Biomedical subjects
L Hafström
Publications and source records attributed to L Hafström.
Management of trauma to the parenchymatous organs.
The incidence of abdominal trauma is increasing, and is related to both increased violence in the society and to the increased frequency of road traffic accidents. Injuries to the liver, pancreas with duodenum, and kidneys are almost always associated with other lesions, and we see the multi-traumatized patient. Splenic injuries however, may be solitary. Since the duodenum and pancreas lie in the depth of the abdominal cavity, they are to some extent surrounded and cushioned against impact by the overhanging liver, the lower lateral and posterior rib cage and the vertebral column. The spleen, on the other hand, is attached to its vascular pedicle, but very mobile and susceptible of injuries involving deceleration and direct blunt trauma.
Intracranial metastases of malignant melanoma treated by surgery.
Metastases in 25 patients with intracranial metastases from malignant melanoma were extirpated. Two patients had a second operation after six and ten months because of tumor recurrence. Single brain metastases were found in 20 and multiple in five patients. The interval between the primary tumor and the intracranial metastases varied from 17 years to six months. Three patients died due to complications from surgery. The median survival time was five months (mean survival ten months). Complete relief of symptoms was observed in 17 and partial relief in two patients. The quality of life was improved in 17 patients and 14 of these 17 went back to their ordinary occupation. The indications for neurosurgery are restricted in patients with extracranial or with multiple intracranial metastases.
Treatment of malignant melanoma with dacarbazin (DTIC-DOME) with special reference to urinary excretion of 5-S-cysteinyldopa.
Seventeen patients were given DTIC, 200 mg/m2/day in five-day courses every four to six weeks. In four patients (stage II) treated on an adjuvant basis, tumor recurrence has been verified in three. Four of the palliatively treated patients were also given DTIC by regional intra-arterial infusion with minimal positive tumor effect and minimal toxicity. 5-S-cysteinyldopa excretion in urine was checked continuously in all patients. Tumor recurrence was revealed in two patients given DTIC on an adjuvant basis three and four months before clinical signs of tumor. In the palliatively treated patients, 5-S-cysteinyldopa excretion increased in 5/6 patients judged to have stable disease, before tumor progression was clinically detectable. The use of 5-S-cysteinyldopa examination is a valuable adjunct to the follow-up of the effect of DTIC therapy in melanoma patients.
Retroperitoneal sarcoma treated by surgery.
A retrospective analysis of extensive surgery with resection of retroperitoneal sarcoma and total or partial resection of adjacent organs in 15 patients is presented. Dominating symptoms were a palpable mass (80%). The tumor was felt in all patients. In 9 of 10 patients, ultrasonography showed a solid tumor with retroperitoneal location. In 14 patients (93%) the tumor was removed, in 11 of them adjacent organs also. Five of the patients were subjected to more than one operation because of tumor recurrence. Two patients died postoperatively. Six patients are alive without tumor recurrence; and three, with recurrence 18 to 62 months after the first operation. Four patients died 5--24 months after primary operation. In seven patients (50%), the tumor recurred locally. Surgery for recurrent tumor was beneficial. Complete surgical removal provides the most effective therapeutic approach. Routine second-look operation within a year after primary surgery may be a way to improve the results. Adjuvant cytostatic therapy could be considered.
Influence of vasoactive drugs on blood flow in subcutaneous tumors--an experimental study in rats.
Subcutaneously implanted tumors in Wistar and Lister rats were used as a model for the study of metastatic tumor blood flow and how it is affected by vasoactive drugs. Blood flow measurements were obtained using the labelled microsphere method and the reference organ technique. Microspheres (15-micrometers) labelled with either 99Tcm or 51Cr isotopes were injected intracardially and a reference sample was drawn simultaneously at constant speed. This was performed before and after the infusion of vasoactive drugs, and (as control), saline infusion. The drugs tested (adrenaline, noradrenaline, glucagon, histamine, and vasopressin) showed profound effects on central hemodynamic parameters and on muscle and skin blood flow. The relative tumor blood flow, measured as the ratio between tumor and skin or tumor and muscle blood flow, was calculated. The results show that no enhancement of the relative tumor blood flow could be registered. In fact, a decrease in the tumor-to-muscle-blood-flow ratio was noted when noradrenaline was infused, and in the tumor-to-skin ratio when adrenaline was infused. Blood flow in subcutaneous tumors was four to five times that in muscle or skin. Tumor blood flow was also inversely related to the size of the tumor.
Fine-needle-aspiration cytodiagnosis of recurrent malignant melanoma.
Sixty-four patients with melanoma (28 with clinical stage I disease and 36 with clinical stages II through IV disease) were fine-needle biopsied on suspicion of recurrent melanoma. Eighty-four biopsies were aspirated percutaneously and three at exploratory laparotomy. A tumor mass was present at 81 biopsies. The remaining biopsies were taken with the guidance of liver scan or fluoroscopy. In the patients with the diagnosis of recurrent malignant melanoma the cytodiagnosis was correct in 45 patients out of 47. One patient was diagnosed as breast cancer and one as malignant mesenchymal tumor. Of 40 biopsies considered normal, three were revised to be melanoma. No false-positive diagnosis was found. The frequency of false-negative diagnosis was 6%. Fine-needle-aspiration cytology is a suitable method to establish a correct diagnosis when there is a suspicion of recurrent disease during the follow-up of melanoma patients. The high diagnostic accuracy in patients with enlarged lymph nodes is excellent and makes the method preferable to diagnostic surgical excision biopsies.
Intraarterial 5-FU infusion with or without oral testolactone treatement in irresectable pancreatic cancer.
The results of a prospective study of 19 patients with pancreatic cancer treated with regional intraarterial 5-FU infusion with or without oral tesolactone are reported. No primary mortality was noted. No measurable tumor remission was seen. The median survival time from the state of infusion therapy was 6.5 months. Median time of hospitalization from the start of infusion therapy was 2 months, which corresponds approximately to 30% of remaining survival time. No significant improvement of quality of life was registered during the treatment period. The results indicate that intrrarterial regional 5-FU--neither with nor without testolactone--cannot be recommended for patients with irresectable pancreatic cancer.
Effects of catecholamines on cardiovascular response and blood flow distribution to normal tissue and liver tumors in rats.
The effects of infusion of adrenaline and noradrenaline were studied in rats with intrahepatic tumors, using 99mTc-and 51Cr-labeled microspheres. The effect on general circulation, cardiac output, and tissue blood flow was pronounced, especially with infusion of noradrenaline. Studies of liver tumor perfusion in relation to surrounding liver parenchyma perfusion showed an increased tumor/liver ratio in noradrenaline-infused rats, thus indicating a preferential blood flow to the tumors induced by this drug. Adrenaline as well as 0.9% NaCl solution infusion had no effect on tumor/liver blood flow ratios. Fluorescence microscopy and monoamine determination could not reveal any noradrenaline containing nerves in the liver tumors. These experiments might suggest that the effect of intraarterial infusion with cytostatic agents might be enhanced by a simultaneously administered vasoconstrictor such as noradrenaline.
Lung resection for metastatic melanoma.
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Symptoms of occult brain metastases initiated by systemic Dacarbazine (DTIC-DOME) therapy in melanoma patients.
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Blood flow in experimental liver tumors: effect of vasoactive drugs.
The effects of infused glucagon, histamine and vasopressin on blood flow in anaesthetized rats with intrahepatic tumors were studied using microspheres labelled with 99Tcm or 51Cr isotopes. Considerable circulatory effects were noted both in central hemodynamic parameters as well as in organ and tissue blood flows. glucagon infusion increased blood flow in the spleen and small intestine while hepatic artery flow was unchanged. Histamine induce a decrease in hepatic and pulmonary blood flow Vasopressin showed a pronounced decrease in blood flow in all organs measured. Relative tumor blood flow was registered as the ratio between tumor flow and arterial hepatic flow. A relative decrease of tumor blood flow in relation to surrounding liver tissue blood flow was registered after infusion of vasopressin. No effects were seen after glucagon or histamine infusion.
Hyperthermic perfusion of recurrent malignant melanoma on the extremities.
Twenty-one patients with recurrent malignant melanoma on the extremities were treated by regional hyperthermic perfusion with melphalan (Alkeran). Four patients had a second perfusion. The recurrence site was on the foot in one patient, on the lower part of the leg in 13 patients, below the mid-thigh in 6 patients and on the elbow in one patient. The temperature of the extremities was registered continuously during the perfusion. Perfusion was performed under hyperthermic conditions with a temperature of 40-41.0 degrees C i.m. The perfusion time was 2 hours. Alkeran was given in a dose of 0.9 mg/kg bodyweight for lower extremity perfusion and 0.45 mg/kg for upper extremity perfusion. Complete tumour regression or more than 50% tumour regression was registered in 8 out of the 10 patients with manifest tumour. As the first sign of recurrence after perfusion, 4 patients had local recurrence and 10 had systemic recurrence. Altogether one-third of the patients had local recurrences and half of the patients systemic recurrences. Local recurrences occurred after a median time of 8 months and systemic recurrences after a median time of 7 months. Nine patients are still alive after an observation time of 5.5 months to 44 months. Three patients are without any signs of recurrent disease.
[Hyperthermia in malignant neoplasms--a review].
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Intraarterial infusion chemotherapy (5-fluorouracil) in patients with inextirpable or locally recurrent rectal cancer.
A retrospective analysis of the results of treatment of advanced rectal cancer of the pelvis with regional intraarterial infusion of 5-fluorouracil (5-FU) is reported. A special technic for positioning the catheters selectively in the internal iliac arteries justifies this analysis. Four patients with primary inextirpable rectal cancer and 10 patients with locally recurrent rectal cancer have been treated. No immediate mortality was noted. Relief of pain was noted in two-thirds of the patients. An objective tumor response was noted in three patients with locally recurrent disease. In one patient with primary inoperable cancer it was possible to extirpate the tumor after infusion therapy. An improvement in quality of life during the first 2 months after therapy was achieved in half of the patients as judged by their performance. Complications were not serious. Hematomas with infection were seen in one patient, two patients had septicemia, and three patients had transient oliguria. Transient thrombocytopenia was reported in two patients. The results indicate that infusion therapy produces a reasonable response such as palliation of pain. Only minor complications were seen and easily controlled. The advantages of infusion therapy are that it can be given in a reasonable time with only a short hospital stay.
Measurements of cardiac output and organ blood flow in rats using 99Tcm labelled microspheres.
The cardiac output and regional blood flow have been simultaneously determined in the anesthetized rat by using the reference organ method. 99Tcm labelled dextran 15 micron microspheres were injected in the left ventricle while simultaneously an arterial reference sample was drawn at constant known rate. The values calculated regarding cardiac output agree well with previously recorded series. Regional organ blood flow in the rat is presented as ml . min-1 . g-1 tissue and values do agree with those reported by others. The results indicate that the reference organ method can be used in the rat for the study of cardiac output and regional blood flow.
Postoperative radiation therapy in mammary carcinoma stage II. Target volume, organs at risk, absorbed dose, time-dose schedule, and dose to organs at risk in a prospective investigation.
A standardized programme for postoperative radiation therapy of carcinoma of the breast stage II is reported. The target volume and the organs at risk are defined, and the target absorbed dose and fractionation are specified. The irradiation techniques is briefly described.
Tumor blood flow in rats measured by labelled microspheres. Influence of catechol amines and the relation to adrenergic innervation of the tumor.
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