Intravesical epirubicin with and without verapamil for the prophylaxis of superficial bladder tumours.

Seventy-five patients with recurrent bladder carcinoma were randomized after electroresection to receive either epirubicin (E) or epirubicin + verapamil (E + V) instillation of the bladder at regular intervals for 2 years. Samples of the bladder wall, tumour tissue and peripheral blood were taken from 20 patients. The average follow-up period was 21 months. Fifty per cent of the patients in the E group and 37% in the E + V group developed recurrent tumours. Recurrence rates (RR) were 6.3 and 4.7, respectively. Before the instillation therapy the RR was 16.0. There was a highly significant reduction of RR during the instillation therapies; in group E p less than 0.005 and in group E + V p less than 0.001. The difference between the treatment groups was not statistically significant. Verapamil increased epirubicin concentrations in both the bladder wall and the tumour tissue, but did not affect concentrations in the peripheral blood. Side effects were few and did not lead to discontinuation of treatment.

Obstruction of appendix vermiformis causing acute appendicitis. An experimental study in the rabbit.

In an experimental model using the rabbit, the role of obstruction in the pathogenesis of acute appendicitis was studied. Twenty-one animals were anaesthesized and underwent laparotomy. The appendices were obstructed by a balloon catheter introduced via a caecostomy. Pressures inside the obstructed appendices were measured by a balloon at the tip of the catheter. The abdominal cavity was closed, anaesthesia was continued, and pressure were registered regularly up to 12 hours afterwards in those animals which remained alive during this period. The animals were then sacrificed, and at autopsy evidence of obstruction, distention and inflammatory changes, both gross and microscopic, was registered. In a total of 15 rabbits, experimental obstruction of the appendix resulted in inflammatory changes in the wall of the appendix, which histologically in all respects were similar to appendicitis in man. In the remaining 6 rabbits, either spontaneous release of obstruction or death early during the experiment occurred. Our experimental data suggest that obstruction is an important agent in the causation of acute appendicitis.