[A comparative randomized phase II study of CDDP, CDDP-carboquone (CQ) and CDDP-etoposide as second-line chemotherapy in small cell lung cancer (SCLC)]

51 SCLC patients who had received prior chemotherapies and had measurable lesions were randomized to CDDP, CDDP-CQ, and CDDP-etoposide treatment group. Prior chemotherapies of 49 complete cases were AVA (ADM, VCR, ACNU; 16 cases), TAVA (THP-ADM, VCR, ACNU; 17 cases), CAV (CPA, ADM, VCR; 4 cases) and others. The median period of 49 cases from prior chemotherapy to this chemotherapy was 4 weeks. In the CDDP alone group, CDDP was given at a dose of 80 approximately 100 mg/m2/4-5 weeks on Day 1, and in CDDP-CQ treatment group, patients were given the same dose of CDDP and CQ 6 mg/body on Day 1, 2. In CDDP-etoposide treatment group, the same doses of CDDP and etoposide 60 mg/m2 Day 1-5 (Total 300 mg/m2) were given. Response rate of the CDDP alone group was 6.7% (PR 1/total 15), that of CDDP-CQ group was 6.3% (PR 1/total 16), and in CDDP-etoposide group it was 16.7% (PR 3/total 18). In CDDP-CQ treatment, the main side effect was strong hematotoxicity (WBC; Grade 3, 5 patients, Grade 4, 2 Pl: Grade 3, 5 Grade 4, 3), and main hematotoxicity of CDDP-etoposide was leukopenia (W BC; Grade 3, 4 patients, Grade 4, 2 Pl; Grade 4, 1). In these patients, it was thought that CDDP was not useful in second chemotherapy, as not only CDDP alone but also the combination with CQ or etoposide.

Treatment of myelodysplastic syndromes with recombinant human granulocyte colony-stimulating factor: a preliminary report

PURPOSE

The expansion of an abnormal hemopoietic stem cell line is responsible for the myelodysplastic syndromes, which are characterized by pancytopenias, often resulting in lethal infections. Cloned granulocyte colony-stimulating factor (G-CSF) was recently shown to enhance the growth and differentiation of normal granulocyte progenitor cells in vitro. The aim of our study was to examine the effects of recombinant human G-CSF in patients with myelodysplastic syndromes.

PATIENTS AND METHODS

Four patients with myelodysplastic syndromes and one patient with smoldering acute myelogenous leukemia following the occurrence of a myelodysplastic syndrome received recombinant human G-CSF by intravenous infusion for six days. Patients received different dosage levels (50 to 1,600 micrograms/m2).

RESULTS

A response was seen in all patients, with an increase in both immature myeloid cells in the bone marrow and mature granulocytes in the peripheral blood. The dose levels that could stimulate granulocytopoiesis differed among patients.

CONCLUSION

These results suggest that, at least in some cases of myelodysplastic syndromes, granulocytopenia can be improved by G-CSF, although it still remains to be determined whether the increase in the number of granulocytes is due to the differentiation and maturation of the myelodysplastic clone or restoration of a residual normal clone.

Congenital arteriovenous fistula of the superior mesenteric vessels

Arteriovenous (AV) fistula of the mesenteric vessel is a rare lesion and is most often iatrogenic or traumatic in origin. An infant boy with congenital superior mesenteric AV fistula is described. The present case is the first reported in a newborn.

A case of malignant melanoma of the transverse mesocolon

A pediatric patient with malignant melanoma of the transverse mesocolon is reported. No cases of malignant melanoma occurring from the mesenterium have been previously reported in the literature.

Cardiotonic activity of 5-methyl-6-(4-pyridyl)-2H-1,4-thiazin-3(4H)-one hydrochloride (ZSY-27)

Cardiotonic activity of a new, non-catecholamine and non-glycoside positive inotropic agent, 5-methyl-6-(4-pyridyl)-2H-1,4-thiazin-3(4H)-one hydrochloride (ZSY-27), was investigated in isolated guinea pig left atria, cat right ventricular papillary muscle and cross-circulated excised dog papillary muscle preparations, and in anesthetized open-chest dogs. In electrically driven guinea pig left atria and cat papillary muscle preparations, ZSY-27 (3 x 10(-6)-10(-4) M) increased the developed tension in a concentration-related manner. The positive inotropic effect of ZSY-27 was not blocked by propranolol (3 x 10(-8) M) in the guinea pig atria, but was significantly inhibited by carbachol (5 x 10(-6) M) in cat papillary muscle preparations. The positive inotropic effect of ZSY-27 was comparable to that of milrinone in guinea pig atria. ZSY-27 (0.01-3 mg) increased dose-dependently the developed tension in cross-circulated excised dog papillary muscle preparations as well. In anesthetized dogs, ZSY-27 (0.03-1 mg/kg, i.v.) produced a dose-dependent increase in left ventricular contractile force and a decrease in blood pressure, while the increase in heart rate was relatively small. The pharmacological profile of ZSY-27 in anesthetized dogs was similar to that of milrinone. These results suggest that ZSY-27 is potent cardiotonic agent with vasodilator activity and its effect may be partially due to an increase in the intracellular adenosine 3',5'-cyclic monophosphate level.

Effects of type beta transforming growth factors on haematopoietic progenitor cells

The effects of type beta transforming growth factors (TGF-beta s) on normal human and murine haematopoietic progenitor cells were examined using bone marrow colony assays. In erythroid colony assays, TGF-beta 1 inhibited human CFU-E derived colony formation, BFU-E derived burst formation, and murine BFU-E derived burst formation in a dose dependent manner between 0.1 and 5.0 ng/ml. However, murine CFU-E derived colony formation was unaffected even at a concentration of 5.0 ng/ml TGF-beta 1. In myeloid colony assays, different sensitivity of progenitor cells to the inhibitory effects of TGF-beta s was observed between both species. TGF-beta 1 inhibited murine granulocyte-macrophage colony (GM-colony) formation and granulocyte colony (G-colony) formation in a dose dependent manner between 0.1 and 5.0 ng/ml, but had no remarkable effects on human GM-colony and G-colony formation. TGF-beta 2 also had similar inhibitory effects on haematopoietic progenitor cells, while its inhibitory effect was less potent than that of TGF-beta 1. Thus our data suggest that TGF-beta may be involved in negative regulation of haematopoiesis and that its inhibitory action may be restricted in lineage and/or species specific manner.

The development of a solitary toxic thyroid nodule following Graves' disease

A 52-year-old woman developed a toxic, solitary, autonomously functioning thyroid nodule four years after antithyroid drug treatment for Graves' disease. When she was initially seen, a thyroid scan showed the homogeneous enlargement of both lobes with increased uptake. Graves' disease was diagnosed and the patient was treated with methimazole. Thyroid function was well-controlled with medication for 18 months, after which the patient stopped taking the drug for three years. Four years after Graves' disease was diagnosed, the patient again showed symptoms of hyperthyroidism. The etiology was a toxic, autonomously functioning nodule.

Osteoclast-mediated osteolysis in bone metastasis from renal cell carcinoma

Osteolytic characteristics of bone metastasis from renal cell carcinoma were morphologically and biochemically investigated. First, undecalcified ground sections of bone metastases were made from four patients with renal cell carcinoma. Second, renal cell carcinoma cell line (RCC-K1) was established from one of the four patients, and its effect on bone resorption in vitro was examined. Marked proliferation and activation of osteoclasts around the tumor cells was histologically demonstrated. Conditioned medium from the RCC-K1 cells contained potent bone-resorbing activity in vitro. The activity was reduced to basal level by calcitonin, but was not blocked by indomethacin. The activity was lost after dialysis (MW cutoff 3500), while it was retained after 2 weeks of storage. Levels of prostaglandin E2 and 1,25-dihydroxyvitamin D of the RCC-K1-conditioned medium were insufficient to cause bone resorption in vitro. The conditioned medium did not stimulate cAMP accumulation in rat osteoblastic cells. These results suggest that renal cell carcinoma causes bone destruction through the stimulation of osteoclasts by locally secreting an unknown humoral factor or factors.

[Attempted marrow rescue with cryopreserved circulating stem cells following high-dose chemotherapy]

Circulating hematopoietic stem cells were collected by three consecutive leukaphereses during post-chemotherapy expansion of the stem cell pool in a 3-year-old boy with advanced and therapy-resistant neuroblastoma. The cells were fractionated by discontinuous Percoll gradient centrifugation, frozen in a programmed freezer and then stored in liquid nitrogen. Following high-dose chemotherapy, the cells were thawed rapidly and re-infused into the patient. Early evidence of marrow recovery was first noted at day 13 and the times required to achieve a granulocyte count of greater than 0.5 x 10(9)/L and a platelet count of greater than 50 x 10(9)/L were 21 days and 30 days, respectively. This new marrow-rescue operation may have potential in cancer therapy as an alternative to bone marrow transplantation and further clinical investigation is warranted.

In vivo effect of 1 alpha-hydroxyvitamin D3 on interleukin-2 production in hemodialysis patients

The immunoregulatory effect of 1 alpha-OHD3, a precursor form of active vitamin D3 1,25 (OH)2D3, was examined in hemodialysis patients. Peripheral blood mononuclear cells (PBM) from hemodialysis patients produced significantly less interleukin-2 (IL-2) than those from normal controls. Four weeks of oral administration of 0.5 micrograms/day of 1 alpha-OHD3 enhanced the IL-2 production of PBM from the patients. This fact suggests that 1 alpha-OHD3 therapy may be useful for the restoration of IL-2 production in hemodialysis patients, and that the vitamin D3 deficiency may be responsible for the impairment of cellular immunity associated with IL-2 production disorder in hemodialysis patients.

Light emission computed tomography system for plasma diagnostics

The 3-D measurement of plasma is a significant subject for analysis; development of practical methods, particularly noninvasive methods, are needed. This paper reports a new method for plasma diagnostics called light emission computed tomography, which is capable of noninvasive imaging the internal emission intensity of a 3-D source over any spectral range by sensing the visible radiation emitted by the plasma. To ensure the effectiveness of this technique, we developed a light emission computed tomography system with automatic data collection; and we performed some experiments on discharge plasmas to estimate the performance of the system. We obtained good images of radiation intensity distributions.

Reactive endosteal bone formation

The microstructure of reactive endosteal new bone was examined using undecalcified ground sections in five pathologic conditions (bone metastasis from prostate cancer in seven cases, intervertebral osteochondrosis in five, Paget disease in four, chronic suppurative osteomyelitis in two, and fracture healing in one). To determine a basic form of rapid intramembranous bone formation, fetal rat calvaria and primitive bones made in clonal osteogenic cell culture were also observed. In slow bone-forming conditions, lamellar new bone was deposited on pre-existing trabecular surface and caused trabecular thickening on radiographs. In contrast, in rapid bone-forming conditions, woven bone was deposited as spicules extending from trabecular surface so as to form new networks in intertrabecular space. This causes obscurity of trabecular margins radiographically. Reactive endosteal bone formation may be nonspecific and have a significance for assessing the virulence of underlying pathologic conditions like periosteal reactions.

[High-risk group--lung cancer]

Carcinogenesis of the lung cancer may have possibly many factors because that lung has been always exposed many extrinsic materials. Investigation of risk factor and recognition of high-risk group of lung cancer possess much important meaning, approached not only carcinogenesis of the lung but also clinical diagnosis and treatment of lung cancer. In this report, risk factors that established hitherto, air pollution, occupation, smoking habit and co-existing other lung disease are reviewed as high-risk groups of lung cancer.

Clinical evaluation of total-body hyperthermia combined with anticancer chemotherapy for far-advanced miscellaneous cancer in Japan

One hundred sixty-eight patients with miscellaneous far-advanced cancer received a total of 444 extracorporeally induced total-body hyperthermia (TBHT) treatments in seven Japanese hospitals. Overall, a regression of malignancy was observed in 39 of 132 evaluable patients (29.5%) and the most favorable results were obtained for patients with lung cancer. Irrespective of whether the tumors were primary or secondary lesions or recurrences, favorable results were obtained in patients whose tumors were in the lung, liver, lymph nodes, and soft tissue. No relationship was found between an objective response to TBHT and histologic types of the tumors. There was no clear relationship between an objective tumor response and the nature of the simultaneous chemotherapy during hyperthermia. Antitumor effects were not evaluable in 36 patients (21.4%). Of these 36 patients, 33 died before evaluation could be made; 24 died of various complications and 9 died of cachexia without complication. The mortality increased in proportion to the reduction of the performance status of patients before TBHT. These results indicate that TBHT should be used as therapy for patients whose tumors are in the lung, liver, lymph node, and soft tissue and then only on patients in generally good condition.