Document XRJZwxo57gM8qjB8K70yay0wy

i I SCHREINER, WENDE: ADVANCED CANCER TREATED BY COLLOIDAL LEAD 115 X-ray pictures showed somedestruction oi the upper roof 2. An extra-articular graft is preferable to an of the acetabulum and slight destruction of die head. There was considerable atrophy of the femur and ilium. On December S, 1927, a strut-graft operation was per formed. After the muscles were split, a fairly large abscess intra-articular or para-articular procedure. 3. The method described is simple. It requires only a single incision. was encountered. Guinea pig inoculation of the pus 4. The results have been uniformly successful. demonstrated the presence of tubercle bacilli. ) The postoperative convalescence was uneventful. On ! February 5 the cast was chanjred. Immobilization of the J hip joint was evident at that time. There was no pain on REFERENCES attempted motion. On April 2,1927, the cast was removed. There was firm immobilization of the hip joint, no evidence x. Al b e e, Fr e b. J. Am. M. Ass., 1925, Ixxxv, 1345. of swelling about it, and no tenderness. 2. Bar o n . Zentralbl. f. Chir., 1921, xlviii, 1047. X-raypicture, April 2, showed firmunion of the graft. The 3. Has s . Zentralbl. f. Chir., 1922, xlix, 1466. atroohy of the femur and ilium was much less marked than 4. Hib b s , Ru s s f l l . J. Bone & Joint Surg., 1926, viii, previously. A short hip spica was applied and the patient 522. was allowed up with crutches. 5. Kappis . Zentralbl. f. Chir., 1922, xlix, 1749. 6. Ma t h ieu and Wil mo t h . J. dc chir., 1926, xxviii, 130. SUMMARY 7. Mu e l l e r , W. Bcitr. 2. klin. Chir., lxxiv, No. 2. i. Hip fusion operations are a well established 8. Wid e r a l . Norsk Mag. f. Liegevidqnsk., 1927, lxxxviii. 9. Wil s o n , Jo h n C. California & West. Med., 1927, surgical measure. xxvii. Li nths following >11 at both the id. At time of t, and a draine present. Unrmity was cor:n given heliole wore a cast tion had gradfor the next 2 en's Hospital. had a marked J with a trace performed on return of his raft was done id infection of ^ discharging I'he cast was At the end of :nrl about on ' , v iat the right grees, flexion n the hip, no was closed, he graft was The neck of am and lines to the other, ge, was first func r, rg27. right hip in dopment of it cries. By t hip and a r the rest of ie so severe nd traction child home, > continued. > j > j 1 ADVANCED CANCER TREATED BY COLLOIDAL LEAD A Re p o r t o f Nin e t e e n Ca s e s BERNARD F. SCHREINER, M.D., F.A.C.S., a n d REINHARDT C. WENDE, M.D., Bu f f a l o , Ne w Yo r k State Institute for Study of Malignant Disease, Burton T. Simpson, M.D., Director A FTER the preliminary reports of Blair Bell in 1922 (1) as to the results obtained in cancer cases with the use of lead given in travenously we were hopeful that a new weapon had been given us to combat the ravages of this disease. At this time we used colloidal lead made from radio-active lead in two far advanced cases without any clinical improvement and for the time being the pursuit of this method was aban doned. Again in 1924 (2) and in 1925 (3,4,5) Bell published further papers on the use of colloidal lead in the treatment of cancer. This prompted us again to undertake systematic investigation of the value of colloidal lead in the treatment of far advanced cancer.. After preliminary work on the part of our physicists. Dr. Wilhelm Stenstrom and Melvin C. Reinhard, they succeeded in making an excellent preparation of colloidal lead (6). This prepara tion was used in mice to gain some knowledge, if possible, of the effects on the mouse carcinoma as well as of the toxicity of this agent. The results of these investigations, which were carried on by Mr. M. C. Marsh, our biologist, were not very encouraging. Nevertheless, it was thought ad visable to treat a series of human cases by this method. . In March, 1926, we began the treatment of far advanced cancer with colloidal lead. Nineteen cases were selected as follows: 6 of carcinoma of the breast, 4 of epithelioma of the cervix uteri, 2 of carcinoma of the stomach and one each of carcinoma of the bronchus, epithelioma of the larynx, epithelioma of the lip, nsevus cell carcino matosis, osteosarcoma of the femur, epithelioma of the penis, and adenocarcinoma of the vagina. In the beginning we used 0.025 grams of lead, which was gradually increased to 0.1 grams, given once a week over a period of 5 to 6 weeks; 1 to 10 injections, intravenously, totalling 12 to 510 cubic centimeters of solution containing 0.102 to 0.646 grams colloidal lead per patient. During the course of treatment on these patients, careful blood counts, urinalyses, and observations were made. It was readily seen that we were dealing with an extremely poisonous substance which caused profound ansemias and asthenias and some times death. Six cases treated showed local reactions which consisted of burning, pain, itching, and swelling in the site of the lesion. The general reactions consisted of chills, nausea, vomiting, expectora tion of blood, haematuria, weakness, and loss of appetite. Jaundice was noted in three cases during '] L, rw*- N36957 116 1005000000 SURGERY, GYNECOLOGY AND OBSTETRICS 8ft-_ J5 ii %8 ? c 0,, vA v \V \X \\ 1 PAT! :mt Mo s s o c / /\ RtO B.OOD COt IT------HAEMOUtOBm " "t \ /\ Hr\ fV \ ' DAYS \ \ V\ V\ DAYS Y\ \| \\s SCHREINER, V too...--I pt,,, ---- oo| S* ii iJ ofi 18 bo. loooaooj Lwo MattftCcTuCk uC,I , j1 iii 6l o o o pAThOLOGY 1 II s> 2 i! ** i * > a) ij................... ... A0 DA TS H nE cs A 1 aa i ? .................ii ': - 1 >5 -j | 2.................. t ! * c t Fig. i. Blood chart for Case 9500, breast, now alive. treatment, two of these being carcinoma of the breast and one carcinoma of the stomach. Two, with metastases in the liver, developed an ascites, one being a carcinoma of the breast and the other the nsevus cell carcinomatosis. The case of epithelioma of the lip developed encephalitis. All patients at times had varying amounts of al bumin and casts present in the urine; two breast cases had suppression of urine, one with con vulsions. There were no embolic accidents. The usual colic, constipation, and neuritis of lead poi soning were almost" absent. Only one case--the breast case now alive--showed some of these symptoms 2A months after treatment was started. All patients were stricken with a rapid, grave aiMemia after receiving o.x grams of colloidal lead, losing 10 to 60 per cent hsemoglobin and as many as 2,500,000 red corpuscles per cubic millimeter within 2 to 5 days, wherein basophilic granules also appeared. Concentrated solutions of lead brought these about much sooner, or in 1 to 3 days. This anaemia, which at times presented a high color index of 1 plus, tended toward spon taneous recovery. Iron citrate and liver diet were of value in combating the anosmia. Injections of 0.05 to 0.1 gram of lead, in a case fairly well re covered from the anaemia, acted very sharply in reducing haemoglobin and red cells; it looked like an accumulated action. Blood charts Figures 1,2, and 3 show the action of colloidal lead in reducing the amount of haemo globin and total red count in four of these cases. Of 6 cases of carcinoma of the breast treated with colloidal lead only one is alive, and she has definite metastases. This case is presented In view of the possibility that the lead in conjunction with high voltage X-ray and chemical amputation of the breast may have prolonged her life. Figure 1 shows the lesion before the lead treatment was started, and Figure 2 shows the same lesion after lead treatment. Figures 3 to 6 show the lesion since the lead treatment was discontinued and after chemical amputation of the left breast and skin grafting was done. The other five breast cases died 2 months, ^A months, 3 months, 6 months, and 1 year 3 months after lead treatment, was started. All the other cases died--the time indicated being from the beginning of the lead treatment: the 4 patients with epithelioma of the cervix died in 2 weeks, 1 month, 5 weeks and $A I II Lcoa 2KSS ll RABTltotOoLdfiGV-1 ,1Q0- . ..So q o o q o l It0 4 OOOOOoL V./ ^~\t |2Q----------- lOOOMC] iuVmy I 1 I I Bl o o d ] Pa t >c s _o g y j Fig. 3. Case 949 DUP050315190  -C-. . . --./,.; -. . ..>^.- t-r.......... >.. ; ! SCHREINER, WENDE: ADVANCED CANCER TREATED BY COLLOIDAL LEAD 117 ly well resharply in ooked like the action . of hsemolese cases. st treated id she has ed in view ction with utation of Figure 1 ment was :sion after the lesion nued and ireast and ve breast nonths, 6 reatment, -the time the lead tiut of the s and 5yi i | ? ! f | [ j I | * t | | f \ | 1 { [ lOQ_____ S00000c 6 Fig. 2. Blood chart for Case 8696, breast case, died in 3 months. -v~\ 80 4000000 \ Pa t ic mt r > ............... \y 9*36 a & <5 00 is m HO--.J^OOOOOC \\ ''X \\ ss. - '1 V\]JV,VS a. \ /. OMfS U___4 /\ / / \r-' pArtcrtr Mo 94 26 Re d Bt 000 Co u n t -- 20________loeocoo Lc a o _ kMtoto I 6cooo' Pa t h o l o g y i ill ,, 11 IO ZO I .ill i-....................... - J Hj* 10 OAYS I *1 i st> .................... ZO 30 ou W sitfs ... fl.,.,. n v, w Fig. $. Case 9496, n&vus cell carcinomatosis, died in 4 months. Case 9328, epithelioma of lip, died in 3 months. s- r. DUP050315191 uS SURGERY, GYNECOLOGY AND OBSTETRICS GRATZ: ' MULTI .i HE techniq Tvalue for 1 grees of kyj dicated. Arthrr multiple overlap fusion of the sp in cases of spina the diseased vei : r. this purpose we later devised the the baas of the Fig. 4. Case 9500, on admittance March 20, 1926. Lead treatment be gun. Fig. 5. Case 9500, October 13,1926, ter lead treatment. Fig. 6. Case 9500, May 16, 1927, high voltage X-ray treatment having been instituted. The tibial gr permit bending; curvature, whik tensile strength :k ! The distance : -l varies directly \ the diseased ve: described perm grafts as may bi of the individn; measures emplc : Fig. 7. Case 9500, January 19, 1928, when chemical amputation of the breast was begun. Fig. 8. Case 9500, February 24, 1928, following chemical amputation of breast. Fig. 9. Case 9500, April 30, 1928, following skin grafting of March 8, 1928. months; one patient with carcinoma of the stomach 3. There was severe haematuria observed in at died in 8 days, the other in 3 months; the patient least two cases treated with colloidal lead. with carcinoma of the bronchus committed suicide 4. In our hands the lack of clinical improve in 6yi months; the one with epithelioma of the ment together with the severe ansemias and larynx died in 1 month; the one with epithelioma asthenias produced by this form of treatment was of the lip in 3 months; the one with naevus cell cause enough for discontinuing the use of colloidal carcinomatosis in 4 months; the one with epithe lead in the treatment of far advanced cancer. : lioma of the penis in 6 months; the one with osteosarcoma of the thigh in 3 months; and the one with adenocarcinoma of the vagina died in s months. REFERENCES 1. Be l l , W. Bl a ir . Lancet, 1922, ii, 1005. 2. Ibid. 1924, i, 267. CONCLUSIONS 3. Be l l , W. Bl a ir , He n d r y , R. A., and An n et t , H. E. J. Obst. & Gynasc. Brit. Emp., 1925, xxxii, 1. r. No clinical improvement in the tumor was noted in any case treated in this series. 2. Colloidal lead as used in the treatment of these cases produced a grave anaemia. 4. Be l l , W. Bl a ir , Wil l ia ms , W. R., and Cu n n in g h am, L. Lancet, 1925, ii, 793. 5. Ibid. 1925, ii, 1003. 0. St e n s t r o m, Wil h e l m, and Re in h a r d , Me l v in . J. Biol. Chem., lxix, 607. Fig. 1. X-ray \ 1 Prase > r i : DUP050315192