Breast cancer, prostaglandins and patient survival.

Prostaglandins may have both undesirable and desirable effects in malignant disease. Their possible roles in breast cancer were studied by examining the relationships between different variables and the amounts of prostaglandin-like material (PG-LM) extracted from 141 breast carcinomas. Univariate analysis indicates a direct correlation with patient age and menopausal status, with a greater yield from cancers of post- compared with pre-menopausal women. Tumours up to 2 cm diameter yielded more PG-LM than those measuring greater than 2-5 cm. Although there was also a direct correlation with bone metastasis near to the time of surgery, this was because no positive bone scans occurred in patients whose tumours yielded little total PG-LM (less than 16 ng PGE2 equivalents per g tissue). Since tumour PG-LM did not predict later spread to bone, and yields of greater than 16 ng g-1 were similar in the positive and negative bone scan groups, tumour PG-LM appears to be unimportant for skeletal metastasis. There was no obvious relationship of tumour PG-LM to the grade of malignancy, tumour type, amounts of fibrous tissue (and therefore malignant cells), invasion of blood vessels and lymphatics or presence of plasma cells. Multivariate analysis indicates that disease-free survival is longest with an intermediate production of tumour total PG-LM. Of the 82 patients now dead, the cause was attributed to metastatic disease in 69 cases. No relationship of PG-LM to the length of survival was seen with univariate or multivariate analysis. However, when just the post-menopausal patients who died within the first 3 postoperative years were analysed, there was a highly significant inverse correlation between the tumour total PG-LM and the time to death. The reason(s) for these different findings on overall survival compared with just the patients who died are not understood, but the results may indicate that one or more other variables must co-exist with a high tumour PG-LM to hasten death.

Spontaneous haemoperitoneum from rupture of a primary hepatic adenoma in an adult man.

Hepatic cell adenomata have been described as the rarest of benign liver tumours. Their incidence has increased with the advent of the oral contraceptive pill and they have been reported to rupture spontaneously in women. In men such a phenomenon appears to be an extreme rarity and, to our knowledge, spontaneous rupture of an uncomplicated primary hepatic adenoma, in an adult man, is previously unrecorded.

Increased survival of cancer-bearing mice treated with inhibitors of prostaglandin synthesis alone or with chemotherapy.

In mice with a transplantable mammary carcinoma, treatment with the prostaglandin-synthesis inhibitors flurbiprofen or indomethacin produced various beneficial effects. Survival time after excision of the transplanted tumour was increase, particularly when the drugs were given with the chemotherapeutic agents methrotrexate and melphalan, and there were more disease-free survivors. The combined treatment with flurbiprofen also gave less tumour recurrence at the excision site. Flurbiprofen did not seem to alter the bioavailability of the chemotherapeutic agents.

Decrease in aspirin-induced gastric mucosal damage in rats by oral administration of the cytotoxic drugs melphalan and methotrexate.

Gastric mucosal damage by aspirin and chemotherapeutic drugs was studied in Wistar rats. Aspirin 60 mg given by stomach tube caused substantial gastric mucosal damage as judged by visual examination of the stomachs removed four hours later. Melphalan and methotrexate given daily for four days had no significant macroscopic effect on the gastric mucosa, but reduced the damage caused by aspirin. This protective effect my involve a stimulation of prostaglandin synthesis by the stomach, increased mucus secretion, and/or inhibition of acid secretion.

Haemorrhoidectomy without tears.

A study of 50 patients undergoing haemorrhoidectomy under general anaesthesia in Reading was undertaken. Half the patients received, in addition, a caudal anaesthetic given by the surgeon at the beginning of the operation with the patient in the lithotomy position. The rest of the patients had no form of local anaesthetic. The amount of analgesia needed, general comfort after the operation, and the number of days after surgery of the first bowel movement were recorded. The use of caudal anaesthesia resulted in a 79% reduction in the number of doses of papaveretum needed by the patients after the operation and a reduction by half in the period of postoperative constipation. Possible reasons for the latter finding are discussed. The possible risks of caudal anaesthesia are considered, but it is concluded that they are far outweighed by the benefits obtained.