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[Evaluation of intraperitoneal chemotherapy using CDDP combined with MMC in gastric carcinomatous peritonitis].

Based on the experimental studies using Meth A and L 1210 transplantable mouse, which indicated that simultaneous combined administration of MMC and CDDP prolonged life span more significantly than individual administration, clinical application was performed on 14 cases with carcinomatous peritonitis in gastric cancer. One hundred mg of CDDP was administered before the closure of abdomen and drainage tubes were opened 2 hours later. Then, repeated administration of 10 mg/body of MMC and 40-50 mg/body of CDDP was continued once a month via the drug delivery system. Negative change of cytology was observed in seven out of 14 cases, and the prognosis of these patients was better than in the unchanged cytology group. Side effects such as severe gastro-intestinal symptoms and bone marrow toxicities were not recognized. Further studies should be done to confirm the efficacy of the intraperitoneal chemotherapy for carcinomatous peritonitis.

Animals↗

Effect of intraperitoneally administered recombinant murine granulocyte-macrophage colony-stimulating factor (rmGM-CSF) on the cytotoxic potential of murine peritoneal cells.

We studied the effect of recombinant murine granulocyte-macrophage colony-stimulating factor (rmGM-CSF) on the cytotoxic potential of murine peritoneal cells. Mice received rmGM-CSF intraperitoneally using different dosages and injection schemes. At different time points after the last injection, mice were sacrificed, peritoneal cells isolated and their tumour cytotoxicity was determined by a cytotoxicity assay using syngeneic [methyl-3H]thymidine-labelled colon carcinoma cells. Also, the cytotoxic response to a subsequent in vitro stimulation with lipopolysaccharide was determined. Upon daily injection of 6000-54,000 U rmGM-CSF over a 6-day period, the number of peritoneal cells increased over ten fold with the highest rmGM-CSF dose. Increases in cell numbers was mainly due to increases in macrophage numbers. Upon injection of three doses of 3000 U rmGM-CSF per day for 3 consecutive days, the number of macrophages remained elevated for minimally 6 days. Although the peritoneal cells from rmGM-CSF-treated mice were not activated to a tumoricidal state, they could be activated to high levels of cytotoxicity with an additional in vitro stimulation of lipopolysaccharide. Resident cells isolated from control mice could be activated only to low levels of tumour cytotoxicity with lipopolysaccharide. Tumour cytotoxicity strongly correlated with nitric oxide secretion. When inhibiting nitric oxide synthase, tumour cell lysis decreased. Thus, the expanded peritoneal cell population induced by multiple injections of rmGM-CSF has a strong tumour cytotoxic potential and might provide a favourable condition for immunotherapeutic treatment of peritoneal neoplasms.

Animals↗

[Cause-specific mortality of asbestos-cement workers compensated for asbestosis in the city of Bari].

The cause-specific mortality of 233 asbestos cement workers employed by the Fibronit company in Bari and compensated for asbestosis was investigated. Cohort members were enrolled on 31.12.1979 and followed through 30.4.1997; follow-up was completed for 98.3% of study subjects, and causes of death were ascertained for 96.6% of deceased subjects. Observed mortality was contrasted to that expected according to cause-sex-age- and calendar time-specific rates of the population resident in the Apulia Region. All causes observed mortality exceeded expected value (SMR: 117, 87 observed), due to a significant' increase in pneumoconiosis (SMR: 11238, 14 observed) and malignant neoplasms (SMR: 163, 38 observed)). A significant decrease of circulatory diseases was found (SMR: 64, 18 observed). Among cancer deaths, the following sites showed a significant excess: lung (SMR: 206, 17 observed), pleura (SMR: 2551, 4 observed), mediastinum (SMR: 2367, 2 observed) and peritoneum (SMR: 2877, 2 observed). The excess mortality due to asbestosis, respiratory cancer and peritoned neoplasms can be causally attributed to occupational asbestos exposure.

Asbestos↗

Metastatic melanoma of mesentery.

A case of malignant melanoma metastatic to small bowel mesentery in an old female is reported. Her primary malignant melanoma of nasal mucosa was already treated. She presented with intestinal obstruction, underwent surgical excision of the tumour and was tumour-free postoperatively.

Aged↗

Rapid intra-abdominal spread of pancreatic cancer. Influence of multiple operative biopsy procedures.

Intra-abdominal spread of tumor is a common cause of treatment failure in patients with pancreatic cancer. We have reviewed 62 patients with pancreatic cancer undergoing repeat laparotomy in order to learn what factors are associated with the high risk of intra-abdominal metastases. Patients who underwent two or more operative biopsy procedures were at a markedly increased risk of developing intra-abdominal tumor seeding. These metastases were not detectable by preoperative computed tomography scan or ultrasound. This information affirms that multiple biopsies of pancreatic tumors increase the risk of local disease failure, and regimens based on nonoperative staging are likely to incorrectly minimize the extent of tumor involvement.

Adult↗

The abdominoinguinal incision: the equivalent of thoracoabdominal incision for the lower quadrants of the abdomen.

In the past, tumors of the iliac fossa, those of the area of the external iliac vessels, and those fixed to the wall of the lesser pelvis with extension into and involvement of the pubic bone were often considered unresectable through the conventional surgical incisions or were treated with hemipelvectomy. For such tumors, although there was exposure of the cephalad aspect through routine incisions, there was lack of exposure on the caudal or lateral aspects, which often extended anteriorly to involve the lower abdominal wall or continued behind the inguinal ligament or through the obturator foramen into the thigh. The abdominoinguinal incision provides exposure for resection of the majority of these tumors with preservation of the extremity. It involves a lower midline incision, which is extended from the pubic symphysis transversely to the midinguinal point on the affected side and then vertically for a few centimeters in the femoral triangle. The femoral vessels are exposed, the ipsilateral rectus abdominis and anterior sheath are divided off the pubic crest, the inguinal ligament is divided off the pubic tubercle, the inferior epigastric vessels are ligated and divided near their origin from the vessels, and the lateral third of the inguinal ligament is detached from the iliac fascia. This incision provides full exposure of the lower abdominal aorta, inferior vena cava, and iliac vessels on the side of involvement in their continuity with the femoral vessels. With improved exposure and vascular control, the majority of tumors with lateral pelvic fixation become resectable.

Abdomen↗

Biological considerations with pelvic neoplasms.

The strategy of therapy for any neoplasm is determined to a significant degree by the biological characteristics of the neoplasm. The ones benefited most by surgical ablation are the cancers that grow locally but never metastasize. The second group is composed of neoplasms with exceedingly slow growth rates permitting long periods of symptom-free survival before recidivation. Many such cancers occur in pelvic structures requiring understanding of the nature of the cancers and then techniques necessary for their resection. The review provides an introduction to some of the relevant biological considerations.

Adenocarcinoma↗

Adoptive immunotherapy for advanced cancer patients using in vitro activated cytotoxic T lymphocytes.

BACKGROUND AND OBJECTIVES: We evaluated the clinical efficacy of adoptive immunotherapy using in vitro activated cytotoxic T lymphocytes (CTL) in the treatment of patients with advanced cancer. METHODS: CTL were induced with the mixed lymphocyte and tumor cell culture method, in which lymphocytes isolated from patient peripheral blood mononuclear cells were mixed with inactivated autologous tumor cells. Activated lymphocytes were administered intravenously to 11 patients once every 2 weeks for 10 weeks (i.e., 5 doses). RESULTS: Tumor reduction and decreased tumor marker were observed in 4 patients. Notably, successful CTL induction was identified in all of these patients. In patients who did not show induction of CTL response, a decreased proportion of lymphocytes, especially CD8(+) cells, and increased levels of CD14(+) cells were frequently observed. Fluorescence-activated cell sorter analysis indicated that expression of HLA class I and costimulatory factor B7-1 molecules was diminished on tumor cells. This was partly recovered with interferon-gamma, which resulted in successful induction of a CTL response. CONCLUSIONS: It was suggested that in vitro CTL induction is difficult in patients with advanced cancer. However, once the cells were induced successfully, some favorable clinical effects were seen by the adoptive transfer of such cell populations.

Aged↗

The role of fine-needle aspiration cytology in the evaluation of metastatic clear cell tumors.

BACKGROUND: Clear cell tumors (CCTs) occur as primary neoplasms in a number of anatomic sites. Due to their overlapping morphologic features, these tumors can be challenging for the cytologist, particularly when they present as metastatic lesions. METHODS: Forty-nine fine-needle aspirations (FNA) of metastatic CCTs from 46 patients (age range, 29-87 years; mean, 64 years) were reviewed retrospectively. In addition to the routine smears and cell block preparations, ancillary studies were performed in selected cases. Clinical and/or histologic follow-up was obtained for all patients. RESULTS: The sites of the 49 FNAs were the lung (12 cases), lymph nodes (9 cases), liver (7 cases), bone (7 cases), soft tissue (4 cases), pelvis (2 cases), adrenal gland (2 cases), pancreas (1 case), thyroid (2 cases), peritoneum (2 cases), and vagina (1 case). Twenty-seven patients had a previous history of a CCT and the FNA material in these cases was consistent with a metastasis. The primary anatomic sites in these cases were the kidney (20 cases), ovary (2 cases), salivary gland (1 case), and cervix (1 case). On light microscopy, these tumors had a similar appearance and often were indistinguishable. Nineteen patients did not have a prior history of malignancy; 12 of these patients had a concurrent renal mass and the diagnosis of metastatic renal cell carcinoma was made. The anatomic site of origin of seven of the ten remaining tumors (kidney [2 cases], lung [2 cases], ovary [1 case], germ cell [1 case], and endometrium [1 case]) was established through immunocytochemical studies of cytologic material and clinical follow-up. CONCLUSIONS: FNA plays an important role in the diagnosis of metastatic CCT. Cytologic examination, ancillary studies, and clinical information can establish the anatomic site of origin in the majority (95%) of cases, precluding the necessity of obtaining additional tissue. Cancer (Cancer Cytopathol)

Adenocarcinoma, Clear Cell↗