Haemodynamic Effects of Occlusion of Abdominal Aorta During Nitorgen Mustard Therapy

Harries, James; Brown, F.; Beecher, J. L.; Oettgen, Herbert F.

doi:10.1136/bmj.2.5360.783

Cited by 9 publications

(3 citation statements)

References 4 publications

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“…of mercury. Femoral arterial studies have shown that at this pressure arterial occlusion is complete (Harries, Beecher, Brown and Oettgen, 1963). During the past 3 years 312 occlusions have been applied to 94 patients.…”

Section: Figmentioning

confidence: 99%

The Administration of Chemo-Therapeutic Agents in the Treatment of Advanced Head and Neck Cancer

Clifford

1964

J. Laryngol. Otol.

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Section: Figmentioning

confidence: 99%

The Administration of Chemo-Therapeutic Agents in the Treatment of Advanced Head and Neck Cancer

Clifford

1964

J. Laryngol. Otol.

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“…Later the release of histamine like substances in the compressed gut and occluded lower limbs may produce a condition akin to " tourniquet shock ". Harries et al (1963) have shown that a fall in cardiac output and a rise in pulmonary arterial pressure occurs during occlusion. This indicates that an increase in pulmonary peripheral resistance occurs, which may be due to compression of the pulmonary vessels and a reduction in the venous return to the heart.…”

Section: Effects Of Post Occlusion Hypotensionmentioning

confidence: 99%

“…Harries, Beecher, Brown and Oettgen (1963) have examined the haemodynamic effects of this procedure and suggested that post occlusion hypotension may be initially due to an overall decrease in peripheral resistance, due to a sudden increase in the vascular bed when the Kidde tourniquet was released. Later the release of histamine like substances in the compressed gut and occluded lower limbs may produce a condition akin to " tourniquet shock ".…”

Section: Effects Of Post Occlusion Hypotensionmentioning

confidence: 99%

Intensive Nitrogen Mustard Therapy with Abdominal Aortic Occlusion in Nasopharyngeal Carcinoma

Clifford¹,

Bhardwaj²,

Whittaker³

1965

Br J Cancer

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THE incidence of anaplastic carcinoma of the nasopharynx in hospital patients in Kenya is high (11 %), relative to admissions for malignant disease of other sites (Clifford, 1961;Clifford and Beecher, 1964). Surgery has little or no place in the management of this condition (Lederman, 1961) and, as radiotherapy is not yet available in East Africa, treatment depends on cancer chemotherapy. Untreated, the late stages of this disease can cause acute pain and severe misery to the patient ( Fig. 1 and 2), the majority of whom arrive in hospital when the disease is far advanced.Initially palliation with nitrogen mustard (HN2) was attempted, using the recommended pharmacopoeial dose of 0 1 mg. /kg. daily for 5 days, but experience showed that tumour response was proportional to the dose administered, and in the majority of these patients, little, if any, symptomatic relief was achieved using this dosage. Cancer chemotherapy is suitable only for hospital in-patients in Kenya. The prolonged administration of cytotoxic drugs to out-patients, with frequent haematological examinations, is neither safe, or satisfactory under conditions in this country, and consequently efforts have been made to achieve the maximal therapeutic effect within the period of time that the patient resides in the hospital. Even using larger doses of HN2, 2.0 mg./kg., with autologous bone marrow infusions to compensate for marrow depression, useful tumour regression was limited. Higher doses, 2 5 mg. /kg. caused death due to septicaemia secondary to gastrointestinal toxicity, before the marrow graft had fully developed (Clifford, Clift and Duff, 1961).As HN2 is active in the circulation for less than ten minutes, Miller and Lawrence (1961) were able to protect the pelvic bone marrow by temporarily occluding the abdominal aorta. It was found possible to effectively occlude the abdominal aorta distal to the renal arteries for short periods of time, by tightly applying an Esmarch's bandage, over small sandbags, placed on the lower abdomen in a fully relaxed patient (Duff, Dennis, Clift, Clifford and Oettgen, 1961). Studies indicated that the circulating blood volume was reduced to approximately one half by an occlusion applied at this site, so that the tumour dose to the upper half of the body of a drug calculated on a whole bodyweight basis was almost doubled. To reduce the risk of cerebral toxicity the total dose of mustard was fractionated. Occluding the abdominal aorta with a Kidde tourniquet and a 20 cm. Baum cuff (Fig. 3), inflated to a pressure of 200 mm. Hg from a Medican cylinder (compressed di-chloro-difluoromethane) was subsequently found to have technical advantages

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Results of regional chemotherapy of neoplasms of the upper body by temporary mid-torso vascular occlusion

Clapp

Tayao

Miller

et al. 1964

Cancer

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Haemodynamic Effects of Occlusion of Abdominal Aorta During Nitorgen Mustard Therapy

Cited by 9 publications

References 4 publications

The Administration of Chemo-Therapeutic Agents in the Treatment of Advanced Head and Neck Cancer

The Administration of Chemo-Therapeutic Agents in the Treatment of Advanced Head and Neck Cancer

Intensive Nitrogen Mustard Therapy with Abdominal Aortic Occlusion in Nasopharyngeal Carcinoma

Results of regional chemotherapy of neoplasms of the upper body by temporary mid-torso vascular occlusion

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