Preoperative autologous blood donation in patients with malignant tumors of the head and neck region

Twelve instances of preoperative autologous blood donation were assessed in 10 patients with malignant tumors of the head and neck region. All patients received preoperative radiation therapy and chemotherapy and most of the cases were also given recombinant human erythropoietin (EPO) and iron sulfate. Hemoglobin concentrations immediately before starting the 800ml blood donations were higher than 13g/dl in 5 cases and less than 13g/dl in 6 cases. The mean hemoglobin concentration just prior to donation and one week after donation in these two groups changed from 14.4g/dl to 12.5g/dl and 11.7g/dl to 11.7g/dl, respectively. A 1000ml blood donation was carried out in only one patient, and the hemoglobin concentrations just before donation and one week after donation were 11.4g/dl and 10.5g/dl, respectively. Only half of the blood volume scheduled, 400ml, was achieved in 3 of the 12 cases attempted because of fever, diarrhea and a change of the day of surgery, respectively. The mean estimated blood loss in the 10 patients that underwent surgery as planned was 898ml, and allogenic blood transfusion was avoided in all cases. We concluded that 800-1000ml preoperative autologous blood donation can be performed safely in patients with advanced malignant tumors of the head and neck region who have undergone preoperative radiation therapy and chemotherapy by giving EPO and iron sulfate.     

Atypical and malignant solitary fibrous tumors in extrathoracic locations: evidence of their comparability to intra-thoracic tumors

Solitary fibrous tumor (SFT), first described as a pleural lesion, has been reported at numerous extrathoracic sites over the past 10 years. About 10% to 15% of intrathoracic SFTs are histologically or clinically malignant, but such cases have very rarely been described at other locations. Among 92 cases of extrathoracic SFT in our files, we identified 10 that either had recurred (2 cases) or had a least one atypical histologic feature (8 cases). The ten tumors occurred in five men and five women, 32 to 81 years old (median 56), measured 1.9 cm to 20 cm (median 11.5 cm), and were located in the abdomen/pelvis (4 cases), retroperitoneum (3 cases), groin, trunk, and upper arm. Nuclear atypia (8 cases), markedly increased cellularity (6 cases), areas of necrosis (4 cases), and greater than 4 mitoses/10 HPFs (3 cases) were seen in addition to the typical histologic features of SFT. Six tumors had at least two of these atypical histologic features. Nine cases were positive for CD34, six were positive for O-13, and one was focally positive for smooth muscle actin. Eight were excised completely. Subsequent follow-up revealed tumor relapse in eight cases (follow up 6-180 months, median 24). Four patients had local recurrence at 12 to 168 months. Distant metastasis developed at 1 to 6 years in five cases with spread to lung (2 cases), liver (4 cases), and bone. Metastasis or local recurrence developed within 2 years in five patients. To date, no patient has died of their tumor. These findings demonstrate that nuclear atypia, hypercellularity, greater than 4 mitoses/10 HPFs, and necrosis may be seen in up to 10% of extrathoracic SFTs, and are associated with, but are not by themselves predictive of, aggressive clinical behavior. In addition, our findings confirm that the behavior of extrathoracic SFTs is unpredictable, entirely comparable to that of their better known pleural counterparts, and confirm that patients with SFTs in all locations require careful, long-term follow up. It is probably unwise to regard any such lesion as definitely benign.     

Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors

BACKGROUND: Patients with neuroendocrine gastrointestinal tumors usually present with inoperable metastatic disease and severe hormonal symptoms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction of both hormonal symptoms and tumor burden in these patients. METHODS: Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verified neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastases. Medical treatment was continued after embolization. RESULTS: An overall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observed in 6 of 12 patients with EPTs (50%), with a median duration of effect of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival analyses showed a median survival of 80 months and a 5-year survival rate of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months. CONCLUSIONS: Liver embolizations performed relatively late in the clinical course in our series appeared to be as effective as "early" embolizations in other series of patients with carcinoid tumors. The results for those with EPTs were poorer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involvement, severity of carcinoid heart disease, and somatostatin receptor status.     

Effect of acupuncture on the regulation of cell-mediated immunity in the patients with malignant tumors

In order to investigate the role of acupuncture in the regulation of cellular immune function, we observed acupuncture therapy affecting the levels of T lymphocytes subgroup (CD3+, CD4+, CD8+), soluble interleukin-2 receptor (SIL-2R) and beta-endorphin (beta-EP) in the peripheral blood of patients with malignant tumors. Here was used the random-gioland method, the patients were divided into a group treated by acupuncture (acup. group, 20 cases) and a control group (20 cases). The acup. group was treated using points PC6, LI4, ST36, RN4 and location of symptomatic points bilaterally, one treatment of 30 min daily for 10 days. The results showed that there were increased levels of CD3+, CD4+ percentage, CD4+/CD8+ ratio and radioimmunoassay of beta-EP in blood plasma, a decreased level of SIL-2R after acup. The statistical significance was found to be remarkable (P < 0.01), so has a notable difference, the correlation analysis indicated: (1) there was a positive correlation between beta-EP and T-lymphocytes subgroups; (2) a negative correlation between beta-Bp and SIL-2R, so did it between T subgroups and SIL-2R. Our results showed that beta-EP enhanced immune function of patients by increased T lymphocyte subgroups, reduced SIL-2R, and this action of beta-EP may be mediated by opioid receptor. The above mentioned results prevented evidence that there was an adjusting-network of immune in the body, through this way, acup. therapy can heighten the cellular immune function of patients, providing a beneficial effect in anti-cancer treatment.     

Phase I study of topotecan for pediatric patients with malignant solid tumors

PURPOSE: To determine the dose-limiting toxicity and potential efficacy of topotecan in pediatric patients with refractory malignant solid tumors. PATIENTS AND METHODS: In this phase I clinical trial, 27 patients received topotecan 0.75-1.9 mg/m2 by continuous intravenous infusion daily for 3 days. Fifty-three treatment courses were given to these patients. RESULTS: Myelosuppression was the dose-limiting toxicity at levels of 1.3 to 1.9 mg/m2 for 3 days, requiring significant support with transfused packed RBCs and platelets. Myelosuppression was variable in severity at the 1.0-mg/m2 dosage level; thus, additional patients were treated with this dosage, followed by human recombinant granulocyte-colony stimulating factor (G-CSF). Other toxicities were not significant. One patient with neuroblastoma had a complete response that lasted for 8 months. Stable disease activity was recorded for other patients with neuroblastoma, rhabdomyosarcoma, and islet cell carcinoma. Pharmacokinetic studies showed that topotecan plasma concentrations ranged from 1.6 to 7.5 ng/mL during infusions of 1.0 mg/m2/d, and that there was a biphasic plasma distribution with a mean terminal half-life of 2.9 +2- 1.0 hours. CONCLUSION: Topotecan is a promising anticancer agent that deserves phase II testing in pediatric solid tumors. We recommend that pediatric phase II topotecan trials use 1.0 mg/m2/d for 3 days as a constant intravenous infusion, followed by G-CSF for 14 days, and that these treatment courses be repeated every 21 days.     

Comparison of Quick/INR values of whole capillary blood (CoaguChek Plus) and venous citrate plasma in patients with and without oral anticoagulation

BACKGROUND: The prothrombin time, also called thromboplastin time ("Quick"), is usually measured by using citrated plasma from venous blood. Recently, portable coagulation monitors have been developed which measure prothrombin time using non-anticoagulated capillary whole blood from a finger-stick. In the present study we evaluated the CoaguChek Plus coagulation monitor in comparison with a standard laboratory method in various patient groups: patients on oral anticoagulation with or without heparinisation, patients receiving heparin without oral anticoagulation, patients with a deficiency of one of the coagulation factors of the extrinsic or common pathway, and patients with liver disease. Furthermore, we studied the influence of the haemoglobin concentration on the test results. METHOD: Capillary prothrombin time was measured by using the portable coagulation monitor CoaguChek Plus and venous prothrombin time was assessed by using Thromborel S. RESULTS: We found a correlation coefficient of 0.94 between capillary and venous INR values in 216 determinations from 167 patients. The slope of the regression line was 1.03, and the y-intercept 0.05, 93.5% of the results were within 0.9, 90.7% within 0.7, and 83.8% within 0.5 INR units. Similar results were obtained in patients on oral anticoagulation, patients with a deficiency of a factor of the extrinsic system and in patients with liver disease. Correlation and agreement were somewhat lower among patients on oral anticoagulation and simultaneous heparinisation (40 patients): correlation coefficient was 0.83, slope of the regression line was 0.87 and y-intercept was 0.27 INR units. No influence of the haemoglobin concentration on INR results could be demonstrated. CONCLUSION: Our results show the CoaguChek Plus coagulation monitor to be a valuable tool for measuring prothrombin time in patients on oral anticoagulation, in patients with liver disease to estimate the capacity of protein synthesis, and to screen for possible deficiencies of one of the coagulation factors of the extrinsic or common pathway. However, based on our preliminary data we cannot recommend the use of the CoaguChek Plus coagulation monitor in heparinised patients.     

Chemiluminescence response of whole blood in patients undergoing urological operations

We compared falloposcopy employing a new coaxial system with traditional laparoscopic chromotubation and hysterosalpingography in a prospective, multicenter clinical trial at five tertiary infertility centers. Based on findings at hysterosalpingography or laparoscopic chromotubation, the 16 women (22 tubes) in group 1 had a presumed diagnosis of proximal tubal obstruction, and the 4 (7 tubes) in group 2 had unexplained infertility. Cannulation was successfully achieved in 83.3% of tubes. In group 1, 85% (17/20) of visualized tubes were patent and 35% (7/20) were normal. In group 2, 40% (2/5) of visualized tubes were abnormal. Management was changed in 52.4% of women as a result of falloposcopic findings. Falloposcopy with this new coaxial system allows improved visualization with less bulky and less traumatic instruments. The system provides valuable information regarding the fallopian tube lumen that correlates poorly with that obtained with more traditional techniques.     

Quantitative analysis of acetaldehyde in whole blood from human and various animals by gas chromatography

Acetaldehyde present in the blood of bull, chicken, hamster, horse, human, monkey, pig, rabbit, rat and sheep, was quantitatively analyzed by a newly developed gas chromatographic method. Acetaldehyde in a blood sample was reacted with cysteamine to give 2-methylthiazolidine, which was extracted with dichloromethane and subsequently analyzed by gas chromatography with a fused-silica capillary column and a nitrogen-phosphorus detector. The quantities of acetaldehyde found in blood ranged from 2.04 micromol/ml (hamster) to 14.8 micromol/ml (pig). The quantity of acetaldehyde recovered from human blood was 6.17 micromol/ml.     

Spontaneous and stimulated nitroblue tetrazolium tests of leukocytes from patients with solid malignant tumors

Histochemical nitroblue tetrazolium (NBT) reduction tests, spontaneous and endotoxin-stimulated, were performed on samples of blood from 202 adult patients with solid neoplastic tumors and 37 healthy control subjects. The patients were classified according to activity of the disease, chemotherapy, and presence of bacterial infection. The NBT test did not prove helpful in detecting the latter condition in these patients. Low median spontaneous reduction values were recorded for patients with active malignancies, or receiving chemotherapy, compared with controls or cured patients without chemotherapy. Stimulated reduction values were significantly lower for all groups of patients than for controls, although for those apparently cured and untreated, stimulated reduction attained significantly higher values than for the other patients. A leukocyte dysfunction caused by both the underlying disease and its chemotherapy is assumed, and the usefulness of the endotoxin-stimulated NBT reduction test in detecting this dysfunction is stressed.     

Comparison of 5-fluorouracil pharmacokinetics in whole blood, plasma, and red blood cells in patients with colorectal cancer

STUDY OBJECTIVE: To compare 5-fluorouracil (5-FU) pharmacokinetics in whole blood, plasma, and red blood cells in patients with colorectal cancer. DESIGN: Prospective, unblinded observational study in consecutive patients. SETTING: Large regional teaching hospital. PATIENTS: Five patients with colorectal cancer. INTERVENTIONS: Patients received folinic acid 200 mg/m2 intravenously over 2 hours, followed by 5-FU 600 mg/m2 intravenous bolus over 30 minutes, then 5-FU 600 mg/m2 intravenous infusion over 22 hours, administered on days 1 and 2. This 48-hour cycle was repeated every 14 days. MEASUREMENTS AND MAIN RESULTS: Concentrations of 5-FU in whole blood, plasma, and red blood cells were determined by high-performance liquid chromatography. ADAPT II was used for pharmacokinetic computations. The optimum model was determined for each matrix by calculating Akaike's information criteria values. Concentrations of 5-FU in whole blood were 106-115% of simultaneous plasma concentrations (median 112%), and packed red blood cell levels were 5-17% of plasma concentrations (median 11%). The drug's concentration-time profile was similar in the three matrices. The drug is reported to be unstable in whole blood, and red blood cell 5-FU concentrations were near the limit of detection (10 ng/ml), supporting plasma as the preferred matrix for therapeutic drug monitoring studies. Six pharmacokinetic models were fitted to the 5-FU individual data sets to determine the best curve fit. The optimal model for whole blood and plasma data sets was one compartment with both linear and nonlinear elimination models; a one-compartment model with nonlinear elimination provided the best curve fit for 5-FU in red blood cells. A two-compartment model with nonlinear elimination gave a similar degree of curve fit for plasma 5-FU as the one-compartment model with both linear and nonlinear elimination. CONCLUSIONS: These pharmacokinetic results provide the basis for further investigation into the ability to correlate 5-FU systemic exposure with clinical drug activity.     

DNA- and RNA-hydrolyzing antibodies from the blood of patients with various forms of viral hepatitis

Antibodies (Abs) hydrolyzing proteins, DNA, and RNA are detected in the blood of patients with various autoimmune diseases. In the present work, homogeneous preparations of IgG Abs from the blood of the healthy donors as well as patients with A, B, C, and delta types of viral hepatitis, influenza, pneumonia, tuberculosis, tonsillitis, duodenal ulcer, and some types of cancer were purified. For the first time, the fraction of IgG and its Fab fragments of patients with viral hepatitis were shown to have high DNA- and RNA-hydrolyzing activity. In case of Abs from the healthy donors and patients with other diseases, high activity of Abs was not detected. The data obtained by various methods indicate that the activity of hepatitis Abs is an intrinsic property of the immunoglobulins. The relative rates of hydrolysis of cCMP, poly(U), poly(A), poly(C), and tRNA(Phe) by hepatitis Abs were compared with those of RNase A and other RNases from human blood. Significant differences in activities of Abs and nucleases in hydrolysis of model substrates were demonstrated. Thus, catalytically active Abs can appear in the blood of patients not only with autoimmune disorders, but with viral diseases as well.     

Reliability of reporting self-measured blood pressure values by hypertensive patients

For self-measurement of blood pressure to be useful, patient reporting of test results must be reliable and accurate. Until now no study directly measured the accuracy and reliability of patients' reporting of self-measured blood pressure values. Thirty hypertensive patients (69 +/- 11 years) were instructed to measure blood pressure at home over 14 days with the highly accurate Omron IC monitor and to keep a record of all readings in a patient logbook. To assess the reliability of the records, patients were not informed about the memory capacity of the device. We compared automatically stored blood pressure readings with the respective logbook entries to analyze deletion (under-reporting), addition (over-reporting), and precision of reporting of test results. The prevalent pattern was under-reporting, averaging 36% +/- 24% (3% to 89%), which occurred significantly more than over-reporting (9% +/- 11%; 0% to 38%). The precision of reporting (identical values at corresponding times) was 76% +/- 34% (0% to 100%). This observer error did not affect group comparisons of automatically stored values and logbook entries, although the estimated limits of agreement were wide. Blood pressure control, duration of hypertension, age, or previous use of self-measurement and patterns of logbook entries were not found to be predictive of the patients' reliability. Our results demonstrate a substantial observer error in the reporting of self-measured blood pressure values. This bias may be reduced by memory-equipped blood pressure devices.     

Changes in plasma levels of lipid peroxidation products and myoglobin in patients with malignant tumors in the early postoperative period

Changes in the levels of free myoglobin and lipid peroxidation products (hydroperoxides and malonic dialdehyde) were studied in cancer patients. Their baseline levels were found to be higher in patients with cancer of the lung, large bowel, and rectum than those in controls, which indicates higher lipid peroxidation, which led to the destabilization of cellular membranes and seems to cause baseline hypermyoglobinemia. There was a drastic rise in the levels of free myoglobin in the first 24 postoperative hours. The duration and severity of hypermyoglobinemia were much higher in the complicated than uncomplicated postoperative period. There was a less rise in malonic dialdehyde concentrations, whose peak was observed on days 1-2 postsurgery. The content of hydroperoxides decreased in the first 24 postoperative hours and began gradually increased from day 2. The correlation between the concentrations of myoglobin and malonic dialdehyde suggests that there is an association between hypermyoglobinemia and the status of cellular membranes.     

Clinical pattern of malignant brain tumors in patients over 50 years of age

A patient with a syphilitic aneurysm of the aorta treated by the insertion of wire is presented. The patient remained well for almost 40 years, but finally succumbed after rupture. The autopsy findings are discussed. To our knowledge, this represents the longest reported survival after treatment of an aortic aneurysm by wiring.     

Epidemiology of malignant tumors of the uterus

The authors describe the frequency, incidence, number of deaths and mortality from malignant tumours of the uterine corpus in the Czech Republic in 1961-1988. The mean incidence of 13.06 during the five-year period 1961-1965 rose to a mean incidence of 25.12 during the five-year period 1984-1988, while during this period a paradoxical decline of the mortality from 9.00 to 6.7 occurred. This implies a decline of the lethality during 1961-1965 from 76.56% to 28.98%, i.e. to 37.85% of the original value. The reasons of the decline in lethality may be earlier detection of the disease and possibly a rise in the incidence of less aggressive forms of hormone-dependent carcinomas only, because therapy did not change essentially during the mentioned period.     

Superoxide anion scavenge effect of Quercus glauca Thunb. in whole blood of patients with ankylosing spondylitis

Nine phenolic compounds, catechin (1), epicatechin (2), gallocatechin (3), epigallocatechin (4), procyanidin B-4 (5), catechin-3-O-rhamnoside (6), rutin (7), querglanin (8) and isoquerglanin (9) were isolated from oak leaves (Quercus glauca Thunb. Fagaceae), and the latter two (8, 9) were identified as new compounds. Several Quercus species have been used in folk medicine as an astringent for hemorrhoids and for treatment of inflammation, jaundice, and tumor. In this study, these compounds were tested for scavenging effects of the superoxide anion in the whole blood of patients with ankylosing spondylitis by means of an ultra-sensitive chemoluminescence (CL) analyzer and lucigenin amplification. The results showed that at a concentration of 2.3 x 10(-5) M, isoquerglanin (9) displayed the strongest inhibition activity (73.55%), followed by querglanin (8) (68.81%) and then gallocatechin (3) and epigallocatechin (4) (66.97 and 60.17% inhibition, respectively). In addition, the blood chemoluminescence (CL) level of patients with ankylosing spondylitis was inhibited by superoxide dismutase (SOD) but not by catalase, suggesting that superoxide anion is the major component of reactive oxygen species (ROS) involved in this assay system.