Prevention of stomal recurrence in patients requiring emergency tracheostomy for advanced laryngeal and pharyngeal tumors.

Since 1976, patients requiring emergency tracheostomy for advanced laryngeal and hypopharyngeal cancer at the University of Cincinnati have been treated with a short course of prelaryngectomy radiation in an attempt to decrease the incidence of stomal recurrence. Twenty-one patients were treated after emergency tracheostomy with a course of radiation that usually consisted of 20 Gy in five fractions followed by laryngectomy 1 or 2 days later. Most patients also received postoperative radiotherapy of some type. The follow-up of 18 evaluable patients revealed only two (11%) stomal recurrences--a quite acceptable rate for this high-risk population. Overall, however, local recurrences were seen in ten patients (56%), which is higher than reported in most series of similar tumors. The most likely explanation for this seems to be that the short course preoperative radiation prevented the administration of adequate postoperative radiation for residual disease, which was usually present. An alternative treatment policy would be a planned course of moderate- to high-dose postoperative radiation, which could sterilize tumor in the entire locoregional area including the stoma.

Muramyl tripeptide: an effective immunotherapy in the surgical setting for pediatric abdominal neoplasms.

A potential complication of intraperitoneal neoplasms is the occurrence of peritoneal metastases. This experiment hypothesizes that resident peritoneal macrophages, activated by muramyl tripeptide (MTP-PE), will destroy peritoneal tumor. MTP-PE is a lipophilic derivative of the mycobacteria cell wall component responsible for induction of cellular immunity and activation of macrophages to a tumoricidal state. A transplantable murine fibrosarcoma, MCA-F was utilized. Murine hosts were challenged intraperitoneally with 5 X 10(3) MCA-F cells. Treatment with MTP-PE micelles or liposome-encapsulated MTP-PE was initiated 48 hours prechallenge and on the day of tumor challenge and continued at 72 hour intervals for the subsequent 21 days. Hosts were observed for survival. At 45 days after tumor challenge, all untreated control animals had succumbed to overwhelming neoplastic disease. In contrast, 30% of the mice treated with liposome-encapsulated MTP-PE (P less than .05) and 50% of the animals treated with MTP-PE micelles (P less than .001) remained alive at 60 days. Followed for 120 days, 20% of MTP-PE micelle treated mice are long-term survivors. These results suggest that control of intraperitoneal seedings may be achieved with MTP-PE when the tumor burden is small.

[Local mitomycin-C therapy of infiltrating bladder cancer]. / Lokale Mitomycin-C-Therapie des infiltrierenden Harnblasenkarzinoms.

Adjuvant local chemotherapy for superficial cancer of the urinary bladder (TA-Tis) is meanwhile performed on a nearly standardized level. The indication for infiltrating tumours (T1-T4) however is controversial. The prevention of tumour cell implantation which is promoted by transurethral resections is advantageous. On the other hand a curative effect cannot be expected from local chemotherapy in infiltrating tumours. The long-term results of adjuvant local chemotherapy in 86 patients with infiltrating urinary bladder carcinomas are reported, who received mitomycin instillations after transurethral resections.

[25 years of curative cancer-therapy stagnation--a change in a sight?]. / 25 Jahre Stagnation der kurativen Krebstherapie--Eine Wende in Sicht?

Two measures are urgently needed to improve curative therapy results in cancer treatment. 1. Improvements in the early recognition of specific types of tumor and in appropriate modes of preventitive treatment.--2. The introduction of a metastasis prophylaxis before each diagnostic and therapeutic operation for cancer; several possibilities are proposed. The stagnation of cancer therapy results can only be overcome by an alteration in the current concept of treatment, which in cases of early cancer is as yet directed exclusively at the primary tumor.

[Height of rectum amputation. Management, complications, disease significance]. / Die Rectumaputationshöhle. Versorgung, Komplikationen, Krankheitswert.

Management of the pelvic space after rectal excision is still problematic. Two methods have to be preferred: (1) closed suction lavage drainage and (2) open wound plugging; then the pelvic floor best remains unsutured. Plugging is always indicated in difficult pelveoperitoneal suture, unsatisfactory hemostasis and fecal contamination of the pelvic space. Retardation of wound healing is compensated for by more comfort for the patient and elimination of late complications, compared with those with partially closed or secondary opened wounds. The sacroperineal scar is the origin of a lot of complaints and morbidity. The most important are: infectious complications and persistent fistula (17.3%), pseudosinus perinealis (10%), perineal hernia and genital prolapses (16%), urologic complications (recidivating infections [26.9%], changes of the position of the urinary bladder [56%], secondary retroperitoneal fibrosis with urinary restriction [19.2%] or hydronephrosis [3.8%], disturbances of bladder emptying [36.5%], frequently combined with neurogenic lesions because of intraoperatively dissected autonomous pelvic nerves), local recurrence of carcinoma (17.3% in reexamination, but still much more important), and pain, often of unknown origin (34%).

[Renal cancer embolization with isobutyl-2-cyanoacrylate. Experimental study and first clinical applications (author's transl)]. / Embolisation des cancers du rein avec l'isobutyl-2-cyanoacrylate. Etude expérimentale. Premières applications cliniques.

Isobutyl-2-cyanoacrylate (IBC) is an acrylic monomer which quickly polymerizes in contact with blood. It has been rarely used as an embolic material and never in embolization of renal cancer. The authors report their experience on the use of this substance as embolic material, based on an experimental study in the rat and on two human cases of renal cancer, where a preoperative transcatheter embolization was performed. IBC revealed as a substance which can produce a very efficient and lasting embolization. No complications were observed.

[Early diagnosis of corpus-carcinoma. The Gravlee-Jet-Washer withdrawal method on--safety from iatrogenic lesions]. / Beitrag zur Früherkennung des Korpuskarzinoms. Der Gravlee-Jet-Washer: Entnahmetechnik--Sicherheit vor iatrogenen Schäden

A short review is given about the development and method of cytology from the endometrium; the accuracy of aim and the advantage of the Jet-wash technique by Gravlee has been described. The practicability of obtaining the best material is discussed. Metastasis implantation by spreading the material is nearly impossible when accurate operating is done.

Elective transcatheter renal artery occlusion prior to nephrectomy.

An hour before nephrectomy 10 patients with hypernephroma and 2 with pyonephrosis underwent occlusion of the renal arteries with gelfoam via selective catheterization, using the Seldinger percutaneous technique. This technique facilitated the operation by collapsing the renal and perirenal veins, decreased blood loss and prevented the dissemination of tumor cells or septic emboli from organ manipulation.

Ballon occlusion of the renal artery in tumor nephrectomy.

A method of preoperative intraluminal occlusion of the renal artery in cases of kidney tumors using a 5F Swan-Ganz ballon catheter is presented. The procedure was used in 26 tumor nephrectomies without complications and resulted in marked facilitation of the operation in 70 per cent of the cases.