Ronald R. Rozin

Active immunotherapy of human solid tumor with autologous cells treated with cholesteryl hemisuccinate a phase I study

A marked increase in specific immunogenicity of tumor cells is induced upon incorporation of cholesteryl hemisuccinate (CHS) into the cell membrane, which presumably promotes the expression of latent tumor‐associated antigens. Immunotherapy with CHS‐treated and irradiated tumor cells as vaccine was found to be very effective in various murine experimental tumors and in eliciting delayed‐type hypersensitivity in cancer patients. Based on these findings, we have carried out a Phase I study on 21 patients with solid tumor who had exhausted standard therapeutic options. All participating patients were examined by conventional physical and clinical tests prior and during the study. The immunotherapy regimen for most patients consisted of an intramuscular injection of 2 × 107 CHS treated and irradiated autologous tumor cells given at 2‐week intervals. Variations on this regimen were mostly due to the lack of sufficient number of cells. None of the patients displayed evidence of toxicity or any other local or systemic adverse effects. In seven patients, regression of tumor mass was observed. In six of nine patients who were tested for delayed‐type hypersensitivity against their CHS treated tumor cells, a significant increase in skin reaction was observed after immunotherapy. The lack of any adverse reaction in this treatment, in addition to the observed positive clinical and immunologic response in advanced cancer patients, indicate a safe therapeutic potency which is planned to be investigated in the subsequent clinical studies. Cancer 58:650‐654, 1986.

New concepts of forward combat surgery

A modular, mobile and versatile evacuation hospital evolved by the Israel Defence Forces (IDF) during the last 15 years serves as a sorting facility for the hospitals in its rear, in much the same manner as an emergency department functions within a hospital. It has extensive sorting and resuscitation capabilities, contrasting with a relatively small hospitalization potential. Surgery is performed only for resuscitation or for limb salvage. The evacuation hospital handled more than 4500 casualties during the 1973 and 1982 Arab-Israeli wars. Only 3 per cent of the wounded had to be operated on prior to further evacuation. Seventeen per cent were returned to the front lines after minor treatment and 80 per cent were sorted and stabilized and then evacuated further to rear hospitals. The eventual mortality for these 4500 casualties was 2.3 per cent.

Training aids for instruction in the initial management of injury casualties and in resuscitation procedures

Practical experience in the initial treatment of injured patients is not easily available to the medical student. The small number of injured patients available for observation in a short time, the fact that the patients do not necessarily arrive in regular teaching hours, and the large number of students present in teaching groups compound this difficulty. Specialized instruction in these subjects is therefore important. The acquisition and use of teaching aids facilitate precise and efficient presentation of the material. We present teaching aids specifically prepared for instruction in the initial management of the injured and in resuscitation procedures. These aids include a library of video recordings documenting important emergency procedures, a TV camera used for filming these procedures, a collection of slides on the subject of emergency medicine and recent injuries, mannequins for instruction in cardiopulmonary resuscitation (CPR), utilization of the hospitals animal research laboratory for instruction in critical procedures such as venous cutdown, chest drainage, etc., and simulated computer programs.

Prolonged Fever as a Presenting Symptom in Adrenal Tumors

Four patients with adrenal tumors in whom prolonged fever was the foremost symptom are presented. Two of the patients had nonfunctional adrenocortical carcinoma, one had a pheochromocytoma without adrenergic hyperactivity, and in the fourth, an aldosteronoma was found. Only in 1 case was the tumor (pheochromocytoma) resectable and this patient became afebrile post surgery. A review of the literature revealed that fever is encountered in 6-10% of cases with adrenal tumors, sometimes as the first manifestation of disease. However, a survey of the large series of fever of unknown origin revealed no mention of adrenal tumors in that group of solid tumors which many cause prolonged fever.

Perforation of the Esophagus (Boerhaave’s Syndrome) during Hemodialysis

The first case of spontaneous perforation of the esophagus during hemodialysis is reported. This occurred in a 73-year-old patient, following vomiting, which he frequently experienced during dialysis.

Intramural haematoma of the duodenum following blunt abdominal injury—the place for conservative treatment

Two patients with intramural haematoma of the duodenum following blunt abdominal injury are presented. They responded well to conservative treatment. Complete resolution of the duodenal obstruction was demonstrated by consecutive radiological studies. Because haematomas usually resolve spontaneously, awareness and diagnosis of this rare condition are important in order to prevent unnecessary operation.