Immune RNA Therapy as an Effective Adjuvant Immunotherapy After Surgery: An Animal Model

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METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY

phy was performed on all patients >30 years old. The renal fascia (Gerota's fascia) was identified in 23 of 110 normal IVPs (21 per cent). Of these 23 patients 10 were evaluated because of benign prostatic hypertrophy, 2 had cystitis, 2 had ureteral colic, 6 had undergone pelvic surgery, 1 had hypertension and 2 had prostatic carcinoma. The renal fascia was recognized as a radiodense line paralleling the lateral margins of the kidney. The fascia was seen on the right side in 9 cases (39 per cent) and on the left side in 14 (61 per cent). Any pathologic process (blood, pus and tumor) infiltrating the normal fat planes of the perirenal and/or pararenal spaces makes the fascia undetectable by conventional radiographic methods. The results of this study do not support the concept of undetected renal disease as a major factor in visualization of the renal fascia associated with radiographically normal kidneys. Only the presence of an intact perirenal and pararena1 fat plane is required for the radiographic identification of this structure. C. E. M. 1 figure, 7 references

used in staging, treatment planning, making therapeutic decisions, detection of recurrences and judging the response to therapy.

Abstracter's comment. Since clinical staging errors in prostate cancer occur in 20 to 50 per cent of patients, any noninvasive procedure is a welcome addition to our armamentarium. The authors in both studies found CT to be helpful in limiting therapeutic options and indicate that it may be useful in detection of local recurrence and judging response to treatment. H.D.P. 5 figures, 3 tables, 32 references

METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY The Renin-Angiotensin-Aldosterone System in Normal Elderly Subjects J.

Virilizing Adrenal Tumor in a 3-Year-Old Girl: Diagnosis by Computed Tomographic Scan and Ultrasound

P. B. KAPLOWITZ AND J. MANDELL, University of North Carolina School of Medicine, Chapel Hill, North Carolina Amer. J. Dis. Child., 137: 406-407 (Apr.) 1983 Virilization in a prepubertal girl is a rare phenomenon that can result from a tumor of either the adrenal or ovary. Differentiation of the 2 conditions by preoperative tests is not always easy. A 3-year-old girl was seen because of clitoromegaly, accelerated growth, pubic hair and facial oiliness that had been noted first when she was 2 years old. Serum testosterone was elevated to 136 ng./dl. but dehydroepiandrosterone-S and 17hydroxy progesterone levels were normal. No pelvic or abdominal masses were palpated but a computerized tomography scan revealed a 2 cm. mass in the left adrenal that was confirmed on sonography. An adrenal tumor was removed at operation. Although more than half of such tumors in children are malignant no evidence of metastatic disease was found in this patient and all signs of virilization had disappeared 10 months postoperatively. T. D. A. 2 figures, 12 references

L. GARCIA ZOZAYA, M. P. VILORIA, L. RODRIGUEZ AND A. CASTRO, University of Carabobo School of Medicine, Renal

Division, Valencia, Venezuela and University of Miami School of Medicine, Department of Pathology, Miami, Florida Res. Comm. Chem. Path. Pharm., 40: 289-299 (May) 1983 The authors have studied changes that occur in the reninangiotensin-aldosterone system in 40 normal, healthy subjects >60 years old under ordinary living conditions and on a normal diet. Values obtained were compared to a similar control group <60 years old. There was a gradual but continuous decrease in plasma renin activity, serum and urinary aldosterone, and daily excretion of sodium with advancing age until approximately 60 years, at which time plasma renin activity demonstrated a sudden decrease unaccompanied by a decrease in the level of aldosterone. G. W. K. 4 tables, 10 references

Immune RNA Therapy as an Effective Adjuvant Immunotherapy After Surgery: An Animal Model S. AARONS, E. C. KRISHNAN, W. K. MEBUST AND W. R. JEWELL, Department of Surgery, University of Kansas Medical Center, College of Health Sciences and Hospital, Kansas City, Kansas J. Surg. Oncol., 23: 21-26 (May) 1983

Role of Computed Tomography in the Evaluation and Management of Carcinoma of the Prostate

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GIRi, J. WALSH, T. A. HAZRA, J. H. TEXTER AND W. W. KOONTZ, Divisions of Radiation Therapy, Diagnostic

P. G.

Radiology and Urology, Medical College of Virginia, Richmond, Virginia Int. J. Rad. Oncol. Biol. Phys., 8: 283-287 (Feb.) 1983 Twenty-five patients with biopsy-provedprostatic carcinoma were evaluated by computerized tomography (CT). CT results differed from clinical staging in 7 patients (28 per cent). In 6 of the 7 patients a change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. An operation confirmed histologically the CT findings in 12 patients (48 per cent). CT identified nodal involvement accurately in 10 of 12 patients (83 per cent). The authors believe that CT is an excellent adjuvant that can be

The efficacy of various combinations of surgery, xenogeneic immune ribonucleic acid (RNA), xenogeneic normal RNA, tumor vaccine and nonspecific splenocytes as adjuvant therapy for B16 melanoma in the C57BL/6J mouse was studied. B16 melanoma has a doubling time of 2.8 days and metastasizes to lung, tiver and spleen. Amputation of palpable primary isografts results in 80 to 100 per cent death of metastases. B16 melanoma was transplanted by trocar into the right hind limb of 6-weekold mice. The tumors that were readily palpable 9 days after transplantation were amputated. Immune RNA was prepared by hot phenol extraction from immune sheep spleens. Various combinations of immune RNA, normal RNA and tumor antigen, with or without normal mouse spleen cells, were administered intraperitoneally every other day beginning 11 days after transplantation (2 days postoperatively) for a total of 10 injections. All mice without any treatment died in <30 days. Immunotherapy alone had no effect on retarding the growth of

MISCELLANEOUS

the primary lesion but adequate surgical therapy alone improved survival markedly. When all groups that received postoperative immunotherapy were combined there was marked improvement over those that received surgical therapy only. Individual group comparison of all groups that received amputations with adjuvant immunotherapy of any tested method revealed no statistically significant differences. However, immune RNA appeared somewhat superior to normal RNA or antigen only. Most surgically treated mice died of metastatic disease without local recurrence. Mice that died with a late local recurrence survived longer than some without evidence of local recurrence. Perhaps adjuvant immunotherapy improves survival significantly by retarding the spread of metastases. M. G. F. 3 figures, 2 tables, 34 references

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substantial symptomatic improvement with calcitriol or la-OH D3 therapy. Few patients experience a reversal to normal histology of the bone. Hyperparathyroidism in these patients may be corrected by calcitriol therapy. Patients with dialysis-associated osteomalacia may improve symptomatically without histological changes in the bone. Because of the poor prognosis of these patients the addition of chelating agents (deferoxamine) to remove aluminum deserves further evaluation. Calcitriol therapy used in children results in improvement of rate of growth. Patients with chronic renal failure may remain stable when on calcitriol therapy but careful monitoring of these patients is warranted to prevent hypercalcemia and hyperphosphatemia. C. E. M. 85 references

The Lymph Node. An Important Site of Antigen-Induced Recruitment of Circulating Lymphocytes

MISCELLANEOUS Focal Adrenal Necrosis and Fibrosis. In a General Autopsy Population A. HYMAN, A. PODOLSKY ANDS. M. FACTOR, Department of Pathology, Albert Einstein College of Medicine and the Bronx Municipal Hospital Center, The Bronx, New York N. Y. State J. Med., 83: 829-834 (May) 1983

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The authors reviewed retrospectively microscopic sections of adrenal glands in 341 consecutive autopsies performed during a 2-year interval in which tissue was available for repair. Focal adrenocortical lesions were detected in 41 cases (12 per cent). One patient had amyloidosis, 1 had Hodgkin's disease, 1 had an adrenal fibroma and 2 had tumor metastases. Additionally, there were 5 instances of acute focal infarction, 21 of focal cytolytic necrosis and 19 of focal fibrosis. Multiple lesions were seen in some cases. Of the 41 cases 16 also had abnormal thickening of the periadrenal arteriolar walls and each had hypertensive or arteriosclerotic cardiovascular disease. Nine patients had diabetes mellitus. There was evidence of pulmonary embolization or infarction in 17 cases, while 9 had evidence of old or recent focal renal infarction. An atherosclerotic plaque embolus was seen in only 1 case. The incidence of adrenal changes noted in this series is considerably higher than that reported in previous studies of this subject. G. W. K. 6 figures, 6 references

E. E. EMESON, Department of Pathology, Montefiore Hospital and Medical Center, Albert Einstein College of Medicine, Bronx, New York N. Y. State J. Med., 83: 823-828 (May) 1983 A recently developed radioisotope assay was used to monitor the traffic of specifically reactive lymphoblasts to lymph nodes draining the sites of antigenic challenge in 2 experimental murine models. In the first model either xenoantigens or alloantigens were injected into footpads and in the second model the same antigens were injected into the lungs. There were marked increases in the retention of circulating lymphoblasts in the lymph nodes draining the paws and lungs challenged with either xenoantigens or alloantigens, and there was some preferential retention in these lymph nodes of lymphocytes with specific reactivity to the antigen used for immunization. Recent evidence suggests that the increased traffic in challenged lymph nodes is related to increased blood flow. Also, since the lymph node is a site of lymphocyte recirculation and, at the same time, can sequester antigen specifically reactive lymphocytes that also arrive in increased numbers are retained selectively by adhering to fixed antigen. M. G. F. 3 tables, 28 references

A New Look at the Phenomenon of N eurosecretion B. SCHARRER, Departments of Anatomy and Neuroscience, Albert Einstein College of Medicine, Bronx, New York

The Effects of Calciferol and its Metabolites on Patients With Chronic Renal Failure A. L. VOIGTS, A. J. FELSENFELD AND F. LLACH, Nephrology

Section, Department of Medicine, University of Oklahoma Health Sciences Center, and the Veterans Administration Medical Center, Oklahoma City, Oklahoma Arch. Intern. Med., 143: 1205-1211 (June) 1983 The vitamin D metabolite, 1,25-dihydroxycholecalciferol (1,25-[0HbDa) is synthesized in the proximal renal tubules of the cortex. A synthetic analogue of calcitriol, (1,25-[0H]2D 3 ), la-hydroxyvitamin Da (la-OH Da), is active in higher dosages with results similar to those obtained with calcitriol. Both substances are used as replacement therapy in anephric patients, dialysis patients and patients with chronic renal failure. Patients with mild to moderate osteitis fibrosa experience

N. Y. State J. Med., 83: 817-818 (May) 1983 Peptidergic neurons have been identified in almost all parts of the nervous system, where they actually outnumber the rest of the neuronal elements. The wide spectrum of individual neuropeptides known to date surpasses that of all other neuroregulators combined. Biochemical and ultrastructural studies have established that neuropeptides can function in a variety of ways not confined to traditional concepts ofneuroregulators. Increasing evidence for the coexistence in individual cells of peptidergic and nonpeptidergic neuroregulators calls for a reevaluation of the significance of the attributes of conventional neurons. A sharp distinction can no longer; be made between the neurons and other cellular species, especially endocrine cells. With the recognition of a neuroendocrine axis the special status of peptide-hormone secreting nerve cells in the hypo-