Gold Injections Research Articles

Microendocytosis in eosinophilic leukocytes.

Rat peritoneal eosinophils were examined after intraperitoneal infusion either of a mixture of phosphate-buffered saline (PBS) and colloidal gold or of fetal calf serum. These cells characteristically contained vesiculotubular structures, cuplike structures, and small granules during centrifugation. The cup-shaped structures and elaborate labyrinths of vacuole-like spaces increased markedly after injection of the PBS-colloidal gold mixture, presumably as features of heightened microendocytic activity. The vesiculotubular structures increased greatly after infusion of fetal calf serum. A few cyrstalloid granules exhibited fine-structural changes after the PBS-colloidal gold injection, and more numerous crystalloid granules appeared altered after fetal calf serum. Infrequent small granules contained a lucent, crystal-like silhouette after the fetal calf serum injection. Eosinophils evidenced microendocytic uptake of gold spherules into coated vesicles, the cup-shaped structures, and the small granules, but not into the vesiculotubular structures or crystalloid granules after intraperitoneal infusion of the PBS-gold mixture. Strong unmasked acid phosphatase activity in small granules contrasted with the general lack of activity in normal-appearing crystalloid granules and moderate activity in apparently altered crystalloid granules, presumably reflecting active and latent forms of enzyme in the different granules.

Blood and urine gold levels during chrysotherapy for rheumatoid arthritis.

In this study the value of undertaking routine blood and urine estimations was assessed in relation to achieving maximum efficacy and safety in chrysotherapy. It was found that a favourable response to gold was forthcoming in approximately two-thirds of patients and occurred irrespective of the patients' disease duration or severity, or the mean serum gold level or the mean urinary gold excretion, estimated immediately before the next gold injection was due. The presence of rheumatoid nodules and the patients' advancing age were associated with a less favourable clinical response to gold. Those patients who derived a marked benefit from chrysotherapy did so significantly earlier in their course than those who derived only moderate benefit. A frequent correlation was seen in individual patients between serum gold levels and urinary gold excretion. This was most marked in those patients showing a favourable response to gold.

Gold-Associated Thrombocytopenia

Six patients who developed thrombocytopenia while receiving gold injections for rheumatoid arthritis were studied and observed for six months to three years. In all of them bone marrow examinations performed at the time of maximum thrombocytopenia revealed normal to increased numbers of megakaryocytes. There was no evidence of lymphocyte transformation in the presence of gold, nor were circulating antibodies detected. Following prednisone therapy the platelet counts returned to normal and therapy was discontinued. Despite the fact that in vitro studies disclosed no abnormalities, it is probable that this clinical disorder represents a form of immune drug purpura.

Electron Microscopy of Bone Marrow Following Thf, Intravenous Injection of Colloidal Gold

Electron Microscopy of Bone Marrow Following Thf, Intravenous Injection of Colloidal Gold

Gold in the Dermis Following Gold Therapy for Rheumatoid Arthritis

Six patients who had received gold injections for the treatment of rheumatoid arthritis had histologically visible deposits of gold in the skin. In two of the patients, no gold had been administered for 20 years or more. The identity of the deposits was confirmed by emission spectroscopy using a laser microprobe, as well as by their resistance to microincineration and their removal by Lugol solution.

Gold Retention and Subsequent Mortality in Strains of Chickens Resistant and Susceptible to Lymphoid Leukosis or Marek’s Disease

A correlation between mortality from gold injections and resistance to the avian leukosis complex was observed in five strains of chickens selected by two investigators for resistance or susceptibility, but not in three other strains similarly selected by another investigator. Gold retention in these five strains of chickens generally was similar to mercury retention from phenylmercuric acetate injections. Within a selection program, these resistant chickens previously found to retain larger amounts of mercury also retained larger amounts of gold. The retention of gold was greater (P < 0.01) in the liver of strains of chickens classed as resistant to lymphoid leukosis than strains classed as susceptible. One strain of chickens having high mortality and retention from gold injections excreted gold more slowly than another strain with lower mortality and retention.

CHROMOSOME DAMAGE IN PATIENTS WHO HAVE HAD INTRA-ARTICULAR INJECTIONS OF RADIOACTIVE GOLD

The findings of a high proportion of damaged circulating lymphocytes in a woman given injections of radioactive gold ( 198Au) for rheumatoid arthritis prompted an investigation of chromosome abnormalities in peripheral lymphocytes of twelve other patients who had had 198Au injections only and two who had had radioactive gold and external irradiation. The frequency of damaged cells in patients without external irradiation was 8·5% (mostly dicentrics), compared with 0·48% for controls. The significance, to patients, of this damage is difficult to assess, but its scale is such that it cannot be ignored. It is suggested that 198Au injections should be limited, particularly in younger patients, to cases where the procedure is thought likely to give much better results than other methods.

Thoracic Lymph Node Scintiscan as a Diagnostic Test in Mediastinal Malignant Enlargement

The visualization of certain thoracic lymph nodes by subcutaneous injection of colloidal gold (¹⁹⁸Au) consists of a simple and reliable examination in the differential diagnosis between an advanced central bronchogenic carcinoma and a mediastinal lymphatic tumor. In our study of 12 patients with central lung cancer and supraclavicular or subcarinal or mediastinal metastases according to the clinical stage of each patient, we found that: (a) in six cases there was no lymph node visualization on both sides; (b) in five cases there was poor or partial visualization on the affected side; (c) in one case there was no lymph node visualization on the affected side. Besides, in our study of nine patients with mediastinal lymphomas, the thoracic lymph nodes showed diffuse irregularities in the distribution of the radioactive colloidal gold (¹⁹⁸Au).

Nitritoid Reactions to Gold Treatment for Arthritis

To the Editor.— The side effects of gold sodium thiomalate therapy in the treatment of rheumatoid arthritis include dermatitis, stomatitis, nephritis (with or without proteinuria), and bone marrow depression (with or without eosinophilia). A less commonly mentioned side effect is the vasomotor or nitritoid reaction. 1-3 During a one-month period, two patients with rheumatoid arthritis receiving gold therapy developed the nitritoid or vasomotor reaction. Following are their brief summaries. Report of Cases.—Case 1.— A 47-year-old white woman with a ten-year history of seronegative, nonnodular rheumatoid arthritis was first seen at the William Beaumont General Hospital Clinic, while she was receiving a maintenance dosage of gold sodium thiomalate, 50 mg every two weeks. Gold injections were given on (1) March 31, 1969, 50 mg, without reaction; (2) April 9, 50 mg, with mild nitritoid reaction; (3) May 7, 35 mg, without reaction; (4) May 23, 35 mg, with a mild

Intra-articular injection of radioactive gold in treatment of chronic synovial effusion in the knee.

SummaryReview of 44 knee joints (40 patients) treated with colloidal 198Au because of chronic effusion revealed that the effusion had ceased in 16 of the 19 with degenerative arthritis and idiopathic synovitis and in 12 of 25 in patients with rheumatoid and psoriatic arthritis. Most of the remaining joints showed improvement. The interval between treatment and the review was, on the average, 3.2 years. It therefore appears that this method should replace external radiation and largely also chemical synovectomy with osmic acid, nitrogen mustard or Thio-Thepa. The method is not suitable for the treatment of severely destroyed joints.

Extravascular protein in the renal medulla.

The permeability to protein of the vessels of the renal medulla in the rat was studied by intravenous injection of Evans' Blue or fluorescent‐labelled serum, followed by perfusion of the whole vascular system with saline. The vessels of the inner medulla and the vasa recta of the vascular bundles of the outer medulla were found to be rapidly and freely permeable to protein. Electron microscopy, after the injection of ferritin, Thorotrast or colloidal gold, showed the vessels probably concerned in the protein leak to be ascending vasa recta and the capillaries of the medulla. The findings support suggestions that extravascular albumen is important in the process of concentration of the urine.

Localized "radiation hepatitis" as demonstrated by scintillation scanning.

The liver has usually been considered radiation-resistant. Ingold et al. (1) recently summarized the literature on radiation effects on the liver and added some observations of their own. They noted that in 13 of 40 patients receiving radiation to the entire liver evidence of radiation “hepatitis” developed. A relationship was shown between the dose of irradiation and the incidence of radiation effect on the liver, no effect being observed with doses of less than 3,000 rads. Liver dysfunction was seen in 7 of the 17 patients who received doses in the 3,800–4,000-rad range and in 3 of the 4 patients who received doses in excess of 4,000 rads. On the other hand, they noted that “limited portions of the liver can apparently stand doses as high as 5,500 rads without detectable deleterious effects to the individual.” Ingold et al. also demonstrated alteration in some liver function tests in many of the patients in whom treatment was delivered to the entire liver. They stated that the serum alkaline phosphatase was the most reliable laboratory index of radiation damage when the entire liver was irradiated. Evidence concerning serum biochemical alterations following segmental irradiation of the liver was not presented. Usselman (2) demonstrated by photo-scanning alterations in liver function, using both Au198 and rose bengal I131, in patients who had received segmental irradiation of the liver. Johnson et al. (3) believed that they had demonstrated by scintillation scanning radiation-induced suppression of hepatic reticuloendothelial function in 6 patients who had received therapeutic irradiation of the liver. Our observations indicate that scintillation scanning of the liver following intravenous injection of radioactive colloidal gold may be a more sensitive index of localized radiation hepatitis than that provided by clinical and biochemical data. Evidence of a radiation-induced abnormality of the liver was shown by scintillation scanning in 6 patients with neoplastic disease, in whom a segment of the liver was irradiated. A scintillation scan of the liver was obtained shortly after completion of a course of radiation therapy to an upper abdominal portal in 4 patients with a malignant neoplasm of the testis and in 2 young women with Stage II Hodgkin's disease. Liver scans prior to treatment were available for 3 patients and an additional scan was obtained in two others several months after completion of the radiotherapy. Illustrative Cases Case I: E. K., a 37-year-old white male, underwent a left orchiectomy on Dec. 29, 1965, with a histologic diagnosis of mixed seminoma and teratocarcinoma of the testis. Abdominal exploration on Jan. 18, 1966, confirmed the presence of unresectable retroperitoneal disease. Prior to radiation therapy, a scintillation scan of the liver (Jan. 12, 1966) was normal (Fig. 1,A), as were serum values for bilirubin, alkaline phosphatase, glutamic pyruvate transaminase, and Bromsulphalein retention.

Generalized Granuloma Annulare

A patient with generalized granuloma annulare is described. The eruption was restricted to exposed sites. Forty-seven cases from the literature are reviewed. The clinical appearance may be confused with lichen planus, sarcoidosis, tuberculosis cutis, and lichen myxedematosus. The histology is variable and collagenous; cellular or vascular changes may occur separately or in combination. Treatment with gold injections, antihistamines, x-ray therapy, and bismuth have not been consistently effective. Claims for improvement with diethylstilbestrol, systemic corticosteroids, and penicillin have been made but these are difficult to assess because of the variable course of the disease. Antimalarials may be of value.

Generalized granuloma annulare. A report of a case and review of the literature

A patient with generalized granuloma annulare is described. The eruption was restricted to exposed sites. Forty-seven cases from the literature are reviewed. The clinical appearance may be confused with lichen planus, sarcoidosis, tuberculosis cutis, and lichen myxedematosus. The histology is variable and collagenous; cellular or vascular changes may occur separately or in combination. Treatment with gold injections, antihistamines, x-ray therapy, and bismuth have not been consistently effective. Claims for improvement with diethylstilbestrol, systemic corticosteroids, and penicillin have been made but these are difficult to assess because of the variable course of the disease. Antimalarials may be of value.

Evaluation of lymph node function following irradiation or surgery.

EVALUATION OF LYMPH NODE FUNCTION FOLLOWING IRRADIATION OR SURGERYPRENTISS M. DETTMAN, M.D., E. RICHARD KING, M.D. and YALE H. ZIMBERG, M.D.Audio Available | Share

Treatment of advanced carcinoma of the sigmoid and rectum

Advanced carcinoma of the sigmoid flexure and rectum will continue to present multiple problems until the diagnosis is made at an earlier stage of the disease. Delay in the diagnosis is a serious problem and merits a major crusade on the part of all who are interested in carcinoma of the colon and rectum. Preoperative knowledge, or suspicion that a carcinoma of the sigmoid flexure or rectum has extended to adjacent structures, provides an opportunity to prepare the patient adequately and to plan the operative procedure. The more that is known preoperatively about a patient’s physical and mental condition, the better is the opportunity to decide just what is the best procedure when advanced carcinoma is found. In spite of careful preoperative investigation, the surgeon occasionally will be surprised to discover unsuspected advanced disease at operation. On the other hand, what appears at first to be a non-resectable advanced carcinoma of the rectum or sigmoid flexure may still be curative. A concerted effort,consistent with sound surgical judgment, should be made to remove the involved organs. The end results in a given case will depend upon many factors, which often will be surprising and gratifying. “Preventive colostomies” are unnecessary and should be avoided. A few technical procedures have been discussed, including intralymphatic injection of radioactive gold and 5-fluorouracil, preoperative radiation, intra-abdominal ureteral catheterization, ligation of internal iliac arteries and the primary blood supply to the pelvis, concomitant hysterectomy, oophorectomy, cystectomy, prostatectomy, vaginectomy and reconstruction of the vagina.

Combined Therapy of Rheumatoid Arthritis with Gold and Chloroquine: II Evaluation of the Side Effects

Summary and ConclusionsThe chloroquine course was completed without interruption by 87.5 per cent of 200 hospitalised rheumatoid arthritis patients, and after interruption of medication or reduction of dosage by 94.5 per cent.Combined chloroquine and gold therapy was completed without interruption by 66 per cent of 200 patients and after interruption or reduction of dosage by 85.5 per cent.Concurrent administration of gold and chloroquine preparations for hospitalised rheumatoid arthritis patients did not increase the termination percentage of either drug on account of side effects. A reaction reminiscent of anaphylactic shock was established after injection of gold in 1 case of the combined therapy group. No other serious or dangerous side effects were established in either therapeutic group.

Clearance rate in relation to agglutinins for gelatin-stabilized colloid in the rat.

Intravascular clearance rates of gelatin-stabilized gold were compared with circulating titers of gelatin agglutinins in rats at increasing time intervals after blockading injections of gelatin-stabilized gold and S. marcescens endotoxin. The degree and duration of reticuloendothelial system (RES) blockade against the homologous colloid were directly related to the circulating levels of gelatin agglutinins. In contrast, plasma agglutinins were not decreased in endotoxin-induced blockade against the gelatin-stabilized colloid. In a further experiment, the plasma response to blockading injections of colloidal thorium dioxide, iron oxide, and zymosan was characterized by a transient increase in gelatin agglutinins suggesting the nonspecific release of opsonins from an extravascular source. The findings indicated that clearance rates of gelatin-stabilized colloids were dependent on the total available opsonin in the rat rather than the total circulating opsonin. It is suggested that RES blockade is effected by the prior nonspecific depletion of opsonins from an extravascular reserve which is the major component of the total available opsonin.

Direct intralymphatic injections of radioactive colloidal gold in the treatment of malignant disease.

A technique of direct intralymphatic injections of colloidal 198Au to produce selective internal irradiation of lymphatic vessels and nodes is described. Experimental and clinical results are discussed. The indications are outlined.

Tinea faciei simulating chronic discoid lupus erythematosus.

Howell et al.1reported two cases of scalp infection in adults caused by Trichophyton tonsurans in which the clinical lesions closely resembled chronic discoid lupus erythematosus. This paper reports four cases of chronic tinea faciei, due to different dermatophytes, simulating chronic discoid lupus erythematosus. Report of Four Cases Case 1.— The patient, a 65-year-old woman of dark complexion, complained of a symmetrical butterfly-like eruption on the nose and cheeks of eight years' duration. These lesions always flared up in summer when she was exposed to the sun. The patient also gave an eleven-year history of recurrent inflammation of the left foot accompanied by rise of temperature. She had been previously diagnosed as suffering from discoid lupus erythematosus and treated with gold injections without improvement. On inspection there were variously sized scaly red lesions with polycyclic, moderately well-defined, borders on the nose and cheeks. The central parts of the lesions showed