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[Results of tri-component treatment of lung cancer (pre- or postoperative radioisotope teletherapy and radioactive colloid gold Au-198)].

Radical surgery adjuvant to pre- or postoperative teleradiotherapy and intravenous injection of radioactive colloid gold did not aggravate the course of the postoperative period in pulmonary carcinoma patients, nor did it increase the total number of postoperative complications and the postoperative mortality. Side effects of treatment presenting as radiation responses were transitory and cured conservatively. Three-component treatment for pulmonary carcinoma, including preoperative irradiation in doses 20, 30 Gy, radical surgery, and intravenous 198Au after surgery is indicated to patients with Stage III pulmonary adenocarcinoma and epidermoid cancer, whose 5-year survival rate elevated by 36 and 30 percent, respectively, as against surgical treatment, and to those with stages II and III metastatic adenocarcinoma and epidermoid cancer of the lungs, whose 5-year survival rate increased by 39 and 32 percent, respectively, as against those treated surgically.

Aged

Radioactive colloidal gold as a tool to quantify extravasation of macromolecules in the rat cremaster muscle.

Since previously described simple methods were too insensitive to quantify the extent of microvascular permeability increase in the rat cremaster muscle, we applied a new quantitative technique using radioactive colloidal gold (198Au) as the macromolecular tracer. Dose-response effects on microvascular permeability were found with increasing doses of subscrotally injected serotonin or histamine. The presence of colloidal gold particles in the subendothelial space of the postcapillary venules, as verified ultrastructurally, indicated endothelial permeation of the tracer macromolecules. The increased permeability elicited by serotonin was inhibited in a dose-dependent way by serotonin receptor antagonists (potency: methysergide greater than or equal to ketanserin = ritanserin greater than cinanserin), suggesting the presence of functional S2-serotonergic receptors on postcapillary venular endothelial cells. A dose-related inhibition of the histamine-induced extravasation was seen with the H1 antagonists astemizole and azatidine (astemizole greater than azatidine); the H2 antagonists cimetidine and ranitidine had no inhibitory effect. The radioactive colloidal gold technique is a sensitive and reliable tool for pharmacological experiments aimed at investigating the extravasation phenomenon in small tissue samples such as the rat cremaster muscle.

Animals

Spread of gold injected into the joints of healthy rabbits.

This study shows that after intra-articular injection, aurothiomalate and colloidal gold of small (200 A) particle size were rapidly absorbed from joints while the larger, 300 A, particle size colloidal radioactive gold could not be found outside them. Larger particle size suspensions seem therefore more likely to remain localised in the joint and its lining synovium after intra-articular injection, the systemic absorption from the joint cavity diminishing with increasing particle size. It was also found that the intra-articular injection of small amounts of aurothiomalate, of colloidal gold and of colloidal radioactive gold produces identical degenerative lesions in the lining cells of the proximal convoluted tubules of the kidneys. These lesions were always found, although gold particles were demonstrated only in sampled kidney tissues of the animals injected with the soluble gold preparation whereas no gold could be detected in the tissues of animals injected with colloidal non-radioactive or radioactive gold. Electron microscopic evidence is presented to suggest the possibility that the mitochondria are the "target" organelles of the gold-induced cellular damage. Mitochondrial damage was demonstrated in liver and spleen in addition to the already described kidney damage. The correlation between structure and function of the mitochondrial changes is not clear, and ionic shifts may be both a cause and a result of damage.

Animals

Synovitis of familial mediterranean fever. A histologic and ultrastructural study.

The microscopic and ultrastructural features seen in the synovium of twelve patients affected by the protracted arthritis variety of FMF is described. It would appear that the small vessels of the synovial membrane are the principle target organ in this articular pathology. Intra articular injections of colloidal radioactive gold, or hydrocortisone, do not alter the histologic and ultrastructural appearance of the affected synovia. Neither do these findings change in the regenerated synovia, growing after a surgical synovectomy. The implications of these findings are discussed.

Familial Mediterranean Fever

[Contact radiotherapy of rheumatoid arthritis].

The authors have devised a method of contact radiotherapy with open radionuclides (198Au) to be used in the treatment of patients suffering from rheumatoid arthritis. Indications for therapy have been defined. In 360 patients suffering from rheumatoid arthritis, radioactive colloid gold was administered to the affected joints. The therapeutic effect was slow in development. The best clinical results were recorded at month 12. Considerable improvement was noticed in 70% of the patients, improvement in 20%, and in 10% of the patients, no therapeutic effect could be recorded. Good effect was ascertained in patients with X-ray Stage I and II disease (70%).

Adult

[Treatment of patients with cancer of the colon].

Experience in the treatment of 317 patients with cancer of the colon is discussed. Surgery was conducted in 226 patients, 91 patients received combined treatment (operation and intravenous injection of radioactive colloidal gold). Postoperative mortality was 5.99%. The main cause of death was peritonitis (4.1%) due to incompetence of the anastomosis. Combined treatment of patients with stage III cancer of the colon improves somewhat the late-term results of management.

Adenocarcinoma

[Characteristics of the postoperative period in stomach cancer patients undergoing combined treatment].

Postoperative course was studied in 423 radically treated patients: 175--surgery only, 96--preoperative 5-fluorouracil chemotherapy, 79--intravenous radioactive colloid gold postoperatively, and 73--both 5-fluorouracil preoperatively and colloid gold postoperatively. The two latter procedures did not affect postoperative course adversely; nor did they influence the spectrum of postoperative complications or increase lethality rate.

Combined Modality Therapy

Intracavitary uses of colloids.

Pleural and peritoneal effusion secondary to primary malignancy is a significant problem in the management of the cancer patient. Respiratory embarrassment and discomfort associated with the formation and collection of fluid in the chest and abdomen are among the most distressing symptoms encountered as a result of malignant disease. The guidelines for treatment should be based on respiratory symptoms, and with the understanding that the procedure is palliative. Both surgical and medical forms of treatment have been used. These include thoracostomy-tube drainage alone or with the instillation of antimicrobial agents. Pleurectomy is effective but should be reserved for situations in which conservative approaches have failed. Antitumor agents, such as nitrogen mustard, are effective but toxic. The mode of action of antineoplastic agents is related to their ability to cause pleural sclerosis and obliterate the pleural space. Systemic chemotherapy and external beam radiation are rarely effective. The intracavitary application of radioactive colloids has been used since 1945. Colloidal radioactive gold Au 198 has been replaced by the pure beta emitter, colloidal chromic phosphate P 32. Instillation of a colloidal suspension of radioactive phosphorus represents a significant and effective palliative therapeutic modality for malignant effusion.

Adult

[Results of the intraperitoneal application of radioactive gold in cases of ovarian cancer (author's transl)].

Radioactive gold was instilled once into the peritoneal cavity of 248 patients with ovarian carcinoma of varying stages. The criterium for the radioactive gold instillation was either for the post-operative treatment in stage 1A or for the treatment of ascites in more advanced stages. The treatment had no clear cut influence on the five year survival rate. The treatment with radioactive gold Au 198 was very effective in the treatment of ascites and had less side effects than other radioactive colloidal materials.

Ascites

Liver blood flow and blood volume following chronic phenobarbitone administration.

Mlae rats were ra&ndomly divided into 2 groups one of which received 30 mg/kh phenobarbitone for 4 days i.p. and the other sodium chloride. Liver blood flow was measured 24 hr following the last injection of phenobarbitone or sodium chloride using the radioactive colloidal gold clearance technique. In addition, blood volume, liver weight and extraction of radioactive gold were estimated. Following 4 daily infections of phenobarbitone the body weight and the blood volume of both groups were not significantly different. The liver weight in the phenobarbitone treated groups was 27% higher than that found in the control group. Liver blood flow increased from 22.7 ml/min (92,8 ml/min/kg body weight) to 30.1 ml/min (123.7 ml/min/kg body weight). This increase of 33% was highly significant (p less than 0.005). In contrast, the extraction of radioactive gold was 11% lower in the phenobarbitone treated groups than in the controls. The earlier, semiquanititative finding of increased blood flow using a chronic implanted thermocouple could thus be quantified by the present study.

Animals

Screening for pancreatic disease: A comparison of grey-scale ultrasonography and isotope scanning.

The efficiency of ultrasound in the diagnosis of pancreatic disease was compared prospectively with that of selenomethionine isotope scanning in 46 patients presenting with abdominal pain or weight-loss or with jaundice. Of 14 patients who later proved to have pancreatic carcinoma, all had an abnormal isotope scan and 13 had an abnormal ultrasound scan. Of 10 patients with chronic pancreatitis, all had an abnormal isotope scan and 9 had an abnormal ultrasound scan. The small advantage of selenomethionine was, however, offset by a higher false-positive rate: of 22 patients who proved not to have pancreatic disease, 13 had abnormal isotope scans compared with only 3 with ultrasound. Review of earlier experience with the two techniques yielded similar results: in pancreatic carcinoma and chronic pancreatitis, isotope scanning gave slightly fewer false-negative results than ultrasound but many more false-positives. Because of its lower false-positive rate, because it avoids ionising radiation, and because it can usually distinguish carcinoma from pancreatitis, ultrasound is the procedure of choice for initial investigation of patients with suspected pancreatic disease.

Chronic Disease