Results of living-related kidney transplantation in Puerto Rico.

A total of 103 kidney transplantations from living-related donors were performed in the Puerto Rico Kidney Transplant Program between January 1977 and June 1984. The majority of these patients were male, 76% were between 21 and 50 years of age, 33% were indigent, and 38% were either black or of mixed race. Rigid exclusion criteria were established in the selection of kidney donors. All donor operations were at least 2-antigen-compatible. Surgical technique and posttransplant management were standard, except that in 1980 the immunosuppressive policy was changed as follows: posttransplant prednisone was very rapidly tapered to 20 mg/day at two weeks after transplantation and antilymphocyte globulin was used to treat all rejections. The overall 3-year patient survival for the 7 1/2 years is 91.6%, but after 1980 it increased to 98% perhaps a reflection of the changes in immunosuppressive policy. Eight of ten deaths were due to sepsis, most of them related to rejection treatment. The 3-year kidney survival was 77%. All kidney losses were due to rejection. A low incidence of urological complications is reported. There were no technical losses. A relatively low incidence of cancer is reported. Cutaneous mycosis is highly prevalent in our patients, but systemic fungi are virtually absent.

Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report.

This prospective evaluation of 5-FU and methyl-CCNU administered in combination to patients with curative surgery for histologically proved colorectal adenocarcinoma is based upon 645 patients randomized between August 1973 and July 1979. Beyond the requirement that the resection be clinically and microscopically complete, patients were not stratified prior to random treatment assignment to surgery alone or surgery followed by adjuvant chemotherapy. Drug therapy consisted of discrete 5-day courses administered at 7-week intervals, start to start. Toxic reactions were reported in association with 40% of courses. In 10% of patients with hematologic toxicity, the reactions were sufficiently severe to require the suspension or discontinuation of treatment. Treated patients experienced a slightly more favorable survival than did controls. However, the advantage was seen only in the 216 patients (34% of total) with one to four positive lymph nodes in the resected specimen. Similar proportions of treated and control deaths were attributed to residual or recurrent disease.

Efficacy of prolonged intermittent therapy with combined 5-FU and methyl-CCNU following resection for gastric carcinoma. A Veterans Administration Surgical Oncology, Group report.

This prospective evaluation of 5-fluorouracil (5-FU) and methyl-CCNU administered in combination to patients with surgery for histologically proved gastric adenocarcinoma is based upon 312 patients randomized between August 1974 and May 1980. Patients were stratified into three categories of resectability, (1) complete, (2) proven incomplete, and (3) nonresectable, prior to random treatment assignment to surgery alone or surgery followed by adjuvant chemotherapy. Drug therapy consisted of discrete 5-day courses administered at 7-week intervals. Toxic reactions were reported in association with 42% of the courses. Treatment was suspended or discontinued in 6% of the courses because of hematologic toxicity. Treated patients with curative resections experienced a more favorable survival than did controls, but the early advantage was lost by the end of the second follow-up year. However, no statistically significant improvements in survival or reductions in risks of recurrence were observed. Similar proportions of treated and control deaths were attributable to residual or recurrent disease.