Electrocardiographic changes following intravenous administration of thioridazine to macaque monkeys

Treatment with thioridazine has been associated with electrocardiographic abnormalities, and there are individual case reports of fatal cardiac arrhythmias in patients taking thioridazine. Thioridazine or its metabolites can cause T-wave changes, but there is no evidence for a causal relationship between exposure to thioridazine and the occurrence of arrhythmias. In this study, the authors administered up to 6.7 mg/kg of thioridazine intravenously to macaque monkeys. Two of the animals had minimal T-wave changes immediately after the thioridazine injections and premature ventricular contractions a week later. The premature beats disappeared immediately after the next injection of thioridazine was administered. The authors suggest that when thioridazine has minimal effects on the T-wave, it may have both antiarrhythmic and arrhythmic activity. This could explain why cardiac arrhythmias have not been demonstrated in patients receiving regular, frequent doses of thioridazine, and suggests that arrhythmias may occur more frequently in patients with minimal T-wave changes.

Malignant melanoma with unknown primary site

From 1955 to 1976, 129 patients were seen with metastatic malignant melanoma from an unknown primary site, comprising 8.1% of all the referred patients with malignant melanoma. Eighty-two percent of the patients presented with a history of mass or lump. Overall median survival and 5-year survival rates after onset of symptoms were 10 months and 13%, respectively. Patients with lesions of the head and neck area had 5-year disease-free survival of 25%, whereas those with lymph node disease had a survival of 18%. Twenty-nine patients with regional disease had wide excision (usually lymphadenectomy) and their 5-year disease-free survival was 58%. Regional disease in patients with malignant melanoma of unknown primary site should be treated with radical surgical excision, since the survival is comparable or better to that of patients with regional disease having known and excised primary site.

Natural history of adrenal cortical carcinoma: a clinicopathologic study of 42 patients

To study the biologic behavior and natural history of this rare but challenging tumor faced by oncologists, a clinicopathologic study of 42 patients with histologically proven adrenal cortical carcinoma from Roswell Park Memorial Institute (1929--1977) was done. These constituted .04% of all cancer cases and 0.2% of all autopsy cases. Age range was 3--74 years with median of 53 years; female to male ratio was 1.5 to 1. Clinical manifestations were: abdominal mass (36%), metastatic disease (30%), hormonal excess (17%) and weakness with lethargy (17%). Nine of ten functioning tumors were seen in female patients. Tumors arose in left adrenal in 26 patients, right adrenal in 12, and in four the site could not be determined because of bilateral presence of cancer. Median duration of symptoms was six months. At diagnosis, 52% had distant metastases, 41% had locally advanced tumor and 7% had tumor confined to adrenal. Sixteen patients underwent "curative" resection. Tumor diameter ranged from 1--30 cm with median of 10 cm. Of 28 patients who received different chemotherapeutic regimens, three (11%) had objective response; four of ten patients had objective response to radiation therapy. Overall median and five-year survival rates were 14 months and 24%. Prolonged survival (P less than .05) was noted in women, patients who had "curative" resection, a disease-free interval of more than 12 months, and tumor size greater than 10 cm diameter. Patients with functional tumors had longer median survival than those with non-functional ones (28 vs. 12), but P value was greater than .05. A second primary cancer was noted in 22.4% of cases, breast and lymphoma being the most common. At autopsy in 31 patients, the most common metastatic sites were retroperitoneal lymph nodes 68%, lung 71%, liver 42%, and bone 26%. To improve survival, an aggressive surgical approach is recommended to extirpate the tumor with involved organs and retroperitoneal lymph nodes. Adrenal carcinoma should be suspected in patients with metastatic cancer with an occult primary.

Failure of actinomycin D entrapped in liposomes to prolong survival in renal cell adenocarcinoma-bearing mice

The potential prolongation of survival of actinomycin D entrapped in liposomes was examined in Balb C/Cr mice inoculated intrarenally with renal cell adenocarcinoma. There were five groups of animals: group A, a control group, received phosphate-buffered saline 0.3 cm3 i.p.; group B received free actinomycin D 300 micrograms/kg i.p.; group C received liposomes containing actinomycin D 300 micrograms/kg i.p.; group D received a mixture of free actinomycin D 300 micrograms/kg and empty liposomes i.p.; group E received empty liposomes i.p. The best median survival was of group D (free drug) - 54 days followed by group C (liposome entrapped actinomycin D) 45.2 days and group E (a mixture of free and entrapped actinomycin D) - 42 days. In vitro studies utilizing cell lines obtained from the tumor showed no statistical difference in ID50 or in cytotoxicity between the cells treated with free actinomycin D and those treated with liposomes containing drug.

Effect of actinomycin D-containing lipid vesicles on murine renal adenocarcinoma

Forty Balb C/CR mice inoculated with renal cell adenocarcinoma were divided into five groups. Group A (seven animals) received phosphate buffered saline intraperitoneally; group B (seven animals) received free actinomycin D 300 microgram/kg IP; group C (nine animals) received lipid vesicles containing actinomycin D 300 microgram/kg IP; group D (eight animals) received a mixture of free actinomycin D 300 microgram/kg and empty lipid vesicles IP. The median survival of group A was 32 days, of group B 30 days, of group C 45.2 days, of group D 54 days, and of group E 42 days. It is suggested that giving the mixture of the drug and the lipid vesicles produces a balance similar to that found in a vesicle solution containing the actinomycin D. It is also suggested that liposomes slow the absorption of actinomycin D from the peritoneum.

Biologic behavior of ocular malignant melanoma and comparison with melanoma of the head and neck

Ocular melanoma is the most common malignant tumor of the eye and accounts for 70 to 80 percent of all extracutaneous melanomas. Its biologic behavior differs from that of its cutaneous counterpart. To elucidate this, 62 patients with histologically proven melanoma of eye (58 uveal tract and 4 conjuntiva) at Roswell Park Memorial Institute from 1945 to 1977 were studied. The prominent contradistinctions from other head and neck melanomas were (1) a very high percentage of patients had either locally advanced or systemic disease at diagnosis, although the eye is the most sensitive organ; (2) regional lymph node involvement was absent even in the late stages of disease; (3) hematogenous spread involved single organs, most commonly the liver and the lung; (4) local recurrence was rare; (5) most recurrences occurred evenly in first 10 years after treatment; (6) regional resection, chemotherapy or both are advocated for distant metastases since they are confined to a single organ and are amenable to it; and (7) despite hematogenous spread and advanced disease at diagnosis, the overall prognosis of ocular melanoma is comparable to that of cutaneous melanoma.

Effects of intravenously administered Leu- or Met-enkephalin on arterial blood pressure

The purpose of these studies was to determine if two endogenous opioids, leucine (Leu) and methionine (Met) -enkephalin, alter blood pressure and, if so, by what mechanisms. Studies from our laboratory show that intravenous administration of Leu-enkephalin in doses of 0.032-320 microgram/kg induced a biphasic response in pentobarbital-anesthetized cats. A transient rise in mean arterial pressure was followed by a more prolonged decline. Administration of Met-enkephalin caused only a decline in mean arterial pressure. Neither agent significantly altered heart rate, venous pressure or the EKG. Having determined that both enkephalins altered blood pressure and observed that the responses were qualitatively different, selected pharmacological antagonists were employed to see if the alterations in blood pressure could be blocked. Naloxone blocked the hypertensive responses and antagonized the hypotensive effects seen with the administration of Leu-enkephalin. Naloxone also shifted the dose-effect curve of Met-enkephalin to the right. Diphenhydramine attenuated both the hypertensive and hypotensive responses of Leu-enkephalin. However, diphenhydramine pretreatment did not alter the decline in blood pressure seen with the higher doses of Met-enkephalin. Propranolol exerted some antagonistic activity in association with the rise in blood pressure seen with Leu-enkephalin, but propranolol did not alter the drop in pressure observed with the administration of either enkephalin. These results show that intravenous administration of the enkephalins can alter blood pressure and these effects are not alike for each enkephalin. Additionally, the enkephalins are not blocked in the same fashion by antagonists, giving support to the hypothesis that the two enkephalins interact with different receptors.

Quantification of myocardial infarction by computer-assisted positron emission tomography

The accuracy of three-dimensional transverse section positron emission imaging for quantification of myocardial infarction size was validated and compared with the accuracy of two dimensional planar positron imaging. After induction of acute anterior myocardial infarction in anaesthetised dogs, gallium-68 albumin microspheres were injected into the left atrium. Planar and transverse section images of the thorax were obtained with a multicrystal positron camera. After staining with tetrazolium tetrachloride injected intravenously, the hearts were excised, sectioned manually, and planar imaging repeated. Each myocardial infarction was clearly delineated by transverse section imaging with high contrast ratios (mean 0.68 +/- 0.02 SEM); planar imaging identified seven of nine infarcts but with lower contrast ratios (0.24 +/- 0.04; P < 0.001). The volume of infarcted myocardium determined from transverse section images correlated well with true infarct volume (r = 0.94); whereas planar images poorly predicted infarct size (r = 0.63). Thus, computer-assisted transverse section positron imaging provides in vivo localisation of microsphere distribution for improved radioisotopic quantification of myocardial infarction.

Comparison of subcutaneous versus intradermally inoculated murine C-1300 neuroblastoma

A subcutaneous (S.C.) was compared with an intradermal (I.D.) inoculation route of C-1300 neuroblastoma cells in adult A/J mice. This study was prompted by a recent report of increased metastases in intradermally inoculated murine neuroblastoma. The median survival in our line was longer in the I.D. group (44 days as compared to 34.5 days). Despite this feature, liver metastases, when detecp). In this series of experiments no other metastatic sites were found. Histologically both groups showed a similar picture under light microscopy, i.e., a highly undifferentiated tumor with little matrix and an absence of neuronal elements. It appears that the C-1300 neuroblastoma cell line utilized in this study differs biologically from that used by other investigators.

Significance of 99mTc-sulfur colloid splenic image in malignant melanoma

To evaluate the clinical significance of 99mTc-sulfur-colloid (TsSC) spleen scan findings in patients with malignant melanoma, a retrospective study was undertaken. Eighty-one patients with histologically proven malignant melanoma who received treatment in Roswell Park during a five-year period were included in this study. The scans were analyzed for spleen size, differential uptake of the tracer in liver and spleen, and for the presence of metastases in these two organs. These data were compared with stage of disease, survival, and autopsy findings. Significant correlation was found between the splenic size as measured on the scintiscan and at autopsy examination. The spleen size was found to be normal in 92% of the patients in early melanoma. The median survival of patients who had a normal-sized spleen by scan criteria was found to be longer than those who had splenomegaly. No significant difference in survival was noted between the patients with and without augmented splenic uptake of TcSC. Only a small number (17.7%) of patients with augmented splenic uptake had splenic metastases; hence, the possible role of immunological factors was considered.

Measurement of tamoxifen in serum by thin-layer densitometry

A method is described for the determination of tamoxifen in serum. The drug was extracted from the serum and separated from its metabolites by thin-layer chromatography. Irradiation of the thin-layer plate with ultra-violet light after development converted tamoxifen to a fluorescent product which could be estimated in situ by densitometry. The fluorescent product was identified as a substituted phenanthrene by thin-layer chromatography, and gas chromatography--mass spectrometry. The method allowed concentrations as low as 6.8 nmol/l serum to be measured. After an oral dose of tamoxifen (10 mg) to a female patient the maximum serum concentration (66.2 nmol/l) was achieved in 3 h. When 10 mg tamoxifen were taken twice daily for 21 days by the same patient serum concentrations of about 500 nmol/l were achieved.

The quantitative determination of acrylonitrile, acrolein, acetonitrile and acetone in workplace air

A simple and sensitive procedure for the routine determination of personnel exposures to organic vapors in the workplace has been developed using porous polymer adsorption/thermal desorption with a subsequent analysis by gas chromatography. Detailed instructions for the packing of the adsorption tube and the operation of the thermal concentrator (flasher) are given. Calibration data obtained with both a static on tube injection procedure and a dynamic method using a permeation device are discussed. More than two years of experience with 6000 samples involving a wide variety of compounds has shown the sensitivity and versatility of the techniques. The additional equipment involved is commercially available costing about $2000.

Adenosine deaminase activity in a transplantable murine renal adenocarcinoma

Adenosine deaminase (ADA) activity was studied in tumor tissue, spleen, and bone marrow of animals bearing a transplantable murine renal carcinoma. Tumor tissue and splenic ADA specific activities were elevated in these animals when compared to controls although splenic specific activity subsequently declined with increasing tumor burden. Marrow ADA specific activity was the same in tumor bearing animals as in controls regardless of variations in tumor size. Studies of this enzyme may offer insight into salvage pathways of purine biosynthesis thereby suggesting exploitable targets for chemotherapy.

Modification of the effects of LSD-25, d-amphetamine and tryptamine on electrically evoked responses in the visual system by methiothepin and octoclothepin

LSD-25 (32 microgram/kg), d-amphetamine (3.2 mg/kg), and tryptamine (320 to 3200 microgram/kg) given intravenously depressed the response recorded in the visual cortex to electrical stimulation of the optic chiasm of the chloralose anesthetized cat. Relatively large doses of 1 mg/kg of the dibenzothiepin derivatives, methiothepin and octoclothepin, antagonized the depressant effects of both LSD-25 and tryptamine to a greater degree than d-amphetamine.

Detection of experimental pulmonary emboli in dogs by sequential positron imaging after inhalation of 15O-carbon dioxide

After inhalation, C15O2 (T1/2 = 2 minutes) rapidly diffuses into pulmonary blood and is cleared from the lungs within 10 seconds. The purpose of this study was to determine whether impaired clearance of inhaled C15O2 from oligemic zones, distal to areas of obstructed pulmonary blood flow, could be detected by serial pulmonary imaging with a positron camera. Experimental obstruction of branches of the pulmonary artery was induced in 19 anesthetized dogs by inflation of balloon-tipped catheters (8-12 mm in diameter), injection of radiopaque silicone spheres (0.5-4.0 mm), and embolization with barium-impregnated autologous blood clots (1-5 mm) via the right external jugular vein. After a single bolus injection of 2 mCi of C15O2 into the endotracheal tube, serial lung images of 15O activity were obtained over 60-180 seconds. Obstruction of pulmonary arterial branches resulted in visualization of discrete zones of impaired 15O clearance which varied in area with catheter diameter. Location and size of these zones were confirmed by repeat imaging after direct injection of 15O-labeled blood through the distal catheter lumen. In dogs receiving autologous clots (n = 8), similar zones of impaired 15O clearance were consistently imaged, and single emboli as small as 2 mm in diameter produced regions of retained 15O activity. Zones of retained 15O activity corresponded to the location of radiopaque emboli on chest radiographs. This study introduces a new technique of radionuclide imaging for detection of pulmonary emboli that is noninvasive, safe, sensitive, and repeatable at short intervals.

Metastatic carcinomas from occult primary tumors. A study of 254 patients

From 1950 to 1973, 254 patients with metastatic cancers from occult primary tumors, comprising 0.5% of all the referred cancer patients were seen. The average age was 59 years. Clinical presentation was commonly in the form of metastatic lesions in lung, cervical lymph node, bone or liver. Radiological and radioisotopic investigations proved helpful in determining the extent of disease rather than the origin of primary tumor. Adenocarcinoma was the commonest type, followed by undifferentiated and squamous cell carcinomas. The origin of the primary tumor was established in 77 (30%) patients, mostly at autopsy. It was in the lung in 40% of the cases, followed by stomach, pancreas, kidney, ovary and colon. Some correlation was found between clinical presentation and the origin of the primary tumor. Histologically different second cancers were detected in 28 (11%) patients. Overall median and five-year survival rates were nine months and nine per cent respectively. Longer survival was seen in patients with squamous cell carcinoma metastases, middle and upper neck lymph node lesions, and those who had "curative" surgery. In localized metastatic lesions, surgical extirpation should be done. Depending on the histological type of the metastatic lesions, chemotherapy and/or radiation therapy have definite roles in the management of these patients. Periodic follow-up examinations also prove valuable.

Surgical treatment of penile cancer: a follow-up report

One hundred and fifteen patients with penile cancer were treated at Roswell Park Memorial Institute from 1952 to 1975. A full follow-up is reported and factors involving the prognosis are analyzed. Although the clinical error of staging was near 30%, the lymphography results suggest that this study may result in added improvement in preoperative staging. Early diagnosis, adequate surgical resection, and lymph node dissection will improve the survival significantly. When dealing with an individual patient the prognosis is poor when any one or more of the follow factors are present: the lesion involves the shaft; there is a positive margin at the surgical resection; total penectomy is necessary to obtain tumor-free margin; lymphography is positive for tumor involvement of lymph nodes; lymph node dissection has not been performed; positive lymph nodes are found on surgical exploration. The good prognostic factors include: a lesion confined to the glans and partial penectomy is sufficient to obtain a tumor-free margin of resection; no clinical evidence (including lymphography) of lymph node invovlement; performance of lymph node dissection. The histological grading of the tumor should not influence the clinical decision for treatment in our opinion at this time, based on our current results. Further prospective studies of different factors involved in etiology, diagnosis, and treatment of penile cancer are suggested.

Adenosine deaminase activity in patients with renal adenocarcinoma

Erythrocyte and lymphocyte adenosine deaminase (ADA) levels were studied in 31 patients with renal cell carcinoma (RCC). Decreased lymphocyte ADA levels occurred in patients with RCC. Erythrocyte ADA levels were reduced only in blood type B and O patients. Nephrectomy resulted in a rise in lymphocyte and erythrocyte ADA levels. Progression of clinical disease was associated with a fall in lymphocyte ADA values in all patients and with a rise in erythrocyte levels only in blood type A patients. Our results suggest that changes in erythrocyte and lymphocyte ADA levels in RCC patients are acquired and may offer insight into host-tumor interactions.

Secondary involvement of the bladder in malignant lymphoma

A study of 599 patients who had died of malignant lymphoma between 1952 and 1972 revealed involvement of the bladder in 13 per cent. Bladder involvement was always a secondary event, occurred in association with disseminated disease and was more common in non-Hodgkin's lymphoma than in Hodgkin's disease. Direct infiltration from adjacent pelvic foci as well as discrete apparent metastatic foci was noted. Involvement was usually microscopic although the presence of gross disease was invariably clinically manifest. Cystoscopy and cystography were valuable in the diagnosis of gross lesions. In contrast to primary vesical lymphoma the treatment of secondary vesical lymphoma was symptomatic and an operation was indicated rarely. Local radiotherapy was effective in treating the symptoms of secondary vesical lymphoma.

Accuracy of roentgenograms of the chest in metastases to the lungs

The findings on roentgenographic and tomographic examination of the chest were compared in 63 instances of suspected pulmonary metastases. These were further compared with the findings at thoracotomy in 41 instances. Of the 60 patients, 30 had soft tissue or bone sarcomas and 30 had carcinomas arising from colon, ovary or breast, and it also included five with malignant melanoma. Three patients with sarcomas had more than one thoracotomy. The diagnosis of pulmonary metastases by roentgenography of the chest was correct in 60 of 63 instances. Tomograms showed more lesions in 14 of 33 instances of sarcomas and 14 of 30 instances of carcinomas. Thoracotomy revealed even more lesions than were detected by tomography in 21 out of 26 instances with sarcomas and eight of 15 instances of carcinomas. Of the 37 patients with a solitary metastasis detected on roentgenograms of the chest, 22 were found to have additional lesions on the tomograms, 11 of 16 sarcomas and 11 of 21 carcinomas. At thoracotomy, however, nine of ten patients with a single metastasis from sarcomas were found to have even more lesions, while, in patients with carcinomas, tomograms were found to be accurate. Routinely, prior to major ablative operations for sarcomas and before excision of pulmonary metastases, it is suggested that tomography be carried out.

Progestational agents and blood coagulation. VIII. Effect of low-dose, alternate-day, estrogen-progestin combinations on blood coagulation factors in man, with a special note on the effect of freezing of blood samples

Changes in the blood coagulation system were studied in three groups of 20 patients each. The first group received 0.5 mg. of norethindrone daily, plus 0.06 mg. of ethinyl estradiol on alternate days from cycle Day 5 through 25. The second group, all of whom had been fitted with an intrauterine contraceptive device (IUD), received no hormonal treatment and served as a control group. The third group received 0.5 mg. of norethindrone daily, combined with 0.045 mg. of ethinyl estradiol given on alternate days from cycle Day 5 through 25. Blood samples were drawn prior to the initiation of the study and after three months of treatment. Tests of the following parameters of the blood coagulation system were performed: direct platelet count; platelet adhesiveness; prothrombin time; thrombin time; fibrinogen; factor II assay; activity of factors V, VII, VIII, IX, and X; antithrombin III; and fibrin/fibrinogen degradation products. For a number of these factors, both fresh and frozen blood samples were examined. It was concluded that the two treatment regimens, with the use of alternate-day estrogen administration over a three-month period, had no clinically significant effect on the blood coagulation system.