Biomedical subjects
Publications and source records attributed to R S Foster.
A case of upper urinary tract infection with Salmonella enteritidis is presented. The patient was diabetic which may have resulted in diminished immunocompetence, but no other predisposing factor was uncovered. Thorough search for an extraurinary primary source of this infection was unrevealing. The implications of this type of infection are reviewed.
A case report of endometriosis of the bladder is presented, with special reference to treatment options. Recent experience with this lesion illustrates the dilemma facing the physician who must determine a course of treatment. It seems that removal of the bladder lesion by segmental cystectomy is the preferred treatment.
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Most vesical neck contractures occur after resection of adenomas weighing less than 20 gm. This complication is believed to be secondary to excessive resection or fulguration of an undilated bladder neck. Prophylactic bladder neck incision was performed in conjunction with transurethral resection of the prostate on 114 patients with prostatic adenomas weighing less than 20 gm. Vesical neck contracture occurred in 1 patient (0.87 per cent), compared to 12 contractures in 161 patients who underwent transurethral resection of the prostate alone (7.5 per cent). Increasing bladder neck diameter by incision appears to be protective against formation of vesical neck contractures in patients with small obstructing prostatic adenomas.
Forty-two shoulders in 37 patients with polyarthritis were treated with Neer total shoulder replacements and reviewed 12 to 66 months afterwards. There was good pain relief and improvement in function, but the range of movement was less than that seen after replacements for osteoarthritis; this may have been related to the fact that 34 shoulders had abnormal rotator cuff tendons. Although there was a high incidence of radiolucent lines around the glenoid component, there was no clinical evidence of loosening. There were a few complications, but on the whole we feel that the Neer total shoulder arthroplasty is a valuable procedure for a patient with polyarthritis.
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We have previously shown that disulfiram (DSF) blocks the urotoxicity of cyclophosphamide (CYT) in mice and increases the oncolytic effect of CYT in the L1210 murine leukemia. However, mice treated with CYT and DSF appeared to have longer-lasting neutropenia than animals treated with CYT alone. To determine whether DSF uroprotection of CYT-treated mice was associated with increased myeloid toxicity, we examined the effects of DSF plus CYT treatment on the bone marrow granulocyte/macrophage progenitor cell (GM-CFC). Marrow cellularity and GM-CFC numbers were analyzed at 1, 2 and 3 days after injection of CYT (62.5 or 125 mg/kg) or CYT plus DSF (200 mg/kg). CYT alone caused a decrease in total marrow cellularity varying from 20% to 50% of control. Animals given CYT plus DSF had a somewhat greater decrease in total marrow cellularity than those treated with CYT alone. However, in mice treated with CYT plus DSF, the GM-CFC were relatively well preserved and the recovery of the GM-CFC was not prolonged by DSF. It appears from these studies that the acute toxic effect of CYT on the granulocyte/macrophage progenitor cells is not enhanced by DSF.
Corynebacterium parvum (C. parvum), an immunostimulant, was examined for its effects on wound healing in mice. Animals injected intraperitoneally with C. parvum, 1400 micrograms 48 hr prior to wounding had significantly decreased wound strength at 5, 7, 11, 14, and 21 days after wounding compared to saline-injected controls (P less than 0.05-P less than 0.001). Mice injected with C. parvum at 48 or 2 hr before wounding, synchronous with wounding and 2 or 48 hr after wounding had significantly decreased wound disruption strength of 11-day-old wounds (P less than 0.01-P less than 0.001). Formalin fixations of wound strips from C. parvum-treated animals were consistently weaker than similarly treated wound strips from controls (P less than 0.05-P less than 0.01). Histologic analysis of wounds from C. parvum-treated animals revealed decreased amounts of wound collagen and increased inflammatory reaction compared to saline-injected animals. While C. parvum can improve survival following injury or septic challenge, the potential for marked alterations in wound healing may limit its clinical application in surgical and trauma patients.
Congenital posterior urethral polyps are benign growths that can cause a variety of symptoms in young boys. They are pathologically distinct growths usually discovered by voiding cystourethrography. We present 5 cases of congenital posterior urethral polyps, and discuss the presentation and pathophysiological status of these lesions. These lesions must be considered in the differential diagnosis of voiding dysfunction in young boys.
Random-donor blood transfusions are deliberately given before cadaver renal allografting to improve allograft survival. Since host modifications that improve the outcome of an allograft might be associated with a decreased ability of the host to control cancer growth, the relationship between blood transfusions and the outcome of 146 Dukes' stages A, B, and C colon cancers treated by resection during the years 1974 to 1979 was studied. It was found that 65 patients (45%) had been transfused and that at 5 years, overall survival was significantly better in the nontransfused patients compared to the transfused patients (0.68 and 0.51 5-year product limit survival fractions respectively; P = 0.03 for unadjusted log-rank comparison of entire survival curves). Relative risk of death due to cancer in transfused patients versus nontransfused patients was 2.3 (P = 0.05) when controlled for sex, age, stage, histologic differentiation, cancer location, and pre-resection hemoglobin level using Cox regression analysis. Thus, blood transfusion appears to be an additional important prognostic variable. The hypothesis suggested but not proven by these data that the outcome for some malignancies may be related to the immunomodulating effects of blood transfusions needs further study.
Tumor and host tissue DNA synthesis in C3H female mice with MA16/C tumors were examined for the effects of starvation and refeeding. Animals with subcutaneously implanted tumors were randomized to either regular diet or starvation for 48 hr followed by refeeding for 6, 12, 24, 48, or 72 hr. With starvation, both tumor and host tissues demonstrated a decrease in DNA synthetic activity. After refeeding, resumption in DNA tumor synthesis preceded that of host tissues and was greatest within the first 6-12 hr. Host tissue DNA synthetic activity resumed at different times in the various tissues examined with bone marrow being earlier than spleen or liver. The differential time course between induction of tumor and host DNA synthesis could allow a more precise modeling in studies dealing with the interaction of nutritional repletion and antitumor therapy.
The immunosuppressive effects of blood transfusions in renal transplantation patients are now well documented. The question arises as to whether the possible immunosuppressive effects of blood transfusions in cancer patients cause a more favorable host environment for tumor growth. One hundred fifty-five patients undergoing resection for lung carcinoma were analyzed retrospectively, and it was shown that the use of blood transfusions was associated with a significant decrease in survival time in patients undergoing curative resection of lung carcinoma despite multivariate adjustments for age, sex, cell type, right lung versus left lung location, type of operation, and stage. This association supports, but does not prove, the hypothesis that blood transfusions, possibly through an immunosuppressive mechanism, are responsible for a poorer prognosis in patients who undergo resection for carcinoma of the lung.
We have previously shown that Corynebacterium parvum (C. parvum), a nonspecific immunomodulator, partially protects splenectomized and nonsplenectomized mice when challenged with aerosolized pneumococci. We report here the effects of both splenectomy and C. parvum on the phagocytic function of the lavageable pulmonary alveolar macrophage (PAM). Groups of young adult male Sprague Dawley rats underwent splenectomy or sham operation 3 weeks before injection of C. parvum 1.5 mg IP (or saline) per animal. One week postinjection PAM's were harvested. The in vitro phagocytic indices (PI) for PAM incubated with tritiated thymidine-labeled S. aureus or Streptococcus pneumoniae, type 14, opsonized with normal rat serum, were determined. Splenectomy had no effect on lung weights, PAM yield, or PAM phagocytic activity. C. parvum administration significantly increased spleen weight in sham-operated animals, but had no effect on lung weights, PAM yield, or phagocytic activity of either control or splenectomized animals. Splenectomy in the adult rat did not induce a phagocytic defect in the PAM and thus the lavageable PAM cannot be considered a significant site of the postsplenectomy defect. Since C. parvum protects animals from respiratory challenge with Streptococcus pneumoniae but does not alter the number or activity of lavageable alveolar macrophages, we hypothesize that C. parvum protection is more likely related to our previous finding of an increased clearance of blood-borne bacteria by the expanded and enhanced reticuloendothelial system.
Using a model of uncomplicated burn injury in mice, we assayed the bone marrow and splenic production of granulocytes and macrophages after burn injury. The effects of burn size and burn wound excision and closure were studied. Using an in vitro quantitative clonal culture technique for granulocyte/macrophage progenitor cells (GM-CFC), myeloid precursors were directly assayed. Burns of a 10% body surface area were equal to burns of larger magnitude for effects on marrow and splenic granulocyte/macrophage production. The total peripheral blood leukocyte and lymphocyte counts were depressed at days 1 and 4 postburn but were elevated at days 8 and 12. Granulocytes, however, remained significantly increased at days 8 and 12. The bone marrow response to burning showed an initial depression in marrow cellularity on day 1 with return to normal values by days 8 and 12. The numbers of GM-CFC were significantly elevated on days 4-12 with a near threefold increase in the number of GM-CFC 12 days following burn injury. The splenic response to burn injury was characterized by a decrease in the splenic index on day 1 but then a persistent increase at days 8 and 12. Total splenic cellularity was depressed on day 1 but significantly increased at days 8 and 12. The total number of splenic GM-CFC was increased on days 4-12 with a 100-fold increase on day 8. The immediate or delayed excision of the burn wound did not alter marrow or splenic response to burning. We conclude that following a cutaneous injury there is a marked alteration in the generation of the phagocytic cells of the granulocyte and macrophage series and that this response is secondary to the wounding process.
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To determine the relation between breast self-examination and survival of breast cancer patients, the authors studied 1004 newly diagnosed invasive breast cancer patients in Vermont general hospitals from 1 July 1975 to 31 December 1982. More frequent breast self-examination was associated with a greater likelihood of the patient's detecting her own cancer, less delay from first symptom to histologic diagnosis, earlier clinical stage, smaller pathologic tumor size, and fewer axillary node metastases. At a median follow-up time of 52 months (maximum follow-up, 92 months), 14% of the breast self-examination performers had died of breast cancer versus 26% of the nonperformers (P less than 0.001 based on chi-square). The product limit survival curve for breast self-examination performers (N = 424) was significantly better (P less than 0.001 by log-rank test) than for breast self-examination nonperformers (N = 411). Survival at 5 years was 75% for breast self-examination performers versus 57% for the nonperformers. The significant survival differences persisted after adjusting for any combination of the covariates age, method of detection, family history of breast cancer, and delay in treatment (P less than 0.002). Lead-time would have to be at least 3 years to negate the apparent beneficial effects of breast self-examination on survival. The authors conclude that in this population of breast cancer patients, breast self-examination was related to earlier detection and improved survival.
Numerous reports have demonstrated that blood transfusions given prior to renal allografting have an immunomodulating effect that leads to increased graft survival. To determine if blood transfusions would adversely affect the outcome for patients with breast cancer, we examined 226 patients with invasive breast cancer who had a mastectomy and found 65 (29%) had received transfusions. The patients who had transfusions and those who did not were similar in age, clinical tumor-node-metastasis stage, and number of histologic nodal metastases. At a median follow-up of 52 months for surviving patients, 48 (21%) of the patients were dead. Log-rank and Cox regression analyses that compared patients who had transfusions v those who did not showed no excess of either overall deaths or deaths due to cancer in the group that received transfusions. The hypothesis that blood transfusions might have an adverse effect on survival was not supported by this study. Additional studies involving other groups of patients with malignant neoplasms and other blood donor populations are needed.
The history of the use of surgery and radiotherapy for the management of primary breast cancer is reviewed with an emphasis on the conclusions to be reached from the controlled clinical trials. Prophylactic treatment of clinically negative regional nodes by either surgical extirpation or radiotherapy does not improve survival in comparison with a policy of observation and treatment at the time of clinical progression. Axillary node dissection is currently important for histologic staging of the axillary nodes. Early results of the controlled trials appear to support the concept that for selected patients, a regimen of complete excision of the primary tumor and breast irradiation produces results equivalent to those of total mastectomy in terms of distant recurrence and survival.