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Research was undertaken to study the chronic effect of interleukin-6 (IL-6) on carbohydrate metabolism using mice bearing IL-6-secreting tumor. Mice were injected with allogeneic tumor cells transduced with the murine IL-6 gene. Secretion of IL-6 from the developed tumors was associated with decreased food consumption, reduced body weight and reduced blood glucose levels. Insulin levels did not change and 2-deoxyglucose uptake was not affected in most tissues examined.

Background. There is not yet an agreed adjuvant treatment for melanoma patients with American Joint Committee on Cancer stages III B and C. We report administration of an autologous melanoma vaccine to prevent disease recurrence. Patients and Methods. 126 patients received eight doses of irradiated autologous melanoma cells conjugated to dinitrophenyl and mixed with BCG. Delayed type hypersensitivity (DTH) response to unmodified melanoma cells was determined on the vaccine days 5 and 8. Gene expression analysis was performed on 35 tumors from patients with good or poor survival. Results. Median overall survival was 88 months with a 5-year survival of 54%. Patients attaining a strong DTH response had a significantly better (p = 0.0001) 5-year overall survival of 75% compared with 44% in patients without a strong response. Gene expression array linked a 50-gene signature to prognosis, including a cluster of four cancer testis antigens: CTAG2 (NY-ESO-2), MAGEA1, SSX1, and SSX4. Thirty-five patients, who received an autologous vaccine, followed by ipilimumab for progressive disease, had a significantly improved 3-year survival of 46% compared with 19% in nonvaccinated patients treated with ipilimumab alone (p = 0.007). Conclusion. Improved survival in patients attaining a strong DTH and increased response rate with subsequent ipilimumab suggests that the autologous vaccine confers protective immunity. [ABSTRACT FROM AUTHOR]

The thyroid gland is a known site for metastatic tumors from various primary sites. Thyroid metastases are not an exceptional finding at autopsy, and they are encountered in 2% to 9% of the patients with malignant neoplasm. The most frequent tumors to metastasize are breast, lung, melanoma, and kidney carcinomas. Despite the fact that it is one of the largest vascular organs in the body, clinical and surgical cases have given an incidence of 3% of secondary malignances of this organ. Metastatic colon carcinoma to the thyroid gland has been reported, and it is not as rare as one might think. We present a very unique case of colon carcinoma metastasis to the right thyroid lobe and lung five years after colon resection, with reoccurrence two years later in the contralateral thyroid lobe. The literature regarding colon cancer metastasizing to the thyroid gland was reviewed with an attempt to disclose features of this presentation regarding patient's prognosis. [ABSTRACT FROM AUTHOR]

Aim: Recent clinical experience suggests that minimal access portoenterostomy (the Kasai procedure) for biliary atresia leads to transplantation sooner, compared to the traditional open approach. It should be emphasized that elevated intra-abdominal pressure (IAP) may reduce hepatic and portal blood flow and thus may cause histologic liver damage. The aim of the present study was to evaluate the effects of IAP on blood flow in the portal vein (PV), compared to the superior mesenteric artery (SMA), and on the systemic mean arterial blood pressure (MABP). Materials and Methods: Male Sprague-Dawley rats were anesthetized with intraperitoneal ketamine (90 mg per kg) and xylasine (13 mg per kg). Polyethylene catheters (PE-50) were introduced into the right carotid artery for the measurement of MABP. After a midline laparotomy, the SMA and PV were isolated. Ultrasonic blood-flow probes were placed on the vessels for the continuous measurement of regional blood flow. Two large-caliber percutaneous peripheral intravenous catheters were introduced into the peritoneal cavity for inflation of air and for the measurement of IAP. The time course of MABP and SMA and PV flow as well as the relationship between IAP and SMA and PV flow were determined. Results: Although all three hemodynamic parameters decreased with the increase in the IAP, the most significant changes were observed in PV blood flow. IAP at 3 mm Hg resulted in a 26% decrease in PV flow ( P < 0.05), a 19% decrease in SMA flow ( P < 0.05), and an 11% decrease in MABP ( P < 0.05). IAP at 6 mm Hg caused a two-fold decrease in PV flow ( P < 0.05), a 30% decrease in SMA flow ( P < 0.05), and a 19% decrease in MABP ( P < 0.05). There were no changes in the time course of MABP and PV and SMA flow. PV and SMA flow returned to normal values immediately after abdominal deflation. Conclusions: Persistent IAP decreased MABP, SMA, and, especially, PV flow by 50%. We speculate that in biliary atresia patients with already present liver dysfunction, decrease in SMA flow and even a greater decrease in PV flow from increased IAP, which occurs during a laparoscopic Kasai procedure, may further compromise liver function. This may be one of the explanations for the progression to earlier transplantation in infants undergoing a laparoscopic Kasai procedure. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that neutrophil recruitment may initiate germ cell apoptosis in the ischemic testis. The purpose of the present study was to examine the relationship between germ cell apoptosis and neutrophil recruitment in the contralateral testis following testicular ischemia-reperfusion (IR) injury in a rat. Adult male Sprague-Dawley rats were divided randomly into two experimental groups: Group A: Sham operated animals; Group B: IR rats underwent 90 min of unilateral testicular ischemia following by 96 h of reperfusion. The rats were sacrificed and testes were harvested. Johnsen's criteria and the number of germinal cell layers were measured to categorize the spermatogenesis. TUNEL assay was used to determine germ cell apoptosis in both the ischemic and contralateral testis. The recruitment of neutrophils was calculated per 100 venules. Expression of E-selectin was determined using immunohistochemical analysis. Statistical analysis was performed using Student's t test, with P less than 0.05 considered statistically significant. Germ cell apoptosis in both the ischemic and the contralateral testis increased significantly after IR. E-selectin expression was significantly greater in ischemic testis from IR rats compared to sham animals. The small increase in E-selectin expression and the concomitant increase in neutrophil recruitment in the contralateral testis of the IR rats (vs. sham animals) were not statistically significant. In conclusion, testicular ischemia causes an increase in germ cell apoptosis in the contralateral testis. Mechanisms other than neutrophil recruitment apparently initiate this process. [ABSTRACT FROM AUTHOR]

Objective: To find out if routine omentectomy reduced the incidence of obstruction and other complications of catheters inserted for continuous ambulatory peritoneal dialysis (CAPD). Design: Retrospective study. Setting: Teaching hospital, Israel. Subjects: 60 patients with end stage renal failure who needed catheters for CAPD. Intervention: Routine omentectomy during insertion of the catheter, usually under local anaesthesia. Main outcome measures: Short and long term morbidity, and mortality. Results: No patient died as a result of the procedure. The catheter obstructed in only one patient (2%) during a mean follow-up period of 28 months (range 2–108), and 90% of the catheters survived one year. Conclusions: Routine omentectomy during insertion of a catheter for CAPD under local anaesthesia is safe and the incidence of obstruction is low. Prospective randomised studies are needed before it can be recommended as the procedure of choice. [ABSTRACT FROM AUTHOR]

Presents several articles on internal medicine. Mild hypertension and cardiovascular risk; Enalapril and vulvovaginal pruritis; Hemoccult screening and colorectal neoplasms; Busulfan and veno-occlusive disease of the liver; Metastatic prostatic carcinoma.

During a two-year period, five patients were treated by us for acute intestinal obstruction caused by an incarcerated paracecal hernia. All patients underwent surgery early, so none required bowel resection. The possibility of an internal hernia as a cause of intestinal obstruction and a profound knowledge of the pericecal anatomy, however, are necessary for successful diagnosis and treatment of paracecal hernias. [ABSTRACT FROM AUTHOR]

Diffuse ischemic colitis leading to colonic necrosis is a rare complication of systemic lupus erythematosus. A 16-year-old girl who developed such a complication and underwent emergency subtotal colectomy is described. The incidence and significance of intestinal symptoms and the difficulties in the differential diagnosis in patients with systemic lupus erythematosus presenting with abdominal manifestations are discussed. [ABSTRACT FROM AUTHOR]

A case of Meckel's diverticulum is presented with a symptomatic duration of over 30 yr, eventually complicated by megaloblastic anemia. A severe ileal stenosis was associated and probably caused by the diverticulum. Dilatation and stasis in the obstructed ileal loop were the cause of bacterial overgrowth and vitamin B12 deficiency. Resection of the involved ileal segment led to complete clinical and hematological recovery. [ABSTRACT FROM AUTHOR]

Presents a case study of a man with a permanent ileostomy who developed adenocarcinoma after total proctocolectomy. Number of similar cases reported in English medical literature; Medical history of the man; Theories for the emergence of the complication.