Left renal pelvis of male neonates is predisposed to dilatation

Dilatation of the renal pelvis has been observed as an ultrasonographic finding of ureteral reflux as well as hydronephrosis. However, little information is available on the prevalence of renal pelvis at dilatation in neonates. We measured the inner pelvis dimension of the kidneys in 511 apparently healthy neonates (279 boys and 232 girls) using an ultrasound scanner to determine the prevalence of renal pelvis dilatation. Ninety per cent of the neonates had an inner dimension of both renal pelvises below 5 mm. The prevalence of left renal pelvis dilatation of 5 mm or more was significantly higher in the boys than in the girls, 25 (9%) compared to 5 (2%). In contrast, no significant difference was found in the prevalence of right renal pelvis dilatation between the sexes. In the boys, the prevalence of renal pelvis dilatation of 6 mm or more was significantly higher on the left side than on the right. Moreover, the left renal pelvis dilatation of the male neonates had a tendency to persist at 1 month of age. These findings suggest that the left renal pelvis of the baby boy may be predisposed to dilatation.

[Late phase II trial of high-dose l-leucovorin and 5-fluorouracil in advanced colorectal carcinoma. l-Leucovorin and 5-FU Study Group (Japan Eastern Group)]

A multicenter cooperative study was conducted from Dec. 1992 to April 1994 to evaluate the clinical efficacy of high-dose l-leucovorin (l-LV) and 5-fluorouracil (5-FU) treatment in 76 patients with advanced colorectal carcinoma. Treatment consisted of intravenous bolus injection of 5-FU (600 mg/m2) 1-hour after the initiation of a 2-hour infusion l-LV (250 mg/m2), 6 weekly treatments were administered followed by a two-week rest. These treatment were repeated until progressive disease or intolerable toxicity. Seventy patients were evaluated for response. Responses were the following: PR 21, NC 29, PD 20 and the overall response rate was 30%. Grade 4 hematological side-effect was observed in three cases, and severe diarrhea in one case. These data suggested that high-dose l-LV and 5-FU was effective for advanced colorectal carcinoma but showed some hematological toxicity, and a further investigation should be carried out.

Magnetic resonance imaging of titanium anterior cervical spine plating systems

Magnetic resonance imaging (MRI) of titanium anterior cervical plating systems and their effect on postoperative images were evaluated ex vivo and in vivo. The Synthes and Caspar plating systems were examined by 0.5- or 1.5-T MRI scanners. A phantom study of these implants showed that in spin-echo modes, the plates and screws were seen as areas of signal loss accompanying a marginal hyperintense band, which was more obvious in higher tesla magnetic fields. Distortion of the magnetic field was more prominent in T2-weighted images. In gradient echo mode, the plate and screws were seen as areas of signal loss larger than the size of the metal because of the magnetic susceptibility effect. Postoperative MRI produced images of the implants similar to those observed ex vivo. The Synthes plating system did not interfere with the evaluation of the spinal cord, and the Caspar screw (which penetrated the posterior cortex of the vertebral body) caused a small artifact to be present at the anterior aspect of the spinal cord. In addition to being able to provide fixation of the cervical spine, titanium anterior cervical plates allow superior MRI of the postoperative spine.

Effects of platelet activating factor on mouse embryo implantation in vitro

PURPOSE

Our purpose was to assess the role of platelet activating factor (PAF) in embryo implantation, we examined the effects of PAF and a PAF antagonist on the in vitro implantation of mouse embryos, using an in vitro embryo culture system in the absence of the endometrium.

METHODS

BDF1 mouse pronuclear-stage embryos were cultured until they developed to the two-cell, the four- to eight-cell, or the morula stage in the absence of PAF or its antagonist CV6209. The medium was then changed and supplemented with PAF or CV6209 at various concentrations. We also examined the reversible effects of PAF addition to the media containing the PAF antagonist.

RESULTS

The addition of PAF to the culture from the two-cell stage significantly (P < 0.05) increased the rates of embryo implantation in vitro (control, 69.8%; 10(-10) M PAF, 90.1%; 10(-9) M PAF, 95.5%). Similarly, the addition of PAF to the cultures from the four- to eight-cell and morula stage also significantly (P < 0.05) increased their rates of implantation in vitro. In contrast, the addition of CV6209 to the culture significantly (P < 0.01) decreased the rates of embryo implantation in vitro. CV6209 also decreased the rate of blastocyst formation. The degree of inhibition by CV6209 decreased with the advancing stage of embryos. The addition of PAF to media containing CV6209 reversed the inhibition and restored the implantation rate in vitro.

CONCLUSIONS

These results suggest that PAF may act directly on the mouse embryo and favor its implantation like an autocrine activating factor, irrespective of the presence or absence of the endometrium.

[The effect of combination treatment consisted of 5'-deoxy-5-fluorouridine and medroxyprogesterone acetate for recurrent breast cancer patient]

The effect of the combination treatment consisted of 5'-deoxy-5-fluorouridine (5'-DFUR) and medroxyprogesterone acetate (MPA) was investigated in 20 recurrent breast cancer patients. Out of 20 patients, 8(40.0%) responded to the treatment. The average duration of response was 10.3 months. Response rates stratified by recurrence site were soft tissues 36.4%, bone 44.4%, liver 60.0% and lung 20.0%, respectively. No serious side effect except body weight gain, which was caused by MPA, was seen. In a 76-year-old woman with liver metastases, a marked response was obtained and has continued for more than 24 months. It was suggested that the combination of 5'-DFUR and MPA may be effective for recurrent breast cancer patients.

Expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase in human breast cancer

We have investigated the expression of platelet-derived endothelial-cell growth factor/thymidine phosphorylase (PD-ECGF/dThdPase) in human breast-cancer tissues by the immunocytochemical method using anti-PD-ECGF/dThdPase monoclonal antibody. Out of 100 invasive-ductal-carcinoma tissue samples, 39 (39%) were evaluated as PD-ECGF/dThdPase-positive. The expression of PD-ECGF/dThdPase was identified mainly in the cytoplasma of tumor cells. The expression of PD-ECGF/dThdPase was significantly associated with the microvessel density assessed by immunostaining to factor-VIII-related-antigen (p < 0.05). However, there was no correlation between expression of PD-ECGF/dThdPase and menopausal status, tumor size, axillary lymph-node metastases, hormone-receptor status, epidermal-growth-factor receptor, or erb-B-2-protein and p53-protein expression. We suggest that expression of PD-ECGF/dThdPase plays an important role in the promotion of angiogenesis in human breast cancer.

[Early phase II trial of l-leucovorin and 5-fluorouracil in advanced colorectal cancer. l-Leucovorin and 5-FU Study Group]

We report the results of a multicenter clinical trial comparing three combination chemotherapeutic regimens including 5-fluorouracil (5-FU) and l-leucovorin (l-LV). One hundred and twenty-two patients were randomized to three regimens comprising 5-FU (600 mg/m2) plus high-dose l-LV (250 mg/m2) in six doses given weekly by i.v. injection midway during a 2-hr infusion of l-LV (regimen A), 5-FU (370 mg/m2) plus high-dose l-LV (100 mg/m2) given simultaneously for 5 consecutive days and a 23-day interval between treatments (regimen B) and 5-FU (370 mg/m2) plus low-dose l-LV (10 mg/m2) with the same dose administration schedule as regimen B (regimen C). The response rates were 32.4% (12/37 cases) in Regimen A, 20.0% (8/40) in regimen B and 11.1% (4/36) in regimen C. The most prominent side effects observed in regimen A were diarrhea (53.8%) and leukopenia (53.8%); however, they were within permissible levels. The combinations of high-dose l-LV and 5-FU (regimen A and B) had higher response rates than that of low dose l-LV and 5-FU (regimen C). Weekly administration of high-dose l-LV and 5-FU (regimen A) is now being expanded to late phase II trials.

[Significance of tumor angiogenesis as an independent prognostic factor in axillary node-negative breast cancer]

The value of tumor angiogenesis, EGFR and c-erbB-2 oncoprotein, a long with p 53 protein expression for predicting relapse-free survival was investigated in 110 node-negative breast cancer patients. The grade of neovascularization was assessed by the microvessel density which was obtained by an immunocytochemical staining by factor VIII-related antigen. EGFR, c-erbB-2 oncoprotein and p 53 oncoprotein were also determined by immunocytochemical assay. Univariate analysis showed no statistical significance of EGFR, c-erbB-2 and p53 status as a prognostic indicator. However, the microvessel density was a significant predictor of relapse-free survival. Patients with over 100 counts of factor VIII-RA positive cells per mm2 field in the most active areas of neovascularization showed significantly poorer prognosis compared to those with less than 100 counts (p < 0.005). Multivariate analysis demonstrated that microvessel density was an independent prognostic indicator in node-negative breast cancer patients (p < 0.0005). It was suggested that microvessel density might be of use in selecting the high-risk group in node-negative breast cancer patients needing adjuvant therapies.

[Long-term clinical study on TAP-144-SR, an LH-RH agonist depot formulation, in premenopausal patients with advanced or recurrent breast cancer. TAP-144-SR Breast Cancer Study Group]

Efficacy and safety of long-term treatment with an LH-RH agonist, TAP-144-SR were studied in premenopausal patients with advanced or recurrent breast cancer. The drug was given sc every 4 week at the dose of 3.75 or 7.5mg. The best objective response rates were 37.0% (17/46) in 3.75mg group, 30.6% (15/49) in 7.5mg group, respectively. The median duration of 12 PR patients in 3.75mg group was 280 (range: 84-830+) days. Serum estradiol level was maintained at < 30pg/ml in most patients given 3.75mg or 7.5mg as scheduled. There was no adverse reactions specific to the longterm administration subsequent to the foregoing 12-week administration study in both dose groups. In conclusion, TAP-144-SR is expected to be one of the first line therapies for patients with premenopausal breast cancer.

A similarity and a difference between two models of late eosinophil accumulation into the airway induced by antigen exposure in actively sensitized brown Norway (BN) rats

1. Exposure of sensitized Brown Norway (BN) rats to ovalbumin aerosol induced a remarkable and a sustained accumulation of eosinophils into broncho-alveolar lavage (BAL) fluid. 2. When male BN rats, sensitized by i.m. injection of ovalbumin and i.p. injection of killed Bordetella pertussis, were exposed to the antigen on day 14, eosinophils accumulated into BAL fluid, maximal 48 hr after antigen exposure. This accumulation of eosinophils was inhibited completely by administration of cyclosporin A (Cs A, 50 mg/kg/day) during induction phase, whereas it was inhibited slightly by administration of CsA (50 mg/kg) during the effector phase. 3. When BN rats were sensitized by weekly exposure of ovalbumin, eosinophils accumulated into BAL fluid, maximal 48 hr after the third exposure of antigen. The accumulation of eosinophils by this method was observed only in female rats and was inhibited completely by administration of CsA (50 mg/kg) during induction phase, whereas it was inhibited slightly by administration of CsA (50 mg/kg) during effector phase. 4. The present study demonstrates similarities and differences between two models of eosinophilia and also suggests increased function of T cells in BN rats.

[A randomized early phase II study of l-leucovorin and 5-fluorouracil in gastric cancer. l-Leucovorin and 5-FU Study Group]

A randomized early phase II study using l-leucovorin (l-LV) and 5-fluorouracil (5-FU) in gastric cancer was conducted. The administration schedules: Arm A was 250 mg/m2 of l-LV and 600 mg/m2 of 5-FU weekly, arm B was 100 mg/m2 of l-LV and 370 mg/m2 of 5-FU for 5 consecutive days, and arm C was 10 mg/m2 of l-LV and 370 mg/m2 of 5-FU for 5 consecutive days. PR was obtained in 10/28 (35.7%) of arm A, 7/28 (25.0%) of arm B and 0/17 (0%) of arm C, in complete cases. In eligible cases, 30.3%, 21.9% and 0%, respectively. Because there was no responder in arm C, the entry to arm C was stopped by controller at the point where 17 patients were treated with arm C. Median survival time was 9.6 months in arm A, 8.0 months in arm B and 5.9 months in arm C. Major toxicities were stomatitis, diarrhea and neutropenia. Stomatitis was seen more in arm B and C than in arm A. These data suggest that the high dose of l-LV and 5-FU seems to be a very promising combination, but there was no responder using low-dose l-LV schedule against gastric cancer. We thus selected arm A for the next late phase II study against gastric cancer.

[A dose-comparative study on TAP-144-SR, an LH-RH agonist depot formulation, in premenopausal patients with advanced or recurrent breast cancer. TAP-144-SR Breast Cancer Study Group]

A comparative phase II study was performed with different doses of TAP-144-SR in ER-positive or ER-unknown premenopausal patients with advanced or recurrent breast cancer. One hundred and six patients were randomly allocated to either 3.75 mg or 7.5 mg treatment by a centralized telephone registration system. TAP-144-SR was administered sc at 4-week intervals for 12 weeks (a total of 3 injections). Ninety-five cases were evaluated with the response rate of 30.4% (14/46) in the 3.75 mg group and 24.5% (12/49) in the 7.5 mg group, respectively. Serum estradiol was decreased to postmenopausal level (< 30 pg/ml) within 3-4 weeks after the first dose in the both dose groups, and this suppression was maintained throughout the treatment period. The adverse reactions most frequently observed were climacteric disturbances like hot flashes which was likely to be due to the hypoestrogen status. In conclusion, there was no significant difference between both dose groups in terms of response rates, adverse effects, and hormonal suppression. Therefore, the lower dose is recommended for the further study.

[Clinical effects of carmofur (Mifurol) on advanced and recurrent breast cancer in a cooperative study. Research association for re-evaluation of direct effects of Mifurol on breast cancer]

The direct effect and safety of carmofur (Mifurol) in cases of advanced and recurrent breast cancer were evaluated as a cooperative study at twenty-two facilities nationwide. Carmofur 12 mg/kg/day within the maximum daily dose of 600 mg was administered orally for eight weeks or longer. Of 42 patients registered for the study, 38 met the eligibility criterial (qualified patients), of whom 31 completed all tests for evaluation (completely qualified patients). The response rates were 18.4% with the qualified patients (PR, 7; Long NC, 3; NC, 11; PD, 12; NE, 5; ie, 7/38), and 22.6% with the completely qualified patients (PR, 7; Long NC, 2; NC, 10; PD, 12; ie, 7/31). The interval before the onset of PR after administration of carmofur was started was a minimum 29 days, a maximum 190 days and a median 82 days. Side effects were observed in eighteen patients (42.9%). Frequent micturition, loss of appetite, dizziness or feverish feeling were major symptoms, but none were serious.

[The clinical phase I study of TNP-351. The TNP-351 Research Committee]

The clinical phase I study of TNP-351, an antifolate drug having a novel structure, was performed through a multicenter cooperative program in 40 patients with solid tumors. The test drug was used on dosage schedules of single and daily doses for 5 or 3 days (by intravenous drip over 30 minutes, respectively). From the daily administration for 5 days, severe adverse reactions such as myelosuppression, became manifest at 5 mg/m2 (1n). This schedule was then switched to daily administration for 3 days. Administration of the test drug was initiated at a dose of 5 mg/m2. On a single-dose schedule, the dose was increased up to 100 mg/m2 (20 n), and on the 3-day daily administration schedule, up to 10.8 mg/m2 (2.2 n). Consequently, 26 of the study patients received single doses; three of them the 5-day daily administration, and 11 the 3-day daily administration. The dose-limiting factors were leukopenia and thrombopenia on both the single-dose and 3-day daily administration schedules. MTD was 100 mg/m2, and MAD, 75 mg/m2 for the single-dose schedule; and 10.8 mg/m2 and 9 mg/m2 for the 3-day daily administration schedule. WBC and platelet counts fell to nadirs at 1-2 weeks on either the single-dose or 3-day daily administration schedule, and it took the respective parameters about 1 week to recover. Subjective and objective adverse reactions to the test drug consisted of digestive tract disorders manifested as stomatitis, anorexia, nausea and vomiting; and laboratory abnormalities such as elevations of GOT and GPT in addition to the myelosuppression. Many of these adverse reactions subsided within 3 weeks after initiation of TNP-351 treatment. On the single-dose schedule, the test drug occurred chiefly in unchanged form in the blood, and in this form it disappeared from the blood biphasically with an alpha phase of 0.29-0.95 hours, and a beta phase of 7.8-14.4 hours. This disappearance pattern did not vary with an increase in dose. The 24-hour urinary excretion rate of the unchanged form amounted to 42-62% of the administered doses. On the 3-day daily administration schedule, the test drug was not accumulated in vivo. In the present study, two patients with malignant fibrous histiocytoma responded to the test drug with tumor regression. The results suggested that the recommended dosage regimen for the clinical early phase II study of the test drug should comprise a course of 9 mg/m2/day (by intravenous drip infusion over 30 minutes) every day for 3 days, which should be repeated every 3 weeks.

[Clinical study on incidental renal cell carcinoma]

Between 1985 and 1992, 119 patients with renal cell carcinoma were treated at our hospital. Among these cases, 71 cases (59.7%) were incidentally detected in the absence of any suggestive clinical signs of a tumor, 41 cases (34.5%) presented urological or general signs suggestive of the tumor, and 7 cases (5.88%) were detected by metastatic lesions initially. We reviewed 71 cases of incidental carcinoma compared with 41 cases of symptomatic carcinoma. The ratio of incidental carcinoma has been increasing steadily for 8 years, and it was more than 70% of all cases in the last 3 years. The carcinoma was detected at routine health examinations in 25 cases, and during examination for unrelated diseases in 46 cases. Forty-seven cases (66.2%) were detected by ultrasonography, 24 cases (33.8%) by computerized tomography and none by intravenous pyelography. Tumor extension was within the renal capsule in 94.4% of the incidental carcinoma and the mean diameter was 4.39 cm, which was significantly smaller than that of symptomatic carcinoma (p < 0.0001). Peripheral tumors and clear cell subtype tumors were more frequently detected in incidental carcinoma (p < 0.0001 and p = 0.0018). Tumor stage and grade of tumor cell were significantly lower than symptomatic carcinoma (p < 0.0001). The five-year survival rate in incidental carcinoma was 98.5%. There was a significant difference in survival between the incidental and symptomatic carcinoma (p < 0.001).

Comparative anatomy of the baboon and the human cervical spine

STUDY DESIGN

The anatomy of baboon and human cervical spines were compared by measuring adult, cadaveric specimens.

OBJECTIVE

The objective of the study was to compare human and baboon cervical motion segments to determine whether the baboon provides a suitable model for spinal research.

SUMMARY OF BACKGROUND DATA

Several studies have examined the quantitative anatomy of the human cervical bones and ligaments. Several animal species have been used for cervical spine research; however, no studies have validated whether the animal models resemble the human cervical spine closely enough to provide generalizable data.

METHODS

Multiple morphologic parameters were measured directly from nine baboon and six human adult cadaveric cervical spine specimens. The bone structure and geometry of each of the seven cervical vertebrae were analyzed; the structure and histology of the ligaments were measured; and histomorphometry of the vertebrae was performed.

RESULTS

The architectural composition and geometry of individual cervical vertebrae of baboons and humans were similar at each level. The proportional relationship of bone and ligament structures in the two species was almost identical. There were, however, several differences: 1) The baboon spine was about half the size of the human spine; 2) its vertebral arteries were encased fully within the C1 lateral mass; 3) its uncovertebral joints were more prominent; 4) its vertebral endplates were more concave; 5) its pedicles were thinner; 6) its transverse processes were longer; and 7) its spinous processes were horizontal and nonbifid.

CONCLUSIONS

The geometry and anatomy of the baboon cervical spine closely resemble that of the human cervical spine. It therefore provides an excellent model for in vivo and in vitro research.

Serum human hepatocyte growth factor in human menstrual cycle and pregnancy: a novel serum marker of regeneration and reconstruction of human endometrium

Serum concentrations of human hepatocyte growth factor (hHGF) were measured in normal menstrual cycles and during uncomplicated pregnancies. In the normal menstrual cycle, the concentrations of hHGF increased through the mid and the late luteal phases to reach the highest peak during the menstrual phases, followed by a gradual decline during the follicular phase toward the trough levels seen in the ovulatory and the very early luteal phases. During pregnancy, serum hHGF concentrations increased continuously from the late luteal levels and constituted 4 distinct peaks. By immunostaining, c-Met protein, a receptor for hHGF, was localized not in the stromal but in the epithelial layer of the endometrium. In cultured isolated endometrial cells, hHGF stimulated the proliferation of both the epithelial and the stromal cells. It is likely that hHGF is involved in the repair or reconstruction process of the endometrium after menstrual shedding and implantation.

Tumor angiogenesis in breast cancer: its importance as a prognostic indicator and the association with vascular endothelial growth factor expression

The importance of tumor angiogenesis in the process of tumor growth and progression in solid tumors has been widely accepted. We have investigated the significance of tumor angiogenesis as a prognostic indicator in a retrospective study including 328 primary breast cancer patients. The postoperative survey demonstrated that the microvessel density (MVD) evaluated by immunocytochemical staining for factor VIII-related antigen is a potent prognostic indicator. The relapse-free survival (RFS) rate of patients with over 100 microvessels/mm2 in a microscopic field was significantly worse compared to that of patients with less than 100 microvessels/mm2 (p < 0.00001). The significance of MVD was found in both node-negative and node-positive patients (p < 0.005 and p < 0.01, respectively). Multivariate analysis confirmed that MVD is an independent prognostic indicator for RFS. In the background factor analysis, MVD was significantly correlated with the number of metastatic nodes (p < 0.01). In addition, the immunocytochemical analysis for vascular endothelial growth factor (VEGF) demonstrated a close association between the increase in MVD and the expression of VEGF (p < 0.001). VEGF status also was a significant prognostic indicator in univariate analysis for RFS (p < 0.01). It was concluded that MVD is a potent prognostic indicator in primary breast cancer. Furthermore, it was also suggested that VEGF plays crucial roles in the promotion of angiogenesis in breast cancer.

Management of an infected urachal cyst during pregnancy

An infected urachal cyst complicating a pregnancy is extremely rare, but is considered to present a high risk to both the mother and the fetus. We treated a patient with an infected urachal cyst diagnosed at 29 weeks of gestation. A healthy infant was delivered by cesarean section at 37 weeks of gestation. The patient underwent excision of the unruptured cyst 37 days later. This is the first reported case of an infected urachal cyst complicating a pregnancy, that was diagnosed before rupture and was managed without serious sequelae for either the mother or the fetus. The diagnosis and management of the infected urachal cyst complicating the pregnancy is discussed.

[New strategy of breast cancer treatment]

Incidence of the patients with breast cancer has been increased continuously in Japan and it will be the top of all kinds of cancers in female by the end of this century. Early detection of the disease is very important and thus the surgical treatment such as breast conserving therapy (BCT) is much more acceptable. However BCT should be performed carefully and individually for each case. The new hormonal treatments and the new anti-cancer agents are developed recently and powerful therapy with combination of these drugs and the others will be expected.

Monitoring of brain tissue haemoglobin concentration and oxygen saturation using a three wavelength spectrophotometric method

The authors report a new method of monitoring tissue oxygen saturation and haemoglobin concentration simultaneously and continuously using a three-wavelength spectrophotometry. Light emitting diodes were used as light source which made the recording probe small and flexible enough to be placed on the brain surface tightly. Stable and reliable recording of the tissue oxygen saturation and haemoglobin concentration was ascertained in the experimental studies using middle cerebral artery occlusion model of rabbit. In the clinical studies, monitoring during bypass surgery detected rapid changes of local oxygen metabolism and haemoglobin concentration in ischaemic brain. Simultaneous and continuous monitoring of tissue oxygen saturation and haemoglobin concentration enables more practical analysis of brain circulation and oxygen metabolism in experimental and clinical situations.