Biomedical subjects
Publications and source records attributed to M J Koretz.
We report three cases of erroneous positioning of Hickman catheters into central venous tributaries. The malposition was not diagnosed intraoperatively because of proximity of such veins to the superior vena cava. Suspicion of misplacement raised by early postoperative catheter malfunction should allow for correction by percutaneous vascular catheters.
The purpose of this study was to evaluate the efficacy and safety of a continuous-infusion interleukin 2 (IL-2) regimen for patients with metastatic melanoma and renal cell cancer. To investigate the contribution of adoptively transferred lymphokine-activated killer cells, patients were randomized to receive either IL-2 alone or IL-2 plus lymphokine-activated killer cells. Twenty-three patients with renal cell carcinoma and 20 with melanoma were entered into the protocol. There were no objective responses noted in the 38 assessable patients (20 with renal cell carcinoma, 18 with melanoma). Most patients demonstrated progressive disease following one 31-day cycle of weekly continuous-infusion IL-2. Grade I and II toxic reactions, including fever, rash, anorexia, and weight gain, were common and treated symptomatically. Significant in vivo stimulation of lymphokine-activated killer and natural killer cell activity was noted in most patients. This continuous-infusion IL-2 regimen with or without lymphokine-activated killer cells was ineffective in the treatment of melanoma and renal cell carcinoma.
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This study was undertaken to determine whether the phorbol diester, phorbol 12-myristate 13-acetate (PMA), causes differentiation of the human colon carcinoma cell line, SW 48. Under routine growth conditions, the cells are round, have a high nuclear-to-cytoplasmic ratio, and lack cytoplasmic vacuoles. After treatment for 1 hour with 100 nmol/L of PMA at 37 degrees C, the cells assumed a spread-out, flasklike shape, displayed a low nuclear-to-cytoplasmic ratio, and exhibited cytoplasmic vacuoles. An inert but lipophilic phorbol diester, 4 phorbol 12,13-didecanoate, failed to induce these morphological changes. Cell kinetic studies showed that whereas SW 48 cells have a doubling time of 35 hours, those incubated with 100 nmol/L of PMA have a doubling time of 90 hours. Although the flow cytometry histograms were similar until 8 hours into the cell cycle, the PMA-treated cells ultimately spent proportionately less time in S and more in G2/M. Finally, under routine growth conditions, SW 48 cells express neither carcinoembryonic antigen nor G7 antigen. These antigens, which are present on the surface of well-differentiated cells, were expressed after treatment of SW 48 with PMA. The data suggest that PMA causes profound changes in structure, cell growth kinetics, and antigen expression, consistent with induction of differentiation of the cell line SW 48.
Acute intra-abdominal conditions due to metastatic primary lung cancer have been reported rarely in the literature, with a very high associated operative mortality noted. We report on 13 patients with metastatic lung cancer who underwent exploratory celiotomy from 1976 through 1988. Twelve were men, and their ages ranged from 43 to 68 years. All but 1 of the patients had known extra-abdominal metastases (primarily brain) at the time of the abdominal symptoms. In 11 patients the small bowel was the site of metastases. One patient had cecal involvement, while the 13th had common bile duct obstruction. The most common histologic type was a large-cell carcinoma. The extent of surgery was dependent on the pathologic findings encountered; most patients underwent resection of obstructed or perforated intestine. Eight of the 13 patients survived and were discharged from the hospital after a mean stay of 17 days. We conclude that acute intra-abdominal conditions from metastatic lung cancer can often be treated successfully by prompt surgical exploration, including bowel resection or bypass if necessary.
The surgeon operating upon patients with primary or metastatic hepatic cancers must determine if resection is feasible and, if it is, the magnitude of required resection. In an attempt to determine which tests best aid the surgeon in these determinations, the authors prospectively compared preoperative computed tomography (CT) of the liver and intraoperative ultrasound (IOU) in 42 patients with liver tumors who underwent 45 exploratory operations. The primary diseases included colorectal cancer metastases in 27 patients, hepatoma in 11 patients, and metastatic cancers of other origins in 4 patients. In the 42 patients there were 89 identified hepatic lesions that were confirmed to be malignant by resection, biopsy, or continued growth on follow-up CT. The sensitivity of either test for detecting these lesions was 69/89 (77%) for CT and 87/89 (98%) for IOU. Resection was not feasible in 13 patients. Five had extrahepatic disease, 4 had more nodules discovered by IOU, 3 were found by IOU to have involvement of all three hepatic veins by tumor and 1 patient had portal-vein invasion. Alternatively, in four patients tumors thought to involve all three hepatic veins by CT were shown to be free of at least one hepatic vein, thereby permitting resection. In one patient who had been previously operated upon, a tumor thought to involve the remaining right hepatic vein was seen to be free of the vein, also permitting resection. Regarding the extent of resection, IOU was also helpful. Lesser procedures than anticipated were proved possible by IOU in seven patients. A more extensive resection was shown to be necessary by IOU in two patients. Thus, IOU affected the operative management in 22 of 45 operative episodes (49%). It was conclude that IOU is superior to both preoperative CT and surgical exploration in assessing both the feasibility and the extent of resection required for primary and secondary hepatic cancers. In the authors' experience, IOU is the most sensitive indicator of number of lesions present in the liver. In addition, the ability of IOU to determine hepatic venous anatomy is a helpful adjunct in determining resectability of liver tumors.
Experience with primary adenocarcinoma of the jejunum at the Union Memorial Hospital is reviewed. Six patients treated from 1968 to 1986 with this interesting but rare tumor were identified. Although symptoms appeared to be of long duration, all patients were diagnosed with advanced disease, with only one patient surviving long-term. Data on primary jejunal adenocarcinoma reported in the medical literature were reviewed. The survival figures appear to correlate with stage at presentation, and therefore early and aggressive diagnostic and therapeutic intervention seems indicated to improve the outlook in these patients with historically poor survival rates.
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Extrarenal Wilms' tumor is a very rare disease, occurring mostly in children. Sixteen cases have been reported in the world medical literature. A case of retroperitoneal extrarenal Wilms' tumor is reported in a 36-year old white male and the literature reviewed. Pathologic examination revealed both undifferentiated renal blastoma plus differentiated areas containing immature tubules and glomeruli. No evidence of extrarenal teratomatous tissue was seen. Theories for the histogenesis of this rare tumor are discussed.
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A series of 21 emergency operations performed upon 19 patients with acute leukemia was reviewed. The most common procedure performed was laparotomy for intra-abdominal emergency complications which was associated with a high mortality (58 per cent), especially in those patients with leukemia not in remission (78 per cent). Patients who underwent extra-abdominal procedures, even with leukemia not in remission, had a low mortality (14 per cent). All five patients who were operated upon while in remission survived. The most accurate prognostic signs associated with postoperative mortality were abnormal white blood cell counts and development of leukemia not in remission. Early surgical intervention is advised combined with intensive supportive care to improve survival rates of patients with acute leukemia who undergo emergency surgical procedures.