Effect of local tumor removal and retained oncolysate on lung metastasis.

We reported earlier that oncolysate retained in the excision wound of a local tumor inhibits growth of remote tumor in the rat. We further studied this effect on pulmonary metastasis. C57BL/6 mice were given B16 melanoma F10 cells subcutaneously into the gluteal area (Day 0) and then intravenously on Day 10. On Day 14, mice were divided into four groups. Group 1 received a sham operation and no further treatment. Tumors were excised in the remaining mice. Group 2 received tumor excision alone. Groups 3 and 4 received injections of freeze-lysed tumor cells (TC) and lysate modified (PTC) with a hapten, L-phenylalanine mustard (PhM), respectively, into excision wounds. On Day 24, metastases were assessed by determining metastatic burden. Average diameters of excised tumors in repeated experiments ranged from 8.7 to 10.9 mm. In repeat experiments, pulmonary metastatic burden increased by as much as 52 to 181% in the tumor excised group (Group 2) in comparison with those receiving sham surgery (Group 1). However, metastatic burden was always reduced in Group 3. An even greater reduction was seen in Group 4. To study the possible involvement of macrophages, the production of prostaglandin-E2 (PGE2) and cytotoxicity of macrophages in these animals were examined. It was found that tumor excision enhanced PGE2 production by macrophages and suppressed their cytotoxicity, while TC inoculation prevented both of these changes. An even greater prevention was observed with PTC inoculation. These results indicate an association among macrophage cytotoxicity, PGE2 production of macrophages, and metastasis. In order to clarify the mechanism for these reactions, we did experiments using adherent splenic macrophages from the four groups of animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of retained components of excised tumor upon coexisting tumor.

Effects of locally treated and retained tumor tissue on the growth of a tumor at another site were investigated using Lewis rats bearing syngeneic fibrosarcoma. When an established tumor had completely regressed upon repeated intratumoral injections of L-phenylalanine mustard (PhM), the growth of secondarily transplanted tumor cells was inhibited. However, early excision of the PhM-injected tumor prevented the development of this effect. To study this effect directly, we excised one of the two established tumors in each thigh, and reinoculated into the excision wound either freeze-lysed 1 X 10(8) tumor cells (TC) or lysate chemically modified with PhM (PTC). We found that TC inoculation into the excision wound in 7 rats inhibited the growth of the remaining tumor and extended survival time (mean +/- SE, 27 +/- 1 days). With inoculation of PTC into the excision wound, the remaining tumor regressed and survival was significantly prolonged (32 +/- 2 days). In contrast, 7 untreated rats, each bearing two tumors, had a mean survival time of 22 +/- 0.1 days. Excision of one tumor (6 rats) did not affect the growth of the remaining tumor or survival time (23 +/- 1 days). We employed PhM to modify the immunogenicity of TC. However, if PhM dissociates from PTC, its cytotoxic effect may directly inhibit growth of the distant tumor. To examine this possibility, we divided 30 rats who had excision of one tumor, into three groups of 10 10.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of pentoxifylline on skin-flap survival.

Experimental studies were performed on rats to demonstrate the effects of pentoxifylline (20 mg/kg per day), administered enterally, on skin-flap viability. This was compared to saline controls and to the alpha-blocking agent (phenoxybenzamine 1 mg/kg per day). Pentoxifylline-treated flaps had a greater than 50 percent increase in tissue survival over controls as compared to 22 percent with phenoxybenzamine. The two drugs in combination appeared to have no additional benefit over the use of pentoxifylline alone. Although a quantitative difference in red-cell flow could not be demonstrated in the experimental flaps utilizing 99mTc pertechnetate-tagged red-cell imaging, the dramatic increase in tissue viability suggests that the rheologic properties of pentoxifylline are important in altering the pathophysiology of skin-flap failure.

Management of acute postoperative thrombosis following carotid endarterectomy.

We reviewed 326 carotid endarterectomies performed from 1960 through 1981 and encountered five instances of acute postoperative thrombosis. Clinical decompensation occurs with the acute onset of severe neurologic deficits, most characteristically dense hemiplegias contralateral to the side that has been operated on. These deficits developed between two and 72 hours postoperatively. Prompt reoperation with thrombectomy and reestablishment of carotid flow within two hours from the onset of the neurologic deficit was performed on four patients with complete resolution of the deficits in three patients. The fourth patient recovered from a severe hemiplegia but retained a slight residual weakness of the hand. The one patient whose condition did not improve underwent thrombectomy more than 24 hours after the onset of her deficit. Time-consuming diagnostic procedures are not warranted as the success of reoperation depends on rapid reestablishment of cerebral flow.

Mechanism for dynamic changes in stenotic severity.

The mechanism responsible for rapid changes in stenotic severity or resistance due to alterations in perfusion pressure and distal resistance is addressed by this study. An in vitro, eccentric arterial stenosis model was created using 15 canine carotid arteries cannulated with silicone plugs containing special pressure-transducing catheters designed to measure pressure directly, within the stenosis. The vessels were perfused at perfusion pressures of 150, 100, and 75 mmHg and at two levels of distal resistance while perfusion pressure, distal pressure, stenotic pressure, and flow were recorded. Orthogonal arteriograms were performed. Stenotic resistance was calculated as (perfusion pressure--distal pressure)/flow. All variables changed significantly (P less than 0.05) with decreases in perfusion pressure. Stenotic resistance always increased (P less than 0.02) as perfusion pressure or distal resistance decreased. These dynamic changes in stenotic resistance occurred at stenotic pressures well above the atmospheric, extraluminal pressure. Arteriographic data demonstrated decreasing stenotic luminal area with decreasing stenotic pressure. These results confirm the assertion that rapid changes in stenotic resistance are related to changes in stenotic luminal area and are not due to extrinsic forces. The principles of the Starling resistor are, therefore, not applicable to dynamic arterial stenoses. This information is immediately relevant to clinical situations in which complaint, severe stenosis results in ischemia.

Hemodynamics of human arterial stenoses.

We assessed the hemodynamic and geometric changes in compliant, human arterial stenoses in response to manipulation of vascular tone, perfusion pressure and distal resistance. Coronary and popliteal arteries were harvested from human cadavers shortly after death. Following incubation for several hours to permit recovery of physiologic energy stores and ion gradients, the vessels were attached to a perfusion apparatus and perfusion pressure (PP), distal pressure (DP), and flow (F) were recorded as perfusion pressure and distal resistance (DR) were varied. The experiments were then repeated in the presence of a vasoconstrictor (100 mM KCl). Orthogonal arteriograms were performed at maximums of vasoconstriction and vasodilation. Stenotic resistance (SR) was calculated as (PP-DP)F. Minimum cross-sectional area was determined by computer assisted analysis of the arteriograms. Stenosed vessels with normal wall segments at the stenosis responded to vasoconstriction with a large stenotic resistance increase (111 +/- 15%; P less than 0.05) and a flow decrease averaging 39.3 +/- 6.2% (P less than 0.05). In addition, decreased perfusion pressure also increased stenotic resistance significantly (P less than 0.05). Stenotic resistance changes were of sufficient magnitude to be both statistically significant and clinically important. These results confirm the existence of dynamic arterial stenoses in humans and further support the assertion that dynamic stenotic severity changes elicited by manipulation of proximal and distal vascular tone and pressure are of sufficient magnitude to create acute ischemia. This information may apply to clinical situations in which compliant stenoses and acute ischemia coexist.

Reduction of dithizone-reactive granules of blood granulocytes in humans and rats bearing tumor.

To confirm scattered reports suggesting a significant reduction of dithizone-reactive granules of granulocytes in neoplastic diseases, the peripheral blood of 20 normal adults, 22 patients with non-malignant diseases, and 39 cancer patients were studied by using a modified dithizone staining method and scoring of the stained granules. The dithizone score in the cancer patients was significantly (p less than 0.001) lower than those in the normal controls or the noncancer patients, with mean scores of 226.0 +/- 6.3 (S.E.), 277.5 +/- 4.7, and 265.9 +/- 5.8, respectively. When compared with the lower limit (score 233) of the 95% confidence interval of a normal score distribution, 24 (61.5%) of the 39 cancer patients showed abnormally low scores, and one (2.4%) of the 42 individuals without cancer exhibited a low score (p less than 0.001). No relationship was found between the score and the patient's age, total serum protein, serum globulin, serum albumin, albumin/globulin ratio, absolute numbers of neutrophils or lymphocytes, or serum zinc level. In the rats transplanted with syngeneic tumor, the dithizone score progressively declined as the tumor increased in size, with a close negative correlation (r = -0.81) in a manner best fitting a power curve. This change was not found in the control rats injected with killed tumor cells. These results indicate that the dithizone-reactive granules of the granulocytes significantly decreased in a tumor-bearing host. The mechanisms are not known and this staining method can not be considered as a diagnostic tool, but this phenomenon appears to have potential usefulness in the systemic effect of solid tumor.

Diverticulitis of the terminal ileum: report of a case and review of the literature.

In the past two decades, several reports have documented inflammatory changes in acquired diverticula of the terminal ileum and their associated complications, namely, perforation, intestinal obstruction, gastrointestinal hemorrhage, and fistulization. A comprehensive review revealed 28 cases of diverticulitis of the terminal ileum documented in the world medical literature. Only one case of internal fistula (ileovesical) has been reported previously. This report describes another patient with diverticulitis of the terminal ileum with associated perforation and jejunoileal fistula and reviews the world literature.

Leiomyosarcoma of the abdominal aorta: a case report.

A case report of a leiomyosarcoma of the abdominal aorta is presented. The patient was referred to our institution because of symptoms of an acute occlusion of the infrarenal aorta. En bloc resection of the tumor and reconstruction of distal arterial flow were performed.

Significance of ulcerated plaque in transient cerebral ischemia.

The results of 210 endarterectomies in 174 patients are reviewed. The average age was 60.3 years for women and 62.1 years for men, with women comprising 53 percent of the population. Pathologic evaluation of tissue removed at time of surgery revealed macroscopic ulcerations in 50 percent of specimens and microscopic ulcerations in 33 percent, with 15 percent of specimens having both macroscopic and microscopic ulcerations. We were unable to identify a set of factors on the basis of symptoms or preoperative studies that would unequivocally indicate ulceration, but we believe that this study reinforces the concept that atheromatous embolization is probably a more frequent remedial cause of transient ischemic attacks than ischemia secondary to large vessel disease.

A study of anastomotic aneurysms following aortofemoral prosthetic bypass.

Between 1960--1979, 19 patients with aortofemoral prosthetic bypass for aneurysmal and/or occlusive disease subsequently developed 36 false aneurysms at the suture line, for an incidence of 4.5% (19/426 patients). The two major aneurysm sites were the femoral anastomosis 4.5% (33/727) patients), and the aortic anastomosis 0.7% (3/430 patients). Additionally, one patient with bilateral false aneurysms of the groin subsequently developed an aortoduodenal fistula. The initial operation was for aortoiliac occlusive disease in 14 and for abdominal aortic aneurysms plus severe occlusive disease in five. The false aneurysm(s) appeared three months to 17 years after the aortofemoral procedure. Eleven of 19 patients (57.9%) had multiple aneurysms (two to five) and developed both right and left groin aneurysms concomitantly or at different times. Suture failure was the major finding at operation. However, a common alternative finding was partial or near complete separation of the prosthesis from the host vessel and an intact suture line, thus indicating a structural weakness in the host vessel and/or severe mechanical stress, as the causative factor. One experience leads us to favor an aggressive surgical approach to these lesions. All false aneurysms were corrected as they were detected with good surgical results.

Combined aneurysmal and occlusive arterial disease.

Acute arterial occlusion secondary to embolization from aneurysms located upstream occurred in 16% in 277 aneurysms involving subclavian, abdominal aortic, femoral, and popliteal vessels. This association should be suspected in those instances when the occlusive symptoms are severe and sudden in onset. The study emphasizes the importance of aortic outlining, as well as arteriographic mapping of both lower extremities, when occlusive disease of one or both legs is present. An aneurysm upstream should be suspected when there is failure of a previously implanted graft peripherally. Asymptomatic, small abdominal aortic aneurysms should be resected.