- Email: [email protected]
16. The pathology of experimental gastric freezing
13
A B,., FRAC I h
n i q u c s to R e s e t | i o n of Parenchymatous Organs. Itix'IN~ S . COOPER .J,~'D TEItuo l:lmost.:* (De1)artmerit of Neurologic SurgeIT, St,. Barn,d)as Hospital, New York, New York). ]."xtrem(: cohl m a y be useful , s a surgical tool eittier to produce necrosis of biologic tissue bz situ or to make its resection tec.hnlcallv easier, relative.ly avas('ular, and safer. It is the purpose of thi.-: report to describe the investigative use of ery()genie surgery for the latter purpose; t httt is, to make the resection of a parenclrym'ttous organ t echni(-alh, simpler, x.l,ttix(k, free of bleeding, more rapt(l, .iml safer. A ~e(;hMque has been developed, in experimental anitnals, w i m r e i n a section of lhe liver is frozen prior to its reseetim;. Resection is then earried out within tim frozen mass, perniitting a few millimeters of frozen tissue to remain behin,l in the n()m(.._(~trd'~¢~e , portion of tim organ. The 1'e,...ec~ , tRm may be p e r f o r m c ( i employing an electric saw withiri the frozcu tissue. Capillaries and small x~es,,.el,., ' - ~ ,,¢ are necrosed by the extreme cold. Consequenlly,, only t h e larger arteries must be indivMually conLrolle(t in order to achieve hemostasis.:, This m a y be a.cconlplislled Siml)ly elnpioying a stapling device. Tl~is technique of liver resection will t)e demonstr
two
('~'i,-.'~s Ol,Orale(l ripen, T ] i c v u r i a l i o l i is (l(l(~ t o ~liffer(mc(,s in |)l'l(,C'll•lent of li;e l ) r o b ( ) a l l d to bloo~l s~li)i~lv in llie l)lu'{iclilar Itrea ()f the spin,,tl cor¢l. 1,I.
Cryosurgery
ill t i l t : T r c a l n l e n t
of
Cat;u-acts
and R c t l n a l ] D e t i i c h n l e n t . i' CIIAIILF,,.! D , IXEL. IAN ((+ry()~llrgory l{escarch ] ) e p ' u ' t l n e n t , : l , i n h r t t t a l l Eye, Ear ariel Tin'oaf Hosl)ital. N'ew Y o r k , New York). l:r(,ezin~ a iissue I.,rodileos tin ilnniediate ,~;olidificafit,)ll. ~O!11{) t i m e aft('r thawing there l i l l y t)e.iil-i ill fin Ill ll-I Ii 1.ilia ,lad (h}gl.;lliWll lion depend in g on .many vonll,loX factors. The solit|ific'it.ion is the raisoa d ' / l r c elf (,rvo~tir~ii,itl. , cali-iracl, 0xlra(:iion.- T i l e ,..e-¢ ,: 1,,ctive inll,inll-niitioli ani[ (let/enerqtioil . is l.}le 1)rhlcilJh~ t~(,}iiiid other !.15o~ of cryostlrg(q'y in (l])h th:lltn(ilogy. (-)no of lho (w~i'-!wescnt d,/i~gei'~ (If enlnr'lc£ ~lirgery i~ rll|)l.lli-(.~ of Ibe delh'ate c,
•
(i
' Sui)port.ed bv a grant, from the J o h n , A . Barl~ford Foundation.
~
"
,.
)
.
*
adl,iof.nt, n o r n l a l 1;)riiin, T h e frozen t t l m o r m a y t)e resecled by. employing tile line of cioavage be¢
•
•
•
twee.n the ico ball and tim adjacent normftl brain. A m o r e recent, innovation has been the use of a high spee(1 electric drill to remove the frozen t;umor, e =:This technique will be demonstrated by inoi, ioli:, i)ieture.
16. The .-
PathMogy of
.
Exper{mental
Gastric
Freezing. R. L. Fus0N, J, V..KLavl~s,* A,xn VI~I'Li4A.M W. SIIINGELTON (Department" of Surg:ery,~Duke University Medical Center, D u r h a m , N o r t a C;arolina). T h ee f f e c t's .- of gastric f r e e z i n g u p o n t h e stomach were studied in 16 (togs (11 to 1 6 kg). Histologsthnuldted gastr.ic free acidity a~,eraged 43 C before fregzing and 20°, 3,; trod 8°C ai0 24, 48, and 72 hr •
.
.
~
,
fief ~ffi~ezing: Histological studies foilÜwing: the P r~e(ture revealed Variabledegrees of focal parie t a l Jcell (h~mageo :in 11 d0gs that demonstrated no -eVidence o f gi?oss gastric: u l c e r a t i o n . T h e ex-
,
15.. -----Thc.Applicati°n~ of Cryogenic. Surt,deal Tech-
•{'l
-,
?l
'
...,
.-
' ' ~ @ "
•
"
"
,
,
"
.,.
•
"
"
~
"
t~nt m :parmtal cell d a m a g e . c o u l d n o t be quant.fiedi':ihi!, many areas t l~e muc:~sa remainbd entirely
normM.Examina~ibrX: 2 weaks aft,or freezing showed
14
A BSTR A CTS
2)(:) cviden(:e of parielal cell regeneration. Tim SUl)erii,'ial muc:osni epii.helium as well ns mucous ne,(d; an(t chief cells a l)peared to be more resistant it) freezing. Five animals demonsl;rnted gastric ulceration (lurin,,," l lm postfreeze period (2,1 lo 72 hr) n#s()eiale(l wit l~ varying degrees of hemorrhage in the t:~mi('n prol)ria, subnmeosa, tm([ nmseularis. / Con(:(:)milant intr'~vaeeuh,r (hrombosis Wns not fotm(l (l~u'ing early ulcer form't(ion, but rather only afler the inflammatory l)rocess had I:)een l)resent for several days. G'~stric uleerntion in the post freeze porio(l appears to be. (lue to enpillary rUl)tt~re, henlorrlmge, and resullant (,issue ischemia. Fo('al (leslruction of ganglion cells in Auerbach's !,lexus was foun(l only in 1he presence of overlying lmmorrlmge ,m(l uleer:t(ion. These resul(s are somewh::d. (liffer(m(~ from tl~()se f)reviously reporte(i i)3' ~Vangens(een et .tl. 17. T , - c a t m c n t of t h t m a n T u m o r s by Freezing. ANDREW A. (LXGE* AND FRI.:I) ]!]31M1N(:~S (])eparl:-
merits of SurgeD" and Oral Surgery, Ve*ernns Administration Hospital, Buffalo, New York). Benign and m , lignant, (umors in humans were treated by freezing with mo, lern cryosurgieal e(luipment, utilizing liquid nitrogen. No nmtter what, the ('ell type, (he effect of freezing was letlml. All frozen cells (lie(l. The manner of rep.dr following cold injury varied wilh the lype of /issue frozen. Cellular tissue ~luiekly bec:~me ne(:rotic and slougluM in several days. Collagenous and elastic tissue was resist ant to st=ructural eh'mge, even though devii;alized. ]3one stru('ture WaS liI l(']hqng('~I and the mn~rix remaine~l as a scaffoM for repair, whM~ involved revnsculnrization an~l cellular repopulation of_ the (levilalized ~2I'O,~l,
We lreate(t selecte(l l)atients with localized c'mcer, often resistant to -K-ray ther.q)y, which couhl not be ~-xeise(l surgically withoul: exlensive bone (lestruelion..Most of (he l):ttienls had e'~neer of th(, ornl eavil y an(I pharynx an(t son,: Im(l vancer of the skin or reelum. In most 1)n.tienls, lh(, lesion wqs ('oni,'olled with lira firsL trealment. Occasionally, relyfitilion of cD'otheral)y was necessary I)ecause an insuftieieni~ qrea was frozen initially. Our results indicate lh'lt, e~o'osurge~ T is an effeetive w:ty to destroy 't, lesion !oe'~lly. Benign tumors nre easily nmnaged t)y the technique. Cryothm'apy will cure localized cancer in which othe, r metho(ls (:)f,lr(.mtnmnt }~ave faih,(l ()r cannot be, ~se(l. 18. Cryothc;'apy o f S k i n M a l i g n a n c y . TM Sm'mu~ A.
~"Sui)porle(! by n special grnnt frrm) Springfield Hospilal, S1)ringfield, M:~ss,'wln~sel.ts, an(l the Massachusells Division of the Americ::,n Cnn('er Soe.iety (:mco2mt N(,). 2310051 ).
Zacam:~x (Boslon I~niversily School of 5l,,livine, De!~:,rlII2eni of l)ernmlology, l~oslon, 5lassavlluseiis, amt Slwin~li(,hl ]tosl)it:ll, SIn'ingfi~'hl. Mass:wlJllsei t s). The l)resenl sltuly of (:'ryoihernpy of skin 2nnlit~nemey is twofold: q) investigntive--ability l~, freeze skin to t:he d'~l)tl), of 10 ram; nnd b) clini~'al - - T r e a t m e n t of ,1,1 1,alienis wiih :2, total of 60 ml(nll(..'O21.b" ('.arviliol1292S, usiT2g :1, newly devised col)l~(,r disc af,1)licql or. Cryolheral)y in (lermn.tology has for 65 years })eel1 eOlll121e(l almost, ex(!lusively to benign nn(l pre('qncerous (lermntoses. Refrigeration theral)y hqs consis)ed of solid carbon dioxide stick an(I/or liquicl niirogc.n nI)ptied with n Q-Tip. These n ietho(ls lmve not been employed for skin m:lli.~nancy be('mts(, of their inability to freeze t:)ey(m(l 2 m2n of skin (h'l~lh. Using 1-era-thick, solid eOl)l)er 4hscs of varying ~iiarneters, freezing depth has now l)een aeeonll)lished uf) to 10 mm of skin. ]{econling of ,leplh freezing has been est,'d:)lisl.,,I l)olh by t:hern2oeouple studies and by hist,ologi(.al examinat.ion of epidermis, dermis, and sld:)('.lllnlleous tissue on animals. Forty-four p:d,ients wilh n, combined total of 60 eul'~neous c:u'vinomns hnve been treated wilh lhe us:e of solid copI)er disc nl)plieators, eoole~l with liqui~l nilrogen. All lesions were biol)sie~l ",nd hislolo~ienlly proven to be era'cinemas prior I.o cO'ol}mr-~py. Coml)lete e.radic:~tion of l]~, neoph~sms was :u'('omplished clinically with a sin,,zle t rent men t. Si2nl)lir'ity of t echni~lue and the al)ility to trenl mull iple lesions at "~ single sitting, with ,'esults of mininml scarring, lea(l us to believe cryotheral0" of (::ul:~neous ~nalignancy is superior t:o other n . ~ dalilies. This is :t preliminary report of 6 nlonlhs' dura.tion. Final (:onclusions as to effeetiveness wit h this mo(tnlity ~nu.-.'t wait ~miil recurrence rate hns }.)cell el)sol'Veal OVel" i/lie, l/exi~ several years. 19. T h e F r e e z i n g R c s i s t a n c e a n d W i n t e r Snrviva! o f I n t e r t i d a l M o i l u s k s Y RI J. ~Vl[mL~MS ( N a v a l Medi('nl Research Institute, Bethesd:l, Maryland). l)uring tim harsh norlhern winler, those speeies of marine inollusks remaining exposed in the intertida! zone are perio~lieally frozen. Low-temp('r:ttim:' resisianee in mollusks is m a r k e d l y different, fl'o211 thai showll t~x" most: (li,~l)ausing insecl:s, since no ~lyc(,rol is l,resent in tim tissues, no mq)er(.ooling occurs before the onset of ice format,ion, " l:rom tile Bureau of Medicine and Surgery, Navy Departnmnt. Res(mrch "F'~sk MR.-00g.020001.07. Supporle(t in lmr( I)y NASA Con.tract R-63. "I'h,~ opinions or assertions contained herein are the 1)rivqte ones of the D.11l[iOl" and are not to 1)e cons{rued as official or reflecting the views of the N a v y D e l m r t m e n t or ihe ne2val service at large.
A B,., FRAC I h
n i q u c s to R e s e t | i o n of Parenchymatous Organs. Itix'IN~ S . COOPER .J,~'D TEItuo l:lmost.:* (De1)artmerit of Neurologic SurgeIT, St,. Barn,d)as Hospital, New York, New York). ]."xtrem(: cohl m a y be useful , s a surgical tool eittier to produce necrosis of biologic tissue bz situ or to make its resection tec.hnlcallv easier, relative.ly avas('ular, and safer. It is the purpose of thi.-: report to describe the investigative use of ery()genie surgery for the latter purpose; t httt is, to make the resection of a parenclrym'ttous organ t echni(-alh, simpler, x.l,ttix(k, free of bleeding, more rapt(l, .iml safer. A ~e(;hMque has been developed, in experimental anitnals, w i m r e i n a section of lhe liver is frozen prior to its reseetim;. Resection is then earried out within tim frozen mass, perniitting a few millimeters of frozen tissue to remain behin,l in the n()m(.._(~trd'~¢~e , portion of tim organ. The 1'e,...ec~ , tRm may be p e r f o r m c ( i employing an electric saw withiri the frozcu tissue. Capillaries and small x~es,,.el,., ' - ~ ,,¢ are necrosed by the extreme cold. Consequenlly,, only t h e larger arteries must be indivMually conLrolle(t in order to achieve hemostasis.:, This m a y be a.cconlplislled Siml)ly elnpioying a stapling device. Tl~is technique of liver resection will t)e demonstr
two
('~'i,-.'~s Ol,Orale(l ripen, T ] i c v u r i a l i o l i is (l(l(~ t o ~liffer(mc(,s in |)l'l(,C'll•lent of li;e l ) r o b ( ) a l l d to bloo~l s~li)i~lv in llie l)lu'{iclilar Itrea ()f the spin,,tl cor¢l. 1,I.
Cryosurgery
ill t i l t : T r c a l n l e n t
of
Cat;u-acts
and R c t l n a l ] D e t i i c h n l e n t . i' CIIAIILF,,.! D , IXEL. IAN ((+ry()~llrgory l{escarch ] ) e p ' u ' t l n e n t , : l , i n h r t t t a l l Eye, Ear ariel Tin'oaf Hosl)ital. N'ew Y o r k , New York). l:r(,ezin~ a iissue I.,rodileos tin ilnniediate ,~;olidificafit,)ll. ~O!11{) t i m e aft('r thawing there l i l l y t)e.iil-i ill fin Ill ll-I Ii 1.ilia ,lad (h}gl.;lliWll lion depend in g on .many vonll,loX factors. The solit|ific'it.ion is the raisoa d ' / l r c elf (,rvo~tir~ii,itl. , cali-iracl, 0xlra(:iion.- T i l e ,..e-¢ ,: 1,,ctive inll,inll-niitioli ani[ (let/enerqtioil . is l.}le 1)rhlcilJh~ t~(,}iiiid other !.15o~ of cryostlrg(q'y in (l])h th:lltn(ilogy. (-)no of lho (w~i'-!wescnt d,/i~gei'~ (If enlnr'lc£ ~lirgery i~ rll|)l.lli-(.~ of Ibe delh'ate c,
•
(i
' Sui)port.ed bv a grant, from the J o h n , A . Barl~ford Foundation.
~
"
,.
)
.
*
adl,iof.nt, n o r n l a l 1;)riiin, T h e frozen t t l m o r m a y t)e resecled by. employing tile line of cioavage be¢
•
•
•
twee.n the ico ball and tim adjacent normftl brain. A m o r e recent, innovation has been the use of a high spee(1 electric drill to remove the frozen t;umor, e =:This technique will be demonstrated by inoi, ioli:, i)ieture.
16. The .-
PathMogy of
.
Exper{mental
Gastric
Freezing. R. L. Fus0N, J, V..KLavl~s,* A,xn VI~I'Li4A.M W. SIIINGELTON (Department" of Surg:ery,~Duke University Medical Center, D u r h a m , N o r t a C;arolina). T h ee f f e c t's .- of gastric f r e e z i n g u p o n t h e stomach were studied in 16 (togs (11 to 1 6 kg). Histologsthnuldted gastr.ic free acidity a~,eraged 43 C before fregzing and 20°, 3,; trod 8°C ai0 24, 48, and 72 hr •
.
.
~
,
fief ~ffi~ezing: Histological studies foilÜwing: the P r~e(ture revealed Variabledegrees of focal parie t a l Jcell (h~mageo :in 11 d0gs that demonstrated no -eVidence o f gi?oss gastric: u l c e r a t i o n . T h e ex-
,
15.. -----Thc.Applicati°n~ of Cryogenic. Surt,deal Tech-
•{'l
-,
?l
'
...,
.-
' ' ~ @ "
•
"
"
,
,
"
.,.
•
"
"
~
"
t~nt m :parmtal cell d a m a g e . c o u l d n o t be quant.fiedi':ihi!, many areas t l~e muc:~sa remainbd entirely
normM.Examina~ibrX: 2 weaks aft,or freezing showed
14
A BSTR A CTS
2)(:) cviden(:e of parielal cell regeneration. Tim SUl)erii,'ial muc:osni epii.helium as well ns mucous ne,(d; an(t chief cells a l)peared to be more resistant it) freezing. Five animals demonsl;rnted gastric ulceration (lurin,,," l lm postfreeze period (2,1 lo 72 hr) n#s()eiale(l wit l~ varying degrees of hemorrhage in the t:~mi('n prol)ria, subnmeosa, tm([ nmseularis. / Con(:(:)milant intr'~vaeeuh,r (hrombosis Wns not fotm(l (l~u'ing early ulcer form't(ion, but rather only afler the inflammatory l)rocess had I:)een l)resent for several days. G'~stric uleerntion in the post freeze porio(l appears to be. (lue to enpillary rUl)tt~re, henlorrlmge, and resullant (,issue ischemia. Fo('al (leslruction of ganglion cells in Auerbach's !,lexus was foun(l only in 1he presence of overlying lmmorrlmge ,m(l uleer:t(ion. These resul(s are somewh::d. (liffer(m(~ from tl~()se f)reviously reporte(i i)3' ~Vangens(een et .tl. 17. T , - c a t m c n t of t h t m a n T u m o r s by Freezing. ANDREW A. (LXGE* AND FRI.:I) ]!]31M1N(:~S (])eparl:-
merits of SurgeD" and Oral Surgery, Ve*ernns Administration Hospital, Buffalo, New York). Benign and m , lignant, (umors in humans were treated by freezing with mo, lern cryosurgieal e(luipment, utilizing liquid nitrogen. No nmtter what, the ('ell type, (he effect of freezing was letlml. All frozen cells (lie(l. The manner of rep.dr following cold injury varied wilh the lype of /issue frozen. Cellular tissue ~luiekly bec:~me ne(:rotic and slougluM in several days. Collagenous and elastic tissue was resist ant to st=ructural eh'mge, even though devii;alized. ]3one stru('ture WaS liI l(']hqng('~I and the mn~rix remaine~l as a scaffoM for repair, whM~ involved revnsculnrization an~l cellular repopulation of_ the (levilalized ~2I'O,~l,
We lreate(t selecte(l l)atients with localized c'mcer, often resistant to -K-ray ther.q)y, which couhl not be ~-xeise(l surgically withoul: exlensive bone (lestruelion..Most of (he l):ttienls had e'~neer of th(, ornl eavil y an(I pharynx an(t son,: Im(l vancer of the skin or reelum. In most 1)n.tienls, lh(, lesion wqs ('oni,'olled with lira firsL trealment. Occasionally, relyfitilion of cD'otheral)y was necessary I)ecause an insuftieieni~ qrea was frozen initially. Our results indicate lh'lt, e~o'osurge~ T is an effeetive w:ty to destroy 't, lesion !oe'~lly. Benign tumors nre easily nmnaged t)y the technique. Cryothm'apy will cure localized cancer in which othe, r metho(ls (:)f,lr(.mtnmnt }~ave faih,(l ()r cannot be, ~se(l. 18. Cryothc;'apy o f S k i n M a l i g n a n c y . TM Sm'mu~ A.
~"Sui)porle(! by n special grnnt frrm) Springfield Hospilal, S1)ringfield, M:~ss,'wln~sel.ts, an(l the Massachusells Division of the Americ::,n Cnn('er Soe.iety (:mco2mt N(,). 2310051 ).
Zacam:~x (Boslon I~niversily School of 5l,,livine, De!~:,rlII2eni of l)ernmlology, l~oslon, 5lassavlluseiis, amt Slwin~li(,hl ]tosl)it:ll, SIn'ingfi~'hl. Mass:wlJllsei t s). The l)resenl sltuly of (:'ryoihernpy of skin 2nnlit~nemey is twofold: q) investigntive--ability l~, freeze skin to t:he d'~l)tl), of 10 ram; nnd b) clini~'al - - T r e a t m e n t of ,1,1 1,alienis wiih :2, total of 60 ml(nll(..'O21.b" ('.arviliol1292S, usiT2g :1, newly devised col)l~(,r disc af,1)licql or. Cryolheral)y in (lermn.tology has for 65 years })eel1 eOlll121e(l almost, ex(!lusively to benign nn(l pre('qncerous (lermntoses. Refrigeration theral)y hqs consis)ed of solid carbon dioxide stick an(I/or liquicl niirogc.n nI)ptied with n Q-Tip. These n ietho(ls lmve not been employed for skin m:lli.~nancy be('mts(, of their inability to freeze t:)ey(m(l 2 m2n of skin (h'l~lh. Using 1-era-thick, solid eOl)l)er 4hscs of varying ~iiarneters, freezing depth has now l)een aeeonll)lished uf) to 10 mm of skin. ]{econling of ,leplh freezing has been est,'d:)lisl.,,I l)olh by t:hern2oeouple studies and by hist,ologi(.al examinat.ion of epidermis, dermis, and sld:)('.lllnlleous tissue on animals. Forty-four p:d,ients wilh n, combined total of 60 eul'~neous c:u'vinomns hnve been treated wilh lhe us:e of solid copI)er disc nl)plieators, eoole~l with liqui~l nilrogen. All lesions were biol)sie~l ",nd hislolo~ienlly proven to be era'cinemas prior I.o cO'ol}mr-~py. Coml)lete e.radic:~tion of l]~, neoph~sms was :u'('omplished clinically with a sin,,zle t rent men t. Si2nl)lir'ity of t echni~lue and the al)ility to trenl mull iple lesions at "~ single sitting, with ,'esults of mininml scarring, lea(l us to believe cryotheral0" of (::ul:~neous ~nalignancy is superior t:o other n . ~ dalilies. This is :t preliminary report of 6 nlonlhs' dura.tion. Final (:onclusions as to effeetiveness wit h this mo(tnlity ~nu.-.'t wait ~miil recurrence rate hns }.)cell el)sol'Veal OVel" i/lie, l/exi~ several years. 19. T h e F r e e z i n g R c s i s t a n c e a n d W i n t e r Snrviva! o f I n t e r t i d a l M o i l u s k s Y RI J. ~Vl[mL~MS ( N a v a l Medi('nl Research Institute, Bethesd:l, Maryland). l)uring tim harsh norlhern winler, those speeies of marine inollusks remaining exposed in the intertida! zone are perio~lieally frozen. Low-temp('r:ttim:' resisianee in mollusks is m a r k e d l y different, fl'o211 thai showll t~x" most: (li,~l)ausing insecl:s, since no ~lyc(,rol is l,resent in tim tissues, no mq)er(.ooling occurs before the onset of ice format,ion, " l:rom tile Bureau of Medicine and Surgery, Navy Departnmnt. Res(mrch "F'~sk MR.-00g.020001.07. Supporle(t in lmr( I)y NASA Con.tract R-63. "I'h,~ opinions or assertions contained herein are the 1)rivqte ones of the D.11l[iOl" and are not to 1)e cons{rued as official or reflecting the views of the N a v y D e l m r t m e n t or ihe ne2val service at large.