E. Eyskens

Isolated lung perfusion with melphalan prolongs survival in a rat model of metastatic pulmonary adenocarcinoma.

Introduction: Survival after isolated lung perfusion (ILuP) with melphalan was tested in a model of unilateral pulmonary adenocarcinoma. Methods: On day 0, rats were randomized into four groups: Group 1 (n = 9) reveived tumor cells intravenously for induction of bilateral lung metastases, whereas groups 2–4 (n = 21) underwent a 10-min occlusion of the right pulmonary artery during tumor cell injection for induction of unilateral left lung metastases. On day 7, groups 1 and 2 received no treatment. Group 3 underwent left ILuP with melphalan (2.0 mg/kg) while group 4 received melphalan intravenously (0.5 mg/kg). The end point of the study was death from metastatic disease. Results: Median survival of ILuP-treated animals (81 ± 12 days) was significantly longer compared to group 1 (18 ± 1 days; p = 0.0001), group 2 (28 ± 3 days; p = 0.0002) and group 4 (37 ± 6; p = 0.0004). Conclusions: ILuP with melphalan prolongs survival in the treatment of experimental metastatic pulmonary carcinoma.

Clinical relevance of neovascularisation on duplex ultrasound in the long-term follow-up after varicose vein operation

Objective: To evaluate the clinical relevance of neovascularisation at the saphenous ligation site. Design: Long-term follow-up after previous varicose vein surgery in a single patient group. Setting: Vascular clinic of a university hospital. Patients: Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning. Intervention: Clinical assessment and colour duplex scanning of all the operated limbs. Reintervention in 15 limbs with perioperative evaluation of recurrent veins. Main outcome measures: Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked. Results: In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings. Conclusions: The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.

Modified Technique of Isolated Left Lung Perfusion in the Rat

Isolated lung perfusion is a novel therapy for the treatment of pulmonary metastases to increase current low survival rates. Due to tumor heterogeneity, perfusion has to be evaluated in different rat species for efficacy and ideal drug regimens. The revised technique of isolated left lung perfusion as described by Wang and originally performed in the Fisher rat resulted in a high morbiditity in the Wag/Rij rat in our laboratory. Therefore, we modified techniques for intubation and anesthesia, and developed a new approach of catheterization with improved results.

Influence of cyclosporin A on the damage and regeneration of the kidney after severe ischemia/reperfusion injury

ISCHEMIA/REPERFUSION injury is unavoidable in renal transplantation. Renal tissue regeneration after this type of injury seems to be delayed as compared with other forms of acute renal injury. The reason for this delay is unknown, but it could be provoked by the use of immunosuppressive drugs such as cyclosporin A (CsA).1 We examined the influence of CsA on the recovery of the post-ischemic kidney. Early functional and morphological events (0 to 10 d) of the postischemia/reperfusion injury and regeneration were investigated qualitatively and semiquantitatively.

Retroperitoneal lymph node dissection as adjuvant therapy in the treatment of non-seminomatous testicular cancer.

Abstract Objective: To assess the results of retroperitoneal lymph node dissection (RPLND) of residual masses in patients with disseminated non-seminomatous germ cell tumour treated with cisplatin-based chemotherapy, both in terms of extension of surgery, morbidity and survival. Patients and methods: Retrospectively, all patients treated for non-seminomatous germ cell tumour at the University Hospital of Antwerp were studied from January 1987 till December 1997. In patients with non-seminomatous testicular cancer more than stage I, the ‘wait and see’ strategy changed and patients were treated with chemotherapy. Patients were assessed at the end of chemotherapy and if a residual masses persisted, a RPLND was performed. If possible, a nerve-sparing lymphadenectomy was performed. Extension of surgery, morbidity and survival were analysed. Results: Sixty patients had a non-seminomatous germ cell tumor of the testis and were analysed. The median follow-up was 78 months (range: 13-144 months). Thirteen patients with stage I disease were treated with orchiectomy only and none of these patients had recurrent disease. Forty-seven patients were treated with cisplatin-based chemotherapy. A complete response was observed in sixteen patients (34%), while 31 patients (66%) achieved a partial response and were treated with a RPLND. Fifteen patients underwent RPLND above the level of the renal trunk. In two patients malignant cells or fibrotic tissue were found above the renal trunk and bilateral. In five patients viable tumour cells were found in the region below the renal trunk. Sixteen patients underwent RPLND below the level of the renal trunk, of which nine had a unilateral resection, containing viable tumour in two patients. Operative mortality was 0%. One patient died six months after RPLND due to metastatic disease. In two patients, an important retroperitoneal bleeding occurred. Resection of adherent organs was performed in two patients. Long term sexual problems were reported by thirteen patients (65%) with bilateral lymphadenectomy versus two patients (18%) in the unilateral group. The survival of the patients treated with a RPLND was 97% and in the whole group of patients with a non-seminoma-tous testicular cancer 98%. Conclusion: RPLND has a place in the treatment of patients with non-seminomatous testicular cancer after chemotherapy in case of residual masses. Although mortality is low, morbidity is acceptable. In a limited number of patients there was a need of resection of adherent organs when a resection above the renal trunk was performed.

Effects of suramin on anastomotic colon tumors in a rat model

Background: The development of antiangiogenic drugs offers new promise in the treatment of malignancy. Suramin has been reported to inhibit tumor growth by blocking angiogenesis and has been used in clinical trials. The aim of the present study was to examine the effects of suramin on colonic anastomotic tumors in the rat. Methods: (a) Colonic anastomotic tumor was induced in 120 WAG/RIJ rats. Half of the animals were given 100 mg/kg of suramin intraperitoneally at the time of tumor induction. Rats were sacrified after 2, 4 and 8 weeks; tumor take and tumor weight were evaluated. (b) The number of red blood cell clusters per ×400 field was counted in each tumor. (c) A lymphocyte transformation test was performed in four groups of animals, 2 weeks before and 2 weeks after tumor implantation and/or suramin administration. Results: (a) A significant enhancement of tumor growth was observed in the suramin-treated animals. (b) This was accompanied by a significant increase in functional blood vessels. (c) Suramin-treated rats had markedly decreased lymphocyte stimulation, pointing to a possible immunosuppressive effect. Conclusions: The growth of an anastomotic colon tumor is rather enhanced by a single intraperitoneal administration of 100 mg/kg suramin in the rat, possibly by an unexpected immunosuppressive effect.