Prediction of fetal macrosomia with ultrasound parameters and maternal glycemic controls in gestational diabetes mellitus.

PURPOSE OF INVESTIGATION: Evaluation of ultrasound measurements of fetal adipose subcutaneous tissue (ASCT), abdominal circumference (AC), liver length (LL), and amniotic fluid index (AFI) in prediction of fetal macrosomia (FM) and gestational diabetes mellitus (GDM). MATERIALS AND METHODS: In a prospective clinical trial, 280 pregnant women underwent 100 g oral glucose tolerance test (oGTT) at 28th week of gestation (wg) and measurements ofAC, LL, AFI, and ASCT at 32nd, 34th, 36th, and 38th wg. RESULTS: For GDM, the best sensitivity was achieved by ACST at 32nd and 34th wg, the best specificity by LL at 32nd wg (90.6%), the best area under the curve (AUC) by LL at 34th wg (0.944). For FM the best sensitivity was achieved by AC at 32th, 34th, 36th, and 38th wg and by ASCT at 34th wg (94.2%), and the best AUC at 38th wg for AC (0.974). CONCLUSION: Ultrasound parameters of glycemic control were good predictors of FM and GDM.

[Appendicitis in puerperium--case report].

Acute appendicitis in puerperium is often diagnosed too late, because clinical signs can be unrelaible. Abdominal wall rigidity is rarely noticed in puerpeium because of weak abdominal wall muscles, laboratory parameters are not enough relaible and atip cal appendix presentation makes dificulties in diagnosis. Knowing clinical signs and symptoms of appendicitis, possible complications and their early detection, make a chanse for a good surgical outcome. Measuring of axillar and rectal temperature can take confusion in, and prolong time until surgical treatment. Leucocytosis in puerperium is not valid for diagnosis. We report a case of patient in puerperium with high laboratory infection parameters. Diagnosis of appendicitis is made based on clinical signs and symptoms, that is proved intraoperatively and histologicaly. Appendectomy without perforation carries less risks for mother and fetus.

Combined treatment of 4'-epi-doxorubicin and radiation on hamster lung cells.

The purpose of this study was to test the type and the degree of cytotoxic effects of epirubicin and radiation in combined treatment on Chinese hamster lung cells in vitro. Experiments were performed with proliferating tissue culture cells. Cell kill was determined by colony-forming ability. The maximum killing effects were obtained when simultaneous action of drug treatment and irradiation occurred. Their interaction was synergistic. Synergism depended on time of drug incubation (epirubicin present for 1 h). Slight antagonism was noted after prolonged drug action (24 h).

Histopathologic and histoenzymatic observations in carcinomas treated with human leukocyte interferon.

In this study histologic and histochemical examinations were performed on the bioptic material of 30 cases of head and neck tumors and 34 cases of uterocervical carcinomas after treatment with human leukocyte interferon (HLI). Particular attention was paid to the interaction between stromal and neoplastic cells as a possible host response to the treatment with interferon. In addition to tumor biopsies, regional lymph nodes were also examined microscopically. Stromal cells (macrophages, T and B lymphocytes, and granulocytes) were detected by enzyme-histochemical methods. Histologic and histochemical criteria for classification of tumor biopsies into five groups included the frequency, the cellular composition of peritumoral stroma, the grade of macrophage infiltration into the tumor (expressed quantitatively), and cytologic changes, followed by the regression of tumor. The overall appraisal of patients with cervical carcinoma based on histopathologic and chemical criteria showed the positive effect of HLI therapy in 70% of the cases; observations of head and neck carcinoma treated with HLI showed positive effects in 82% of the cases.

Influence of splenectomy upon immunologic reactivity of patients with Hodgkin's disease.

Since most patients with Hodgkin's disease benefit from splenectomy, a study was designed to explore whether these beneficial effects could be attributed to the recovery of patients' immunologic reactivity. Using a series of ordinary skin test (PPD-tuberculine, Varidase and Candidin) determination of absolute T and B lymphocyte counts in peripheral blood and their mitogenic responsiveness, assessment of immunologic reactivity was performed in 28 Hodgkin's disease patients, prior to and 14 days after splenectomy. The results showed that overall immunologic reactivity of these patients was suppressed as judged by low absolute lymphocyte counts (1747.2 +/- 171.9), lower counts of T (592.0 +/- 92.1) and B cells (295.9 +/- 40.5) and their poor capacity to respond to phytohemagglutinin (PHA) (20342.6 +/- 3662.8 cpm), although the reactivity towards skin test antigens seemed to be well preserved. After splenectomy the reactivity improved, absolute lymphocyte counts raised to 2654.9 +/- 468.8 and were parallelled by an increase in T (936.7 +/- 138.0) and B cell counts (402.2 +/- 81.2). PHA reactivity recovered as well (26965.5 +/- 4035.6 cpm), however, its remained lower than in control cultures. Furthermore, the immunocompetence of patients' spleens was assessed. The possible influence of some suppressive mechanisms such as serum-blocking factor and prostaglandins is discussed.

Application of human leucocyte interferon in patients with urinary bladder papillomatosis, breast cancer, and melanoma.

Eight patients with malignant papillomaosis of the bladder, four with breast cancer, and two with malignant melanoma, all of whom had a poor prognosis, were treated with injection of crude human leucocyte interferon (HLI) into the tumour or the adjacent tissue and in some cases with intramuscular HLI injection also. All tumours showed complete or partial regression after treatment for up to 6 months. One patient with breast cancer died from distant metastases; all other patients in the trial were recurrence-free after 3--30 months of follow-up.

Application of human leucocyte interferon in patients with carcinoma of the uterine cervix.

15 patients with invasive squamous-cell carcinoma of the uterine cervix were treated with crude human leucocyte interferon (HLI) for 3 weeks before surgical removal of the tumour. 9 patients were given HLI topically and intramuscularly and 6 topically only. In 3 patients the surgical material was free from tumour cells, in 3 it showed a lower grade of carcinoma, and in 9 the findings remained unchanged. In only 1 patient the tumour metastasised to the lymph nodes. Typically a tumour regressed to about a third of its original size. There was a sharp distinction between the tumour mass and the healthy tissue manifested in the formation of a fibrous wall. On the basis of the scores--i.e., stromal response, relation between tumour-cell and macrophage activity and reactivity, and reactivity of the original lymph nodes--the overall appraisal of the response caused by HLI therapy was as follows: in 6 patients excellent, in 5 very good, in 1 moderate, in 2 poor, and in 1 no response. It is suggested that HLI is suitable for administration both before and after surgery in patients with cervical cancer of grade I or II. If stroma cannot be induced to respond within 21 days of treatment, HLI application should be discontinued.

Influence of human leukocyte interferon on squamous cell carcinoma of uterine cervix: clinical, histological, and histochemical observations. III. Communication.

Fifteen patients with invasive squamous cell carcinoma of the uterine cervix were treated with human leukocyte interferon (HLI). HLI was applied topically and i.m. to nine patients, and only topically to six. After therapy, surgical material was free from tumor cells in three patients, tumor cells were identified as invasive carcinoma in one patient and as CA in situ in two patients. Findings remained unchanged in nine patients. Tumor metastases in the lymph nodes were found in only one patient. The patients' overall response to therapy was assessed on the basis of stromal response, relation of tumor cells and macrophage activity, and the reactivity of lymph nodes.

Human leukocyte interferon in therapy of patients with urinary bladder papillomatosis, breast cancer, and melanoma.

The authors report the result of local and parenteral applications of human leukocyte crude interferon in the therapy of eight patients with urinary bladder papillomatosis, four patients with breast cancer, and two patients with melanoma. The doses and effects of treatment are presented in tables. Clinical application of human leukocyte interferon (HLI) to these three types of malignant tumors has yielded encouraging results. The authors believe that investigations on HLI applications to some malignant tumors should continue because the results obtained indicate that interferon possesses not only an antiviral but also an antitumor activity.

Bleomycin infusions combined with radiotherapy in the treatment of inoperable esophageal cancer.

A combination of bleomycin, in a 12 h infusion, and radiotherapy was applied in 25 patients with untreated inoperable esophageal cancer. Bleomycin was administered 15 mg/m2 twice weekly, concurrently with irradiation (total dose 3600-4000 rad). Such combined treatment produced 3 complete remissions of the esophageal tumor, 10 partial remissions (response rate 52%--13/25), 3 stable disease cases, while in 9 cases the disease progressed in spite of therapy. The median duration of remissions was 8.7 months in complete responders, 6.0 months in partial responders, and 3.0 months in stable disease cases. Similarly, median survival was the longest in complete remission cases (10.3 months). Patients who did not respond to therapy had a median survival of only 2.8 months. Adverse treatment reactions were of a milder character, except retrosternal pain and burning caused by irradiation mucositis, which occurred in 80% of patients. The trial showed that the combination of bleomycin applied in the form of 12 h infusion and irradiation can produce remissions in 50% of inoperable esophageal cancer cases, i.e., a rate of remission which is similar to that achieved by irradiation and bleomycin applied in the form of rapid (push) i.v. injections.

Iron, copper, and zinc liver tissue levels in patients with malignant lymphomas.

Levels of iron, copper, and zinc in liver tissue and of copper in serum were studied in 53 cases of untreated malignant lymphoma (14 cases of Hodgkin's disease and 17 of lymphocytic and 22 of histiocytic lymphoma). The values were compared with the levels of these metals in the liver tissue of 23 healthy persons. Liver tissue was obtained by means of percutaneous biopsy examination with a Menghini needle. Part of the samples was used for histologic examination, and the remainder for metal level determination. Atomic absorption spectrophotometry was used in determining metal levels in dry liver tissue and in sera. In all malignant lymphoma patients, a significantly higher serum copper level was established (P < 0.05). A lower iron level in liver tissue was only found in those patients with lymphocytic lymphomas without a lymphomatous process in the liver (P < 0.05), while lymphomatous hepatic infiltration was associated with a higher iron level and lower copper level (P < 9.05). Significant changes in liver zinc levels were only proved by higher levels of this metal in patients with histiocytic lymphoma and lymphomatous hepatic infiltration (P < 0.05). The only redistribution of copper between the serum and liver tissue was found in those patients with lymphocytic lymphomas and lymphomatous hepatic infiltration.

Combination of bleomycin and adriamycin with and without radiation on the treatment of inoperable esophageal cancer. A randomized study.

In a prospective randomized study, 31 patients with inoperable esophageal cancer were treated with a combination of bleomycin and adriamycin, and with a combination of these cytostatics and radiation. Evaluation of treatment results showed 3 partial remissions and 2 stable-disease cases in the group of 16 patients treated by cytostatic drugs alone; in all other cases, the disease progressed. The response rate achieved in this group was 19%. In the group including 15 patients who were irradiated with a dose of 3600--4000 rad and received simultaneously the same cytostatics with a somewhat lower dose of adriamycin, there were 3 complete remissions, 6 partial remissions, and 4 stable-disease cases, while in 2 cases the disease progressed. The response rate was 60%, which was statistically significant (P less than 0.025) when compared with the results achieved by the group receiving the bleomycin adriamycin combination. The average duration of remissions in the complete-response cases was 11 months, and in the partial-response cases, 5.2 months with combined treatment, and 4.2 months with combination chemotherapy. The toxic side-effects were tolerable for the patients, albeit more intensive with the combined-treatment modality. Four esophagobronchial fistulas (four disease progressions) and one rupture of the aorta were noted during treatment. This study has shown the advantages of chemoradiotherapeutic treatment of inoperable esophageal cancer.