TREATMENT OF KELOIDS WITH TRIAMCINOLONE ACETONIDE INJECTED INTRALESIONALLY.
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Injection of emulsified trehalose-6,6'-dimycolate (TDM), a mycobacterial glycolipid, into transplants of an established, syngeneic murine fibrosarcoma induced complete regression of tumor in a number of animals. The number of animals in wich tumor regressed completely depended on the amount of oil in the emulsion. The anti-tumor activity of the TDM emulsion containing the highest concentration of oil was equivalent to that of living BCG.
Bovine ocular squamous cell carcinoma (BOSCC) of clinical stage I, mostly situated in the third eyelid, was chosen as a therapy model for squamous cell carcinoma of the head and neck in humans. Block resection was found to be the best method of treatment. Regression was noticed in 19 out of 30 cows treated intratumourously with a single injection of live BCG or BCG cell wall vaccine, followed by recurrence in 8 cases. In 2 untreated cows, complete lasting regression occurred. Regression was significantly more frequently encountered in intratumourously treated cows than in controls. Regression was associated with a high mitotic index, severe infiltrating growth and small amounts of cellular (lymphoid) infiltration. Metastasis was found in 14 out of 50 cows: 5 in 10 untreated controls, 8 in 30 BCG treated cows and 1 in 10 surgically treated cows. The growth rate of progressively growing untreated and of some treated tumours was not associated with the mitotic index nor with other morphological characteristics tested. The mitotic index was found to be higher in the deep infiltrating layer than in the superficial layer of the primary tumour, suggesting that a single biopsy is not sufficiently representative for cell kinetic studies.
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We have previously shown that avirulent but replication-competent herpes simplex virus (HSV) 1716 causes cell death in human melanoma cell lines in vitro and selectively replicates in melanoma tissue in nude mice. We now present a pilot study of intratumoral injection of HSV1716 into subcutaneous nodules of metastatic melanoma in five patients with stage 4 melanoma. Two patients each received one injection, two received two injections, and one received four injections of 10(3) plaque-forming units HSV1716. In one patient, flattening of previously palpable tumour nodules was seen 21 days after two direct injections of HSV1716, and in injected nodules from all three patients who received two or more injections there was microscopic evidence of tumour necrosis. Immunohistochemical staining of injected nodules revealed evidence of virus replication confined to tumour cells. These findings suggest that HSV1716 is non-toxic and could be of therapeutic benefit in patients with metastatic melanoma.
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On the basis of this study of 111 patients with herpes zoster and 88 with postherpetic neuralgia, it is suggested that the intradermal injection of triamcinolone in saline is a valuable treatment. Mild complications were pain, hemorrhage, abscesses, atrophy, moon face and possibly thrombophlebitis. Zoster patients required treatment for about half as long as those in previously reported control series. In patients treated for active herpes zoster, postzoster neuralgia occurred with about one-third of the frequency noted in other series. In postzoster neuralgia, the patient was benefited sufficiently in 62.5% of the cases to find that life was worth living again.
Freezing with liquid nitrogen in the conventional manner of cryosurgery followed immediately by injection of a suspension of a fluorinated adrenocorticosteroid is an effective way of treating keloids and hypertrophic scars. Details of the method are given.
Injection of living Mycobacterium bovis (strain BCG) into established intradermal tumors caused tumor regression and prevented the development of metastases.
Mycobacterial sulfatides (sulfolipids) in admixture with endotoxin had tumor regressive activity comparable to trehalose-6,6'-dimycolate (TDM) and endotoxin in guinea pigs, but unlike TDM were neither toxic nor granulomagenic and had no antitumor activity in mice. The increased endotoxin lethality in mice pretreated with BCG was not observed in mice pretreated with sulfolipids or TDM instead of BCG.
Intratumoral injection of ultrasonically prepared emulsions of the synthetic glycolipid methly 6-O-(2-tetradecyl-3-hydroxyoctadecanoyl)-alpha-D-glucopyranoside (designated C39) induced complete regression of transplants of a syngeneic murine fibrosarcoma in most of the treated animals as did 6,6'-di-O(2-tetradecyl-3-hydroxyoctadecanoyl)-alpha,alpha,-trehalose (designated C76) in a previous study. The C76 compound, about twice the molecular weight of C39, was more effective therapeutically than the smaller molecule. Ultrasonically prepared emulsions of C39 and C76 were not toxic when given intravenously. Intravenously administered emulsions of C39 prepared by mechanical grinding were more toxic, but less granulomagenic, than those containing C76. Squalane and squalene, but not peanut oil, were effective substitutes for mineral oil as carriers of C39 in the treatment of the tumor.