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Translocation of intestinal bacteria to the blood during hemorrhagic shock (HS) has been confirmed in rats and humans. The current study was designed to trace the path of translocated intestinal bacteria in a murine HS model. Thirty-one rats were gavaged with 1,000,000 counts of viable 14C oleic acid-labeled Escherichia coli. Forty-eight hours later the animals were bled to 30 mmHg until either 80% of their maximal shed blood was returned or 5 hours of shock had elapsed and they were resuscitated with Ringer's lactate as previously described. Control animals were cannulated but not shocked. Eight rats immediately after shock and resuscitation, 6 rats 24 hours after shock, 3 rats 48 hours after shock, and 4 animals that died in shock had their heart, lung, liver, spleen, kidney, and serum harvested, cultured, and radioactive content measured. Translocated enteric bacteria are found primarily in the lung immediately after shock with redistribution to the liver and kidney 24 hours later. Animals surviving to 48 hours were capable of eliminating the majority of the bacteria from their major organ systems. Positive cultures for E. coli were also found in the blood, lung, liver, and kidney. We speculate that the inflammatory response stimulated by the bacteria in these organs may contribute to the multiple-organ failure syndrome seen after HS.

A case of primary non-Hodgkin's lymphoma of the duodenum is presented. A review of the English literature documented 95 cases, and the presenting signs, symptoms, and radiographic findings have been abstracted. Attention is also drawn to the treatment of 27 cases, 11 of which (41%) survived for 2 or more years. Ten of the 11 long-term survivors were treated with radiotherapy with or without resection, whereas only one long-term survivor was treated by surgery alone.

Twelve patients with advanced locoregional (Stage III and IV) squamous cell carcinoma of the oral cavity and oropharynx underwent treatment with cisplatin, vinblastine, bleomycin, and 5-fluorouracil, given by intra-arterial infusion, as primary adjuvant therapy, in preparation for radiation therapy and surgery. Responses were observed during or immediately after infusion therapy in 8 of 12 (67%) of patients (1 complete response, 7 partial responses). Infusion chemotherapy was followed by radiation therapy alone in five patients and by radiation and surgery in six patients. The protocol was initiated in August 1981, and six patients are now free of their primary cancer, at 21 to 36 months, whereas six have died with disease. Arterial infusion of a combination of effective antineoplastic agents is a promising method for the preparation of selected patients for radiation therapy and surgery, as it is less likely to produce serious systemic toxicity and it requires a shorter period than systemic neoadjuvant chemotherapy.

Previous investigations of a treated model of hemorrhagic shock in the rat indicated the frequent occurrence of bacteremia that appeared to derive from the gut. This paper determines the incidence of bacteremia and endotoxemia during the acute shock period and compares this with similar observations in humans in varying degrees of shock. Studies in 26 rats indicated that bacteremia and endotoxemia was present in 50% and 87%, respectively, by the end of 2 hours at a mean arterial pressure of 30 mmHg. Observations in 50 patients admitted to the trauma unit showed that positive bacterial blood cultures were present in 56% when the admission systolic blood pressure was 80 mmHg or less (p less than 0.01 compared with either of the other groups). Endotoxemia was noticed in two such patients. Direct access of bacteria and endotoxin to the blood stream may occur during hemorrhagic or traumatic shock and is the probable cause of subsequent sepsis in traumatized patients when no other source is apparent.

One hundred seventy-four cases of squamous cell cancer of the tonsil (SCCT) were reviewed. Radiation therapy (RT) alone was used in 81 patients, surgery alone (S) in 19 patients, preoperative RT + S in 49 patients, and chemotherapy [( C] methotrexate plus bleomycin plus cisplatin) in 25 patients. The 5-year survival was 83% in Stage I (n = 21), 72% in Stage II (n = 19), 23% in Stage III (n = 34), and 15% in Stage IV (n = 100). RT and S were equally effective in Stages I and II. In Stage III, the 5-year survival for RT + S was 31% versus 11% for RT alone; and in Stage IV, the respective 3- and 5-year survivals for RT + S were 24% and 15% versus 6% and 0%, respectively, for RT alone. There was an 84% response rate to C, and the patients who completed C + RT + S had 3- and 5-year survival rates of 41.7% and 32%, respectively. Our results indicate that RT + S appears to offer better survival in Stage III and IV SCCT. The high response rate in early survival data seen with C + RT + S suggests a promising role for this approach.

Verrucous-type oral tumors have been reviewed. This variety of epidermoid carcinoma of the oral cavity presents as a warty growth in patients who have a history of chewing tobacco and poor oral hygiene. They are slow-growing, locally invasive, and do not metastasize to lymph nodes in our experience. In five of these patients, the microscopic pattern was that of a well-differentiated squamous cell carcinoma. The others presented the classical histologic pattern of verrucous carcinoma. No difference was found in the behavior of these two groups. Three cases developed anaplastic transformation after irradiation and surgery. A change in the clinical behavior of the tumor was observed in these patients and all three died. There is some possibility that ionizing radiations could be the trigger mechanism in this transformation. The authors feel that surgery is the treatment of choice in early or easily resectable lesions. It would appear unnecessary to perform neck dissection in these patients. Radiation therapy should be used in advanced verrucal-type lesions in which surgical resection is difficult or not feasible. These patients require frequent and careful observation. The authors believe that this entity deserves further investigation.

The hemodynamic and microcirculatory effects of prostaglandin E1 and methylprednisolone sodium succinate were compared in a standard canine shock model. Prostaglandin significantly increased cardiac output and decreased total peripheral resistance when compared to control animals while steroids did not. There was no significant effect upon heart rate or arterial pressure by either drug. Methylprednisolone sodium succinate significantly increased arterial pH at the conclusion of the experiment and showed directional improvement in venous lactate and proteolytic activity. Prostaglandin significantly increased length of survival compared to both steroid and control infusion. It is concluded that prostaglandin and steroid have different hemodynamic effects in shock, that steroid protects microcirculatory flow more efficiently and that the prolongation of survival seen with prostaglandin infusion is not entirely due to its hemodynamic or lysosomal stabilizing effects.

We have recently reported the rapid appearance of bacteria and endotoxin in the blood of rats and of trauma patients in the course of 30 minutes to 2 hours of hemorrhagic shock. The current study was designed to determine the effect of this bacteremia and endotoxemia on survival. Thirty-three conventional (C:group 1) and 36 germ-free (GF:group 2) Sprague Dawley rats were subjected to our previously described model of treated hemorrhagic shock. Survival in the GF group was significantly better than the C group at 24, 48, and 72 hours after shock. Endotoxin levels were elevated in 88% of C group during shock and in 28% of GF group. The gut of the GF animal contains endotoxin (26 ng/gm of stool) as does the sterile food supply (393 ng/gm of rat chow).