[Preparation for elective colon surgery using the mannitol-ceftriaxone method]. / Elektív vastagbélmütétek elökészítése a "mannit--ceftriaxon" módszerrel.

The study includes 450 patients undergoing elective colorectal surgery. Patients were divided in three groups. 140 patients were prepared with conventional enema and purgatives and a Neomycin-metronidazole prophylaxis. 160 patients of the second group were prepared with mannitol (10%) oral 12 hours before the operation and a single dose of ceftriaxone (Rocephin) 2 g intravenously 2 hours before surgery. 150 patients of the third group were prepared with mannitol by the same way described above, and a combination of ceftriaxone 2 g i. v. and metronidazole 500 mg. i. v. two hours before the operation. The study proved that the mannitol combined with ceftriaxone provides a sufficient preparation for colorectal surgery within 12 hours prior the operation. The rate of septic complications and septic deaths was higher in the first group then in the two others. The combination of metronidazole used in the third group showed no advantage versus single dose ceftriaxone alone.

Magnetic circular dichroism studies of the active site structure of hemoprotein H-450: comparison to cytochrome P-450 and sensitivity to pH effects.

Ferric, ferrous and ferrous-CO hemoprotein H-450 from rat liver have been examined with magnetic circular dichroism spectroscopy under alkaline (pH 8.0) and acidic (pH 6.0) conditions. The spectral properties of these species require that one of the axial heme iron ligands in the alkaline ferric and ferrous states must be a thiolate sulfur, presumably from cysteine. The data are most consistent with the ligand trans to thiolate being either histidine or methionine. The reversible pH effects on the spectral properties of the ferrous protein, but not of the ferric protein, appear to involve protonation or displacement of the thiolate. As treatment of the ferrous protein with CO does not yield a thiolate-ligated ferrous-CO adduct, CO either displaces the thiolate or its addition is accompanied by protonation of the thiolate.

Malignant fibrous histiocytoma of the mediastinum.

A case of malignant fibrous histiocytoma in the right postero-superior mediastinum in a 43-year-old male patient is presented. He was operated on and a part of the tumor including the infiltrated second segment of the lung was resected. At reoperation, the great vessels were found infiltrated by the tumor and radical exstirpation could not be carried out. The patient died 4 months after discovery of his disease due to further growth of the tumor. This case is the fifth malignant fibrous histiocytoma of the mediastinum described in the world literature.

Anorectal sarcomas.

The authors report on their observations of nine patients with anorectal sarcoma. They agree with others that best results can be expected from radical surgery. Even in operable patients anorectal sarcomas have a worse prognosis than other malignant lesions in the same region.

Primary inflammatory carcinoma of the breast.

Among 2775 cases of breast cancer examined over a 10-year period, primary inflammatory carcinoma was diagnosed in 35 patients. The symptomatology, the clinical and pathological features and problems of differential diagnosis of primary inflammatory carcinoma of the breast are discussed in detail. On the basis of data in the literature and their own experience, the authors do not recommend surgical treatment of the disease.

Comparison of the natural cell mediated and antibody dependent cell mediated cytotoxicity measured as a function of target cell number in patients with mammary tumors and healthy female blood donors.

Peripheral blood lymphocytes of 84 patients with mammary tumors (73 malignant, 11 benign diseases) and 79 healthy female blood donors were tested in three cytotoxicity assays. Natural cell mediated cytotoxicity (NCMC) was measured against K562 cell line, antibody dependent cellular cytotoxicity (ADCC) was tested against K562 cell line sensitized with hyperimmune rabbit anti K562 sera and human 0, Rh positive (C, D, E pos.) erythrocytes sensitized with Ripley antibodies. Effector cell activity was measured as a function of the target cell number in the new cytotoxic capacity test. Maximums were determined experimentally and also by extrapolation from the measured values using the Michaelis-Menten equation. It was found, that activity of patients was lower than that of the controls in all the three tests already at an early stage of the malignant disease. Therefore introduction of the new cytotoxic capacity test to screen NCMC and ADCC is suggested.

Elective Hartmann's Operation.

Hartmann's operation has been performed as an elective intervention. In the case of tumours of the sigmoid and the upper two-thirds of the rectum this operation involves less risk and less stress than Dixon's anterior resection or extirpation of the abdominoperineal rectum. Hartmann's operation is being performed on, and is recommended for, elderly patient and for those suffering from some serious intercurrent disease having therefore a reduced resistance to operational strain. The authors removed under these conditions 16 sigmoidorectal tumours. In 12 cases the operation consisted of radical extirpation.