Improvisation in the developing world.
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Colostomy↗
Biomedical subjects
J L Tarpley
Publications and source records attributed to J L Tarpley.
Perforated typhoid enteritis: operative experience with 108 cases.
A retrospective review of 108 consecutive patients with perforated typhoid enteritis managed operatively over a 4-year period at Baptist Medical Centre, Ogbomoso, Nigeria is presented. There were 75 males and 33 females with an average age of 19.7 years. Presenting symptoms were fever, abdominal pain, vomiting, and either diarrhea or constipation. One hundred patients (93 percent) underwent debridement of the perforation and two-layer bowel closure. Postoperative morbidity included intraabdominal abscess, wound dehiscence, and subsequent bowel perforation. Most of the 35 deaths (32 percent mortality) were attributed to overwhelming sepsis which progressed despite aggressive operative management and antibiotic administration. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.
Adolescent↗
Host immunocompetence in genitourinary cancer: relation to tumor stage and prognosis.
We used delayed hypersensitivity skin testing, in vitro lymphocyte blastogenesis, and lymphocyte surface markers to examine the relationships among host immunologic competence, tumor type, tumor stage, prognosis, and the effects of cancer treatments in patients with genitourinary cancer. We found correlations between host immune competence and both tumor stage and prognosis among patients with bladder cancer, renal cell cancer, and those with advanced prostate cancer not receiving endocrine therapy, but not among patients with prostate cancer receiving endocrine therapy. Radiation and chemotherapy suppressed T-lymphocyte levels, but a chemotherapy-induced tumor remission resulted in a rebound of T-cell counts to above normal levels. In tissue sections of bladder cancers, regions of mononuclear infiltration were virtually devoid of cells with complement receptors or receptors for cytophilic antibody, which suggested that lymphocytes infiltrating bladder cancers are predominantly T-lymphocytes.
Dinitrochlorobenzene↗
Suppression of cellular immunity by anesthesia and operation.
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Adenocarcinoma↗
In vivo and in vitro measurements of the relationship of human squamous carcinomas to herpes simplex virus tumor-associated antigens.
An additional 244 unfiltered sera have now been studied in a series of controlled, coded tests to determine the relationship of squamous carcinomas of the head and neck and cervix to the presence of complement-fixing antibodies to herpesvirus-tumor-associated antigens (HSV-TAA) in both tumor-bearing and cured patients. Ninety % of sera from patients with squamous carcinomas had antibodies to HSV-TAA, in contrast to 11% of sera from patients with nonsquamous cancers and 4% of sera from noraml individuals. The temporal relationship of Stage 1 laryngeal carcinomas suggests that HSV-TAA appearance precedes the immune defects. An in vitro correlate of the previously demonstrated specific delayed hypersensitivity reactions in controlled skin tests of squamous carcinoma patients with HSV-TAA is reported. In leukocyte migration inhibition tests, the migration indices after incubation with HSV-TAA of peripheral blood leukocytes from patients with squamous carcinoma (x = 0.847) were in definite contrast to migration indices seen for normal leukocytes (x = 1.037) and patients with nonsquamous solid cancers (x = 1.03). Thus, these polypeptides elicit both humoral antibody response and cell-mediated reactivity.
Antibodies, Neoplasm↗
Histocompatibility antigens and solid malignant neoplasms.
To evaluate the relation between histocompatibility antigen phenotypes and solid malignant neoplasms, HL-A type was determined in 633 cancer patients and compared with those of 489 normal controls. HL-A8 was elevated in patients with squamous cancer, melanoma, and adenocarcinoma. The highest incidence occurred in patients with salivary gland adenocarcinoma (67% vs only 17% in normal controls). A threefold increase in HL-A5 was detected in patients with connective tissue sarcomas (28% incidence vs 9% in normal controls). Antigen frequencies did not vary when analyzed by time of diagnosis or interval after treatment. The finding that certain malignant neoplasms have associations with increased frequency of individual HL-A antigens may give clues to cause and genesis for these tumors.
Adenocarcinoma↗
Prolonged depression of cellular immunity in cured laryngopharyngeal cancer patients treated with radiation therapy.
Immune competence was evaluated in cured patients who had been treated by irradiation for carcinoma of the laryngopharynx, and compared with that of similar patients treated by surgery alone, and normal controls. Cellular immunity was determined by quantitation of in vitro phytohemagglutinin (PHA)-induced lymphocyte reactivity and peripheral blood thymus-dependent lymphocyte (T cell) levels. Humoral immunity was assessed by measurement of serum immunoglobulin levels and by the effect of serum on in vitro normal lymphocyte reactivity to PHA. In 21 patients who were studied for 4-23 years (mean 8.4) after surgical treatment alone for laryngopharyngeal carcinoma, neither cellular nor humoral immunity differed from that of 44 controls. In contrast, 14 patients who had been irradiated and subsequently cured for 4-15 years (mean 9.0) prior to evaluation displayed significantly impaired cellular immune competence when compared to normals and patients treated by surgery alone. Since previous determinations of the effects of radiation therapy have been in patients who received irratiation to the thymic region or large area of bone marrow, this study indicates that radiation therapy for cancer administered via portals that encompass a minimal area of the immune system may be associated with prolonged impairment of cellular immunity.
Humans↗
High dose methotrexate as a preoperative adjuvant in the treatment of epidermoid carcinoma of the head and neck. A feasibility study and clinical trial.
Thirty patients with operable epidermoid carcinoma of the head and neck were treated with intravenous high dose methotrexate and leucovorin rescue prior to resection. Their clinical courses were compared with those of thirty randomly selected patients matched for tumors site and clinical stage who were treated by surgery alone. No medical or surgical complications associated with methotrexate were encountered. An objective decrease in tumor size (primary lesion or nodal metastases) was noted prior to resection in twenty-three patients (77 per cent). The number of recurrences in the two groups was similar. However, these was a significantly greater disease-free interval in the methotrexate-treated patients (p less than 0.05). No significant differences in survival have been noted to date between the two groups. In view of the absence of complications, the regressions in tumor size, and the increase in postoperative disease-free interval in this trial, evaluation as preoperative adjuvants of higher doses of methotrexate and of other chemotherapeutic agents in combination with methotrexate appears warranted.
Carcinoma, Squamous Cell↗
Thymus-derived lymphocytes in patients with solid malignancies.
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Adenocarcinoma↗
Correlations among cutaneous reactivity to DNCB, PHA-induced lymphocyte blastogenesis and peripheral blood E rosettes.
Comparisons of the results obtained in a study of fifty-two patients with genitourinary malignancies using three assays to monitor the thymus-dependent immune system (delayed cutaneous hypersensitivity to DNCB, PHA-induced lymphocyte blastogenesis, and peripheral blood E rosette-forming lymphocyte counts) yielded statistically significant positive correlations between the DNCB and PHA assays in twenty-one of twenty-eight instances, the DNCB and E rosette assays in thirteen of sixteen instances, the PHA and E rosette assays in twenty-eight of thirty-six instances, and among the DNCB, PHA and E rosette assays in ten of fourteen instances. The results suggest that both PHA-stimulated lymphocyte blastogenesis and peripheral blood E rosette-forming lymphocyte levels provide meaningful in vitro correlates of cell-mediated immunity.
Aged↗
Studies of the nature of herpesvirus-induced tumour-associated antigens induced by herpes simplex virus type 1 and further analysis of their relationship with squamous-cell carcinomas of the head and neck region.
The differences seen in levels of antibody response to HSV-TAA between non-laryngeal and laryngeal cancers in cured and untreated patient populations were due to the use of filtered sera. In previous and present studies using unfiltered sera, these differences were not noted. Of unfiltered sera from patients with squamous-cell carcinomas of the head and neck, 89% (49 out of 55) were positive for CF reactivity to HSV-TAA, and 44% of these unfiltered sera had titres of 1:4 or greater to 44 microng of antigen. The upper band of the antigen appears to be present in early provirus formation and is highly unstable whereas the lower band does not seem to be part of the assembly process.
Antibodies, Neoplasm↗