Biomedical subjects
Publications and source records attributed to W H Isbister.
A CASE OF NON-Hodgkin's lymphoma arising in association with longstanding mucosal ulcerative colitis is reported. The clinical course of the patient is described, and a review of previously reported patients is made.
Patients with progressing tumours have circulating leucocytes which are sensitised to tumour specific antigens and their serum contains blocking factors. Patients who have tumours which have been successfully destroyed do not have circulating blocking factors although their lymphocytes continue to remain sensitised to the tumour antigens. Two tests, known to detect cellular sensitisation and serum blocking activity, the leucocyte adherence inhibition test (LAI) and the macrophage migration inhibition test (MMI) have been compared in a small group of patients with malignant melanoma and carcinoma of the colon. There was agreement between the results of both tests in over three-quarters of the tests performed and in those which failed to agree neither test was favoured in relation to the known tumour state of the patient. Thirty-two tests were performed in 22 patients, there was one false positive with MMI testing, seven false negative results for the LAI test and six for the MMI test.
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Two complications of diagnostic colonoscopy are reported. One patient had a perforation which was recognized immediately, and the other had a serosal tear discovered fortuitously at elective surgery. Previous reports of colonoscopic complications are reviewed, and factors predisposing to such complications are discussed.
A new final year examination in surgery has been devised. It consists of a clinical assessment made by a surgical tutor over a period of six weeks throughout a student's surgical term, a visual, clinically orientated written examination a "spotter-type" practical examination and a viva-voce examination. Correlation with students' previous performances has been good and the examination appears to have solved many of the problems which necessitated its development.
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Thoracic duct lymph was drained for 28 days from a patient with disseminated malignant melanoma. Lymphocytes were separated from the lymph by centrifugation, and returned to the patient daily. Biochemical and hematologic parameters were monitored in blood and lymph, and were maintained at satisfactory levels throughout the period. Cell-mediated immunity and specific blocking activity directed against melanoma antigens were examined by the leukocyte adherence inhibition test. Blocking factors in drained lymph fell to undetectable levels after 6 days' thoracic duct drainage, whereas it took 9 days for serum blocking factors to fall to similar levels. Peripheral blood leukocytes demonstrated cell-mediated immunity against melanoma antigens before and throughout the period of drainage, except for the immediate postoperative period. Within 24 hours of closure of the thoracic duct fistula, serum blocking activity had returned, and 17 days later the patient died.
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Thoracic duct end pressures have been measured in a conscious patient undergoing cannulation in an attempt to remove serum blocking activity. Pressures were measured during rest, coughing, straining and laughing during the last-mentioned activity pressures of the order of 85 mm Hg were recorded. It is suggested that formal ligation of the cannula at the termination of treatment.
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The leucocyte adherence inhibition (LAI) test, previously described for the detection of cell mediated immunity and serum blocking factors associated with murine tumours, has now been adapted for use with human cancer patients. Blood leucocytes from these patients, mixed in vitro with antigenic extracts of tumours of the same type, had their normal adherence to glass surfaces diminished. This inhibition was reversed (blocked) by the addition of the patients' own sera. Both LAI and blocking were tumour-type specific, but showed complete cross-reactivity within each type of tumour (melanoma, colon carcinoma, mammary carcinoma).The LAI test could be of great value in diagnosis and evaluation of treatment, since it seems to reproduce consistently the findings made by more elaborate techniques but has the advantage of being simple, rapid and inexpensive.
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