[Clinical application of photodynamic method to the treatment of malignancies. Part II]. / Kliniczne zastosowanie metody fotodynamicznej w leczeniu nowotworów. Czesc II.

The successfully finished experimental studies in an animal model became the foundation for starting clinical trials with the use of photodynamic therapy in the treatment of malignancies in humans. The data presented in the literature worldwide include mainly early results of such studies. This method seems to be of particular usefulness in the treatment of neoplasma with location accessible to various light sources, including the use of endoscopic techniques. Several thousand patients with various degrees of disease progression were subjected to the treatment. Among others, oesophagal, gastric and large bowel cancers were treated as well as malignancies of the pancreas and bile ducts, lungs, brain, breasts skin and bladder. The results of the presented clinical trials point to the possibility of the use of photodynamic therapy as the main treatment, and also as an element of supportive therapy e.g. in classical surgical treatment.

[The clinical application of the photodynamic method for the treatment of malignancies]. / Kliniczne zastosowanie metody fotodynamicznej w leczeniu nowotworów czesc i.

The use of the photodynamic method creates new possibilities for the treatment of malignancies. The studies started in 1940 on photosensitizing substances made possible to use this method in clinical practice. Low invasiveness, selectivity of action and practically lack of adverse effects are its undeniable virtues. The effect of photodynamic destruction of malignant tissue is obtained through oxidation processes of cell membrane structures. The earliest changes include blood vessels and the degree of their occlusion depends directly on light dose and the concentration of the photosensitizer. This leads to hypoxia within tumor and its subsequent necrosis. No resistance to this method of treatment nor any recurrences at the site of irradiation have been observed as yet.

Protoporphyrin derivatives--the use in localization of neoplasmas by titanium laser-induced fluorescence technique.

Examples of in vivo detection of skin neoplasmas (Mercl, melanoma) and breast carcinoma using laser induced fluorescence (LIF) and bis-1[1-alanylo-N]-ethylodeuteroporphyrin (Ala-PP) are described in this study. Photosensitizer, wave titanium laser and standard CCD camera coupled to vision amplifier enable precise neoplasm imaging, Ala-PP retention monitoring and further photodynamic therapy (PDT).

Gunshot wounds caused by modern firearms in the light of our investigations.

The experiment was carried out on 27 sheep with traumatic-haemorrhagic shock caused by a gunshot wound produced using high-velocity missiles from the HM16 rifle. Sixty minutes after injury treatment with blood-replacing fluids was started. In Group I Ringer's solution with sodium lactate pH 8.2 was infused, Group II received Ringer's solution with sodium lactate pH 6.5, and Group III was given Ringer's solution alone. Volume of the infused fluid exceeded threefold the volume of lost blood. During and after fluid replacement blood samples were drawn for biochemical investigations and haemodynamic disturbances were carefully observed. In conclusion, we can say that Ringer's solution filled the vascular bed and improved tissue perfusion, but it failed to correct metabolic and acid-base equilibrium disturbances to such a degree and for as long a long time as did Ringer's solution with lactate.

Mechanisms of development of shot wounds caused by missiles of different initial velocity.

The investigation were carried out on blocks of 20% gelatin. Some of these models contained bones. Shots were fired from a distance of 100 m using bullets of 7.62 mm calibre and 715 m/sec initial velocity and bullets 5.52 mm of about 990 m/sec initial velocity. The illuminated gelatin block was filmed at the time of bullet impact at a rate of 9000 frames/sec. The pressure in the block during passage of the bullet was measured, and the decrease of bullet velocity and kinetic energy per 1 cm of the bullet canal was calculated. The character and size of injury to the block were estimated. After shots with bullets of high velocity following changes were seen as compared to those following the impact of bullets of lower initial velocity; the mean rate of bullet canal widened and the size of the temporary cavity was greater, the cavity decay was longer, and the disturbances in the model persisted longer, the pressure in the blocks reached higher values, the bullet velocity decreased, the diameters of exit wounds and depth of fissures in the blocks were greater, the fissure in the hit bone appeared earlier, the bone fragments were pushed apart at a greater distance and their reapproachment was delayed. The shot through the bone in the block changed all these parameters, and in some cases it produced the phenomenon of three-bubbles development of the temporary cavity. The temporary and permanent changes in the block depended on the mode of bullet impact. Temporary cavity pulsation developed when air was trapped within the block. Bullets of high initial velocity convey their kinetic energy to the hit object through a much greater absolute loss of its velocity producing thus a much greater injury, especially in the second half of the bullet canal, with longer lasting and more extensive temporary changes, and greater permanent changes than in the case of wounds produced with bullets of lower initial velocity.

Effect of missile velocity on the pathophysiology of injuries.

The investigations were carried out on sheep weighing 55 kg on the average. Under general anaesthesia both hind legs were shot through from a distance of 15 m separately with missiles of high or medium initial velocity. For producing haemorrhagic shock in some animals rapid bloodletting was done with removal of 45% of the circulating blood volume. At definite time intervals the serum levels of adrenaline, noradrenaline, glucose, free fatty acids and insulin were determined in the arterial blood. The heart rate, pressure in the aorta and central venous pressure were measured. Following shots with high velocity missiles the observations were as follows: 1) signs of shock appeared earlier and were more dramatic, 2) the extent of exit wound was on the average threefold as large, 3) haemodynamic disturbances developed earlier, increased more sharply and were much greater, 4) the rise of catecholamines level was much more violent reaching many times higher values and persisting longer, 5) changes or glucose, insulin, free fatty acids and insulin were much more pronounced, developed earlier, and regressed after a longer time than after injuries caused by missiles of medium initial velocity.