Breast cancer as analyzed by the human tumor stem cell assay.

Patients with primary and recurrent carcinomas of the breast were studied by the human tumor stem cell assay to determine if (1) colonies would form from breast cancer specimens, (2) growth in the culture would equate with aggressiveness of disease, (3) the assay would yield specific information on drug responsiveness, and (4) the assay would yield nonspecific information on drug responsiveness. Colony counts ranged from 0 to 363. There was no significant difference in median colony counts by pathologic stage of disease or site. Among stage IV patients presenting for treatment with primary disease, those with colony counts greater than 10 had a mortality rate of 4.7/1000 person-days; there were no deaths among those with colony counts less than or equal to 10 (P = 0.042). Stage IV patients presenting with recurrent disease showed no association between colony counts and survival (P = 0.53). No significant relationship between colony counts and disease-free intervals was observed among stages I, II, and III patients (P = 0.10). Drug sensitivity in vitro was found in 14% of the cultures with colony counts greater than or equal to 30. The only complete clinical responses in stage IV patients occurred in two patients with 0 colony counts. These data demonstrate that colonies grow from breast cancer specimens, that colony formation in vitro may be related to aggressiveness of growth in vivo in patients presenting with stage IV disease, that drug sensitivity is demonstrated in few cultures, and that patients with metastatic disease who have complete response to systemic therapy may be identified by lack of growth in the culture.

Sulindac for polyposis of the colon.

The effect of sulindac, a nonsteroid antiinflammatory drug, on colon polyposis has been evaluated in seven patients after subtotal colectomy and ileoproctostomy and in four patients with intact colons. The patients all had Gardner's syndrome or familial polyposis coli. All polyps were eliminated, except for a few that arose in the rectal mucosa and the anal canal. No cancers developed in these patients on follow-up.

Thirty years of experience with desmoid tumors at Charity Hospital.

The experience of the Charity Hospital surgeons in dealing with desmoid tumors is examined retrospectively over a 30-year period. Sixteen cases are presented. A 33 per cent rate of recurrence was noted despite excisions with margins free of tumor in each instance. In accordance with chi-square analysis, unequivocal statistical significance is given to the fact that women who have been pregnant are more likely to have abdominal than extraabdominal desmoid tumors. It was also found to be significant that parous women in whom desmoids develop are more likely to have the tumor within 10 years of their last pregnancy.

Impact of emergency angiography in massive lower gastrointestinal bleeding.

Fifty patients with massive lower gastrointestinal bleeding were initially managed with emergency angiography. The average age was 67.2; mean hematocrit, 23.7; and average transfusion, 7.6 units. Thirty-six patients (72%) had bleeding site located; bleeding sites were distributed throughout the colon. Etiologies of bleeding included diverticular disease (19 patients) and arteriovenous malformations (15 patients). Twenty of 22 (91%) patients receiving selective intra-arterial vasopressin stopped bleeding; however, 50% rebled on cessation of vasopressin. Thirty-five of 50 (70%) patients underwent surgery, with 57% operated on electively after vasopressin therapy. Seventeen patients had segmental colectomy, with no rebleeding. Nine of the 17 patients had diverticular disease in the remaining colon. Operative morbidity in these 35 patients was significantly improved when compared to previously reported patients undergoing emergency subtotal colectomy without angiography (8.6% vs. 37%) (p less than 0.02). Emergency angiography successfully locates the bleeding site, allowing for segmental colectomy. Vasopressin infusion transiently halts bleeding, permitting elective surgery in many instances.

The use of Mersilene mesh in repair of abdominal wall hernias: a clinical and experimental study.

Use of synthetic materials in herniplasty has been a controversial issue. In order to determine the influence of Mersilene mesh on the strength of healing abdominal wounds and its effectiveness in repair of hernia, experimental and clinical studies were undertaken. Experimental study included 175 male rats divided into three groups subjected to either: 1) an incision made only through the skin and closed with 3-0 silk sutures; 2) a 2.5 cm midline incision through the musculature and peritoneum closed with 2-0 Mersilene suture; or 3) the same procedure as group 2 with the addition of a Mersilene mesh onlay graft. Bursting strength of abdominal wounds as determined in all groups at intervals. Wounds of the group treated with the mesh exhibited significantly greater (P less than 0.01) bursting strength. Clinical trial consisted of 100 consecutive adult patients in which an onlay graft of Mersilene mesh was used in the hernioplasty. Mesh was used as an adjunct in patients with: 1) large ventral hernias; 2) direct hernias resulting from severely attenuated transversialis fascia; 3) indirect hernias associated with a large internal ring and a weak posterior inguinal wall; or 4) combined direct and indirect hernias. All were followed for a minimum of one year to determine the incidence of complication and rate of recurrence. This study suggests that: 1) Mersilene mesh increases the strength of healing abdominal wounds in rats; and 2) repair of large hernias with Mersilene mesh results in an acceptable morbidity and a lowered rate of recurrence.

Effect of impaired renal function on tamoxifen.

There is no information available in the literature on the blood levels of tamoxifen in patients with decreased renal function. As serious side effects of tamoxifen administered at high doses have been reported, a patient with decreased renal function and metastatic breast cancer was studied to determine the blood levels of tamoxifen while under therapy. Since no abnormally elevated levels of tamoxifen were found in this patient during the month of therapy, results of this study indicate that tamoxifen can be administered to patients with some degree of renal impairment without the risk of giving rise to abnormally elevated blood levels.