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This study was carried out to determine the effect of perioperative blood transfusions on the survival of patients operated on for colorectal cancers. Cox's regression analysis was applied to 281 patients operated for cure of Dukes' stage A, B or C disease. Other variables studied were age, sex, tumour location, and preoperative hemoglobin, lymphocyte and albumin values. Perioperative deaths, pre- and postoperative immunodepression, neoplasia in situ, nonresections and stage D disease were excluded. It was found that the number of units of blood transfused had a strong influence on the prognosis of patients with colorectal cancer, particularly colonic cancers, but the effect could not be demonstrated when rectal cancers were studied separately, perhaps because of the small number of cases. The mechanism of action of blood transfusions seems to be independent of the other analysed variables. The authors suggest that perioperative blood transfusions may have an immunomodulatory effect in patients with colonic cancer, as already shown in recipients of transfused kidney allografts.

An experimental model of canine normothermic renal ischemia was used to determine whether lysosomal urinary enzyme excretion reflects the extent of ischemic cellular injury, as assessed by subsequent renal function (serum creatinine level) and morphologic changes. The value of a lysosomal membrane-stabilizing agent (methylprednisolone) in protecting kidneys from ischemic damage by preventing lysosomal enzyme release was assessed. Results showed conclusively that urinary enzyme activities of beta-galactosidase and N-acetyl-beta-glucosaminidase are valuable indicators of renal cellular damage and functional outcome after ischemic injury, and that methylprednisolone at a dose of 30 mg/kg, given intravenously 1 hour before a 1-hour period of normothermic ischemia, protects the kidney both biologically and morphologically, by reducing the excretion of lysosomal enzymes after revascularization.

Between November 1979 and April 1984, 790 consecutive pregnant women who considered themselves as having a "normal" pregnancy were followed in private practice from 9 weeks' gestation until 6 weeks post partum. The women had no pre-existing disease or problem classified as a risk to the pregnancy at the time of their first visit, had a singleton pregnancy and gave birth at Notre-Dame Hospital, Montreal. Maternal complications occurred during the course of pregnancy in 181 women (23%). Complications were mostly related to obstetric conditions (10%), such as preterm labour, intrauterine growth retardation (IUGR) and antepartum hemorrhage, or to medical conditions (12%), the most prevalent of which was hypertension (77% of medical conditions). Neonatal complications occurred in 183 infants (23%). The corrected perinatal death rate was 2.5 per 1000. Prematurity, IUGR and dysmaturity/postmaturity accounted for nearly half of the complications. Hyperbilirubinemia occurred in 7% of the cases. Among women without any maternal complications during pregnancy, the frequency rate of neonatal complications was 19%, compared with 23% among the entire group of 790 women. Our results suggest that the absence of maternal complications does not protect the infant from a neonatal complication. Further refinement is needed to identify markers of obstetric, medical and neonatal complications in pregnancies with no risk factors.

A preparation of cyclosporine (CsA) in liposomes was tested in the rat to evaluate its effectiveness in reducing CsA nephrotoxicity. The drug was injected intravenously in unilaterally nephrectomized Lewis rats at a daily dose of 25 mg/kg for 14 days, either in a cremophore solution (eight rats) or in a preparation of liposomes (eight rats). Another group of four animals received the cremophore solution alone. Overall, rats treated with the CsA-liposome preparation had reduced toxicity, exhibiting better survival rates and less weight loss than those treated with the CsA-cremophore. Incorporating CsA into liposomes induced a statistically significant (p less than 0.05) reduction in the otherwise progressive increase of serum creatinine during week 2 of the experiment. Following administration of CsA-liposome preparation, epithelial cells of the proximal renal tubules appeared morphologically normal, without evidence of vacuolization, which is characteristic of CsA nephrotoxicity and was seen in the CsA-cremophore group. Although the exact mechanism is not clearly understood, it is likely that the tissue distribution of CsA, when incorporated into liposomes, is modified in favour of the reticuloendothelial cells, thereby sparing highly sensitive, but non-target organs such as the kidneys.

The chemotherapeutic effectiveness of the lysosomotropic Adriamycin-DNA complex has been demonstrated experimentally. This study evaluated the immunosuppressive activity of the complex on renal allografts in rats of the Buffalo-Lewis strain. Six rats receiving no treatment served as a control. Five rats received DNA along (at a dose equivalent to that in the complex), seven received the Adriamycin-DNA complex (molar ratio of DNA mononucleotide to Adriamycin, 20:1) and five were given free Adriamycin. Adriamycin, free or linked to DNA, was injected as follows: 2 mg/kg on days 2, 6 and 9 and 1 mg/kg on day 13 after transplantation. The Adriamycin-DNA complex prevented renal allograft rejection in the early postoperative period, by delaying for more than a week, the increase in serum creatinine levels in animals receiving transplants. Histologic examination of renal grafts in these rats confirmed the reduced severity of acute cellular rejection. There was also functional and morphologic evidence of reduced toxicity of Adriamycin when linked to DNA. The beneficial effect of such a drug should be attributed to its lysosomotropic mechanism of activity.

Of 939 patients treated by radiotherapy for carcinoma of the cervix at the hôpital Notre-Dame in Montreal, between 1979 and 1981, 275 (29.3%) had digestive, urologic, gynecologic, vascular, osseous and cutaneous complications. Surgery was necessary to treat 73 complications in 55 patients (5.9%): 42 digestive (25 occlusions, 13 fistulas and 4 perforations); 22 urologic (16 occlusions, 5 fistulas, 1 hemorrhage); 6 gynecologic (3 hemorrhage and 3 uterine necrosis); 1 cutaneous, 1 vascular and 1 osseous necrosis. No direct correlation was found between the incidence of the complications and certain predisposing factors such as the type of radiotherapy, patients' age, stage of the disease and gynecologic surgery before radiotherapy. However, there was a strong correlation between the incidence of complications and the dose of radiotherapy and the need for gynecologic surgery after radiotherapy. High morbidity was observed in the 55 patients treated surgically: they had to undergo a mean of 2.36 operations each, 2.98 general anesthetics, 1.81 hospitalizations (mean duration 75.7 days); 21 had one or more definitive stomas. The death rate was 5.45%. Surgical treatment was individualized. Limited resections were performed for occlusions, fistulas and perforations whenever it was technically feasible to treat digestive and urologic complications. A bypass procedure was used when resection would have been too extensive or dangerous. The majority of rectal lesions were treated by colostomy and a Hartmann procedure.