Biomedical subjects
Publications and source records attributed to R J Doerr.
Diagnostic endoscopic retrograde cholangiopancreatography (ERCP) is a remarkably safe procedure in experienced hands. A series of complications directly related to both the manipulation and cannulation of the ampulla of Vater, as well as consequent to medication and cardiorespiratory events, has been described. Herein we report a case of severe barotrauma complication of diagnostic endoscopic cholangiography.
We have previously shown that levamisole increases the cytotoxic, cytostatic, and proliferative activity of murine nonparenchymal liver cells (NPC) in vitro. We have also shown that the nonadherent subpopulation of NPC, which are composed predominantly of T lymphocytes, is very responsive to this agent when administered to mice. Kupffer cells or immigrant macrophages are also responsive to levamisole but to a lesser extent. These findings prompted us to investigate changes in cytokine production by NPC following-treatment of mice with levamisole (25 mg/kg, i.p.), which may help explain the observed alterations in the immune functions of these cells. We found that levamisole treatment of mice causes a threefold increase in production of interferon (IFN) alpha/beta by adherent NPC (more than 80%-90% Kupffer cells) in vitro. When IFN alpha/beta was added to cultured cells, it decreased the proliferative capacity of liver T cells in a dose-dependent manner. In contrast, the addition of anti-IFN alpha/beta was shown to augment levamisole-induced proliferation of unfractionated NPC and Kupffer cells. NPC production of interleukin 1 (IL-1) and interleukin-6 (IL-6) in vitro was also increased threefold following treatment of mice with levamisole. IL-6 added in vitro to cells significantly augmented levamisole-induced proliferation of liver T cells while anti-IL-6 reduced proliferative activity to control levels. These findings suggested that IFN alpha/beta, IL-6, and IL-1 play important regulatory roles in controlling the proliferative response of murine liver-associated T lymphocytes to levamisole. Finally, the proliferation of bone marrow cells was increased in mice given 5-fluorouracil (5FU). On the other hand, the proliferation of NPC was dramatically suppressed when 5FU was administered. However, the proliferation of these cells was restored when levamisole was given after 5FU.
Limb-sparing surgical procedures, such as the Tikhoff-Linberg resection, have gradually replaced the forequarter amputation as the surgical treatment of choice for soft tissue tumours in and around the shoulder girdle. Although the Tikhoff-Linberg procedure provides limb salvage, it leaves a significant functional and cosmetic deficit in many patients. Scapular resections combined with radical excision of the soft tissues allows wide margins of resection, limited excision of uninvolved bone and excellent physical rehabilitation in treating soft tissue tumours of the shoulder girdle. The case of a young woman with Stage IVA malignant fibrous histiocytoma of the left shoulder girdle who underwent a radical scapulectomy with limb salvage and adequate surgical margins, while preserving a functional and cosmetically acceptable extremity, is reported. A historical review of scapular resections is also presented.
Malignant degeneration is an unusual complication of chronic primary or recurrent pilonidal disease. To date, only 43 cases have been reported, the great majority being squamous cell type. Historically, these cases were treated with primary excision. Recurrence following such treatment was high and prognosis poor compared with nonmelanoma skin cancer. We describe a patient with squamous cell carcinoma arising in chronic pilonidal disease, who is disease-free 3 years after adjuvant radiation therapy following radical excision. This communication describes the clinicopathologic features of 38 cases of squamous cell carcinoma arising in pilonidal disease and suggests treatment modalities.
Colorectal cancer has continued to increase in incidence over the past 25 years. It now ranks as the second most common noncutaneous malignancy for men and women together. The projected 1995 statistics predict 153,000 new cases in the United States, with 109,000 of colonic origin and 44,000 cancers of the rectum. The shift to more proximal colonic involvement and a decrease in size of the presenting lesion is again noted. Unfortunately, the warning signals (rectal bleeding, change in bowel habits and, later, abdominal pain, distention, and weight loss), often become evident only after the tumor has progressed significantly in the patient. Despite improvements in endoscopic detection, anesthesia, pre- and postoperative care and more extensive en-bloc resections, the cure rate for all patients with colorectal cancer remains unchanged at 53 per cent at five years. Although radical resectional surgery is relied on for locoregional control of the disease, there has been an increased use of cross-sectional radiologic studies for staging of the cancer. This newer management of colorectal cancer is the result of a better understanding of the natural history and biologic behavior of the cancer. The main strategy presently is to diagnose the disease sooner, stage the cancer more accurately, select tumors that will respond to adjuvant therapy, and detect recurrences more efficiently. It is in the area of staging of the primary tumor and accurate localization of recurrences that this new modality, immunoscintigraphy, is felt to have an impact.
Fistula-in-ano can be complicated by malignant degeneration. A case of basal cell carcinoma identified in the curettage specimen of a fistulotomy is reported. The clinicopathologic features of cases reported in the literature are reviewed.
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A case of pure squamous cell carcinoma of the stomach in a 72-year-old male is reported. Epidermoid carcinomas of the stomach without a glandular cell component is a rare tumor, described in only 22 patients since 1905. It occurs mostly in males, with a male to female ratio of 5:1, affects a slightly younger age group as compared to adenocarcinoma, and has a predilection for the proximal stomach, especially along the lesser curvature. Squamous metaplasia resulting from injury to the gastric mucosa appears to have a role in the pathogenesis of this disease. The prognosis of squamous cell carcinoma of the stomach is probably less favorable than that of adenocarcinoma due to its higher frequency of lymphovascular invasion.
Percutaneous endoscopic jejunostomy provides good access for enteral nutrition in those patients at high risk for aspiration and poor tolerance of gastric feeding. Positioning the jejunostomy tube through the PEG tube and into the duodenum can be difficult and time consuming. We describe a simple method for gaining rapid control of the jejunal tube and its duodenal insertion.
The aims of this prospective, nonrandomized phase I/II study were to evaluate (1) the safety and (2) the detection rate of tissue culture-derived, 111In-labelled anti-CEA monoclonal antibody IVP ZCE 025 in patients with primary, metastatic and occult colorectal carcinomas. 111In-IVP ZCE 025 imaging correctly identified 31 of 37 primary colorectal carcinomas, 10 of 19 hot liver metastases, 11 of 16 distant metastases and seven of seven local tumour recurrences. Previously unsuspected tumours were detected by IVP ZCE 025 imaging in 11 of 34 patients. The scans were also true negative in four patients. The overall performance characteristics of IVP ZCE 025 at monoclonal antibody doses of 1.0-5.0 mg were comparable to those obtained with 40.0 mg ascites-produced ZCE 025. No clinical or biochemical adverse reactions were encountered in the 61 patients entered into this study.
Recurrent colorectal cancer is seen in as many as 40% of patients after curative resection. In view of the limitations of endoscopic and cross-sectional imaging, external immunoscintigraphy has been added to the follow-up regimen of patients at high-risk of recurrent disease. The authors investigated the utility of immunoscintigraphy with Indium-111 (In-111) CYT-103 (site specifically labeled conjugate of monoclonal antibody B72.3) in 19 patients with suspected recurrences after previous curative resection of colorectal carcinoma. Local or regional recurrences (4 patients) and liver metastasis (6 patients) were indicated by physical examination and computed tomography (CT), whereas nine patients had occult disease with increasing serum carcinoembryonic antigen (CEA) levels and negative conventional workups. Serum CEA levels were elevated (mean, 22 ng/ml) in all patients. Approximately 4.3 mCi In-111 labeled to 1.0 mg CYT-103 was administered intravenously to each patient. Planar and single photon emission computed tomography (SPECT) imaging were performed 2-5 days after infusion. The final diagnosis of recurrence or metastasis was established in 18 patients by second-look surgery or biopsy. One patient died before exploration. Tumor was identified at the following locations: pelvis (12 patients), abdominal wall (2 patients), retroperitoneum (1 patient), liver (5 patients), and omentum (2 patients). Superiority of monoclonal antibody (MoAb) scan is noted in the detection of pelvic and intraabdominal recurrences (100%) versus CT scan (43%). Liver metastases were identified with equal facility by both modalities. In-111 CYT-103 scan findings influenced the management of 10 (55%) of 18 patients. Surgery was avoided in one patient with disseminated metastases detected by the scan. Correct identification of occult local recurrences was made in six patients. An isolated liver metastasis was confirmed in one patient with equivocal CT scan. Finally, additional intraabdominal lesions were detected in two patients. These results suggest an important and beneficial role for In-111 CYT-103 MoAb imaging in patients with suspected recurrent colorectal carcinomas, particularly in patients in whom cross-sectional imaging is negative; such imaging may prevent patients from undergoing unnecessary surgical exploration.
To identify all patients with serious intracranial injury, current treatment strategies include admission and/or computed tomographic evaluation of all patients with head injuries. However, the majority of patients with head injuries who are awake do not require subsequent intervention. A review of 407 consecutive patients with head injuries treated at an adult regional trauma center identified 310 patients with Glasgow Coma Scores of 15 in the emergency department, all of whom were admitted. Five patients with Glasgow Coma Scores of 15 required intervention for intracranial abnormality. All five patients had skull fractures and/or neurologic deficits. Based on this and other studies, criteria for discharge from the emergency department are a Glasgow Coma Score of 15, no deficit except amnesia, no signs of intoxication, and no evidence of basilar fracture on clinical examination or linear fracture on screening skull roentgenography. Safe discharge without universal computed tomographic evaluation or admission is possible and cost-efficient.
During the past two decades, the in vivo application of monoclonal antibodies (MoAbs) in cancer diagnosis and therapy have been widely studied. This can be related to three main factors: (1) dramatic improvement in monoclonal antibody production, revolutionized by Kohler and Milstein; (2) improvement in radioisotopes and monoclonal antibody conjugation procedure and further simplification and ease of use of these procedures; and (3) the apparent safety of single or, in selected cases, multiple administration of MoAbs to humans. The development of radioimmunoscintigraphy or radioimmunodetection has added a significant new dimension to nuclear imaging, and it is very likely to broaden our approach to diagnosis and perhaps therapy of malignant diseases. The indications and limitation of radioimmunoscintigraphy must be clearly outlined to the referring oncologists and surgeons. The unique capability of radiolabeled MoAbs in detecting occult disease, upstaging patients, and, most importantly, changing patient management must be emphasized.
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This study evaluated the ability of ex vivo gamma-probe scanning to detect lymph node metastases in resected surgical specimens from primary colorectal carcinoma patients undergoing external scintigraphy following intravenous administration of 4.1-5.3 mCi of 111In-labeled anti CEA monoclonal antibodies. The ex vivo probe counting technique led to a twofold to fourfold increase in the number of detectable lymph nodes with the majority measuring 2-5 mm in diameter. Results indicate a potentially useful role for ex vivo probe counting in detection and mapping small (2-5 mm) lymph nodes metastases.
To examine the effect of a single hepatic focus of metastatic colon tumor on the immune function of liver non-parenchymal cells (NPCs) from C57Bl/6 mice, we injected 2.5 x 10(5) liver-derived murine colon adenocarcinoma (LD-MCA-38) cells beneath the liver capsule. Three weeks following injection of the tumor cells, the immune function of the NPCs was studied. The NPCs from tumor-bearing mice exhibited increased cytotoxic and proliferative activity. The NPCs from tumor-bearing mice also contained a greater percentage of CD8+ and T-cell receptor gamma/delta+ liver-associated T lymphocytes. Levels of interleukin 6 and tumor necrosis factor were increased in the NPC supernatant, and interleukin 6 levels were increased in serum from tumor-bearing mice. We conclude that the presence of a single hepatic focus of metastatic tumor results in augmented immune function of murine liver NPCs.
Over the past two decades, the role of radiolabeled monoclonal antibodies has been steadily growing in clinical practice, particularly for staging and locating a variety of neoplasms. This is due largely to the availability of these products in pharmaceutical quantities as well as the relatively low incidence of adverse reactions following the intravenous administration of antibodies to patients. One particular area of oncology where radiolabeled monoclonal antibodies are most likely to play an extremely important clinical role is in the evaluation of patients with colon and rectal carcinomas. In this report, we review the current utilization of tumor-associated monoclonal antibodies in the preoperative as well as postoperative screening of patients with colorectal carcinoma.