The wood beyond the trees--an oncologist's view.
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Biomedical subjects
Publications and source records attributed to W M Ross.
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Adult rats, some pretreated for 2 weeks with daily injections of vitamin E (961 IU/kg) were made diabetic by an intravenous injection of streptozotocin. The glucose levels in the serum rose to about five times normal in both groups. In the animals that had not been treated with vitamin E, changes appeared in the lenses that worsened as the hyperglycemia continued: by 4 days, irregular structure of the fibre cells at the equator; by 1 week, twisted ends and irregular undulations of these cells; by 2 weeks, jagged protrusions from the cell surfaces and twisting of the entire cell; by 3 weeks, flakiness of the surfaces of the equatorial epithelial cells, and disorganized and jagged fibre cells in a large area at the equator; and by 6 weeks, extensive subcapsular globular degeneration of the cortical fibre cells. In contrast, the lenses of the diabetic animals that continued to receive vitamin E showed minimal changes: after 6 weeks the equatorial fibre cells displayed the structural irregularities found after 4 days in the diabetic control animals. The protective effect of vitamin E could not be ascribed to the effect on aldose reductase, for at 6 weeks the levels of fructose and glucose in the lenses of the diabetic animals treated with the vitamin, although increased, were not significantly different from those in the lenses of the untreated diabetic rats, and the sorbitol levels were significantly higher in the treated animals. These results are discussed in terms of a multistep mechanism of cortical cataractogenesis.
Bromocriptine therapy may cause regression of prolactinomas, but its effect on nonsecretory pituitary tumors is uncertain. Conventional treatment for such "functionless" tumors is surgery and/or radiotherapy, but recurrences pose a therapeutic dilemma. We describe a patient with such a tumor treated by surgery and radiotherapy who presented with recurrent disease 14 days later. On treatment with bromocriptine, 20 mg daily for 25 months, the intrasellar tumor recurrence had diminished in size and a suprasellar extension had almost disappeared. Bromocriptine therapy may therefore benefit some patients with nonsecretory pituitary tumors considered unsuitable for surgery or radiotherapy.
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In an attempt to derive estimates of the incidence and prevalence of acromegaly a survey of the population in the area served by the former Newcastle Regional Hospital Board has been conducted to detect cases of acromegaly alive after 1 January 1960 and diagnosed before 31 December 1971. Cases were detected by means of letters to general practitioners, hospital physicians, neurosurgeons and to hospital records officers, as well as from death certificates. From the population of 3.1 millions a firm diagnosis of acromegaly was made in 164 patients, in eighty-one on clinical grounds alone and in eighty-three with confirmation by assay of human growth hormone (hGH). The annual incidence of acromegaly appears to be close to three cases per million and the prevalence of diagnosed cases up to forty cases per million. In male acromegalics there was a significant increase in the risk of death from cardiovascular, cerebrovascular respiratory and malignant diseases but in females from cerebrovascular disease only.
Twenty patients with moderately severe ophthalmopathy due to Graves' disease or ophthalmic Graves' disease were treated by supervoltage orbital radiotherapy generated by a linear accelerator. Seven patients (35%) showed some response within 3 weeks of the treatment, four patients (20%) improved minimally while nine patients (45%) were unchanged. Improvement was noted mainly in soft tissue changes while proptosis decreased in only four patients. With one exception, ophthalmoplegia did not improve after the radiotherapy. The benefit obtained with the treatment was not impressive.
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After 2 days, lenses with intact capsules from adults rats remained clear when incubated in medium 199 with a normal glucose concentration but showed opacities when the level of glucose was increased up to 10 times normal. Scanning electron microscopy of the fixed lenses demonstrate globular degeneration in the visibly opaque lenses. The depth of degeneration increased as a function of the glucose concentration in the medium, as did the opacity. Thus, in glucose-induced cataracts, as in other types of cortical cataracts, opacity and globular degeneration of the lens appear to be associated. Sorbitol (but not fructose) also induced globular degeneration and lens opacities, indicating that there may be a mechanism of cataractogenesis other than osmosis. The high risk of cataracts in persons with controlled diabetes may be related to the observation that, in vitro, a lower concentration of glucose in medium 199, 8.9 mM (1.6 times the normal level), with 96 hours of incubation was as effective as the minimum concentration capable of causing cataracts, 11.1 mM (2 times the normal level), with 24 hours of incubation.
Eighteen patients with Cushing's disease were seen over a 40-month period and considered for treatment by pituitary irradiation and adrenal blocking drugs. Fourteen patients entered the study and each received megavoltage therapy to give a mean dose of 4600 rad to the pituitary over 31 days. Each patient was treated for one (two patients) or two (12 patients) years with one or both of the adrenocortical enzyme inhibitors, metyrapone or aminoglutethmide to suppress cortisol secretion. Doses were adjusted to maintain urinary free cortisol secretion below 300 nmol/24 h. One patient failed to complete the trial. Normal urinary free cortisol excretion and plasma cortisol concentration were maintained after treatment in eight of the remaining 13 patients after therapy. Only one patient required cortisol replacement and normal menstrual function was restored in five of the six women. The remaining five patients relapsed and four were subsequently treated by total adrenalectomy. It was noted that the patients who responded to treatment were substantially younger than the therapeutic failures. It is suggested that this treatment is most useful in the management of younger patients.
A patient with previously treated follicular carcinoma of the thyroid developed Graves' disease with a high titre of thyroid-stimulating antibodies (TSAb). He developed functioning pulmonary metastases leading to hyperthyroidism. Levels of TSAb paralleled the functional status of the metastases suggesting that hyperfunction of the neoplastic tissues was caused by TSAb.
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Long-term repopulation of the blood-forming organs of dogs, conditioned by wholebody X-irradiation (1200 R midplane dose), was achieved by transfusion of cryopreserved allogeneic blood mononuclear cells (MNC) without causing graft-versus-host-reaction (GVH-R). Donor and recipient dogs were DL-A identical, MLC-negative, no siblings, non-related. The blood stem cells (CFUc) were procured by a 3- to 4-hour continuous-flow leukapheresis. To increase the CFUc concentration in the peripheral blood, dextran sulfate (DS) was administered intravenously beforehand. About 1 x 10(10) MNC, among them about 1 x 10(7) CFUc, were collected and further segregated using a discontinuous albumin density gradient. Less dense cells were to be found in the upper part of the gradient (fraction 2). These cells included most of the CFUc, enriched by a factor of between 275 and 1730 compared to their concentration in the peripheral blood beforehand. After cryopreservation, these cells, when transfused into lethally irradiated dogs, completely repopulated the marrow and lymph nodes, caused no GVH-R and allowed long-term survival. These dogs received no immunosuppressive therapy, either before or after transfusion. More dense MNC were to be found in fraction 3; their transfusion caused a severe GVH-R, followed quickly by death. Fraction 4 was rich in lymphocytes and poor in CFUc. The transfusion of these cells produced a selective plasma-cell hyperplasia of the lymph nodes but failed to repopulate permanently the marrow. The reappearance of the different cell lineages in the marrow and in the peripheral blood after conditioning and transfusion of these cells produced a selective plasma-cell hyperplasia of the lymph nodes but failed to repopulate permanently the marrow. The reappearance of the different cell lineages in the marrow and in the peripheral blood after conditioning and transfusion of the segregated MNC is described in detail.
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