Biomedical subjects
Publications and source records attributed to M A Rettenmaier.
Eight patients with advanced ovarian cancer were treated with polyinosinic-polycytidylic lysine carboxymethylcellulose (poly(ICLC]. Toxicity was substantial. No responses were seen in this small group of patients. Further clinical trials utilizing poly(ICLC) at the doses described in patients with advanced ovarian cancer do not appear to be warranted.
Using the technique described, Hickman catheters can be inserted by a single operator at low cost and risk. The simplicity of insertion and removal with this method makes the use of this device preferable to standard temporary central venous catheters in most instances.
The activity of 2-beta-D-ribofuranosylthiazole-4-carboxamide (tiazofurin) was determined in nine untreated human ovarian cancer specimens, using the murine subrenal capsule xenograft assay. Tumor cytotoxic effect was demonstrated in seven out of the nine tumors implanted. The drug was well tolerated by the test animals. Tiazofurin may prove to be an effective chemotherapeutic agent in the treatment of ovarian cancer.
Commonly used preoperative diagnostic procedures were analyzed for their ability to predict the presence of early ectopic pregnancy. Patients presenting to the emergency room with acute onset of pelvic pain were evaluated with culdocentesis, pelvic ultrasonography, and qualitative serum and urine pregnancy testing. Clinical examination and urine pregnancy testing were found to be poor predictors of either the presence or absence of an early ectopic pregnancy. The combination of a sensitive serum human chorionic gonadotropin (hCG) determination and pelvic ultrasonography accurately predicted ectopic pregnancy in 93% of proved cases. This predicted accuracy was superior to that of culdocentesis alone or in combinations of culdocentesis and ultrasound or qualitative serum pregnancy testing.
A skinning vulvectomy and split-thickness skin graft were used in the management of four women with benign vulvar disease after the failure of standard medical and surgical therapy. Three women remain free of the primary disease process, with a follow-up of 12-36 months. One woman with lichen sclerosus and another with "diffuse atrophy" developed recurrent disease in their skin grafts 45 and 96 months, respectively, after skinning vulvectomy. Symptomatic improvement was achieved subsequently in both women with the topical application of testosterone.
The indications for insertion of semipermanent right atrial silicone catheters and immediate and long-term complications in patients admitted to a gynecologic oncology service, are described. Eight-five catheters were inserted in 79 patients for a variety of indications. Most catheters were placed under local anesthesia, in the patient's hospital room. Immediate morbidity caused by damage to the pleura was limited to three patients (3.5%). Infectious morbidity related to catheter use was seen in five patients (5.9%). Two patients were unable to administer daily heparin boluses through the catheter, and in both of these patients catheter thrombosis was seen (2.4%). A right atrial catheter can easily be inserted at the patient's bedside or in an outpatient setting. This device should be offered to any patient in whom intermediate or long-term vascular access is desired for nutritional support, chemotherapy, pain control, or similar indications.
The effect of non-localized magnetically responsive albumin microspheres (MR-AMS) on RES phagocytic function was investigated. MR-AMS and MR-AMS containing Adriamycin (MR-AMS-ADR) were injected intravenously in rats at a dose which saturated all RES phagocytes. The ability of the RES to clear the bloodstream of a subsequent suspension of MR-AMS or streptococci was then analyzed over a three day period. MR-AMS clearance was enhanced after initial RES saturation with MR-AMS but depressed when the saturating agent was MR-AMS-ADR. Bloodstream clearance of streptococci was depressed by MR-AMS and MR-AMS-ADR. Localization of MR-AMS in the RES might depress RES phagocytosis by physical saturation of phagocytes or by a direct toxic effect of encapsulated chemotherapeutic agents.
Moxalactam was administered prior to operation to patients undergoing operation for a known or suspected gynecologic malignancy. Subsequent plasma and tissue levels demonstrated a prolonged duration of action and rapid concentration in pelvic organs after infusion.
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A procedure to test chemosensitivity of nonsolid tumors using the subrenal-capsule xenograft assay has been developed. This technique is applicable to the study of malignant effusions and hematopoietic tumors. The tumor cells are centrifuged to form a pellet and the pellet is resuspended in the presence of bovine fibrinogen to form a jelled clot. This clot is cut into fragments which are implanted beneath the renal capsule of normal mice. The growth of the tumor cells from ovarian adenocarcinoma obtained from ascitic fluid is better than that of tumor fragments from the solid tumors. This is probably a reflection of the greater viability of tumor cells from ascitic fluids. The sensitivity to chemotherapy was the same for the solid tumor and its malignant effusions.
Four patients with gynecologic tumors recurrent either to the vagina or skin were treated with photoradiation therapy. A cytotoxic effect on the tumor was achieved by injecting hematoporphyrin derivative intravenously followed by exposing the treatment area to light of 630 nm from an argon-ion pumped-dye laser 72 hr later. Of seven tumor sites which were treated, one was completely destroyed, two were diminished in volume by more than 30%, and no response was seen in four. Toxicity was limited to one episode of facial edema and first-degree burn after prolonged exposure to bright artificial light. Phototherapy might be a useful treatment of some gynecologic tumors which recur after standard attempts at control of disease.
The clinical response to chemotherapy of a series of female patients with advanced pelvic malignancies was compared to the response of their tumors to the same agents in the murine subrenal capsule implant assay. A total of 194 different patients were studied in 242 different assays; 89.3% of the assays were evaluable. There were 83 prospective assays (assays performed before the patient received the chemotherapy) of 66 different patients for which clinical correlations were available. In these assays the sensitivity (frequency of positive test results in responding patients) was 85.0%, the specificity (frequency of negative test results in nonresponding patients) was 57.1%, and the efficiency (percentage correctly classified) was 63.9%. There were 100 retrospective assays (assays performed after the patient had been treated with the chemotherapy) of 69 different patients for which clinical correlations were available. In these assays the sensitivity was 66.7%, the specificity 70.7%, and the efficiency 70.0%. Thirty-one of the patients had both prospective and retrospective assays. There were 59 patients for whom the clinical response to chemotherapy could not be determined. It is believed that the clinical utility of the SRC assay has been validated by the good prospective sensitivity of the assay.
The relationship of maternal weight status to the probability of appearance of one or a combination of three or more undesirable pregnancy events ( UPE ) was analyzed. A total of 711 women presenting for prenatal care before 16 weeks estimated gestational age were categorized according to early pregnancy body mass ( EPBM ) and subsequent weight gain. Statistical analysis revealed weight gain related to the appearance of one UPE only in women with an EPBM less than 120 pounds. In gestations complicated by three or more UPEs , a relationship to weight gain was shown only in women with an EPBM of 120-199 pounds.
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Focal areas of intraepithelial neoplasia were induced in the skin of mice by 1 intraperitoneal injection of urethane followed by twice weekly topical applications of 12-0-tetra-decanoyl phorbol-13-acetate (TPA). Microscopic lesions with histologic characteristics of intraepithelial neoplasia were seen in all animals after 11 weeks of TPA application. Fluorescence microscopy verified the increased DNA content of these lesions. This easily produced animal model of premalignant disease might be valuable in the preclinical testing of topically applied antineoplastic agents.
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A single-cell cytotoxicity assay was used to determine the number of effector cells in the peripheral blood of normal and tumor-bearing Fischer 344 female rats which bound to and lysed K562 target cells. Of the blood leukocytes of normal rats 18.4 +/- 2.6% bound to K562 target cells; one-third of the conjugated target cells were killed as evidenced by trypan blue uptake. Cells isolated from the blood of rats bearing mammary adenocarcinoma R3230 or 13762 bound fewer target cells, 6.3 +/- 1.1 and 7.1 +/- 1.8%, respectively. The proportion of dead conjugated target cells was not different from that of normal rat leukocytes if the leukocytes were from rats bearing 13762 but was reduced by one-half if the leukocytes came from rats bearing R3230. Treatment of the tumor-bearing rats with cytoreductive chemotherapy returned the percentage conjugation to target cells to normal levels if the tumor growth was inhibited more than 70%. Treatment of the tumor-bearing rats with immunomodulating agents did not inhibit the growth of the tumors, but treatment with sodium ibuprofen or muramyl dipeptide increased the percentage conjugation significantly.