Correlation of expression of ABH blood group carbohydrate antigens with metastatic potential in human lung carcinomas

METHODS. The expression of ABH blood group carbohydrate antigens was examined histochemically in tumors and adjacent nontumorous tissues of 89 cases of human lung carcinoma in which nontumorous tissues expressed blood group carbohydrate antigens compatible with the erythrocyte blood group types. RESULTS AND CONCLUSIONS. Loss of ABH blood group antigens in lung carcinomas correlated with their metastatic potential, especially with the recurrence of hematogenous metastasis. Consequently, patients with tumors that retained compatible ABH blood group antigens showed a better prognosis than patients with tumors of altered antigenic profiles. The loss of blood group B antigen more significantly affected both the hematogenous metastasis and prognosis than that of A and H antigens.

Multif requency three-dimensional optical read-only memory disks using metallic island films: preliminary experiments

Basic operation of new multifrequency three-dimensional (3-D) optical read-only memory (ROM) disks has been demonstrated experimentally. Several types of metallic island film exhibiting a selectiveresonance absorption in a visible-near infrared region are used as recording layers on the 3-D disks. The monochromatic light with a suitable wavelength near the resonance wavelength of each layer is used for the readout of information. We demonstrate that bar-code patterns recorded in silver and copper island layers can be read by using transmitted or reflected light. Furthermore, we also show that the 3-D disks with ≥3 recording layers can be realized.

Vibrio parahaemolyticus has a homolog of the Vibrio cholerae toxRS operon that mediates environmentally induced regulation of the thermostable direct hemolysin gene

In an effort to identify the regulatory gene controlling the expression of the tdh gene, encoding the thermostable direct hemolysin of Vibrio parahaemolyticus, we examined total DNA of AQ3815 (a Kanagawa phenomenon-positive strain) for sequences homologous to that of the toxR gene of Vibrio cholerae. The extracted DNA gave a weak hybridization signal under reduced-stringency conditions with a toxR-specific DNA probe. Cloning and sequence analysis of the probe-positive sequence revealed an operon (Vp-toxRS) which was highly similar to the toxRS operon of V. cholerae (Vc-toxRS) (52 and 62% similarities in the two genes, respectively). The deduced amino acid sequences of the Vp-toxRS gene products (Vp-ToxRS) contained regions similar to the proposed transmembrane and activity domains of the Vc-toxRS gene products (Vc-ToxRS). All clinical and environmental strains of V. parahaemolyticus examined possessed the Vp-toxRS genes. In the presence of Vp-ToxS, Vp-ToxR promoted expression of the tdh2 gene, one of two tdh genes (tdh1 and tdh2) carried by Kanagawa phenomenon-positive strains. The DNA sequence located 144 bp upstream of the tdh2 coding region was shown to be important for the Vp-ToxR-stimulated expression of the tdh2 gene in an Escherichia coli background. Comparative analysis of AQ3815 and its isogenic Vp-toxR null mutant gave the following results: (i) Vp-ToxR promoted, in an AQ3815 background, expression of the tdh gene to different degrees in various culture media, with KP broth (2% peptone, 0.5% NaCl, 0.03 M KH2PO4, pH 6.2) being most effective (12-fold); (ii) the promotion of tdh gene expression in KP broth was at the level of transcription; and (iii) Vp-ToxR was essential for demonstration of enterotoxic activity of AQ3815 in the rabbit ileal loop, a model previously used to demonstrate thermostable direct hemolysin-mediated enterotoxic activity of AQ3815. These results demonstrate that Vp-ToxR and Vc-ToxR share a strikingly similar function, i.e., direct stimulation at the transcriptional level of the gene encoding a major virulence determinant (enterotoxin) of a Vibrio species.

Endoscopic ultrasonography in the diagnosis of an early esophageal carcinoma

Patients with epithelial or mucosal carcinoma of the esophagus are considered to have a much better prognosis than those with submucosal carcinoma, although both lesions are classified as superficial carcinomas of the esophagus. With this in mind, we evaluated the usefulness of endoscopic ultrasonography for pre-operatively distinguishing either epithelial or mucosal carcinoma from submucosal carcinoma by comparing the results of endoscopic ultrasonography with the histological findings established in resected specimens. Between 1987 and 1991, 26 patients with no pre-operative treatment were confirmed histologically to have epithelial (2 cases), mucosal (11 cases) or submucosal (13 cases) carcinomas of the esophagus. In 13 patients with epithelial or mucosal carcinoma, 10 were correctly diagnosed with endoscopic ultrasonography (76.9%), while the remaining 3 were overdiagnosed as being submucosal. In 13 patients with submucosal carcinoma, 12 were correctly diagnosed by endoscopic ultrasonography (92.3%), although another case was overestimated. Including one patient with an advanced carcinoma who was underdiagnosed by endoscopic ultrasonography as having a submucosal lesion, the overall accuracy of endoscopic ultrasonography was 81.5% for diagnosing the depth of invasion of a superficial esophageal carcinoma. The above results show that endoscopic ultrasonography can provide surgeons with important information in the pre-operative assessment of a superficial esophageal carcinoma.

Hyperthermo-chemo-radiotherapy for patients with early carcinoma of the esophagus

Hyperthermia combined with irradiation and chemotherapy (hyperthermo-chemo-radiotherapy) was prescribed pre-operatively for 21 patients with submucosal carcinoma of the esophagus, and its effectiveness was evaluated by a comparison with patients who also had massive submucosal carcinoma, but received no pre-operative treatment (n = 12). There was no difference in the survival rates of these groups (hyperthermo-chemo-radiotherapy group: 3-year survival in 56.6%), but the patients who responded well to the HCR therapy (n = 6) demonstrated better survival rates (3-year survival in 83.3%) than did the patients without any pre-operative treatment (3-year survival in 33.9%). An HCR sensitivity test using the succinate dehydrogenase inhibition test was devised and showed good correlation with the clinical remedial values (the diagnostic specificity was 0.89). An accurate diagnosis of the esophageal lesion and appropriate selection of potentially treatable cases are considered essential for the optimal use of HCR therapy in patients with submucosal carcinoma.

[A case of successful surgical treatment for bilateral pulmonary arteriovenous fistulas]

A 55-year-old man was admitted to our hospital with chief complaints of exertional dyspnea and chest x-ray abnormalities. On physical examinations, clubbing and systolic murmur were detected. The patient's hemoglobin rose to a level of 19.0 g/dl, with a rise in hematocrit to 58.8%. While the patient was breathing room air, the PaO2 was 52.8 mmHg, the PaCO2 33.3 mmHg and the pH 7.43. In chest x-ray film, oval well-margined 38 x 30 mm density with enlarged afferent and efferent vessels in the left upper lobe (lts4) and 15 x 13 mm "coin lesion" in the right lower lobe (rts7) were observed. Pulmonary angiography demonstrated that these lesions were arteriovenous fistulas. In cardiac catheterization, an estimated right to left shunt of 31.1% was calculated. Because of the exertional dyspnea and the large shunt, a segmentectomy of the lingula and a wedge resection of the rts7 were simultaneously performed. After the treatment, exertional dyspnea, hypoxia and polycythemia disappeared. As far as we know, this patient is one of the most elderly patients in Japan to be successfully treated surgically for bilateral pulmonary arteriovenous fistulas.

Carcinomatous invasion and lymphocyte infiltration in early esophageal carcinoma with special regard to the basement membrane. An immunohistochemical study

We examined 24 cases of superficial esophageal carcinoma and evaluated 94 areas, including 43 intra-epithelial (ep), 36 mucosal (m) and 15 submucosal (sm) areas, using the immunohistochemical staining of laminin to detect the basement membrane. The staining pattern was divisible into three patterns, i.e., continuous, fragmentary and defective. Defective patterns were observed in 14%, 53%, and 73% of the ep, m, and sm lesions, respectively (p < 0.01). With regard to the degree of lymphocyte infiltration, 77% of the continuous areas were accompanied by a low lymphocyte infiltration, while 56% of the defective areas were accompanied by dense infiltrations with follicle formation. Lymphocyte infiltration was thus statistically significantly (p < 0.01) more closely associated with the defective areas than with the continuous areas. Furthermore, urokinase-type plasminogen activator was detected immunohistochemically in 11.1% of the defective areas, and in none of the continuous areas. These findings suggested 1) that superficial esophageal carcinoma might progress while destroying the basement membrane, and 2) that as host immune reactions lymphocytes might infiltrate the lesions where the basement membranes were destroyed and cancer cells exposed to the underlying layer. The findings also suggested the possibility that the degradation of the basement membrane might be caused by proteolytic enzymes produced by cancer cells.

DNA ploidy as a prognostic factor in early esophageal carcinoma

Cell nuclear DNA content was cytophotometrically determined in biopsy specimens obtained from thirty-five patients with superficial esophageal carcinoma. The relationship between the DNA distribution pattern and histopathological features, prognosis and postoperative survival time was then investigated. Patients with a low ploidy pattern had a more favorable postoperative course, with 62% attaining a 5-year survival rate, than those with high ploidy, of whom 34% attained a 5-year survival rate (p < 0.01). The recurrence rate was higher for the high ploidy pattern (64.3%) than for the low ploidy pattern (35.3%). Moreover, the rate of recurrence within 2 years was 50% in high ploidy, which was higher than the 5.9% rate in the case of low ploidy (p < 0.05). Although there was no clearly established relationship between the DNA distribution pattern and clinicopathological features, a multivariate analysis revealed that the DNA distribution pattern was one of the independent and significant prognostic factors of superficial esophageal carcinoma. These results thus suggest the usefulness of a preoperative DNA analysis of biopsy specimens in predicting the prognosis and determining perioperative therapeutic strategy for both superficial esophageal carcinoma and for advanced cases.

Histopathology of early esophageal carcinoma and squamous epithelial dysplasia

To examine the histogenesis of esophageal cancer and the pathological relationship between dysplasia and carcinoma of the esophagus, 44 cases of superficial esophageal carcinoma (restricted to within the submucosal layer) who received no pre-operative treatment were reviewed retrospectively. There were 40 dysplastic lesions in 17 cases (38.6%) and epithelial dysplastic lesions were classified into 6 with mild, 17 with moderate and 17 with severe, degrees of dysplasia. Although the continuity of dysplastic lesions with the carcinomatous areas was not frequent (35.0%), it was more often encountered in severe dysplasia than in moderate or mild dysplasia, suggesting some relationship between the severity of dysplasia and carcinoma. In the cases with a dysplastic lesion, multiplicity of squamous cell carcinoma was more frequently seen (p < 0.01), suggesting a multicentric occurrence of dysplastic lesions and carcinomas.

Optimality analysis of vascular-tissue system in mammals for oxygen transport

The efficiency of the vascular-tissue system in mammals for oxygen (O2) transport to tissue was evaluated by employing the following simulation models; (i) the spherical tissue model for assessing the maximum tissue mass for which a certain number of capillaries located in the center of each sphere can deliver sufficient O2; (ii) the minimum volume model of the multi-terminal vascular system for estimating the energy cost of blood flow supply to that number of capillaries; and (iii), the efficiency evaluation of the whole system by the ratio (the maximum O2 uptake)/(the energy cost). The computer simulation was carried out by inputting the physiological estimates of tissue O2 consumption rate and cardiac output of mammals in the resting and exercising states, which were calculated from the statistically determined power functions of body weight (the allometric relationship) in the range of 10 g to 500 kg. The results obtained from the data during exercise revealed that the optimum capillary number attaining the maximum efficiency alters nearly in proportion to the body weight and that the total tissue mass corresponding to the optimum capillary number agrees well with the actual tissue mass for virtually all the mammals, while their maximum efficiency remains constant. From these results, it is concluded that any mammal is provided with an equally efficient mass transport system, which is optimized for O2 transport to tissue under the highest metabolic activity, regardless of body weight variation. This may suggest one of the reasons why so many species of mammals with greatly different sizes can exist on the earth.

Expression of Sialyl-Tn antigens in normal squamous epithelium, dysplasia, and squamous cell carcinoma in the esophagus

Two monoclonal antibodies, TKH2 and B72.3, directed toward the Sialyl-Tn antigen (SA 2, 6GalNAc alpha-O-Ser/Thr), were examined immunohistochemically to analyze the expression of these antigens in 20 areas of normal squamous epithelium, 12 lesions of dysplasia, and 86 cases of squamous cell carcinoma including 32 with superficial carcinoma in the esophagus. No expression of TKH2 or B72.3 was found in the normal squamous epithelium. Among the 12 lesions of dysplasia only one expressed TKH2. In carcinoma the expression of TKH2 and B72.3 was found in 40 (47%) and 21 (24%) of the 86 carcinomas, respectively; however, the number of positive malignant cells with TKH2 and B72.3 totaled less than half that in the tissue, and no relationship was found between either prognosis or lymph node metastasis and the expression of Sialyl-Tn antigen. These results indicate that Sialyl-Tn antigen appears in the process of malignant transformation or tumor progression in esophageal squamous cell carcinoma; however, the positive expression of Sialyl-Tn antigen was not directly connected to either prognosis or lymph node metastasis.

[Intracavernous injection of lipo prostaglandin E1 for the diagnosis of impotence: a comparative study with prostaglandin E1-CD]

Intracavernous injection of 20 micrograms prostaglandin E1-CD (PGE1-CD, 8 cases), 5 micrograms lipo prostaglandin E1 (Lipo PG-E1, 8 cases) or 10 micrograms Lipo PGE1 (9 cases) was performed in patients with functional impotence in order to comparatively analyze the diagnostic efficacy of these drugs. Full erection was observed in all patients who received intracavernous injection of 20 micrograms PGE1-CD or 10 micrograms Lipo PGE1. However, full erection was observed in 4 out of 8 patients administered 5 micrograms Lipo PGE1. RigiScan was used on all patients, and latency until erection (achievement of maximum rigidity of the base) after injection, maximum rigidity of the penile tip and base and circumferential expansion rate of the penile tip and base were measured. With regard to these RigiScan data and duration of erection, there were no significant differences among the 3 groups. There were no severe side effects in any of the patients. These findings indicate that 10 micrograms Lipo PGE1 and 20 micrograms PGE1-CD have similar effects and that Lipo PGE1 may be an effective drug for the diagnosis and treatment of impotence.

Surgical treatment of esophageal carcinoma in patients eighty years of age and older

Before 1979, no patient 80 years of age or older had been operated on at our institution for esophageal cancer, while in the middle period (1980-1984), three patients were operated on, and postoperative pulmonary complications and operative death occurred in 66.7 and 33.3%, respectively. However, in the recent period (1985-1990), there was no postoperative morbidity or mortality in the five cases over age 80. On the other hand, there were 12 patients over age 80 who did not undergo operation, of whom all died of cancer. In the eight operated patients over age 80, two cases are still alive 17 and 34 months after operation. According to the above findings, when the patient's general condition is evaluated to be sufficient to tolerate the operation and the cancer is judged to be resectable, esophageal resection is thought to be indicative in all patients over eighty.

Prevention of perinatal transmission of hepatitis B virus carrier state

By means of passive and active immunization with hepatitis B immunoglobulin and hepatitis B vaccine, 396 of 407 babies born to hepatitis B antigen-positive carrier mothers, were protected from establishing the hepatitis B virus (HBV) carrier state during a follow-up period of 12 months or longer. Four infants developed the HBV carrier state before the completion of the immunoprophylaxis schedule, and another seven developed the state after the completion of the schedule. Seroconversion of anti-HBc was observed in 26.8% of the successfully protected infants. In Japan a nationwide program to prevent the vertical transmission of HBV with these procedures was established in 1986, and so liver diseases due to HBV are expected to be eliminated in the near future.

Hyperthermo-chemo-radiotherapy as a definitive treatment for patients with early esophageal carcinoma

Ten patients with early stage esophageal carcinoma were treated with hyperthermo-chemo-radiotherapy (HCR) without surgery. The reasons for the inoperability of these patients included medically inoperable unresectable cancers, advanced age, and/or refusal to undergo surgery. The diagnosis of early esophageal carcinoma was determined by esophagograms, endoscopy, and ultrasonography. Squamous cell carcinoma was histopathologically confirmed in each case. Each patient underwent four to nine sessions of hyperthermic treatment combined with external irradiation and chemotherapy using bleomycin; eight of these patients received additional radiation, and two terminated treatment after the HCR therapy. The tumors in all patients showed either a complete response (CR) or a partial response (PR) after HCR therapy; in two patients viable cancer cells remained, but later disappeared after additional radiation. Five patients experienced no local recurrence for 12 to 70 months and are now alive and doing well, three died of other medical conditions without any evidence of esophageal cancer, and two died of recurrent esophageal cancer 20 to 27 months after initial admission. All ten patients tolerated the HCR well without any systemic side effects. However, in two patients, esophageal erosion was recognized endoscopically. HCR therapy therefore deserves serious consideration when treating patients with small malignant lesions of the esophagus who, for various reasons, are unable to undergo surgery.

Effect of stilbene derivatives on gastric H+, K(+)-ATPase

The effect of naturally occurring hydroxystilbene, 3,3',4,5-tetrahydroxystilbene (piceatanol), and its derivatives on gastric H+, K(+)-ATPase was studied. Piceatanol inhibited H+, K(+)-ATPase in a dose-dependent manner. The 50% inhibition value was 4.3 x 10(-6) M. It was found from the kinetic study that the inhibition of the enzyme by piceatanol was competitive with respect to ATP and was noncompetitive with respect to K+. Piceatanol also effectively inhibited gastric acid secretion. However, methylation of phenolic hydroxy groups of piceatanol resulted in a complete loss of inhibition of the enzyme and acid secretion, suggesting the role of phenolic hydroxy groups in the inhibition. The study on hydroxystilbene derivatives also showed that phenolic hydroxy groups are important in the interaction with H+, K(+)-ATPase and that stilbenes with neighbouring hydroxy groups are the most effective inhibitors.

Detection of human papillomavirus DNA in esophageal carcinoma in Japan by polymerase chain reaction

BACKGROUND

Human papillomaviruses (HPV) have been implicated strongly in the pathogenesis of human squamous cell carcinomas, especially of anogenital carcinomas. Some pathologic changes of the esophagus may be one of the candidates for HPV etiology, but the role of HPV infections in the carcinogenesis of the esophagus remains to be clarified.

METHODS

To elucidate the association of HPV with carcinogenesis of the esophagus, 45 biopsy samples of esophageal squamous cell carcinomas were examined for the presence of HPV DNA by polymerase chain reaction (PCR). Primers for PCR were (1) consensus primers (CP) for the simultaneous amplification of the E6-E7 regions of cancer-associated HPV types (HPV 16, 18, 31, 33, 52b, and 58), which have been shown to have transforming activities; (2) type-specific primers (SP16, SP18) for the E7 regions of HPV 16 and HPV 18, respectively; and (3) general primers (GP) for the simultaneous amplification of the L1 regions of HPV 6, 11, 16, 18, 31, and 33.

RESULTS

PCR using CP first was done for screening and showed that 3 (6.7%) of 45 specimens contained HPV 16 or HPV 18 DNA, the oncogenic high-risk HPV types. This was confirmed by SP16 and SP18 PCR. However, no HPV DNA was detected by PCR using GP. These results suggested that the HPV DNA detected might be integrated into the cell genome with their transforming genes retained and their late regions deleted.

CONCLUSIONS

Most oncogenic types of HPV (HPV 16 and HPV 18) were detected by PCR in carcinomas of the esophagus. Thus, HPV might play a role, although at a low frequency, in carcinogenesis of the esophagus.

Endoscopic diagnosis of early carcinoma of the esophagus using Lugol's solution

Small esophageal lesions, particularly intraepithelial cancers, are extremely difficult to detect. We used Lugol's iodine solution with panendoscopic examination to detect the presence and spread of small squamous cell carcinomas of the esophagus. Serial histologic specimens of the surgically removed esophagus from 32 patients with Lugol's combined endoscopic diagnosis of early esophageal carcinoma were examined to determine the correlation between endoscopic and histologic findings. All of the early staged carcinomas clearly remained unstained by Lugol's solution. We believe that the application of Lugol's solution will greatly aid in instances when a suspicious mucosal lesion is noted, when the margin of the lesion is unclear, or when there is suspicion that a mucosal lesion may have been overlooked.

Evaluation of enzyme immunoassay using a recombinant envelope protein expressed in insect cells for serological confirmation of HTLV-I infection

A recombinant human T-lymphotropic virus type I (HTLV-I) envelope protein expressed in insect cells using a recombinant baculovirus was employed as the antigen in an enzyme immunoassay (renvEIA). Peripheral blood samples were obtained from asymptomatic carriers or healthy individuals. Plasma was tested for HTLV-I antibody by renvEIA, particle agglutination, and Western immunoblot (WB), and lymphocyte DNA was tested for HTLV-I proviral DNA amplification by polymerase chain reaction (PCR). Of 61 people aged 9 months or older, 23 were positive (gag+, env+) and 19 others were in the "indeterminate" category (gag+, env-) when their WB results were interpreted according to the WHO-proposed criteria. Thirty-seven cases, including all of the WB+ cases and 14 of 19 WB indeterminate cases, were positive by renvEIA. In 34 of 37 renvEIA-positive cases, the presence of long terminal repeat (LTR) and tax/rex region of HTLV-I proviral DNA was detected by polymerase chain reaction (PCR) and following Southern blot hybridization. Thus, renvEIA would be a useful supplemental assay to confirm the presence of HTLV-I antibody in HTLV-I asymptomatic carriers.

Detection of human papillomavirus DNA in esophageal carcinoma in Japan by polymerase chain reaction

BACKGROUND

Human papillomaviruses (HPV) have been implicated strongly in the pathogenesis of human squamous cell carcinomas, especially of anogenital carcinomas. Some pathologic changes of the esophagus may be one of the candidates for HPV etiology, but the role of HPV infections in the carcinogenesis of the esophagus remains to be clarified.

METHODS

To elucidate the association of HPV with carcinogenesis of the esophagus, 45 biopsy samples of esophageal squamous cell carcinomas were examined for the presence of HPV DNA by polymerase chain reaction (PCR). Primers for PCR were (1) consensus primers (CP) for the simultaneous amplification of the E6-E7 regions of cancer-associated HPV types (HPV 16, 18, 31, 33, 52b, and 58), which have been shown to have transforming activities; (2) type-specific primers (SP16, SP18) for the E7 regions of HPV 16 and HPV 18, respectively; and (3) general primers (GP) for the simultaneous amplification of the L1 regions of HPV 6, 11, 16, 18, 31, and 33.

RESULTS

PCR using CP first was done for screening and showed that 3 (6.7%) of 45 specimens contained HPV 16 or HPV 18 DNA, the oncogenic high-risk HPV types. This was confirmed by SP16 and SP18 PCR. However, no HPV DNA was detected by PCR using GP. These results suggested that the HPV DNA detected might be integrated into the cell genome with their transforming genes retained and their late regions deleted.

CONCLUSIONS

Most oncogenic types of HPV (HPV 16 and HPV 18) were detected by PCR in carcinomas of the esophagus. Thus, HPV might play a role, although at a low frequency, in carcinogenesis of the esophagus.

Passive immunizations of suckling mice and infants with bovine colostrum containing antibodies to human rotavirus

After immunizing 8-month pregnant Holstein cows with the human rotavirus MO strain, cow colostrum containing neutralizing antibody to four different serotypes of human rotavirus, designated Rota colostrum, was obtained. Oral inoculation of human rotavirus MO strain into 5-day-old BALB/c mice causes gastroenteritis characterized by diarrhea. Using this small animal model, passive protection of suckling mice against human rotavirus infection was achieved with the use of Rota colostrum. Rota colostrum completely protected against rotavirus infection, but purified IgG and IgA obtained from Rota colostrum were unable to protect against infection. After grouping randomly 20 infants from a baby care center, 10 infants received 20 ml of Rota colostrum per day for 2 weeks and 10 control infants did not. Rotavirus-associated diarrhea developed in 7 of 10 infants in the control group. None of the three infants in the every day recipient group of Rota colostrum had such symptoms, and one of three infants in the every other day recipient group developed rotavirus-induced diarrhea. All four infants who received Rota colostrum after symptoms appeared developed diarrhea. Oral administration of Rota colostrum seems to be an effective and safe means of preventing diarrhea caused by human rotavirus infection.

[A clinical study of combined therapy of aspoxicillin and ceftazidime on intractable respiratory infections]

Both aspoxicillin (ASPC) and ceftazidime (CAZ) were administered together to 55 patients with intractable respiratory tract infections. ASPC and CAZ were administered at daily doses of 4 g and 2 to 4 g, respectively. Clinical effects were excellent in 11 cases, good in 33, fair in 7 and poor in 4, thus the efficacy rate was 80.0%. Bacteriologically, identified organisms were eradicated in 14 cases out of 21, decreased in 3, exchanged in 2 and unchanged in 2. The eradication rate was 76.2%. As a side effect, diarrhea was found in only one case, and abnormal laboratory test values were observed in 4 cases. However, these adverse reactions were not severe, therefore it was possible to continue the chemotherapy. These results indicate that the combination antimicrobial chemotherapy of ASPC and CAZ is effective against intractable respiratory tract infections.

[Mode of origin of esophageal squamous cell carcinoma--serial histopathologic and immunohistochemical studies]

I. Serial histopathologic study of esophageal squamous cell carcinoma. A review of 335 cases of squamous cell carcinoma disclosed 55 cases (16.4%) with glandular components in addition to the ordinary component of squamous cell carcinoma, suggesting that this type of esophageal tumor had originated not only from the covering squamous epithelium but from esophageal gland or ductal epithelium. Intra-epithelial carcinoma concomitant with squamous cell carcinoma was seen in 95 cases (28.4%). The incidences of coexistence in such lesion were higher in the groups of early stage esophageal cancer. These observations support the concept of field carcinogenesis of esophageal cancer. II. Histopathologic study of squamous epithelial dysplasia. Among 91 cases without preoperative treatment, there were 40 dysplastic lesions in 23 cases (25.3%). The continuity of dysplasia to the carcinoma was 48.3% and it was often encountered in severe dysplasia rather than in moderate or mild dysplasia, suggesting some relationship between the severity of dysplasia and carcinoma. III. Immunohistochemical study of EGF and c-myc. Among 27 cases, EGF was positive in 10 (37.0%). c-myc was positive in 18 (66.7%) not only cancer but normal epithelium suggesting that some change of products of oncogene occurred also in the normal epithelium of the patients of esophageal cancer.

Immunization of the elderly and patients with collagen vascular diseases with live varicella vaccine and use of varicella skin antigen

Elderly subjects and patients with collagen vascular diseases were immunized with a live varicella vaccine to assess the vaccine's potential for preventing herpes zoster. An improved varicella-zoster virus (VZV) skin test antigen was then used to assess cell-mediated immunity to VZV. The antigen was prepared from culture fluid of VZV-infected cells and had far less protein content than crude antigen prepared by sonication of infected cells. In 11 of 12 patients with ophthalmic zoster and 17 of 21 with dermal zoster, the skin reaction was negative at the beginning of the disease but became positive later. After two doses of VZV vaccine, 8 of 12 elderly subjects (greater than 60 years old) and 4 of 6 patients with collagen vascular diseases, who were VZV-skin test negative but purified protein derivative tuberculin test-positive, became VZV skin test-positive.