- Email: [email protected]
LOW-DOSE COMBINATION CHEMOTHERAPY OF DISSEMINATED HUMAN NEOPLASMS
1324 The patient’s recovery was rapid thereafter and when fully rational he admitted to consuming several grams of potassium bromide daily for some time before admission. He knew the compound to be a good tranquilliser, and obtained his supplies from his place of work, where he had access to the pure product in half-hundredweight sacks ! Mount Vernon Hospital, Northwood, D. S. SPENCE. Middlesex.
LOW-DOSE COMBINATION CHEMOTHERAPY OF DISSEMINATED HUMAN NEOPLASMS
SIR,-The observations of Dr. Halterman and Dr. Leventhal (Sept. 25, p. 704), suggesting that chemotherapy and the immune apparatus of the host may be acting synergistically in leuksemic patients, receive further support from our clinical work employing low doses of three-drug combination chemotherapy in patients with disseminated solid neoplasms of diverse types. Each patient was treated with low-dose C.O.F. chemotherapy-’ Cytoxan’ (cyclophosphamide) 1 mg. per kg. per day orally;Oncovin ’ (vincristine) 0-015 mg. per kg. per week intravenously; and 5-fluorouracil 10 mg. per kg. per week intravenouslywith only mild nausea and vomiting as toxic effects. Of the first five patients who received continuous therapy for at least one month, three patients (with pleural mesothelioma, osteogenic sarcoma, and cervical squamous-cell carcinoma) displayed a greater than 50% reduction in the size of evident pulmonary nodules, while the remaining two patients (with primary hepatoma and hypernephroma) displayed a significant slowing of evident tumour growth. The tumour regressions observed in these patients with disseminated neoplasms of types usually resistant to conventional chemotherapy1 suggest that the immune reactions against neoplastic cells may be less suppressed at low dose-levels of c.o.F. chemotherapy than at higher dose-levels of these same three drugs,l allowing more effective expression of lymphocyte immunity2 against neoplastic cell growth in vivo. In addition, since no significant depression of peripheral-blood lymphocyte counts was observed, it has become possible to add concurrent lymphocyte immunotherapy3 while patients are receiving low-dose c.o.F. chemotherapy. Division of Oncology, Department of Medicine, BRUCE L. ALLEN Stanford University School of Medicine JOHN H. FRENSTER. Stanford, California 94305, U.S.A.
Indeed the use of adrenaline solutions is not unknown many plastic surgeons for this very purpose. The danger of 150-200 ml. of 1/250,000 adrenaline in saline solution, properly injected by keeping the point of the needle moving and superficial to the jugular veins, should carry negligible risk, particularly if the halogenated volatile anaesthetics are avoided, and better still if hypercapnia is avoided by controlled ventilation. To achieve the best effect, with diffusion to the deeper planes, it is advisable to wait for ten to fifteen minutes between infiltration and the start of the operation, so that it is often more convenient for the anaathetist to carry out the procedure. This allows the surgeon some little time for other affairs, something which is usually appreciated by all but the most impetuous.
area.
to
Department of Anesthesia, Teesside Area, West Lane Hospital, West Lane,
Middlesbrough, Teesside.
I. M. J. MAIR.
ANTENATAL DETECTION OF HURLER’S SYNDROME
SIR,-Matalon and his colleagues have reported the antenatal detection of Hurler’s syndrome by demonstration of abnormal amounts of heparitin sulphate and elevated total acid mucopolysaccharides in amniotic fluid obtained at the 14th week of pregnancy. They point out that the use of amniotic fluid rather than cultured amniotic-fluid cells makes for a rapid and relatively simple method of prenatal diagnosis. Danes et al. have shown that total mucopolysaccharides may be very high in patients with a history of rhesus incompatibility, and suggest that qualitative rather than quantitative determinations may be more informative in distinguishing fetuses affected with mucopolysaccharidases. We report here our experience with a pregnancy in which measurement of amniotic-fluid metabolites did not reveal the incipient disorder. The mother, age 24, had given birth 3 years earlier to 1. 2.
Matalon, R., Dorfman, A., Nadler, H. L., Jacobson, C. Lancet, 1970, i, 83. Danes, B. S., Queenan, J. T., Gadow, E. C., Cederqvist, L. L. ibid. p. 946.
INFILTRATION OF ADRENALINE BEFORE THYROIDECTOMY
SiR,-It anaesthetist
was
cruelly confusing
to
a
mere
practical
read Professor Brooke’s condemnation (Nov. 27, p. 1195) of subcutaneous infiltration of the neck with adrenaline-containing solution before operation on the thyroid gland. Having observed several competent thyroid surgeons working with and without infiltration, I have no doubt that the introduction of an adequate amount of solution facilitates the approach to the gland. Moreover, and more important, the reduction in bleeding leads to a lessening of the quantity of catgut and diathermied tissue that is left behind, and this surely must decrease subcutaneous scarring in what is, after all, a cosmetic to
Tucker, W. G., Talley, R. W., Brownlee, R. W., Burrows, J. H., Stott, P. B., Moorhead, E. L., San Diego, E. L. Cancer Chemother. Rep. 1968, 52, 593. 2. Hellström, I., Hellström, K. E., Sjögren, H. O., Warner, G. A. Int. J. Cancer, 1971, 7, 1. 3. Frenster, J. H., Rogoway, W. M. Proc. Am. Ass. Cancer Res. 1970, 11, 28. 1.
Total acid
mucopolysaccharides of amniotic fluid as uronic acid.
LOW-DOSE COMBINATION CHEMOTHERAPY OF DISSEMINATED HUMAN NEOPLASMS
SIR,-The observations of Dr. Halterman and Dr. Leventhal (Sept. 25, p. 704), suggesting that chemotherapy and the immune apparatus of the host may be acting synergistically in leuksemic patients, receive further support from our clinical work employing low doses of three-drug combination chemotherapy in patients with disseminated solid neoplasms of diverse types. Each patient was treated with low-dose C.O.F. chemotherapy-’ Cytoxan’ (cyclophosphamide) 1 mg. per kg. per day orally;Oncovin ’ (vincristine) 0-015 mg. per kg. per week intravenously; and 5-fluorouracil 10 mg. per kg. per week intravenouslywith only mild nausea and vomiting as toxic effects. Of the first five patients who received continuous therapy for at least one month, three patients (with pleural mesothelioma, osteogenic sarcoma, and cervical squamous-cell carcinoma) displayed a greater than 50% reduction in the size of evident pulmonary nodules, while the remaining two patients (with primary hepatoma and hypernephroma) displayed a significant slowing of evident tumour growth. The tumour regressions observed in these patients with disseminated neoplasms of types usually resistant to conventional chemotherapy1 suggest that the immune reactions against neoplastic cells may be less suppressed at low dose-levels of c.o.F. chemotherapy than at higher dose-levels of these same three drugs,l allowing more effective expression of lymphocyte immunity2 against neoplastic cell growth in vivo. In addition, since no significant depression of peripheral-blood lymphocyte counts was observed, it has become possible to add concurrent lymphocyte immunotherapy3 while patients are receiving low-dose c.o.F. chemotherapy. Division of Oncology, Department of Medicine, BRUCE L. ALLEN Stanford University School of Medicine JOHN H. FRENSTER. Stanford, California 94305, U.S.A.
Indeed the use of adrenaline solutions is not unknown many plastic surgeons for this very purpose. The danger of 150-200 ml. of 1/250,000 adrenaline in saline solution, properly injected by keeping the point of the needle moving and superficial to the jugular veins, should carry negligible risk, particularly if the halogenated volatile anaesthetics are avoided, and better still if hypercapnia is avoided by controlled ventilation. To achieve the best effect, with diffusion to the deeper planes, it is advisable to wait for ten to fifteen minutes between infiltration and the start of the operation, so that it is often more convenient for the anaathetist to carry out the procedure. This allows the surgeon some little time for other affairs, something which is usually appreciated by all but the most impetuous.
area.
to
Department of Anesthesia, Teesside Area, West Lane Hospital, West Lane,
Middlesbrough, Teesside.
I. M. J. MAIR.
ANTENATAL DETECTION OF HURLER’S SYNDROME
SIR,-Matalon and his colleagues have reported the antenatal detection of Hurler’s syndrome by demonstration of abnormal amounts of heparitin sulphate and elevated total acid mucopolysaccharides in amniotic fluid obtained at the 14th week of pregnancy. They point out that the use of amniotic fluid rather than cultured amniotic-fluid cells makes for a rapid and relatively simple method of prenatal diagnosis. Danes et al. have shown that total mucopolysaccharides may be very high in patients with a history of rhesus incompatibility, and suggest that qualitative rather than quantitative determinations may be more informative in distinguishing fetuses affected with mucopolysaccharidases. We report here our experience with a pregnancy in which measurement of amniotic-fluid metabolites did not reveal the incipient disorder. The mother, age 24, had given birth 3 years earlier to 1. 2.
Matalon, R., Dorfman, A., Nadler, H. L., Jacobson, C. Lancet, 1970, i, 83. Danes, B. S., Queenan, J. T., Gadow, E. C., Cederqvist, L. L. ibid. p. 946.
INFILTRATION OF ADRENALINE BEFORE THYROIDECTOMY
SiR,-It anaesthetist
was
cruelly confusing
to
a
mere
practical
read Professor Brooke’s condemnation (Nov. 27, p. 1195) of subcutaneous infiltration of the neck with adrenaline-containing solution before operation on the thyroid gland. Having observed several competent thyroid surgeons working with and without infiltration, I have no doubt that the introduction of an adequate amount of solution facilitates the approach to the gland. Moreover, and more important, the reduction in bleeding leads to a lessening of the quantity of catgut and diathermied tissue that is left behind, and this surely must decrease subcutaneous scarring in what is, after all, a cosmetic to
Tucker, W. G., Talley, R. W., Brownlee, R. W., Burrows, J. H., Stott, P. B., Moorhead, E. L., San Diego, E. L. Cancer Chemother. Rep. 1968, 52, 593. 2. Hellström, I., Hellström, K. E., Sjögren, H. O., Warner, G. A. Int. J. Cancer, 1971, 7, 1. 3. Frenster, J. H., Rogoway, W. M. Proc. Am. Ass. Cancer Res. 1970, 11, 28. 1.
Total acid
mucopolysaccharides of amniotic fluid as uronic acid.