Alvin L. Watne

Metastases of cancer to cancer

An unusual case of metastasis of cancer to cancer is reported. The initial malignancy, an adenocarcinoma of the kidney (hypernephroma), was found to have widespread metastases involving the lungs, liver, spleen, left adrenal gland, stomach and small intestine. A primary undifferentiated bronchogenic carcinoma originating in the right mainstem bronchus also existed with widespread metastases to the mediastinal lymph nodes, left lung, liver and left kidney with secondary deposits within the sites of the metastatic hypernephroma. A review of the literature is presented and indicates that in most of the reported cases an instance in which both malignancies display widespread metastases is exceedingly rare as is the occurrence of metastases to the metastases, as most situations involve metastasis to the second primary tumor.

The surgical experience and a one to sixteen year follow-up of 277 abdominal aortic aneurysms

Abstract Between 1960 and 1975, 277 patients with abdominal aortic aneurysms were operated on at the West Virginia University Medical Center. One hundred ninety-three aneurysms were intact lesions and eighty-four were ruptured. Operative mortality for elective resection was 8.8 per cent and for ruptured aneurysms 66.7 per cent. Mortality associated with ruptured abdominal aortic aneurysms was best related to shock and advanced age. Ninety-nine per cent of patients underwent long-term follow-up which ranged from thirteen months to thirteen years and four months (mean, 4 years and 9 months). At present 61 per cent of patients surviving elective resection and 50 per cent of those surviving operation for ruptured aneurysm are alive.

The occurrence of carcinoma of the rectum following ileoproctostomy for familial polyposis.

Ileoproctostomy was performed in 32 patients (13 Female and 19 male), with polyposis coli ranging in age from 10 to 54 years. Seven patients (22%) developed cancer of the retained rectum with a median follow-up of 14 years. Two (20%) of ten patients, followed for 10 to 15 years, and three (50%) of six patients, followed for 15 to 20 years, developed rectal cancer. Rectal cancer developed in two of 14 patients who had their ileoproctostomy at 14 cm and in five of 18 patients who had their ileoproctostomy at a higher level, with a median follow-up of 7 and 11 years, respectively. Rectal cancer developed in two of 15 teenage patients undergoing ileoproctostomy and in nine of 17 patients aged 20 to 54 years. The present average ages of the two groups were 25 and 41 years, and the average age at which rectal cancer appeared was 40 years. Three of the patients who developed rectal cancer had numerous poly-pectomies over the years, and there was a tendency to develop tubulovillous and villous adenomas with a variable degree of atypia leading to carcinoma. One patient also showed a return to high levels of coprostanol and secondary fecal bile acids. Proctocolectomy, if acceptable, may be the treatment of choice; ileoproctostomy may mean that the patient eventually will undergo a proctectomy. The ileoanal endorectal pull-through procedure has a great deal to offer to these patients, and further study is necessary to evaluate this procedure.

Fecal steroids and bacterial flora in patients with polyposis coli

Fecal neutral and acid steroids and bacterial flora have been studied in a series of patients with polyposis coli and normal controls. The patients with polyposis coli showed a higher concentration of cholesterol and primary bile acids, which increased still more after ileorectostomy. The bacterial flora of the patients with polyposis coli showed an anaerobe/aerobe ratio of 2.7/1 with a relative increase in clostridia and bifidobacteria and decrease in eubacteria and bacteroides. After ileorectostomy clostridia disappear, as do rumenococcus, peptostreptococcus, and fusobacteria, whereas eubacteria and lactobacilli decrease and bifidobacteria and bacteroides increase. Eubacteria showed a decrease from normal in the pre- and postoperative patients with polyposis coli and paralleled the reduction of cholesterol to coprostanol.

Dermatofibrosarcoma protuberans with metastases treated with methotrexate

Summary A case is reported of dermatofibrosarcoma protuberans, which was unresponsive to x-ray therapy and steriods, but which responded to intra-arterial infusion of 4-amino-N 10 -methyl pteroylglutamic acid sodium and to formyl tetrahydropteroylglutamic. This sensitivity of dermatofibrosarcoma protuberans to the afore-mentioned drugs may prove of value in treatment of the disease.

SKIN ALLOGRAFT STUDIES IN THE POUCH YOUNG OF THE OPOSSUM

SUMMARY Although adult opossums were shown to exhibit first and secondset rejection phenomena to skin allografts, pouch young less than 12 days old did not reject such grafts. Graft survival in such young extended to at least 80 days in most cases. When the question of induced tolerance to graft acceptance in five opossums with permanently surviving allografts was tested by regrafting with skin from the same donor, two of the animals rejected the second graft in a first-set fashion while the remainder maintained a viable second graft for over 90 days. All grafts from another donor were rejected within 20 days on these same animals. The initial graft never underwent any change regardless of what happened to subsequent grafts.

Infusion chemotherapy in hepatoma and metastatic liver tumors

Abstract Two patients with hepatoma and one with metastatic adenocarcinoma showed an objective and subjective response to infusion chemotherapy of the hepatic artery with methotrexate. Three patients with metastatic adenocarcinoma of the liver did not respond to hepatic artery infusion with 5-fluorouracil. Two patients with methotrexate infusion also had a more prolonged infusion period. Subsequent systemic chemotherapy did not benefit those patients who had shown response to methotrexate infusion, but one patient whose 5-fluorouracil infusion was cut short by technical difficulties did show a 20 per cent decrease in hepatomegaly after systemic chemotherapy with 5-fluorouracil. In patients with primary or metastatic liver cancer, significant palliation may occur after prolonged methotrexate infusion .

Changing management in familial polyposis: Role of ileoanal endorectal pull-through

Total colectomy with ileoproctostomy was performed in 32 members of a family spanning three generations and ranging in age from 10 to 54 years. In seven of these patients (22 percent) carcinoma developed in the retained rectum over a median follow-up period of 14 years. This high incidence of rectal carcinoma has demanded reevaluation of treatment recommendations in patients with polyposis coli. Ten patients aged 7 to 30 years have undergone total abdominal colectomy with ileoanal endorectal pull-through since 1980. All were one stage procedures without reservoir construction. Within 3 months the patients all had good control with 5 to 10 semiformed stools daily and had resumed normal activities. Follow-up date shows adequate dilatation of the distal ileum and no evidence of polyps. Total colectomy and ileoanal endorectal pull-through are effective treatment for familial polyposis in patients of all ages. It should be considered the primary procedure in new patients and an excellent method of converting those patients who have ileoproctostomy to a safer situation.

Fecal steroids in polyposis coli and ileorectostomy patients

Abstract Neutral and acid steroids in fecal samples from patients with familial polyposis have been studied before and after ileorectostomy. Cholesterol, cholic acid, and chenodeoxycholic acid were significantly higher in the familial polyposis group prior to surgery than the control group. In the polyposis group, ileorectostomy resulted in complete disappearance of the bacterial metabolite—coprostanol. Three years postoperative, the polyposis patients were unable to hydrogenate cholesterol. Chenodeoxycholic and cholic acids were also significantly higher in the ileorectostomy patients. Lithocholic and deoxycholic acids were not significantly different in the polyposis coli group but were significantly lower in the ileorectostomy group.

Glycosyltransferase levels in familial polyposis coli

Glycosyltransferase levels have been reported to be decreased in the tumor mucosa of adenocarcinoma of the colon. The purpose of this study was to determine if similar changes are present in the polyp mucosa of patients with Familial Polyposis Coli (FPC). The levels of eight glycosyltransferases were determined by measuring transfer of a radiolabeled sugar from a nucleotide sugar donor to a glycoprotein acceptor. The levels of four of the enzymes were significantly different in the mucosa of tumors and the polyp mucosa of patients with FPC as compared to the colonic mucosa of persons without known neoplastic disease. The changes were specific for these four enzymes and occurred to the same degree in tumor mucosa and the polyp mucosa. These changes in glycosyltransferase levels are a marker of the malignant transformation of the cell and since they occur in the histologically benign cells of FPC may serve as a key to understanding the neoplastic process.