[Local application of anti-cancer drugs for the treatment of malignant pleural and pericardial effusion]

Pleural effusion is a common complication in patients with malignant neoplasm. A randomized controlled study of intrapleural instillation of Adriamycin (control group, 30 patients) and Adriamycin Nocardia rubra cell wall skeleton (N-CWS group, 26 patients) with tube thoracostomy was performed in 55 patients with malignant pleural effusion due to primary lung cancer. The response rates for control of pleural effusion were 73.4% in the N-CWS group and 46.1% in the N-CWS group. These results suggest that intrapleural instillation using a combination of anti-cancer agent and immunopotentiator is an effective treatment for malignant pleurisy. Cardiac tamponade secondary to cancer is a life-threatening complication requiring immediate treatment. Twenty-four patients with malignant pericardial effusion were treated by intrapericardial instillation of anti-cancer drugs, such as Carbazilquinone, Mitomycin-C or ACNU, with pericardial drainage. The range of survival time from the instillation of anti-cancer drug was 3-365 days (average days). In only 4 patients, reaccumulation of pericardial effusion was recognized. There were no serious complications with this procedure. It was considered that local instillation of anti-cancer agents with pericardial drainage was a useful therapeutic modality for malignant pericarditis.

Venous occlusive RN plethysmography: comparison with electrical admittance plethysmography

A venous occlusion plethysmography using radionuclide (RN) was introduced for the measurement of the limb blood flow. This technique, called RN plethysmography, can be carried out in a subject who has been previously administered RN intravenously for the routine angiographic examination. The blood flow is calculated from the initial slope of the RN count rate change (RN accumulation curve) due to venous occlusion. In this study, this method was compared with electrical admittance plethysmography. The blood flow values determined by these two methods correlated well with each other.

Chemical and toxicological studies on bracken fern, Pteridium aquilinum var. latiusculum. VIII. The inability of bracken extracts containing pterosins to cause cattle bracken poisoning

Methanol extracts of bracken frond and rhizomes prepared using a metallic extraction vessel, were proved incapable of producing bracken poisoning in calves. Nevertheless, they contained appreciable quantities of pterosins and pterosides. Thus the poisonous principle(s) in bracken responsible for the toxicological effects are not associated with these major sesquiterpenoids of the plant.

Palliative urinary diversion in patients with advanced cervical cancer

An analysis of 25 palliative urinary diversions for advanced cervical cancer is presented. The median postoperative survival was 176 days and the mean was 329 days. Indication, methods of surgical procedure and duration of known disease did not strongly influence survival. The patients who were treated with radiation therapy after urinary diversion had a longer median survival. Renal function returned to normal in 7 of 9 azotemic patients. 41% of the patients left the hospital and this group subsequently spent 62% of their remaining survival at home. Guidelines for selection of the patients who might benefit from urinary diversion are discussed.

Randomized controlled study of adjuvant immunotherapy with Nocardia rubra cell wall skeleton for inoperable lung cancer

In order to evaluate the clinical benefit of Nocardia rubra cell wall skeleton (N-CWS), a randomized controlled study was performed with inoperable lung cancer patients entered in 5 institutions from October 1978 to June 1981. Patients without pleural effusions were treated initially with conventional therapies such as chemotherapy and/or radiotherapy, according to common protocol, and then patients in performance statuses 0 to 3 were randomized into control and N-CWS groups with stratification into 16 categories according to 4 histological types and 4 clinical stages In the N-CWS group, 400 micrograms N-CWS were initially injected once or twice into the bronchial tumor using a fiberoptic bronchoscope, and subsequently 200 micrograms of N-CWS were injected at monthly intervals into the skin from the shoulders to upper arms. Of 309 patients, 118 patients in the N-CWS group and 108 patients in the control group were eligible for statistical analysis. There was statistically no significant difference in survival rate between the control and the N-CWS groups. According to histological type, significant prolongation of the survival period was observed in patients with small-cell carcinoma. The 97 patients with pleural effusions were initially randomized into control and N-CWS groups. In the control group, local chemotherapy with Adriamycin was performed and, in the N-CWS group, local administrations and monthly intracutaneous injections of N-CWS were given. Tube thoracostomy was performed in both groups. The local response rate was statistically greater in the N-CWS group than in the control group, and survival period was also prolonged significantly in the N-CWS group. The main adverse reactions to N-CWS were skin lesions in the injected sites and fever, but these were temporary and not serious.

[Phase I study of an oral administration of VP 16-213]

A phase I study of VP-16-213 oral capsule was performed in 25 patients with various malignant tumors refractory to standard treatments. Doses were escalated from 50 mg/d to 300 mg/d by a 5-day administration. Leukopenia was dose-related and nadirs at 200 mg/d, 250 mg/d and 300 mg/d were 2,000, 1,600 and 700/cmm respectively, reaching in about 2 weeks and approximately one week was required for recovery. Thrombocytopenia was also dose-related but generally less frequent and milder than leukopenia. Gastrointestinal toxicities such as anorexia, nausea and vomiting occurred in about 20% of patients but well tolerated; alopecia was observed in 40%. The result indicated that an optimal dose of oral VP-16-213 for phase II study was daily 200 mg/d (approximately 130 mg/m2) for 5 consecutive administration in 3-week intervals.

[Conditions suitable for chemotherapy of lung cancer]

The influence of several factors for response to Chemotherapy and survival was analysed in 310 patients with inoperable lung cancer who were treated by single or combination chemotherapy. In small cell lung cancer, survival was strongly affected by the results of induction chemotherapy, and combination chemotherapy with three or four drugs was most effective. In non-small cell lung cancer, performance status and body weight loss on admission were important factors for response to chemotherapy and survival. Combinations did not improve the response rate in non-small cell lung cancer.

[Combination chemotherapy with peplomycin and carboquone (esquinon) for squamous cell carcinoma of the lung]

Eighteen previously untreated patients with squamous cell carcinoma of the lung were treated with a combination of a new bleomycin derivative, peplomycin and esquinon (PQ). One patient achieved a complete response (5.5%) and 5 patients a partial response (27.8%). Overall response rate was 33.3%. Median survival time of 6 patients with complete and partial response was 54 weeks and that of 12 patients with no change and progressive disease was 15 weeks. Toxicities included nausea and/or vomiting in 89%, fever in 61%, interstitial pneumonitis in 28% and leukopenia in 17%. PQ regimen appears to be effective in the treatment of squamous cell carcinoma of the lung.

[Calf blood flow at rest evaluated by thermal measurement with tissue temperature and heat flow and 133Xe clearance (author's transl)]

The regional blood flow in the calf was determined simultaneously by thermal measurement and by 133Xe clearance technique. Calf blood flow (Ft) by thermal measurement was accounted for by the equation of the form Ft = (CdTd + Ho - Mb)/rho bCD (Ta--Td), where Cd is thermal capacitance of the calf compartment, Td is the change of calf tissue temperature, Ta is arterial blood temperature, Td is calf tissue temperature, Ho is the heat dissipation from the compartment to the environment, Mb is estimated metabolism of the calf tissue and rho bCb is the product of density and specific heat of blood. The healthy men were chosen for the experiments. Total calf blood flow was 2.53 +/- 1.31 ml/(min-100 ml calf), and muscle blood flow was 2.63 +/- 1.69 ml/(min-100 ml muscle) and skin blood flow 7.19 +/- 3.83 ml/(min-100 ml skin) measured by 133Xe clearance. On the basis of the results, an estimate has been made of the proportions of the calf volume which can be ascribed to skin and muscle respectively. Estimated muscle and skin blood flow were correlated with total calf blood flow (r = 0.98).

Mutagenicities of 61 flavonoids and 11 related compounds

The mutagenicities of 61 flavonoids (naturally occurring flavonoid aglycones and flavonal glycosides and synthetic flavonoids) and those of 11 compounds structurally related to flavonoids were tested with Salmonella typhimurium strains TA100 and TA98. Among the 22 flavone derivatives tested, only wogonin was strongly mutagenic, while five derivatives, apigenin triacetate, acacetin, chrysoeriol, pedalitin, and pedalitin tetraacetate, were only weakly mutagenic. Two bisflavonyl derivatives, neither of which has a 3-hydroxyl group, were not mutagenic. Of the 16 flavonol derivatives tested, all except 3-hydroxyflavone and the tetra- and penta-methyl ethers of quercetin were mutagenic. Of the five flavanone derivatives tested, only 7,4-dihydroxyflavanone was mutagenic, showing weak activity. Of the four flavanolol derivatives tested, hydrorobinetin and taxifolin were weakly mutagenic. Of the six isoflavone derivatives tested, tectorigenin was weakly mutagenic. Of the 11 compounds in the miscellaneous group structurally related to flavonoids, only isoliquiritigenin was mutagenic, showing weak activity. For the emergence of strong mutagenicity, the double bond between positions 2 and 3 and the hydroxyl group at position 3 are required, except in wogonin, which does not have a hydroxyl group at position 3 but is strongly mutagenic to TA100. The 3-O-acetyl ester of flavonol, quercetin, was mutagenic with S9 mix, but 3-O-methyl ethers were not. Six flavonol glycosides, three quercetin glycosides and three kaempferol glycosides were mutagenic after preincubation with "hesperidinase," a crude extract of Aspergillus niger. Of 66 flavonoid agylcones and compounds structurally related to flavonoids, quercetin was the strongest mutagen. The carcinogenicity of this compound should be clarified because it is ubiquitously found in vegetables.

Characterization of mutagenic principles and carcinogenicity of dill weed and seeds

Among the various kinds of spices tested, the aqueous extracts of dill weed from Anethum graveolens L. and dill seeds from A. sowa D.C. (Umbelliferae), exhibited a mutagenicity to Salmonella typhimurium, strains TA98 and TA100. The aqueous methanol extracts were fractionated by the mutation assay using the strain TA98 with S-9 Mix. Isorhamnetin 3-sulfate (persicarin) and quercetin 3-sulfate were characterized as the mutagenic principles. Carcinogenicity was not observed for dill weed and seeds when the diets containing these in 33% were administered for 450 and 410 days, respectively, to the inbred strain ACI rats.

Small cell carcinoma of the lung and its histological origin. Report of a case

A rare lung cancer consisting in part of small cell carcinoma of intermediate cell type and in part of well-differentiated papillotubular adenocarcinoma is described. Alcian blue-PAS staining was observed in the cytoplasm of the small cell carcinoma cells; the Grimelius argyrophil reaction was also positive in the cytoplasm of these cells. Electron microscopy revealed neurosecretory granules in the cytoplasm. At autopsy, a small cell carcinoma of intermediate cell type was found with both squamous features and gland formation. The cellularity and histological pattern of this tumor suggested the existence of a transitional pattern between small cell carcinoma of intermediate cell type, squamous cell carcinoma and adenocarcinoma. From the above findings, we think that small cell carcinoma including the intermediate cell type is derived from respiratory epithelial cells of endodermal origin with dedifferentiation of those cancer cells into neurosecretory cells.