Combination of internal radiation therapy and hyperthermia to treat liver cancer.

Sixteen patients were treated for liver cancer (primary and metastatic) by a combination of internal radiation therapy with intra-arterial yttrium 90 microspheres and regional hyperthermia with electromagnetic radiation. Four patients have their liver disease apparently controlled; two had a partial regression of more than 50%; and two had a partial regression of less than 50%. The complications consisted of one case of radiation hepatitis and one of peptic ulcer.

Selective tumor heating by shortwave radiofrequency (RF).

Experimental solid tumors were treated in vivo with external high frequency dielectric heating to observe any heat selectivity between the tumor mass on one hand, and the subcutaneous tissue, muscle, and systemic temperatures on the other. Methylcholantrene-induced sarcoma cells were inoculated into the subcutaneous tissue or muscles of the posterior thigh of isologous Fischer rats. When the tumor mass reached the desired size, dielectric heating with a fixed frequency of 13.56 megahertz (MHz) was applied locally to the tumor-bearing area. All the periods of treatment were kept constant at 1 hour. Temperature was measured with thermocouple probes inserted directly into the tumor mass and the tissues lying within the electromagnetic field. Systemic temperature was monitored via a clinical mercury thermometer inserted into the rectum. Temperature recordings were taken at 5-minute intervals during which time the power was turned off in order to avoid the RF interference and to allow thermal equilibrium between the probes and the tissue. The results showed a high selective temperature gradient for the tumor mass as compared to the subcutaneous and muscle tissues when tumor masses were greater than 1.0 cu cm. No selectivity was detected in small tumors or in nontumor-bearing controls. Systemic temperature did not rise by these treatments. No tumor regression was observed at this dosage. Burns were noted in those animals in which normal tissue temperature rose above 43 C.

Bipedicle transverse abdominal cutaneofascial flap for reconstruction of lower thoracic wall defects.

A simple reliable technique for reconstruction of low-lying anterior thoracic wall defects following trauma or excision of neoplasms is illustrated by a case presentation and described. The bipedicle transverse abdominal cutaneo-fascial flap is based on the lateral cutaneous branches of the lower intercostal arteries, which offer an excellent blood supply allowing it to be raised and used even in the presence of radiated tissue. The potentials and contraindications for employing this flap are presented. The simplicity with which this flap can be raised and applied should make the general surgeon consider its use when indicated.

Evolution of the surgical management of primary aldosteronism.

During the past two decades 50 patients were operated on for primary aldosteronism. Diagnosis was based on high aldosterone excretion or secretion during a high sodium intake and, more recently, low stimulated plasma renin activity. Computed tomography and adrenal venography with selective adrenal vein catheterization for determination of aldosterone/cortisol ratios were helpful in the distinction between adenoma and bilateral hyperplasia. As a result of preoperative localization, unilateral posterior or flank approach to the adrenal has replaced transabdominal as the approach of choice. Overall in-hospital mortality in this series was 10% and occurred exclusively with a transabdominal approach in the early part of the series. Adrenalectomy has been curative in 66% of patients with adenoma and in 38% of patients with hyperplasia which includes patients with adenomatous (dominant macroscopic adenoma, 1 cm or greater) hyperplasia when the cure rate was 75%. Currently, only patients who have unilateral adrenal hyperfunction, who respond to spironolactone with a fall in blood pressure, and who are a good operative risk are considered for operation by posterior or flank approach. These guidelines for the management of primary aldosteronism, used since 1974, have been associated with an excellent response (92%), zero mortality and reduced morbidity.

Primary carcinoma of the duodenum producing a malignant duodenocolic fistula.

A unique case of primary duodenal carcinoma with a malignant duodenocolic fistula is reported. En-bloc resection of the lesion with pancreatico-duodenectomy and right hemicolectomy resulted in a 15-month disease-free interval.

Continuous single pass perfusion of the isolated kidney.

The use of continuous single pass perfusion to study the metabolism of isolated kidneys reveals that active metabolic processes continue in the hypothermically preserved kidney. These preliminary experiments described demonstrated a rapid uptake of substrates from the perfusion media in the first 24 hrs of storage, followed by a release of organic acids in the subsequent 24 to 72 hrs. Urea was found to be easily eliminated from the kidney. This technique may be useful for studying events related to loss of renal function by pinpointing specific residual biochemical activity and lesions that occur during prolonged preservations. An eventual correction or prevention of such lesions might be feasible in order to improve preservation techniques.