The clinical course and treatment results of patients with postresection locally recurrent lung cancer

Of 1018 patients with lung cancer seen in the division of radiation therapy between 1963 and 1976, forty-six patients (4.5%) presented with postresection local recurrence and no documented distant metastasis. The median time to recurrence was thirteen months. Most patients had central recurrence with hilar or mediastinal lymph node metastasis, parenchymal consolidation, main stem nodule or bronchial stump tumor. There was a propensity for these tumors to remain limited to the site of origin. Death was most often from local/regional disease rather than distant metastasis. In this clinical setting the effectiveness of radiotherapy was observed in terms of palliation and improved survival. Strong determinants to survival were cell type, tumor dose and tumor response. The median survival was eleven months.

Bicarbonate transport by isolated perfused rabbit proximal convoluted tubules

Proximal convoluted tubules were dissected from rabbit kidneys and perfused in vitro in order to investigate the relationship between the reabsorption of fluid and of bicarbonate. Bicarbonate was absorbed when it was initially present in the perfusate. At slow rates of perfusion the mean concentration of total CO2 was 9 mM in collected fluid with 25 mM bicarbonate in the bath. At faster rates of perfusion the mean rate of reabsorption was 13.6 pmol cm-1 tubule length s-1. Absorption of bicarbonate was inhibited to a large but not complete extent by elimination of sodium from the perfusate and bath or potassium from the bath, and by addition of ouabain. It was not inhibited by elimination of the organic solutes from the perfusate nor by elimination of chloride from the perfusate and bath. Considered with previous measurements of fluid absorption these results are consistent with the existence of a linked sodium-for-hydrogen ion exchange mechanism at the luminal border of the tubule cells, but there are other possibilities which are discussed. Additionally, the effect of acetazolamide was investigated. The drug virtually completely inhibited bicarbonate absorption and inhibited fluid absorption by 30-40%.

Immunological and chromosomal studies in a patient with Sézary syndrome

A patient with the small-cell variant of Sézary syndrome was studied before and during treatment with low-dose chlorambucil. He had depressed responses to phytohemagglutinin (PHA) and concanavalin A that returned to normal with clinical improvement. Spontaneously dividing cells were found in the peripheral blood by culturing lymphocytes without PHA for 24 hours. Seventy-two-hour PHA-stimulated lymphocyte cultures revealed predominantly hypodiploid chromosome numbers. Both abnormalities improved during treatment. Lymphocytes that were studied for sister chromatid exchanges had an increased number of exchanges per metaphase. Immunofluorescence studies revealed immunoglobulins and C at the dermoepidermal junction and in the dermal vessel walls. Our findings demonstrate that the depression of mitogen responsiveness that is sometimes seen in Sézary syndrome can be favorably affected by chemotherapy. Likewise, some chromosomal abnormalities may regress during successful therapy. These findings may provide a way of measuring the response to therapy.

Effect of dose, time, and ascorbate on iron excretion after subcutaneous desferrioxamine

The effect of 12 and 24 h continuous subcutaneous infusion of desferrioxamine (D.F.) on urinary iron excretion was compared in 13 patients with beta-thalassaemia major and 1 with congenital sideroblastic anaemia, all of whom were receiving regular blood-transfusions. 750 mg D.F. given over a 12 h period, gave a mean total (30 h) iron excretion of 17-5 mg, which was not statistically different from the mean iron excretion of 21-5 mg when the same dose was delivered over 24 h. 1500 mg D.F. gave a mean urinary iron excretion of 28-1 mg with a 12 h infusion, which was significantly less than the mean iron excretion of 39-6 mg with 24 h infusion. The 1500 mg dose gave a significant increase in iron excretion compared with the 750 mg dose when given by either 12 h or 24 h infusion. 7 of 8 patients, given D.F. over a 12 h period, had increased iron excretion when the dose was increased from 750 to 2000 mg. When the dose was increased to 4000 mg, however, the effect on iron excretion was variable. On the other hand, ascorbic-acid therapy was invariably associated with increased iron excretion after subcutaneous D.F. In twelve studies at different dose levels of D.F., ascorbate therapy was associated with increased iron excretion ranging from 24 to 245%. It is concluded that in most patients with transfusional iron overload subcutaneous D.F over a 12 h period, at a dose ranging from 2 to 4 g daily with ascorbic-acid saturation, is at present the most satisfactory method of removing excess iron.

Subcutaneous infusion and intramuscular injection of desferrioxamine in patients with transfusional iron overload

The effects of intramuscular injection and subcutaneous infusion of desferrioxamine (D.F.) on urinary iron excretion were compared in eleven patients with thalassaemia major and one with congenital sideroblastic anaemia who were being maintained on regular blood-transfusions. Total (48-hour) urinary iron excretion ranged from 3-3 to 40-3 mg (mean 16-3 mg) in nine patients who received 750 mg D.F. intramuscularly before transfusion and from 3-9 to 32-3 mg (mean 11-9 mg) in ten patients who received D.F. by the same route after transfusion. In all 9 patients studied before transfusion, continuous subcutaneous infusion of 750 mg D.F. over 24 hours increased iron excretion by 61-5 to 135-8% (mean 101+/-25-4 S.D.%) compared with intramuscular injection of a similar dose. In the 10 patients studied after transfusion, the iron excretion produced by continuous subcutaneous infusion was from 18-9 to 213% (mean 128+/-74-3%) more than that produced by a single intramuscular injection of D.F. When the subcutaneous dose over 24 hours was increased to 1500 mg in six patients, 48-hour iron excretion ranged from 29-2 to 81-2 mg (mean 52-4 mg) and was increased by 80-2--794% (mean 429%) compared with the excretion when 750 mg was given by intramuscular injection. It is concluded that continuous subcutaneous infusion of D.F. produces more iron excretion in patients with iron overload than intramuscular injection. Providing a suitable portable pump can be carried by the patients, continuous subcutaneous infusion of desferrioxamine may prove a valuable means of preventing or treating iron overload in anaemic patients maintained on regular transfusions.

Role of monovalent ions in the reabsorption of fluid by isolated perfused proximal renal tubules of the rabbit

Proximal convoluted tubules were dissected from rabbit kidneys and perfused in vitro in order to determine the effect of monovalent ions on fluid absorption and transepithelial voltage. Replacement of sodium in the perfusate and bath by lithium, tetramethyl ammonium or choline caused the rate of fluid absorption and voltage to fall to near zero. Replacement of potassium in the bath by sodium had the identical effect. Replacement of chloride by nitrate or perchlorate had comparatively little effect. The results are consistent with the generally held view that active sodium transport (mediated by a Na- and K- activated adenosine triphosphatase) is the primary process responsible for the absorption of the fluid and the voltage. Replacement of bicarbonate in the perfusate and bath by chloride caused the rate of fluid absorption to decrease by 33%. The possible relation between sodium transport and bicarbonate is discussed.

Organic solutes in fluid absorption by renal proximal convoluted tubules

Proximal convoluted tubules were dissected from rabbit kidneys and perfused with artificial solutions in vitro. The effect of various organic solutes on rate of fluid absorption and transepithelial voltage was tested by removing solutes from or adding them to perfusate and/or bath. Omission of albumin from the bath caused rate of fluid absorption to descrease 33% without any change in voltage. Omission of glucose, lactate, alanine, and citrate from the bath had no effect. In contrast, when they were removed from perfusate, rate of fluid absorption fell by 45-75% (depending on whether they were replaced by NaCl or mannitol and NaCl), and voltage (normally negative in lymen) decreased to near zero. Adding glucose or alanine individually to perfusate caused a small increase in rate of fluid absorption and a relatively large increase in voltage. alpha-Methyl-D-glucoside and cycloleucine (which are transported but not metabolized) had effects similar to glucose and alanine, except that voltage changes were not as great. Phlorizin (10(-5) M in perfusate) had the same effect as removing glucose from perfusate. When glucose and alanine were added to perfusate, epithelial cell swelled significantly. Lactate and citrate also caused rate of fluid absorption to increase when they were added to perfusate, but they did not affect transepithelial voltage nor did they cause cells to swell significantly. Possible mechanisms of these effects and the role of organic solutes in fluid absorption by proximal convoluted tubules are discussed.

Lymphangitic carcinomatosis: lung scan abnormalities

Lymphangitic carcinomatosis of the lung is a late and fatal manifestation of cancer. The diagnosis is seldom made ante mortem. Four patients with breast cancer had autopsy-proven lymphangitic metastases of the lung. Of these patients, two had normal chest x-rays and three had normal ventilation lung scans. The perfusion lung scans of all four showed irregular peripheral perfusion defects. Autopsies showed permeation of the lymphatics by tumor and tumor emboli in small arteries and arterioles.

Pseudomyxoma peritonei-nonoperative management and biochemical findings. A case report

The treatment of choice for pseudomyxoma peritoneai is surgical resection and removal of free mucus. Massive intra-abdominal reaccumulation of viscous mucus has usually been managed by repeat celiotomies. We characterized the mucus of one patient and showed large amounts of immunoglobulins and carcinoembryonic antigens. Intraperitoneal instillation of 5% dextrose and water made the mucus less viscous and easy to remove by paracentesis. The need for repeat celiotomies was obviated.

Prostate carcinoma: measures to improve therapeutic response and prevent complications

Between 1965 and 1973, 80 patients with prostatic carcinoma were treated with definitive supervoltage irradiation; 35 patients received adjuvant estrogens. A favorable tumor response was uniformly observed in patients with less advanced tumors who received a minimum of 6,000 rads tumor dose and adjuvant estrogens. Radiation complications were frequent and severe in patients with locally advanced tumors who had antecedent lower urinary tract surgery and received a minimum of 7,000 rads tumor dose. Complications were less frequent in patients who received adjuvant estrogens, and complications were uncommon and mild in patients who received less than 7,000 rads.

Postresection irradiation for primary lung cancer

A total of 219 patients with proved lung cancer were studied to determine whether postresection irradiation improves survival. The results showed that postresection irradiation improved survival among patients with hilar and mediastinal lymph-node metastases of all histological types but did not improve survival among patients without node metastases. The authors recommend that patients with resectable lung cancer involving the hilar and mediastinal lymph nodes be treated by a combination of surgery and radiotherapy.

Measures to minimize small intestine injury in the irradiated pelvis

Small intestine injury causes long-term suffering and high mortality. Five of 187of our patients had developed serious small intestine injury. Four patients had corrective surgery. Three patients died. All were women. Subsequently, all patients who received definitive pelvic irradiation had small intestine roentgenograms to determine itslocation and mobility. Female patients, thin patients, and elderly patients had larger amounts of small intestine in the whole pelvis, a deeper cul de sac, and a greater incidence of relatively immobile small intestine. Patients with relativelyimmobile small intestine in the treatment field may be predisposed to injury. There wasno relationship of the incidence of relatively immobile small intestine to prior pelvicsurgery. We used the findings from the small intestine roentgenograms to modify indiviually the radiotherapy regimen so as to minimize the risk for small intestine injury. Patients were placed in the prone position to displace the small intestineout of the treatment fields used for booster dose irradiation. The treatment field wasmodified to exclude the small intestine. The total tumor dose delivered was determinedby expectations for curve vs. complications. To date, none of the patients in this study group has developed small intestine injury. Cadaver studies showed the feasibility of elective shortening of the pelvic cul de sac. The small intestine can be displacedaway from the bladder, prostate, or cervix.