Biomedical subjects
Publications and source records attributed to S Wallace.
The authors review the anatomy of the middle sacral artery and its relationship to the lower lumbar and internal iliac arteries. Middle sacral arteriography was performed in 8 patients, transcatheter tumor embolization in 6, and infusion chemotherapy in 1. There were no complications. The authors consider selective middle sacral arteriography beneficial in the diagnosis and treatment of sacral tumors.
Reflecting on the studies by O'Riordan et al. and Doppman and Girton that are reported in this issue, the authors discuss the safety of using ethanol for hepatic artery embolization (HAE) and stress that the optimal indications for this procedure are still to be established. They indicate that the caution necessary with any technique can direct rather than inhibit action.
One hundred fifty-eight patients receiving Adriamycin underwent 226 transjugular biopsy procedures. The specimens were evaluated by electron microscopy for evidence of drug-related cardiotoxicity. Ejection fraction determinations using echocardiographic or nuclear techniques at rest were available for 69% and 81% of the patients, respectively. Analysis of the data revealed a correlation between cumulative Adriamycin dose and biopsy grade (p less than 0.02). No similar relationship existed between cumulative Adriamycin dose and ejection fractions obtained at rest or between biopsy grades and ejection fractions. In patients who underwent serial endomyocardial biopsies and serial ejection fraction determinations, the correlation between changes in biopsy grade and ejection fraction was poor. A change in resting ejection fraction detected by either method did not reliably predict a change in biopsy grade. The poor correlation between ejection fractions and biopsy grades could be due in part to the sensitivity and specificity of the Adriamycin-related structural changes in contrast to the wider range of disease processes that can affect myocardial function, and to the fact that structural changes often precede the ejection fraction abnormalities. The greater sensitivity and specificity of the biopsy grade should prove useful in reducing the risks associated with evaluating new anthracyclines and potential myocardial protectors of Adriamycin toxicity.
One hundred patients with non-small cell lung cancer were entered into a randomized evaluation of two schedules of doxorubicin combined with ftorafur, cyclophosphamide, and cisplatin (FACP). Doxorubicin was given either weekly at 20 mg/m2, or every three weeks (standard) at 60 mg/m2. Fifty-two patients were randomized to the FACP/weekly doxorubicin arm and 48 patients to the FACP/standard doxorubicin arm. The FACP/weekly doxorubicin regimen was associated with higher complete and partial remission rates (31% versus 19%), longer response duration (median, 33 versus 21 weeks), and longer survival duration for responders (median, 58 versus 50 weeks). These differences were not significant. Less neutropenia (p = 0.01) and less infectious morbidity (p = 0.05) were observed in the FACP/weekly doxorubicin arm. Twenty-eight patients underwent 35 endomyocardial biopsies to assess doxorubicin-induced cardiotoxicity. Sixteen biopsies were performed in 12 patients receiving cumulative doxorubicin doses ranging from 250 to 1,190 mg/m2 within the FACP/weekly doxorubicin arm. Nineteen biopsies were performed in 16 patients receiving cumulative doxorubicin doses ranging from 250 to 540 mg/m2 within the FACP/standard doxorubicin regimen. The FACP/weekly doxorubicin regimen was associated with significantly lower cardiotoxicity scores (p = 0.01). This study indicates that weekly administered doxorubicin is as effective and less cardiotoxic than the standard schedule.
This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza, Brazil. Data were collected on 5996 women who delivered at the Maternidade Escola Assis Chateaubriand from October 1980 to July 1981. All women were classified according to how they paid for their care: private (financed at least part of their care with own funds), insured (federal or state), or indigent. Private patients were found to be far more likely than patients in the other two groups to have cesarean deliveries, due primarily to the high percentage of private patients recorded as having prolonged or obstructed labor, combined with a high rate of prior cesarean sections. From this data, it appears likely that financial incentives did play a role in physician decisions on whether to perform cesarean deliveries.
Arterial catheter tip position and arterial flow was monitored by intra-arterial infusion of 99Tcm macroaggregated albumin in patients treated by intra-arterial chemotherapy. Variations in arterial flow pattern as monitored by macroaggregated albumin perfusion studies were encountered in 16 patients without apparent change in the catheter position as monitored by arteriographic and/or radiographic examinations. Possible mechanisms causing changes in arterial flow pattern include: (a) development of collateral circulation, (b) arterial spasm, (c) progressive arteritis causing thrombi with or without associated spasm, and (d) laminar flow. It is important to recognise that changes in perfusion patterns are not always accompanied by change in the position of the arterial catheter.
Sixty-four (57.6%) of 111 cancer patients with cerebrospinal fluid cytology positive for malignant cells had cranial computed tomographic (CT) scans within 2 weeks before or after a lumbar puncture. Twenty-two (34.3%) of the 64 had abnormal CT findings indicative of leptomeningeal metastasis: (1) sulcal-cisternal enhancement, (2) ependymal-subependymal enhancement, (3) widened irregular tentorial enhancement, or (4) communicating hydrocephalus. Thirteen (59.6%) of these 22 patients had associated parenchymal metastases. Recognition of leptomeningeal disease may alter the management of patients with parenchymal metastases. Communicating hydrocephalus in cancer patients should be considered to be related to leptomeningeal metastasis until proven otherwise.
Intraarterial occlusion-infusion of vincristine and Adriamycin was performed in six dogs using balloon infusion catheters. Tissue toxicity was compared with that obtained when the same drugs were administered by simple arterial infusion. Balloon occlusion of the external iliac artery produced reversed blood flow in the deep femoral, caudal femoral, and superficial circumflex iliac arteries, potentially altering the distribution of the drugs. Thrombosis of arterial branches occurred in three dogs, sooner but no more often in the groups receiving occlusion-infusion chemotherapy. Skin ulceration and dilatation of peripheral small vessels were significantly more frequent and extensive in the groups receiving occlusion-infusion. One infusion dog developed a single small ulcer on the hind paw; five of the six occlusion-infusion dogs developed multiple skin ulcers on the thigh and/or distal extremity. These findings suggest that even though intraarterial occlusion-infusion chemotherapy is not applicable in all instances, the technique does produce significantly greater drug-related effects than simple intraarterial infusion.
Eighteen patients with malignant liver disease were treated with hepatic arterial infusion (HAI) of floxuridine (FUDR), Adriamycin (doxorubicin), and mitomycin C (FUDRAM). Twelve of the patients had primary hepatocellular carcinoma and six had metastatic liver carcinoma originating from an unknown primary site. One complete remission and seven partial remissions (greater than or equal to 50% reduction in tumor size) were observed among 12 hepatocellular cancer patients, while only one partial remission was achieved among six patients with unknown primary liver neoplasms. When arterial occlusion was added to HAI of FUDRAM, a prolongation of median survival to 14 months as opposed to six months in patients with an intact arterial tree was observed (P = 0.02). Arterial occlusion had its effect on survival particularly among patients who failed to respond to HAI of FUDRAM. Thus, among nonresponding patients, the addition of arterial occlusion resulted in a median survival of 10.5 months while median survival in those without arterial occlusion was six months (P = 0.08). With procedure-related morbidity being minimal, we conclude that arterially administered FUDRAM offers a notable palliation to patients with primary hepatocellular carcinoma. In patients with unknown primary liver neoplasms and those with hepatocellular cancer who fail HAI of FUDRAM, arterial occlusion can offer additional palliation.
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Intra-arterial CDP was utilized to treat the primary tumor in 11 pediatric patients with osteosarcoma and in one with malignant fibrous histiocytoma. The investigation commenced with a phase I-II pilot study in four osteosarcoma patients. A dose of 150 mg/m2 was found to be safe and effective in producing a clinical response. This was followed by a definitive study in the remaining seven osteosarcoma patients and in the one malignant fibrous histiocytoma patient. The results were assessed by specific clinical, pharmacologic, radiographic and pathologic criteria. The overall response in the definitive study was 50% with two patients exhibiting total tumor destruction. The success of intra-arterial CDP was attributed to its ability to achieve high local drug concentration and tumor penetration. This was demonstrated by pharmacologic studies.
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A 59-year-old woman was evaluated for a mass in the right lobe of the liver. Ultrasonography (US) demonstrated multiple anechoic areas with enlargement of portal and hepatic veins. These areas were enhanced uniformly after bolus injection of contrast material during computed tomography (CT). The diagnosis of portal-hepatic venous fistula was confirmed by the portal venous phase of a superior mesenteric angiogram.
Twenty-two patients with colorectal cancer and metastatic liver disease in whom systemic intravenous therapy with 5-fluorouracil previously had failed were given fluorodeoxyuridine and mitomycin C by hepatic arterial infusion. Ten of the 22 patients (45.4 percent) had a partial response and median survival of 14 months, as opposed to a median survival of six months among the 12 patients who did not have response to the treatment (p = 0.02). Hepatic arterial occlusion was effected in seven of the 10 patients who responded and in seven of the 12 nonresponding patients. Such manipulation of hepatic arterial blood flow did not have a significant effect on the survival duration in either group. Retreatment of patients with colon cancer and liver metastases by hepatic arterial infusion of fluorodeoxyuridine and mitomycin C can result in significant prolongation of survival in patients with response to this treatment.
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The analgesic effects of pentazocine and tripelennamine, alone and in combination, were assessed in rats with a hot plate apparatus. In Experiment 1, the combination of tripelennamine with chronic pentazocine produced analgesia at doses which were not analgesic when the drugs were given alone. This combination also reestablished analgesia in subjects made tolerant to pentazocine's effects. In Experiment 2, development of tolerance to the analgesic effects of pentazocine was delayed by addition of tripelennamine. These data may contribute to a rationale for the current popularity of combined pentazocine and tripelennamine abuse.
We treated 100 patients with metastatic renal cell carcinoma by angioinfarction of the primary tumor followed by radical nephrectomy. Of the patients 88 also received postoperative parenteral progesterones. We achieved an over-all response rate of 28 per cent (complete regression of all metastatic lesions in 7 patients, regression greater than 50 per cent in 8 and stabilization for at least 1 year in 13). Patients with parenchymal pulmonary metastases only have the best survival rate (64 per cent at 1 year) and are most likely to benefit from angioinfarction and nephrectomy. The presence of hilar or mediastinal adenopathy, pleural effusion or nonpulmonary metastases confers a worse prognosis. These patients do not appear to survive longer with preoperative angioinfarction than if treated by nephrectomy alone. Our data demonstrate that it is critically important to stratify patients by site and volume of disease when results are reported and compared for any patient undergoing treatment for metastatic renal cell carcinoma.
Twenty-four patients with hepatocellular carcinoma or cholangiocarcinoma were treated with hepatic artery infusion (HAI) of chemotherapeutic agents (14 patients) or hepatic artery embolization (HAE) (11 patients). One patient had a combination of the two treatments. Ten of the 14 (71%) patients who underwent HAI demonstrated partial remission. The median survival time was 12.3 months. Six of the 9 patients (67%) who underwent HAE and for whom follow-up was available responded to treatment. The median survival time for those patients was 17.4 months.