates the feasibility and relative safety of the use of the pulmonary artery for regional chemotherapy of pulmonary malignant tumors and suggests further cautious exploration of this method.

An analysis of percutaneous transhepatic cholangiograms

Percutaneous transhepatic cholangiograms (PTCs) of 74 cancer cases with obstruction of the biliary tree were reviewed and evaluated as to the location, degree of obstruction, and location of the obstructing elements ie, intraluminal polypoid intrusions and diffuse infiltration. Special attention was given to the diagnostic value of the sign of an extrinsic compressing mass, a disputed entity. Every one of the above parameters, including extrinsic mass compression effect, proved to be worthwhile in arriving at a reasonable diagnosis. A system for coding obstructions to give maximum information in minimum space for large series of cases and to improve diagnostic accuracy of PTC in the single case is presented.

Intra-arterial BCNU therapy in the treatment of metastatic brain tumor from lung carcinoma: a preliminary report

Nine patients with intracerebral metastasis from lung carcinoma were treated with intracarotid and intravertebral artery infusion of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). Four of these patients considered definite responders showed unequivocal clinical improvement and definite decreases in the size of tumors evaluated by neurologic examination, computerized tomographic (CT) scan and radionuclide brain scan (RBS). One patient's clinical condition stabilized with doubtful improvement of diagnostic tests (probable responder). The remaining four patients had further unfavorable progression of the clinical and scan findings and were clearly nonresponders. Complications were transient and included: local pain in the eye, orbit, and occipital-nuchal area during infusion in 7 patients, focal seizure in 3 patients, mild confusion with disorientation in 2 patients, and nausea in 2 patients. Our findings suggest that intra-arterial BCNU therapy may be effective and may be used as an adjuvant to surgery and/or radiotherapy for the treatment of metastatic brain tumor from lung carcinoma.

Percutaneous transhepatic cholangiography with a thin needle. Experience with 25 cases

Percutaneous transhepatic cholangiography with a thin needle was successfully employed in 23 of 25 patients with jaundice. A 100% success rate was seen with dilated bile ducts. Not a single complication was observed in our series. With our limited series, it can be assumed that proximal obstruction is more likely to mean neoplasm of either the gallbladder or bile duct, whereas distal obstruction with visualization of dilated cystic duct means either neoplasm of the head of pancreas or metastatic carcinoma.

Leiomyosarcomas of the extremities: angiography as a diagnostic aid

Thirteen cases of leiomyosarcomas of the extremities are reported. Most of the cases were operated on without information concerning benignancy or malignancy. Plain radiographs showed amorphous calcification in two cases. Three cases had angiographic study and all revealed malignant neovascularity. In no literature that we reviewed was angiography mentioned in the cases of leiomyosarcomas of the extremities. Venography alone has been done in many reported cases. The leiomyosarcoma of the extremities looks often benign but is notorious for local recurrences and distant metastases.

Fermenting yeasts associated with softening and gas-pocket formation in olives

Fermenting, pectolytic yeasts were isolated from a massive commercial outbreak of softening and gas-pocket formation in olives that had been stored in acidified, low-salt brines in an attempt to reduce the problem of brine disposal. The suspected yeasts represented three different species: Saccharomyces oleaginosus, S. kluyveri, and Hansenula anomala var. anomala. All pectolytic cultures produced pectin esterase and polygalacturonase but no pectic acid trans-eliminase when grown in nutrient glucose broth. Crude, cell-free dialyzed enzyme preparations measured viscosimetrically exhibited optimal activity on sodium polygalacturonate at pH 6.0 and 45 C and were active in the range of pH 4.0 to 9.0 and 10 to 60 C.