Julius Wolf

Nitrogen mustard and the steroid hormones in the treatment of inoperable bronchogenic carcinoma

Abstract Four hundred ninety-six patients with bronchogenic carcinoma were divided into comparable groups and each treated for three months with nitrogen mustard, diethylstilbestrol, testosterone propionate, cortisone, progesterone or an inert compound (lactose). Sixty-three per cent of the patients given nitrogen mustard were alive at the end of ninety days as compared to 51 per cent of the patients receiving the inert compound and 37 per cent of the patients treated with cortisone. The first course of nitrogen mustard improved the survival rate at the thirtieth day only. The second course of the drug failed to exert any further effect on survival. Mortality in the group treated with cortisone was highest during the second month of treatment. No explanation could be found for the apparent deleterious effects of cortisone. The median survival time for the control group was ninety-three days as compared to 121 days for the group receiving nitrogen mustard and fifty-six days for the patients given cortisone. The estimated mean survival time also confirmed the very slight advantage of nitrogen mustard as compared to the inert compound as well as demonstrating the accelerated death rate among the patients given cortisone. The results with the other drugs were intermediate between those with the inert compound and cortisone, the experience in the group receiving progesterone being almost as bad as that in the group given cortisone. Thirteen patients died of exsanguinating hemorrhage; six had received diethylstilbestrol and five had keratinizing squamous carcinoma as compared to an over-all incidence of 6 per cent of this type of bronchogenic carcinoma in this series.

Plasma and tumor ACTH in carcinoma of the lung.

Plasma and tissue contents of immunoreactive ACTH were determined in 100 patients undergoing surgical resection for lung cancer. ACTH was detectable (>1 ng ACTH equivalent/g wet weight) tissue in 47 of 49 specimens of epidermoid carcinoma, in 15 of 17 specimens of adenocarcinoma and in 7 of 8 specimens of large cell carcinoma; the median concentrations in these three tumor types were 8, 3 and 9 ng/g, respectively. Patients with oat cell carcinoma were not considered candidates for curative resection and are not included in this series. ACTH was not detectable in 36 specimens of apparently normal lung tissue from the same lobe but distant from the tumor and ranged up to 6 ng/g in 14 other specimens. One‐half of patients with epidermoid carcinoma but only one‐quarter of those with adenocarcinoma had preoperative plasma levels exceeding 250 ng/L plasma. About 75% of patients survived for at least one year whether preoperative plasma levels were greater than 400 ng/L or less than 200 ng/L. In only 4 of 21 patients with preoperative levels >300 ng/L did the plasma fall by at least one‐half in the immediate postoperative period. It is concluded that measurement of preoperative and postoperative plasma immunoreactive ACTH does not have a prognostic value for remission or long term survival in lung cancer, probably because it is unlikely that the tumor per se is the sole source accounting for the elevated levels generally observed in this condition.

Hospital epidemic of hepatitis.

SummaryA small outbreak of viral hepatitis on the Surgical Service of a large hospital has been described. The rapidity of onset, its short duration, its apparent localization, the high attack rate among new house staff members, and the high incidence of prodromal allergic manifestations were outstanding clinical features. The epidemiology of the disease in general, and its application to this outbreak in particular, have been briefly discussed. Several mechanisms of transmission have been proposed.

Gastroscopic findings in patients with subtotal gastrectomy.

Summary 1.The gastroscopic findings in 62 patients who were asymptomatic 3.5 years after a subtotal gastrectomy for peptic ulcer were compared with 82 patients who had symptoms suggestive of recurrent ulcer following such an operation. 2.No difference in the size of the gastric remnant or stoma could be demonstrated in patients with and without dumping symptoms. 3.The incidence of normal gastric mucosa was the same in both the symptomatic and asymptomatic groups. (When abnormalities were seen, there was a tendency for multiple abnormalities to occur in the symptomatic group.) 4.No correlation was noted between the size of the gastric remnant and the recurrence of an ulcer. 5.By the use of both radiologic and gastroscopic examinations 34 ulcers were demonstrated in the 82 symptomatic patients. 6.It is suggested that the finding of a fish-mouth narrowed stoma is significant and indicative of ulcerative disease.