Cefoxitin in the treatment of aerobic and anaerobic infections. Prospective correlation of in vitro susceptibility methods with clinical outcome.

Anaerobic isolates from patients with intra-abdominal infection were tested in vitro by eight methods for susceptibility to cefoxitin. Broth disk elution correlated poorly with clinical outcome. The clinical breakpoint for anaerobic susceptibility to cefoxitin was less than or equal to 32 micrograms/ml.

Pre- and transoperative localization of nonpalpable breast lesions.

Percutaneous needle localization should be performed before biopsy of a nonpalpable breast lesion, thereby eliminating the need for blind biopsy. With small cancers, transoperative localization is just as important to confirm excision of the lesion and ensure that representative sections are obtained from the area in question for histologic study.

Uptake of 5-fluorouracil during isolated perfusion of the canine liver.

This study describes a technique of hepatic isolated perfusion in dogs. The uptake of 14C-labeled 5 fluorouracil (5-FU) by the normal canine liver was fourfold greater when isolated perfusion was used than when peripheral intravenous administration or hepatic artery infusion were applied. Systemic leakage of 5-FU was small during, and even following, hepatic isolated perfusion. This technique, which maximizes chemotherapy delivery to the liver while minimizing systemic toxicity, may be useful in the treatment of primary and metastatic hepatic malignancies.

Serum sialic acid elevations in malignant melanoma patients.

Elevated membrane sialic acid (n-acetyl neuraminic acid) concentration may be a general phenomenon associated with malignant or transformed cells. In this study, sera from 30 normal persons and 25 melanoma patients were examined to determine first, if serum sialic acid elevations were associated with malignant melanoma, and second, if there was a relationship between tumor burden and serum sialic acid level. Significantly elevated sialic acid concentrations were found in the melanoma patients (p less than 0.005), and levels tended to be greater in those with a large tumor burden (p less than 0.05). Thus, increased serum sialic acid could prove to be a valuable clinical monitor of change in tumor burden as a result of therapy or change due to recurrence of disease following treatment.

In vitro assessment of immunocompetence in patients with malignant melanoma.

Ninety-four patients with malignant melanoma and 96 healthy controls were tested for lymphocyte proliferative capacity in a microblastogenesis assay. Each lymphocyte sample was assayed for incorporation of (3H)thymidine after stimulation with PHA, PWM, Con A (two doses), PPD, and allogeneic lymphocytes (MLC). MLC was the only assay that revealed a substantial and significant difference between the melanoma patients and controls. Almost all assays showed lower values in patients with more advanced disease. However, it was not possible to accurately predict clinical outcome from data obtained from in vitro immunocompetence tests. These results indicate the relatively limited clinical usefulness of assays of lymphocyte proliferative capacity in melanoma patients.

Demonstration of lymphocyte blastogenesis--inhibiting factors in sera of melanoma patients.

The proliferative response of lymphocytes obtained from a healthy volunteer to the mitogens phytohemagglutinin (PHA) and concanavalin A (Con A) was evaluated in the presence of sera from 101 patients with malignant melanoma and 75 normal controls. A significant decrease in blastogenic response was observed in the presence of sera from melanoma patients. Sera from patients with advanced disease were particularly inhibitory, suggesting that the circulating immunosuppressive factors were either tumor derived or tumor induced. Our observation that sera from patients who failed to display a delayed cutaneous hypersensitivity reaction to 2,4-dinitrochlorobenzene (DNCB) are more inhibitory to mitogen stimulation than sera from patients who react to this contact allergen suggests that DNCB skin testing may identify an immunological defect mediated by circulating humoral factors.

Carcinoma of the gastroesophageal junction. A ten year experience with esophagogastrectomy.

Eighty-six patients with carcinoma of the gastroesophageal junction were treated between 1966 and 1976. Adenocarcinoma was present in 62 patients and squamous cell carcinoma in 24. Surgical exploration was performed on 68 patients (79%) and 52 lesions (60%) were resected by combined midline laparotomy and right thoracotomy. There were 6 deaths (11%), 2 due to anastomotic leak. The mean survival for all resected patients was 2.1 years with a 22% three year life table survival (10/52). Five of 14 patients with negative nodes are alive more than five years. Palliative resection in 17 patients resulted in a mean survival of 10.5 months and no five year survivals. Esophagogastrectomy utilizing the Lewis technic reduces operative mortality and extends survival for patients with carcinoma of the gastroesophageal junction.

Effects of hepatic ischemia on coagulation in primates. Application to liver transplantation.

Increased fibrinolytic activity and consumption coagulopathy are common consequences of liver transplantation and are a major cause of morbidity and death. In the present investigation the effects of hepatic ischemia on the coagulation mechanism were studied in the stump-tail monkey. The results suggest that, although fibrinolytic activity is induced by both major intraabdominal operations as well as one hour of hepatic ischemia, consumption coagulopathy, presumably due to intravascular clotting, is enhanced by the revascularization of the ischemic liver, possibly because of clotting within the liver itself. Release of a plasminogen activator from the liver due to hepatic ischemia alone is not demonstrated by these studies. It is believed that the first phase of intravascular coagulation after liver transplantation is due to release of tissue activators from vascular endothelium, which may be minimized by the action of ganglionic blocking agents. The severity of fibrinolysis in this stage is aggravated by the "liverless state," in which no clearance of plasminogen activators occurs. The degree of liver injury directly affects the ability of the liver to control hypercoagulability in the second phase. Thrombus formation which we believe occurs during this phase may be minimized by use of continuous controlled heparinization.