Systemic leakage and side effects of tumor necrosis factor alpha administered via isolated limb perfusion can be manipulated by flow rate adjustment.

BACKGROUND: The tolerated systemic dose of recombinant tumor necrosis factor alpha (rTNF-alpha) is very limited, since its administration leads to a severe septic shock-like condition. Its implementation in isolated limb perfusion (ILP) for metastatic melanoma or advanced soft-tissue sarcoma confined to the limb facilitates doses of rTNF-alpha 10 times higher than the systemic tolerated dose. However, with the traditional high flow rate used in ILP, systemic leakage and side effects are not eliminated. OBJECTIVE: To determine if a lower perfusion flow rate would reduce leakage and consequently toxic effects. METHODS: Isolated limb perfusion was performed for melanoma and soft-tissue sarcoma confined to the limb using a flow rate of 869 +/- 122 mL/min in nine patients (group 1) and a lower rate of 286 +/- 62 mL/min in six patients (group 2). RESULTS: The systemic leakage rate was 12.5% +/- 2.9% in group 1, compared with 2.3% +/- 1.0% in group 2 (P = .003). Peak TNF-alpha levels were 29,000 +/- 2700 pg/mL in group 1, higher than 1580 +/- 1355 pg/mL in group 2 (P = .02). The tachycardia, hypotension, increased cardiac output, decreased systemic vascular resistance, bilirubinemia, elevation of liver enzyme levels, hypocholestrolemia, thrombocytopenia, and prolongation of prothrombin and partial thromboplastin times all observed in group 1 were significantly attenuated or eliminated in group 2. The limb PO2, PCO2, pH, and viability remained similar in both groups. Also, the tumor response rate remained high and was unaffected by the decrease in flow rate. CONCLUSIONS: Decreasing perfusion flow rate during ILP results in diminished leakage of TNF-alpha. Consequently, the systemic hemodynamic, metabolic, and hematologic toxic effects are virtually abolished.

Severe thyrotoxicosis caused by an ectopic intrathoracic goiter.

The case of a 71-year-old woman with severe thyrotoxicosis due to an ectopic multinodular intrathoracic goiter is described. Previously reported cases with intrathoracic ectopic thyroid tissue were either nontoxic, or, if thyrotoxic, were a direct continuation of the tissue of the normally located gland. This mass was proved to be of thyroid origin using Tc-99m sodium pertechnetate scanning.

The use of technetium in evaluation of the male accessory glands activity.

This study was performed with the purpose to elucidate the possibility of using Technetium 99m (Tc) as a marker for the evaluation of male sex glandular activity of the rat. Tc was injected into the femoral vein of the rat and its cpm was counted. The studies have shown that 22 hours after injection of Tc the material was accumulated in the glands in much higher values than its activity in the blood (which was only 1% of its zero time activity). In the rat, the dorsolateral coagulating gland has the highest capacity of accumulating Tc. Studies on castrated rats, or rats treated with testosterone enanthate, revealed that the activity of the cells in the glands and the volume of the excretion play an important role in the evaluation of the results. Thus, the use of Tc 99m in evaluating male accessory glands activity is a new interesting approach in the study of the physiology of the male sexual glands.