Nonabsorbable radioactive material in the treatment of carcinomas by local injections.

Nonabsorbable radioactive material was used in treating malignant lesions by local injection. One hundred thirty-five Lewis Wistar rats were inoculated subcutaneously with tumor cells. After 7 days, the rats grew tumors of approximately 1 X 1 X 1 cm at the injection site. The rats then were divided into two groups; 50% were kept as a control group while the other 50% received single injections of 1 mCi yttrium 90 (90Y) microspheres directly into the center of the tumor. This study shows a significant reduction of the tumor growth rate in treated animals. Tumor sizes after 4 days averaged 1.31 ml in the treated rats and 9.74 ml in the control group. Excluding animals that had complete regression of the tumor, treated rats lived an average of 30.8 days from the day of treatment compared with the control rats, which lived an average of 17.4 days. Pathology examinations showed no effects from injected radioactive materials in the liver, bone marrow or the kidney. Examination of the injected area after 6 months showed that microspheres remained locally and that the tumor was replaced with collagen tissue.

Mass screening for colorectal cancer--the Philadelphia experience.

On May 18, 1985, the Philadelphia Division of the American Cancer Society and WCAU-TV entered into a jointly-sponsored colorectal health day to do mass screening throughout the greater Philadelphia area. This was preceded by a week-long series of television awareness programs, and an organization based on having individual hospital coordinators for those hospitals participating. A total of 46 hospitals in Pennsylvania alone participated in this project, and over 16,000 people were screened in a single day. 410 patients had positive stools for occult blood on site, and 359 were positive on take-home 3-packs. Rectal pathology was diagnosed initially in 502 patients. 13 colorectal cancers and 38 polyps have been diagnosed directly as a result of this screen. Total cost to the Cancer Society was $13,300, meaning each diagnosed cancer cost $1,023 and each cancer or polyp cost $266 in actual funds expended for the screen. This overwhelming response by the public to such a mass screening effort indicates the potential for such programs for colorectal cancer, and the techniques employed in planning, implementing, and following up on data retrieval are discussed. This mass screening effort should serve as a model for future projects, and emphasize the importance not only of interrelationships with the media, but also liaison efforts with a network of area hospitals and individual hospital coordinators.

Management of gallbladder perforation by percutaneous cholecystostomy.

Percutaneous cholecystostomy was employed successfully as an alternative to cholecystectomy for the treatment of acute cholecystitis with perforation in an elderly woman. The procedure, performed portably in the cardiac care unit, was selected because progressive cardiac and renal decompensation made the patient an extremely poor surgical risk.

Adsorption of plasma from tumor-bearing hosts over protein A--containing nonviable Staphylococcus aureus Cowan I: possible mechanism of antitumor reactions.

Adsorption of autologous plasma over nonviable Staphylococcus aureus Cowan I (SAC) followed by reinfusion of the plasma causes regression of (a) chemically induced rat mammary adenocarcinomas (MA), and (b) canine transmissible venereal tumors (TVT) and spontaneously occurring dog tumors. Animal data are more impressive than that from trials in humans. Nine of 41 patients receiving perfusions of adsorbed plasma showed some partial objective response. Eight of these nine patients received multiple perfusions over a period of time. Twenty-one of 41 patients showed subjective responses. Adsorption of autologous plasma over non-protein A--containing S. aureus Wood 46 caused regression of MA. Adsorption of normal rat plasma with SAC, and infusion of this adsorbed plasma into mammary tumor--bearing rats, caused regression of MA. Intravenous infusion of purified protein A alone caused regression of both rat MA and canine TVT. Superimposed on this observation is the finding that, during plasma adsorption, bacterial moieties leach from SAC. It is possible that the immunostimulation observed in plasma-perfused hosts is due to the removal of plasma blocking agents on one hand, and introduction of the bacterial agents on the other.

Radical mastectomy: thick vs thin skin flaps.

Radical mastectomy with wide skin excision, ultrathin skin flaps, and autogenous skin grafts was a selected treatment of 45 women with curable breast cancer. A similar group of 45 women were treated by radical mastectomy with less wide skin excision, primary wound closure, and without ultrathin skin flaps. The two patient series were comparable in clinical disease staging, age, axillary node metastases, and frequency of adjunctive chest-wall irradiation. Retrospective chart reviews of the two patient series and statistical analyses indicated that five-and ten-year survival and local recurrences were comparable, but wound complications, hospital stays, and subsequent lymphedema were significantly greater in the series with thinner skin flaps. We recommend that routine use of ultrathin flaps be abandoned for treatment of breast cancer.

Extracorporeal immunoadsorption of plasma from a metastatic colon carcinoma patient by protein A-containing nonviable Staphylococcus aureus: clinical, biochemical, serologic, and histologic evaluation of the patient's response.

A patient with a metastatic colon carcinoma was treated by immunoadsorption (IA) therapy using heat-killed, formalin-stabilized protein A-containing Staphylococcus aureus Cowan I as the immunoadsorbent. The patient experienced both subjective and objective positive clinical response without undue morbidity. The patient's response correlated well with laboratory findings of decreased concentrations of carcinoembryonic antigen (CEA), immunoglobulin G (IgG), immune complexes (IC) and histopathologic data. The patient underwent surgery following 15 IA treatments; she lived for eighteen months, post-treatment.

Specific immunoadsorption of IgG antibody in a patient with chronic lymphocytic leukemia and autoimmune hemolytic anemia. A new form of therapy for the acute critical stage.

Progressive and severe autoimmune hemolytic anemia developed in a patient with chronic lymphocytic leukemia (CLL) despite treatment with chlorambucil, high doses of corticosteroids and attempts to transfuse packed red blood cells. Splenectomy was not performed because of severe coronary artery disease. Direct antiglobulin tests revealed a warm red blood cell autoantibody of IgG-type with anti-e specificity. The patient was treated by extracorporeal immunoadsorption of plasma IgG using a cell separator and protein A as the immunoadsorbent. The patient responded by an increase in the hemoglobin levels and platelet counts after two treatments. Specificity of the procedure was shown by a decrease in the serum IgG and by the demonstration of the same reactivity to ficin-treated reagent red blood cell panel of the eluate from the protein A. Antibody titers of the patient's red blood cell eluate decreased from 1:128 to 1:64 and eventually the anti-e specificity was lost. This is a report of a novel approach to treatment of the acute phase of an autoimmune hemolytic anemia.

Ability of nonviable Staphylococcus aureus Cowan I to bind ionized calcium in vitro and ex vivo in an extracorporeal perfusion system.

During immunoadsorption of plasma immunoglobulin G (IgG) and/or its complexes, using nonviable Staphylococcus aureus Cowan I (SA) as an immunoadsorbent, we observed a consistent drop in plasma calcium during every immunoadsorption procedure. The percentage of decrease in plasma calcium was directly dependent on the amount of SA adsorbent present. Although SA can bind both IgG and calcium, the degree of binding of IgG was greater than that of calcium. Calcium could not be detected in the IgG fraction of the plasma SA, however, could bind an appreciable amount of ionized calcium. Extracorporeal perfusion of plasma over SA greatly decreased plasma calcium in a hypercalcemic patient, indicating the feasibility of this method in such patients. Questions concerning the significance of lowering calcium levels as a concomitant of other effects observed in cancer patients undergoing immunoadsorption therapy using SA evolve from the above and become a new focus for attention.

Extracorporeal immunoadsorption of myeloma IgG and autoimmune antibodies: a clinically feasible modality of treatment.

Using heat-killed, formalin-stabilized Staphylococcus aureus Cowan I suspension, it was possible to remove myeloma IgG and autoimmune anti-red blood cell antibodies from two patients' plasma following an extracorporeal procedure. The arterial anticoagulated blood was processed through a cell separator machine. The separated plasma was pumped through a bacterial filter containing S. aureus suspension. The adsorbed plasma was then reunited with the blood cells and returned to the patient through the vein. S. aureus Cowan I could selectively remove the myeloma IgG and autoimmune anti-red cell antibodies from the patients' plasma prolonging the lives of these two terminal patients. The immunoadsorption procedure appears to be a safe, practical and quick method for the removal of pathological IgG from the patients' plasma.

Efficient removal of abnormal immunoglobulin G from plasma of a multiple myeloma patient. Description of a new method for treatment of the hyperviscosity syndrome.

Patients with multiple myeloma who have complications secondary to hyperviscosity are treated by chemotherapy and/or plasmapheresis. Because the response to chemotherapy is usually delayed, plasmapheresis is required for the removal of larger concentrations of plasma proteins to avoid life-threatening complications. Until now there has been no available means to decrease the abnormal plasma proteins in a selective manner. This report describes a new method for the selective removal of immunoglobulin G from the plasma of a patient suffering from IgG-type multiple myeloma. Results obtained from plasmapheresis and selective immunoadsorption of IgG are compared. It appears that the technique described herein may offer a new, more efficient method for the palliative treatment of diseases associated with elevated concentrations of plasma immunoglobulin G.