G. June Marshall

5-fluorouracil given once weekly: Comparison of intravenous and oral administration

One hundred seven patients with disseminated adenocarcinoma were randomized to receive 5‐Fluorouracil (5‐FU) by vein, Group A (52 patients), or by mouth, Group B (55 patients). Dosage for both groups was 15 mg/kg body weight given once weekly. Clinically useful response rate was 21% for Group A (IV) and 40% for Group B (oral). Duration of response and mean cumulative dose to beginning response were comparable in both groups. Slight differences were observed in toxicities in the 2 groups. G.I. toxicity was more frequent in Group B (oral) and hematologic toxicity was more common in Group A (IV).

Improvements in Dehydration and Cement Line Staining for Methacrylate Embedded Human Bone Biopsies

Undemineralized methacrylate embedded bone biopsies and other bone specimens can be processed much more rapidly by application of acidified 2,2-dimethoxypropane (DMP) dehydration, which requires two hours, than by traditional graded ethanol dehydration, which requires at least four days. This shortened processing time is valuable when biopsy results are urgently needed to detect osteomalacia or to determine bone features prior to possible parathyroidectomy. We have processed over 200 bone specimens with DMP and have compared DMP dehydration to graded ethanol dehydration in 11 biopsies in which two plugs were available from the same patient. DMP dehydration does not compromise the following: tetracycline retention, Goldners stain, acid phosphatase localization or histochemical identification of aluminum. Cement lines, which provide a record of past remodelling, are useful in clinical interpretation of bone biopsies. We have adapted two stains, toluidine blue and methylene blue/basic fuchsin, for improved cement line identification. Five-micrometer sections individually demineralized in acetate buffer prior to cement line staining show best results with toluidine blue at pH 5.5 and with methylene blue/basic fuchsin at pH 2.5-3.5.

Randomized clinical trial of cystosine arabinoside and 6-thioguanine in remission induction and consolidation of adult nonlymphocytic acute leukemia

One hundred and forty‐seven adults with acute nonlymphocytic leukemia were randomized to one of two treatment regimens utilizing cytosine arabinoside and 6‐thioguanine. In regimen A the drugs were administered every 12 hours until marrow cellularity was reduced by at least 50%. In regimen B the drugs were administered every 12 hours for 5 days with five to 7 days rest intervals between courses. Decisions to continue or reinstitute therapy were based solely on marrow cellularity and marrow ratings. The overall response in refereeverified cases in both groups was similar (41%); regimen B proved to be the easier protocol to administer but required greater support. Younger patients or those with an initial high hemoglobin count responded best to these drug regimens. Only 36% of our patients experienced severe marrow hypoplasia (i.e., a 75% or greater reduction in marrow cellularity) prior to complete remission, suggesting that cytosine arabinoside and 6‐thioguanine in combination may selectively suppress leukemic cells while sparing normal hematopoietic elements.

Synovisol as an irrigant for electrosurgery of joints

The appropriate irrigation fluid for use during arthroscopic procedures should be selected on the basis of fluid-tissue and fluid-instrumentation compatibility. This study describes a new irrigation fluid, Synovisol, that is isomolar, nonhemolytic, nonantigenic, has a low viscosity, and is nonconductive. The rabbit knee was used as a model to demonstrate the immediate and long-term (3 weeks) effects of irrigation with Synovisol compared with water, normal saline, mannitol, sorbitol, glycine, and with nonirrigated controls. Results were assessed by light- and electron-microscopic evaluation of synovium and cartilage dissected from rabbit knees. While the greatest amount of damage was seen in water-treated samples, significant effects were noted with other irrigants compared with Synovisol and controls. Long-term animals showed recovery of tissues in all cases. Systemic effects evaluated by measuring plasma glycerol levels showed a transient increase that peaked at 20 min. No hemolysis was detected and kidney morphology was normal. The physiological, electrocompatible, simplicity of formula, low cost, and long-shelf-life properties of this solution makes it a fluid uniquely suited to arthroscopy.

Peripheral B- and T-lymphocyte counts in patients with sarcoma and breast carcinoma.

Peripheral B‐ and T‐lymphocyte counts were studied in 50 patients before they received any therapy for their conditions: 16 had carcinoma of the breast; 8 soft tissue sarcoma; and 26, benign disease. Among 11 males, the six patients with advanced soft tissue sarcoma had significantly lower percentages of T lymphocytes than five patients with benign conditions. And six female patients with advanced breast cancers had significantly higher numbers of B lymphocytes than the 10 patients with early breast malignancies. Pertinent reports in the literature were reviewed and discussed. Presently, the clinical and prognostic values of quantitative study of T and B lymphocytes remain to be defined. Cancer 40:667–671, 1977.

Laser arthroscopic surgery of the shoulder and knee

The laser is used less in orthopaedics than in any other medical specialty. Improving technology and the impressive effect of the CO2 laser on orthopaedic tissues has, however, accelerated the interest of orthopaedic surgeons over the past two years. The carbon dioxide laser is now commonly used in orthopaedics for difficult to access lesions of the knee - particularly those of a degenerative nature with high surface area and low volume. The results are presented in this paper and reveal no evidence of lasting complications. Although several types of lasers are being experimentally utilized in orthopaedics, the YAG and CO2 lasers are the only lasers commonly utilized. The YAG laser is utilized for shoulder arthroscopy and offers the advantage of passage of energy through fiber and the ability to utilize the tool in an aqueous environment. It is too early to determine as to whether or not the YAG laser or the CO2 laser will be the most efficient energy delivery system for use in the shoulder.

Alteration in osteoblast cell number and cell activity in the presence of invading malignant fibrous histiocytoma

Correct prediction of tumor behavior and interpretation of local factors in the tumor microenvironment rely in part upon accurate determination of tissue changes after tumor invasion. The authors examined local bone changes in primary malignant fibrous histiocytoma (MFH) of bone in a 59‐year‐old woman. Three noninvolved and three tumor‐involved sites were evaluated by quantitative determinations of bone structural and dynamic features. Compared to noninvolved sites, tumor‐involved bone was characterized by significantly increased osteoblast index (89.4 ± 15.6 [mean ± SEM] versus 7.3 ± 6.0, P = 0.008), percent osteoid area (12.1 ± 2.7 versus 1.2 ± 0.5, P = 0.02), percent of trabecular surface covered by osteoid (70.0 ± 6.0 versus 14.5 ± 4.8, P = 0.002), and percent osteoid lined by osteoblasts (36.4 ± 3.6 versus 3.7 ± 3.0, P = 0.002). Bone 7.8 mm distant from invading tumor cells showed features characteristic of noninvolved sites, whereas bone completely surrounded by tumor showed markedly decreased osteoblast features. Osteoblast function also was affected by tumor; the amount of matrix laid down per day bore a significant positive correlation with the osteoblast index. These data indicate the following: (1) distinctive bone morphologic changes occur in situ during invasion by MFH; (2) changes affect aspects of bone formation but not resorption during invasion; (3) both osteoblast number and osteoblast activity are significantly altered; and (4) changes are local in nature and probably reflect the osteoblast response to local tumor factor(s) and are dependent upon the extent of tumor invasion. Cancer 59:755‐760, 1987.

Student-constructed examination items

Student‐written items were compared with teacher‐written items on an objective examination given to first year medical students. While student scores were higher on the student‐written items than on teacher‐written items, there was a positive correlation between the scores. Student items did not differ from teacher items in the course, according to student ratings of emphasis. As a by‐product of this study, correlations were found which suggest that student scores on an item often reflect the degree of teaching emphasis given the content area of the item rather than the inherent difficulty of the content. It is suggested that further research is needed to determine whether students learn through the process of writing examination items. Therefore, if the process proves to be educational, this study indicates that it will be feasible to incorporate the student‐constructed items in examinations.