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10,001,100 | Impaired gastric emptying in gastric ulcer patients has generally been explained by gastric hypomotility. The gastric motor response to an electrical vagal stimulus was measured intraoperatively in patients with gastric ulcers (GU, n = 21), duodenal ulcers (DU, n = 25) and combined ulcers (GDU, n = 6). Amplitude and duration of the contraction and integrated motor response were found to be significantly greater in GU patients than in patients with duodenal and combined ulcers. Thus, hypermotility of the gastric muscle exists in GU patients and the delayed gastric emptying in GU disease may be the result of antropyloric motor dysfunction rather than of gastric hypotony. Abnormal motility associated with duodenogastric reflux appears to be a key feature in the pathogenesis of gastric ulcer. | [
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10,001,101 | The effect of altered luminal nutrition on cellular proliferation and plasma concentrations of enteroglucagon and gastrin after small bowel resection in the rat. | [
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10,001,102 | Luminal nutrition is known to have a trophic effect on small bowel mucosa after intestinal resection. Humoral agents, however, may also contribute to this process. Two of the proposed humoral agents, enteroglucagon and gastrin, were therefore investigated after intestinal resection and transection in the rat, and changes in their concentration in the plasma were related to cellular proliferation. Forty-eight male Wistar rats had either 75 per cent proximal small bowel resection or jejunal transection. The animals were further divided into three groups, each with a different nutritional intake. The first group were allowed food ad libitum. The second group were kept under hypothermic conditions which resulted in hyperphagia, while the last group were nourished intravenously. A further 8 animals had a laparotomy only (sham operation). All animals were killed 12 days after operation, plasma enteroglucagon and gastrin were measured, while determination of the crypt cell production rate (CCPR) was used to denote cellular proliferation. In each group resected rats had significantly higher crypt cell production rates and greater enteroglucagon levels compared with transected animals. However, only in the normally fed group was plasma gastrin increased in resected animals, there being no significant difference in the plasma concentration of this peptide in transected compared with resected rats, in both the intravenously fed and hyperphagic groups. In the models studied enteroglucagon appears to be a more likely candidate for a humoral trophic agent than gastrin in intestinal adaptation. | [
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10,001,103 | A comparison of circular stapling devices in colorectal anastomoses. | [
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10,001,104 | The short term results of colorectal anastomosis using the Russian SPTU and American EEA circular staplers are compared. Anastomoses with these stapling devices were attempted in 61 patients between October 1978 and December 1980. In 1 patient the stapling method failed at operation, so that 60 patients had a stapled anastomosis as their definitive form of anastomosis. Of these, 31 were stapled using the Russian SPTU device and 29 using the American EEA device. Parameters of age, indication for operation, surgical assessment of curability, tumour stage and distance from the anal verge are compared to demonstrate similarity of the groups. Practical aspects of the use of the staplers are discussed. Local complications of dehiscence, anastomotic haemorrhage, stenosis and fistula formation occurred in 17 patients. Complications related specifically to the stapling procedure occurred with similar frequency in both groups: 8 patients treated with the SPTU stapler and 9 patients treated with the EEA stapler. No significant advantage was demonstrated for either stapler with respect to overall local complications; however, the authors have found the EEA stapler both easier to use and easier to maintain. | [
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10,001,105 | Trophic effect of short chain fatty acids on mucosal handling of ions by the defunctioned colon. | [
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10,001,106 | Sodium and water absorption were measured in defunctioned loops of colon of dogs either in the presence or in the absence of the bacterial fatty acid, n-butyrate. In freshly defunctioned colonic loops n-butyrate enhanced sodium absorption twofold (P less than 0.05) and promoted sodium absorption for 48 h. In the absence of n-butyrate, defunctioned loops lost the ability to absorb sodium and water within 48 h. Pre-treatment of colonic loops with fatty acids for 3 h significantly diminished (P less than 0.05) sodium and water losses into the colonic lumen compared with loops pre-treated with saline only. Butyrate was absorbed at a steady rate even when no sodium was absorbed. Results suggest that fatty acids act on the colonic mucosa to exert a trophic effect on absorption of sodium. This trophic effect determines the efficiency of absorption of ions and could have clinical implications in the genesis of postoperative diarrhoea. | [
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10,001,107 | Hospital admissions for acute cholecystitis: changes in the age and sex distribution in Oxford in the post-war period. | [
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] |
10,001,108 | Admissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974-1978 have been reviewed and compared with figures previously published for the period 1953-1962 (1). There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives. The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same time. | [
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] |
10,001,109 | Neurovascular traction injuries of the upper limb root. | [
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10,001,110 | Eight cases of injury to the subclavian and axillary arteries are described. All were accompanied by injury to the brachial plexus. Arterial continuity was restored in all cases. Six young patients sustained high velocity injuries and they showed no neurological improvement. Two elderly patients with low velocity injuries recovered neurological function in the limb. Primary amputation should be considered when nerve damage is obviously very severe. | [
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10,001,111 | The effect of sustained venous hypertension on the skin capillaries of the canine hind limb. | [
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10,001,112 | An increased number of skin capillaries has been found in human skin subjected to sustained venous hypertension. To investigate this observation, venous hypertension was produced in the hind limb of Greyhounds by fashioning an arteriovenous (AV) fistula between the femoral vessels. This caused an increase in the number of capillaries in the skin of the lower leg. The capillary permeability of normal legs and legs subjected to chronic venous hypertension was then studied by observing the movement of radioactive molecules from the plasma to the fluid within Guyton capsules. Fibrinogen, a large molecule, leaked out of the capillaries significantly faster in the limbs with a high venous pressure and an enlarged capillary bed. It is suggested that the increase in the size and permeability of the dermal skin capillaries secondary to prolonged venous hypertension is the cause of lipodermatosclerosis and venous ulceration. | [
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10,001,113 | Carotid artery occlusion following endarterectomy: evaluation by spectral analysis of Doppler ultrasound signals. | [
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10,001,114 | The clinical results of carotid endarterectomy are well documented, but there is little objective information on the incidence of postoperative occlusion. We have studied the postoperative patency of the internal and external carotid arteries using continuous wave Doppler ultrasound with spectral analysis (Spectrascribe BOC--Medishield). Seventy-nine patients who had had 89 endarterectomies during the past 5 years entered the study. The mean follow-up was 21 months. Fourteen patients had an occluded internal carotid artery of whom 4 had suffered an immediate postoperative stroke and 1 a delayed stroke: transient ischaemic attacks occurred in another 4 patients. Of the 60 patients with a patent internal carotid artery one suffered an immediate postoperative stroke and 2 a delayed stroke; 6 patients had recurrent transient ischaemic attacks. None of the 5 patients who had an external carotid endarterectomy developed postoperative symptoms, although there was occlusion in 2. The carotid artery was occluded in 4 of 43 completely asymptomatic patients. Thus, 18 per cent of all carotid endarterectomies and 9 per cent of asymptomatic patients in this series had postoperative occlusion of the carotid artery. | [
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10,001,115 | Difficulties in the diagnosis and management of pyogenic liver abscess. | [
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] |
10,001,116 | Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978. The overall mortality was 43 per cent (13 patients). The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem. Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived. The remaining 3 had a multicentric abscess, and only 1 of them survived. Difficulty in diagnosis was sometimes increased by misleading results fom special investigations. Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure. | [
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10,001,117 | Stenosis of the common bile duct in chronic pancreatitis. | [
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10,001,118 | The incidence of common bile duct stenosis in patients with chronic pancreatitis was studied in a consecutive series of patients admitted for endoscopic retrograde cholangiopancreatography (ERCP). Thirty-six out of 79 patients (46 per cent) with moderate or advanced chronic pancreatitis as defined by radiological criteria were found to have a stenosis of the intrapancreatic portion of the common bile duct. There were no age or sex differences between the patients with and without biliary stenosis, but significantly more patients with stenosis had advanced chronic pancreatitis. In about two-thirds of the patients the stenosis was smooth, symmetrical and tapering. In the remaining cases, a shorter stricture of the hour-glass type was found. A complete obstruction was never seen. About one-half of the patients with bile duct stenosis were icteric at the time of the investigation. The jaundice resolved spontaneously in all but 1 patient in 3-42 (median 14) days. Stenosis of the common bile duct is a frequent complication of chronic pancreatitis, but biliary-enteric bypass operation seems to be unnecessary in the great majority of the patients. | [
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10,001,119 | Delayed presentation of small intestine damage due to closed abdominal trauma. | [
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10,001,120 | Use of the t test in the British Journal of Surgery. | [
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10,001,121 | Toxic dilatation complicating fulminant amoebic colitis. | [
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10,001,122 | Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5--9-year follow-up. | [
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10,001,123 | From 1970 to 1974 proximal gastric vagotomy without drainage was performed in 158 patients for duodenal ulcer. One patient died, giving an operative mortality of 0.6 per cent. Nine unrelated deaths occurred during the period of survey and 5 other patients were lost to follow-up. The remaining 143 patients were followed-up for a minimum of 5 years and a maximum of 9 years. The most frequent symptoms were epigastric fullness and intolerance to milk. Early dumping, detected in 6.7 per cent of the patients, was always mild. Diarrhoea, also very slight and often only related to the ingestion of milk, was seen in 9.6 per cent. Recurrent duodenal ulcer was proved in 7.7 per cent and strongly suspected in 0.7 per cent and the presence of a new gastric ulcer was also proved in 1.4 per cent of patients, making a total incidence of recurrence of 9.8 per cent. Approximately 89 per cent of the patients were classed as having a satisfactory result and 11 per cent were classed as unsatisfactory. Proximal gastric vagotomy is clearly effective in reducing the side effects of gastric surgery, while the incidence of recurrent ulceration in the long term is similar to the incidence of recurrence after truncal or selective vagotomy with a drainage procedure. For these reasons, consideration should be given to the wider use of proximal gastric vagotomy in the elective surgical treatment of duodenal ulcer. | [
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] |
10,001,124 | [Eye drug therapy. Principles and practice]. | [
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10,001,125 | Extremity lesions in the Intergroup Rhabdomyosarcoma Study (IRS-I): a preliminary report. | [
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10,001,126 | The sites in which rhabdomyosarcoma occurs most frequently in children and young adults are the head and neck, genitourinary tract, and the extremities. Among these three sites, tumors of the extremities have been associated with the highest relapse rate and lowest survival rate in patients treated by protocols of the Intergroup Rhabdomyosarcoma Study (IRS). In five of six patients treated by primary extremity amputation, tumor recurred. Seven of 21 patients in Clinical Group I (completely resected tumors), and 9 of 27 patients in Clinical Group II (patients with gross tumor excision but positive lymph nodes, "microscopic residual" disease, or extension beyond the muscle of origin) had relapse. Thirteen of 18 patients (72%) in Clinical Group III (gross residual disease) responded to a chemotherapy-radiotherapy regimen, but ten have subsequently had relapses; and 13 of 18 are dead. Of 30 patients in Clinical Group IV (disseminated disease on entry), 15 initially responded to chemotherapy, but 25 of 30 are dead. The period of surveillance is 2 1/2 to 7 1/2 years, with a mean of 46.3 months at least examination. Increased rates of relapse were seen in patients with extremity tumors, as opposed to tumors in other sites, irrespective of the specific IRS chemotherapy-radiotherapy regimen employed. In Clinical Group I (nonamputation), relapse rates by histologic subtype of rhabdomyosarcoma were alveolar subtype, 5/8; embryonal, 1/7; and all other subtypes, 1/6. Clinical Group II, relapse rates were alveolar, 6/12; embryonal, 5/11; all other subtypes, 3/10. | [
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10,001,127 | Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis. | [
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10,001,128 | The cytologic, histologic and ultrastructural features of a malignant carcinomatous mesothelioma of the tunica vaginalis testis in a 30-year old patient are described. This is the first such case with preoperative diagnosis by cytologic examination of hydrocele fluid and the second with documented history of exposure to asbestos. The identity of the tumor was confirmed by a positive immunoperoxidase reaction directed against mesothelial cells. A review of the previously described ten cases is presented. | [
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] |
10,001,129 | Neuromuscular hamartoma--a benign "triton tumor" composed of mature neural and striated muscle elements. | [
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10,001,130 | Two infants with benign, hamartomatous tumors composed of well-differentiated and intimately admixed neural and striated muscle components are presented. Their histogenesis is discussed in light of embryologic concepts of the derivation of mesenchymal tissues from neuroectoderm and in reference to previous reports of benign and malignant tumors of the nervous system with striated muscle components. | [
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10,001,131 | Tumors of the cerebral aqueduct. | [
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10,001,132 | Two cases of tumor of the cerebral aqueduct are described. Case 1 is a pilocytic astrocytoma in a 16-year-old girl with a two-year history of intermittent increase of intracranial pressure. The tumor was completely confined within the lumen of the aqueduct. Case 2 is a subependymoma of a 68-year-old man. The tumor extended beyond the aqueduct to the periaqueductal gray matter and produced signs and symptoms suggesting normal pressure hydrocephalus. The literature contains 18 other cases of tumor of the aqueduct: 13 gliomas and five vascular malformations. All, except one, produced clinical manifestations of generalized hydrocephalus lasting from 20 days to six years. The result generally did not correspond to the histologic type of the tumor. Like gliomas of the brainstem in general, those in the aqueduct tend to occur in childhood and adolescence and affect male more than female patients. | [
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10,001,134 | Data collected from review of 99 patients with carcinoma of the nasopharynx was submitted for statistical analysis. The purpose of the analysis was to determine patient, tumor and treatment factors that influence survival. The only patient factor observed to influence survival was patient age (P = 0.05). Greatest survival was noted for patients in the age group 0 to 20 years (44%), while poorest survival rates were in patients over 60 years of age (14%). Tumor factors influencing survival included the location of regional metastases (P = 0.05). Homolateral cervical metastases was associated with survival rates approximating 30% compared with 10% when bilateral metastases were present. Survival decreased markedly as cervical metastases progressed from the upper third of the neck to involvement of the middle and lower thirds. Survival was 20% when nodal involvement was confined to the upper neck compared with 8% when metastases extended to lower cervical regions. The only treatment factor apparently influencing survival was duration of therapy (P = 0.08). Longer treatment periods offered better five-year control rates. Higher dosage levels of radiotherapy were associated with improved survival, but not significantly so. | [
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10,001,135 | Myosarcomas of the stomach: natural history, prognostic factors and management. | [
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10,001,136 | A retrospective study was made of 41 patients treated for gastric myosarcoma to identify prognostic factors that influence results. The adjusted five- and ten-year survival rates were 56% and 43% respectively, with no significant difference between leiomyosarcoma and malignant leiomyoblastoma. A histopathologic grade of malignancy could be assigned to each tumor according to the degree of hypercellularity, nuclear abnormality, mitotic rate and other characteristics. High histopathologic grade, large tumor size (greater than 5 cm diameter) and invasion of adjacent organs adversely affected prognosis. Five-year survival after curative treatment was: 100% (9/9) for small tumors, of which six were treated by wedge gastric resection; 67% (8/12) for large tumors, mostly after subtotal gastrectomy; and 0% for tumors that invaded adjacent organs, despite extended resections. It is concluded that the management of gastric myosarcomas can be planned according to these prognostic factors and that multimodal therapy of tumors with adverse factors warrants consideration. | [
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] |
10,001,137 | Effect of doxorubicin on liver regeneration and host survival after two-thirds hepatectomy in rats. | [
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10,001,138 | The effects of doxorubicin (Adriamycin) on regenerating liver were studied after two-thirds hepatectomy in rats. In Group I, standard two-thirds hepatectomy was performed. Doxorubicin in a dose of 2 mg/kg (Group II) and 6 mg/kg (Group III) was given intravenously immediately after the same hepatectomy. In Group IV, 6 mg/kg doxorubicin was given after sham operation. Animal survival, body weight restoration, wet weight and mitotic activity of remnant livers, and serum albumin concentrations were examined 1-14 days after operation. The survival rates were 95.5% in Group I, 76.8% in Group II, 10.3% in Group III, and 96.7% in Group IV. Although there were no differences in the residual liver weights among the hepatectomized groups, treatment with doxorubicin induced substantial, dose-dependent suppression and delay of liver cell division. Serum albumin levels dropped considerably in hepatectomized, doxorubicin-treated rats. Light microscopy showed degenerative changes with a single cell necrosis of hepatocytes in Group III. Death among rats hepatectomized and treated with doxorubicin was considered to be mainly due to the failure of residual livers since albumin synthesis was impaired and no marked changes were seen in vital organs other than the liver. For patients with hepatoma, the present results may indicate that the administration of adjuvant chemotherapy with doxorubicin, when necessary immediately after hepatectomy, should be performed with great care. In the absence of such necessity, doxorubicin should be withheld until life-sustaining liver regeneration has taken place. | [
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10,001,139 | Relationship between patients' early recognition of melanoma and depth of invasion. | [
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] |
10,001,140 | The correlation between time to diagnosis and thickness of lesion in patients with superficial spreading melanoma was explored. Charts of 245 patients diagnosed since 1976 were reviewed for data on lesion duration and time since elevation (as perceived by patients); and the degree of elevation (if any); thickness, and diameter of lesion (as measured histologically). No correlation emerged between time to diagnosis and the biologic state of disease as reflected by thickness. The majority of melanomas in this series were not recognized by patients in an early, pre-elevation, low-risk phase. Whether an emphasis on identification of melanoma in this phase will lead to an increase in the percent of patients presenting with biologically early, curable disease remains to be tested. | [
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10,001,141 | A pilot investigation of the psychologic functioning of patients with anticipatory vomiting. | [
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10,001,142 | A pilot investigation of nine cancer patients receiving chemotherapy on an outpatient basis at the University of Florida's Shands Teaching Hospital is reported. The focus of the study was comparing patients with anticipatory vomiting symptoms with patients who did not exhibit prechemotherapy vomiting on measures of affect and coping style. The data indicated that patients exhibiting prechemotherapy vomiting, compared with the other patients, were more anxious and depressed; additionally, they exhibited a coping style which was inhibitive rather than facilitative in nature. A theoretical context for defining and treating prechemotherapy vomiting is offered. | [
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10,001,143 | Radiation therapy with or without primary limited surgery for operable breast cancer: a 20-year experience at the Marseilles Cancer Institute. | [
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10,001,144 | Since 1960 more than 3000 consecutive patients with operable infiltrating breast carcinoma were treated by radiation therapy with or without primary limited surgery, which usually consisted of local excision. For tumors smaller than or equal to 5 cm the ten-year crude survival rate is 77% for patients without palpable axillary nodes (T1-2N0) and 63% for patients having axillary adenopathy (T1-2N0). For operable tumors exceeding 5 cm of diameter (T3N0-1) the ten-year crude survival is 34%. Thirty-five percent of the patients alive free of disease at ten years required a secondary operation for presumed local or regional tumor persistence or recurrence, although no residual disease was found in 24% of the operative specimens. Local-regional recurrence had no adverse effect on ten-year survival. This conservative approach offers most women with operable breast cancer an excellent chance at breast preservation with the same chance for ten-year survival as with radical mastectomy. | [
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10,001,145 | Radiation-induced tumor regression as a prognostic factor in patients with invasive cervical cancer. | [
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10,001,146 | Radiation-induced tumor regression was evaluated as a prognostic factor in 200 patients with invasive cervical cancer treated at the University of Kentucky Center during the years 1973-1977. Radiation responses were classified as complete (Type A), intermediate (Type B), or incomplete (Type C) based upon pelvic examination findings one month following completion of therapy. Patients with Type A response to radiation had a recurrence rate of 5%, as compared with 27% in patients with a Type B response and 85% in patients with a Type C response. The direct relationship between radiation response and the incidence of tumor recurrence was observed in all stages of disease. Seventy-five percent of patients with Stages IB and IIB disease and a Type C response to radiation developed recurrent cancer, and tumor recurrences were confined to the central pelvis in the majority of cases. Patients with keratinizing squamous cell cancers had the lowest incidence of complete response to radiation. These findings suggest that careful observation of cervical cancer throughout radiation therapy can provide prognostically significant information concerning radiation-induced tumor regression. The therapeutic implications of this data is discussed. | [
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10,001,147 | Granulomas in melanoma patients treated with BCG immunotherapy. | [
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] |
10,001,148 | Autopsy slides from 22 melanoma patients who received bacille Calmette-Guérin BCG immunotherapy and who had a postmortem examination at the UCLA Center for the Health Sciences were examined for the presence of granulomas. Granulomas were found in six patients (29%) who received BCG but not in a group of 25 melanoma patients who did not have BCG immunotherapy. A number of factors were tested for correlation with the presence of granulomas in the autopsy material. Fifty-five percent of the patients who received BCG by both intralesional and time technique developed granulomas. No patients given BCG by the tine technique alone developed granulomas. No correlation was found between granulomas and the presence of symptoms after the administration of BCG, the duration of BCG immunotherapy, the patient's age, the number of BCG administrations, treatment with immunosuppressive agents, the length of survival after the last BCG administration, the presence of a positive PPD reaction, a positive history for granuloma-forming diseases and tests for immunocompetence. However, these results provide evidence that the route of BCG administration strongly influences the frequency of granulomas in melanoma patients who received BCG immunotherapy. | [
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10,001,149 | Sézary syndrome with a 14:14 (q12:q31) translocation. | [
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10,001,150 | The Sézary syndrome was diagnosed in a 71-year-old black woman with erythroderma, generalized lymphadenopathy and hepatosplenomegaly. The laboratory data revealed a white blood cell count of 65,000 mm3 with 81% lymphocytes, the majority having an indented or a cerebriform nucleus. The skin biopsy, the lymph node biopsy and immunologic surface marker studies confirmed the diagnosis of Sézary syndrome. The cytogenetic studies of the bone marrow and the peripheral blood revealed a (14:14) (q12:q31) translocation present, consistently in majority of the lymphocytes. This translocation is considered characteristic of ataxia-telangiectasia and, to our knowledge, has not been previously described in Sézary syndrome. | [
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10,001,151 | LDH isoenzyme patterns in tumors, polyps, and uninvolved mucosa of human cancerous colon. | [
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10,001,152 | By using a method of electrophoresis separation, the authors determined the relative values of each one of the lactic dehydrogenase (LDH) isoenzymes in the normal colonic mucosa. In adenocarcinomas, there is a significant rise in the percent of LDH-5. A similar disturbance has been demonstrated in 14 polyps, which confirms the known precancerous condition of these lesions. In the uninvolved mucosa surrounding neoplasm, the authors found that the increase in the relative proportion of "type M" isoenzymes, starting at 2 cm from the edge of the tumor, progressively disappears as the sample are taken farther away from the neoplasm. The authors conclude that these LDH isoenzyme pattern shifts in a normal mucosa could be an early sign of malignancy before the morphologic changes and could also be of great interest in the prediction of cancer relapse in the suture line after surgery. | [
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] |
10,001,153 | Malignant intrathoracic oncocytoma. | [
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10,001,154 | A case of malignant intrathoracic oncocytoma occurring in a 56-year-old man is reported. Preoperative films of the chest showed a large superior mediastinal tumor. Radical excision through a right-sided thoracotomy was impossible because of the extensive growth. Light and electron microscopic findings revealed a malignant oncocytoma with metastases in lymphoid tissue and tumor emboli in lymph vessels. Postoperative treatment with cyclophosphamide was recommended for one year. After two years there was no radiologic or scintigraphic evidence of metastases. Review of the literature on malignant oncocytoma suggests a relatively benign course after surgical excision. The role of radiotherapy and chemotherapy cannot yet be established. | [
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10,001,155 | Discriminant analysis of radiation therapy procedures: the Patterns of Care Process Survey for carcinoma of the larynx. | [
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10,001,156 | Discriminant analysis was applied to larynx data from the Patterns of Care Study (PCS) in order to evaluate and classify radiation therapy procedures. Since PCS has recorded information on a large number of separate procedures, a method was needed to treat them coherently. Discriminant analysis provided such a method through a comprehensive score of performance. The particular discriminant score used was calculated from the contrast between facilities with and without radiation therapy resident training programs. Because residents drastically affect the practice of radiation therapy in a facility, this factor provided a foundation for analyzing the procedures themselves. Results of the discriminant analysis were used to derive a condensed list of generalized procedural criteria which contains almost all the discrimination information of the original procedures and which elucidates their relative importance and the relations among them. | [
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10,001,157 | Clear cell sarcoma and selective IgM deficiency: a case report. | [
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] |
10,001,158 | A case of clear cell sarcoma of tendons and aponeuroses and a co-existent IgM deficiency is reported. The tumor arose in the Achilles tendon with metastases to the skin, bone, and lymph nodes. The tumor, examined by light and electron microscopy, consisted of glycogen-containing clear cells with melanotic and amelanotic features. There was no detectable serum IgM. The IgA levels were normal and IgG levels were elevated. Peripheral blood lymphocytes contained a normal amount (4.5%) of IgM-bearing cells. Cultured mononuclear cells from the patient suppressed production of IgM by normal lymphocytes, suggesting a role of suppressor cells in the IgM deficiency. The co-existence of soft tissue sarcomas and immunoglobulin deficiency states is reviewed. | [
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10,001,159 | The in vitro effect of a calf thymus extract (thymostimulin) on the immunologic parameters of patients with untreated Hodgkin's disease. | [
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10,001,160 | The in vitro effect of a calf thymus extract, thymostimulin (TP--1), on the E-rosette-forming capacity and on the PHA blastogenic response of peripheral blood lymphocytes was evaluated in 20 patients with untreated Hodgkin's disease. The mean percentage of lymphocytes forming E rosettes increased in patients from 44.2% to 57.5% (P less than 0.005). The mean PHA stimulation index rose with all three concentrations tested, but returned to the normal range only with the highest PHA concentration (60 mu/ml). An increase in the immune parameters was greatest in those patients who presented with decreased E-rosetting cells of total lymphocyte counts or whose disease was Stage III or IV or of mixed cellular histology. | [
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10,001,161 | Peripheral nerve sheath tumors: an electron microscopic study of 43 cases. | [
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10,001,162 | To obtain data concerning their histogenesis, 23 benign solitary schwannomas (including five cellular variants), 10 neurofibromas, and 10 malignant peripheral nerve sheath tumors were studied by electron microscopy. The results confirm previous findings that solitary schwannomas (so-called neurilemomas) are composed principally of cells showing features of differentiated Schwann cells. The principal cells of neurofibromas on the other hand did not resemble differentiated Schwann cells. The predominant cell type in six cases was indistinguishable from normal perineurial cells. Schwann cell-axon complexes seen in three cases may have represented entrapped normal structures or perhaps one component of a hamartomatous tumor. In contrast to the benign neoplasms the cells of the ten malignant peripheral nerve sheath tumors were in general poorly differentiated. When differentiated, they shared some features with Schwann and perineurial cells. Cell forms intermediate between them and fibroblastic cells were also identified. These findings indicate that schwannoma and neurofibroma are distinct entities. In the authors' experience schwannomas rarely undergo malignant change. For this reason and because it is unclear whether malignant tumors of peripheral nerves arise from more than one sheath cell, the designation of malignant peripheral nerve sheath tumor (PNST) is preferable to malignant schwannoma. | [
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10,001,163 | Myoepithelial cell adenoma of the parotid gland: a light and ultrastructural study. | [
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] |
10,001,164 | Light, histochemical, and ultrastructural features of a myoepithelial cell adenoma of the parotid gland are described. Ultrastructurally, the neoplasm was almost entirely composed of myoepithelium. The spindle-shaped myoepithelial cells and their processes were filled with longitudinally oriented myofilaments with characteristic densities along their course and marginal attachment plaques. The tumor cells were interconnected by desmosomes. The role of myoepithelium in the genesis of some salivary gland tumors is discussed. | [
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10,001,165 | Morphology of adenocarcinoma in situ of the uterine cervix: a study of 14 cases. | [
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] |
10,001,166 | Fourteen cases of adenocarcinoma in situ (ACIS) of the cervix in patients 30 to 52 years old were studied. In its pure form (four cases, ACIS was discovered cytologically, but when associated with a squamous abnormality (ten cases), it was found histologically. Two different types of ACIS were distinguished both histologically and cytologically. The first type, which was similar to the common form reported in the medical literature, predominated in 12 cases, and consisted of cells with hyperchromatic and pseudo-stratified nuclei. The second type, which predominated in two cases, displayed a conspicuous structural disorder with unequal, larger, and often clear nuclei containing enlarged nucleoli. | [
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10,001,167 | Analysis of the androgen response of 23 patients with agnogenic myeloid metaplasia: the value of chromosomal studies in predicting response and survival. | [
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10,001,168 | The responses of 23 patients with agnogenic myeloid metaplasia (AMM) to androgen therapy were studied. Various clinical and laboratory parameters were analyzed for their value in determining response to therapy and length of survival. Fifty-seven percent of patients responded, as determined by a sustained increase in hematocrit within three months of therapy which thus eliminated the need for transfusions. Chromosome study of the abnormal hemic population was the best predictor of response: 92% of patients with normal chromosomes responded, while 78% of patients with chromosomal abnormalities did not. Responders had a mean survival time of five and a half years from the time of diagnosis as compared with two years for the nonresponders. The degree of thrombocytopenia, suppression of the ferrokinetic, and lack of activity in axial skeleton on bone marrow scans indicated severely compromised hemopoiesis in the nonresponders. The results suggest that in some patients with AMM, more extensive cytogenetic alterations in the abnormal hematopoietic cells result in an inability to respond to androgen therapy and that the chromosome study is the test most accurate for predicting the outcome of therapy. | [
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10,001,169 | Self-healing reticulohistiocytosis: a clinical, histologic, and ultrastructural study of the fourth case in the literature. | [
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10,001,170 | A case of self-healing reticulohistiocytosis is reported. Our case differed from those previously reported in that tumors developed 17 days after birth (instead of at birth) and all tumors disappeared rapidly within three weeks (instead of two to three and one-half months). Hematologic abnormalities such as absolute neutropenia, marked lymphocytosis with many atypical cells, and atypical monocytes in bone marrow in association with this disease have not previously been reported. The patient had palpable liver which persisted with absolute neutropenia for about a month. The diagnosis of self-healing reticulohistiocytosis was confirmed by characteristic histology and by the demonstration of Langerhans' cells with typical granules in the tumor cells. | [
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10,001,171 | Bone involvement in Hodgkin's disease. | [
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10,001,172 | Eighteen patients with osseous involvement were identified from a series of 124 consecutive patients treated with combined-modality therapy with advanced-stage or relapsing Hodgkin's disease. Multiple lesions were seen as frequently as were solitary lesions. Nodular sclerosing histology was as prevalent as mixed cellularity disease. However, those five cases initially diagnosed at protocol entry were predominantly mixed cellularity (80%) with multiple lesions (80%). Sites of involvement included: the spine, 24; pelvis, 8; ribs, 4; femur, 3; skull, 1; and shoulder 1. Actuarial survival for these patients was 84% at nine years. Only three patients were induction failures and no patient has had a relapse. Patients with bone lesions had favorable responses to combined-modality therapy. | [
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10,001,173 | Basal cell epithelioma (carcinoma) in children and teenagers. | [
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] |
10,001,174 | Among over 390,000 routine dermatopathologic specimens there were 85 cases diagnosed as basal cell epithelioma (carcinoma) (BCE) in persons 19 years old or younger. This number was refined to 40 cases de novo BCE in children and teenagers. Basal cell epithelioma unrelated to other conditions is rare in the young and it should be differentiated from similar fibroepithelial growths. | [
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10,001,175 | Glucose-6-phosphate dehydrogenase: a possible clinical indicator for prostatic carcinoma. | [
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10,001,176 | Any system of biochemical analysis that can be used to detect chemical differences between normal and malignant cells may add potentially valuable information to complement the histologic data which provide the practical definition of human prostatic carcinoma. A difference (P less than 0.0001) was observed in the levels of glucose-6-phosphate dehydrogenase (G-6-PD) activity in prostatic tissue with benign hyperplasia and prostatic carcinoma. Measured as a function of the amount of protein extracted from whole-tissue homogenates, the values for G-6-PD activity in prostatic carcinoma are almost four times those measured for benign prostatic hyperplasia. The degree of elevation of the activity of this enzyme suggests a correlation between enzymatic activity and clinical prognosticators, ie., histologic differentiation and clinical stage. | [
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10,001,177 | Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of nonfunctioning parathyroid cancer. | [
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10,001,178 | Seven cases of functioning and two cases of nonfunctioning parathyroid carcinoma are presented together with a general discussion of this disease. Functioning parathyroid carcinoma may be associated with prolonged survival. The morbidity and mortality from this disease are generally related to the prolonged hypercalcemia that occurs. The hypercalcemia is best treated with excision of local recurrences; however, this surgery is most often palliative and seldom curative. The best operative results were obtained when the disease could be localized preoperatively. Neck and mediastinal exploration in the absence of physical or radiographic evidence of recurrence failed to affect serum calcium levels. Two patients with nonfunctioning parathyroid cancer did poorly compared with those with functioning parathyroid carcinoma. The few cases reported in the literature are also suggestive of a more aggressive disease. The failure of this tumor to produce parathyroid hormone may allow it to escape clinical attention until it has achieved an advanced state. | [
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10,001,179 | Benign clinical behavior of immature mediastinal teratoma in infancy and childhood: report of two cases and review of the literature. | [
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10,001,180 | Germ cell tumors of the mediastinum can be divided into three categories: 1) mature teratomas which have all elements at a mature level; 2) immature teratomas which are similar to the mature teratomas, but also contain immature epithelial or mesenchymal elements or blastema; and 3) embryonal tumors which contains elements which are recognized as dysgerminoma, embryonal carcinoma with or without yolk sac elements, and choriocarcinoma. Immature teratomas are the rarest type, accounting for only about 1% of mediastinal teratomas. Two cases of immature teratoma of the mediastinum occurring in infants are reported. One tumor was completely excised. The child is well without evidence of disease two years later. The other immature teratoma was unresectable. Biopsy showed it to be similar to the teratoma that was excised. No postoperative treatment was given. The tumor has not changed appreciably in size, but the child has grown normally for six years so that the tumor mass, which initially filled his chest, is now evidenced as mediastinal widening. A review of the reported cases of immature teratomas in the mediastinum shows that the prognostic value of the histologic appearance of these tumors has not been developed to the same degree as it has for teratomas in the ovary or the sacrococcygeal region. The immature teratomas that occur in infants behave as mass lesions as do the mature teratomas. Immature teratomas in the mediastinum of children in their late teens and in young adults behave as highly malignant tumors similar to the embryonal carcinomas. | [
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10,001,181 | Treatment results in males with breast cancer. | [
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10,001,182 | Between 1948 and 1978, 39 previously untreated males with breast cancer received curative treatment at M. D. Anderson Hospital; an additional 30 males were referred for first treatment failure after outside definitive treatment. Of 21 patients who were treated with mastectomy, six had radical mastectomy alone, and 15 had radical mastectomy and postoperative irradiation. Of 18 patients who had less than radical surgery and postoperative irradiation to the chest wall and peripheral lymphatic areas, 7 had simple mastectomy, 3 excision biopsy and 8 had needle biopsy. Chest wall recurrences developed in four of six patients with grave signs treated with radical mastectomy, one had a recurrence in an unirradiated chest wall following peripheral lymphatic irradiation and three others had orthovoltage irradiation of 2400, 3000, and 4200 rad. No local or regional recurrences had developed in patients treated with simple mastectomy, excision, or needle biopsy, and radiation therapy to the chest wall and peripheral lymphatics. The ten-year disease-free survival (Kaplan-Meier) is 50% for the entire group, 70% for patients with histologically or a clinically negative axilla, and 34% for those patients with histologically or clinically positive axilla. Recommendations for the management of primary and regional disease are reviewed. | [
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10,001,183 | Testicular mass: an initial sign of colon carcinoma. | [
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10,001,184 | Molecular transformation of tumor adenylosuccinate synthetase and characteristics of its converting factor. | [
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10,001,185 | The properties of adenylosuccinate synthetase [inosine monophosphate:L-aspartate ligase (guanosine 5'-diphosphate-forming) EC 6.3.4.4]) of rat Yoshida sarcoma ascites tumor cells changed during purification. The isoelectric points (pI) of the crude and purified enzymes were 5.0 and 5.9, respectively. The Km values of the crude enzyme for inosine monophosphate, aspartate, and guanosine 5'-triphosphate were calculated to be 99 +/- 1 (S.E.), 870 +/- 40, and 27 +/- 2 microM, respectively, while those of the purified enzyme were 410 +/- 10, 980 +/- 50, and 69 +/- 5 microM, respectively. These data indicate that the crude enzyme should be more effective for activity than the purified one. It was found that the change in pI occurred during diethylaminoethyl cellulose column chromatography and that, during this step a compound, named pI-converting factor (ICF), was separated from the enzyme molecule. On addition of ICF, the pI of the purified enzyme changed from 5.9 to 5.0, indicating that the pI conversion was dependent on ICF and was reversible. ICF was nondialyzable, heat stable, and partly precipitated with 1 N perchloric acid but was not affected by 1 N KOH. It was partially degraded by DNAse I. These results suggest that ICF is a DNA-like compound. | [
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10,001,186 | Cytokinetic and biochemical effects of 5-iminodaunorubicin in human colon carcinoma in culture. | [
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10,001,187 | The semisynthetic anthracycline, 5-iminodaunorubicin (IM), was investigated to see whether modification of the benzoquinone moiety to produce a drug with low free radical potential would alter the cytotoxic and biochemical characteristics of this drug in comparison to Adriamycin (ADR), an agent with high free radical potential. Cell viability was measured in human colon carcinoma (HT-29) cells by soft-agar cloning. Upon exposure to either log-phase or early plateau-phase cells for 2 hr to IM or ADR, a threshold exponential cell lethality curve was obtained. Prolonging during exposure to 24 hr produced an exponential decline in cell survival and a marked reduction in viability of both log-phase and early plateau-phase cells. Inhibition of DNA synthesis in log-phase cells after 2 and 24 hr of exposure to IM and ADR paralleled the increased cell lethality produced by the drugs. In contrast, total RNA synthesis was not inhibited by IM, whereas ADR impaired both RNA and DNA synthesis. Nuclear rRNA, synthesis was not significantly inhibited following 24 hr of exposure to 10(-7) M ADR or IM but was inhibited by 85 and 35% at 10(-6) M ADR or IM, respectively. The affinity of IM and ADR for HT-29 DNA was measured in vitro by displacement of acridine orange binding and was found to be similar for both analogs. These studies suggest that the cytotoxicity of IM and ADR results from the interactions of these drugs with DNA. | [
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10,001,188 | Turnover and transport of plasma very-low-density lipoprotein triglycerides in mice bearing Ehrlich ascites carcinoma. | [
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10,001,189 | Effects of estrogens and antiestrogens on estrogen receptor dynamics and the induction of progesterone receptor in MCF-7 human breast cancer cells. | [
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10,001,190 | Effects of rat urine fractionated by molecular weight on urinary bladder carcinogenesis. | [
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10,001,191 | Monoclonal antibody-defined human lung cell surface protein antigens. | [
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10,001,192 | Monoclonal antibodies were used to define four distinct antigens present on the surface of human lung tumors. Immunoprecipitation of the four antigens by monoclonal antibodies and sodium dodecyl sulfate:polyacrylamide gel electrophoresis reveals that they have distinct complex structures. Different patterns of expression of these antigens on cells of other than lung tumor origin were detected by the same panel of monoclonal antibodies. | [
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10,001,193 | Correlation of circulating levels of a serum protein with triiodothyronine levels and hepatoma growth. | [
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10,001,194 | In this communication, we provide evidence that proliferation of transplantable Morris hepatoma 7777 might to some extent be regulated by triiodothyronine and/or a specific serum protein, the levels of which are correlated with levels of triiodothyronine. The protein has an estimated molecular weight of 80,000 and migrates as one band on polyacrylamide gel electrophoresis. In normal rats, this protein accounts for approximately 1% of the total serum protein. Both the circulating levels of the serum protein and proliferating of transplanted hepatoma cells were decreased in thyroidectomized rats. Elevated levels of the serum protein and increased cell proliferation were observed when animals had 70% of their lives removed prior to transplant, were given injections of triiodothyronine, or had a 10-day-old first transplant surgically removed. Some evidence is also provided suggesting that the synthesis of the serum protein is stimulated by thyroid hormone. | [
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10,001,195 | Effects of liposome structure and lipid composition on the activation of the tumoricidal properties of macrophages by liposomes containing muramyl dipeptide. | [
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10,001,196 | Various vesicle structures and lipid compositions have been studied to identify the optimal type of liposome for delivery of the macrophage-activating agent muramyl dipeptide (MDP) to macrophages. Evaluation of the ability of liposomes to be phagocytosed by macrophages established that optimal initial rates of engulfment were obtained when multilamellar vesicles (MLV) composed of distearoylphosphatidylcholine (18:0 PC): phosphatidylserine (PS) (7:3 mol ratio) were used. MLV composed exclusively of 18:0 PC were phagocytosed at rates greater than or equal to those of MLV composed of egg phosphatidylcholine (PC):PS, whereas MLV composed only of egg PC were very poorly phagocytosed. Although phagocytosis was enhanced by incorporation of PS into MLV, the inclusion of PS brought about significant enhancement in liposome permeability in the presence of serum. The inclusion of PS, however, was a requirement for the delivery of MLV to the lungs following i.v. injection into mice whether used in conjunction with 18:0 PC or egg PC. Activation of macrophages to become tumoricidal against syngeneic tumor cells wtih liposome-encapsulated MDP was superior in both degree and duration when MLV composed of 18:0 PC:PS (7:3 mol ratio) were used. MLV were found to be superior to large unilamellar vesicles containing equal amounts of lipid and entrapped MDP. On the other hand, higher levels of macrophage activation were obtained when an equivalent amount of a lipophilic MDP derivative, muramyltripeptide:phosphatidylethanolamine, was incorporated into the liposome bilayer irrespective of whether the adjuvant was incorporated in liposomes composed of 18:0 PC:PS or egg PC:PS. | [
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10,001,197 | Significance of cellular pharmacokinetics for the cytotoxic effects of daunorubicin. | [
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10,001,198 | The effect of free and DNA-linked daunorubicin on the colony-forming ability of granulocyte-macrophage committed stem cells and spleen colony-forming cells (i.e., multipotent stem cells) from normal mice has been studied in vitro and in vivo. After incubation of bone marrow cells in short-term suspension cultures, both committed and multipotent stem cells were more sensitive to the free drug than to the DNA complex, whereas the reverse was found in vivo after i.v. injection. However, when the in vitro cell-killing effect was related to the cellular retention of daunorubicin, no difference in activity was found between free and DNA-linked drug. Incubation of the bone marrow cells with a higher drug concentration for a shorter time resulted in a considerably lower cell survival than incubation with a lower concentration for a longer time, the intracellular exposure dose being the same. When the in vivo cell survival was related to the cellular retention of daunorubicin, the DNA complex was slightly more toxic than free drug, which can be explained by the higher peak concentration obtained. The results obtained with committed granulocytic stem cells and multipotent stem cells were comparable. Thus, the observed discrepancy between the in vitro and in vivo toxicity of free and DNA-linked daunorubicin can be explained by the differences in cellular retention of daunorubicin under these two conditions; i.e., the DNA complex probably acts as a slow-release preparation of daunorubicin. The results also demonstrated for the first time the importance of the peak concentration of daunorubicin in the target cells and indicate an important role of dose scheduling for the cytostatic effect of the drug. | [
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10,001,199 | Inhibition of pancreatic carcinogenesis by retinoids in azaserine-treated rats. | [
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] |
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