Adjuvant mitomycin-C prolongs survival time of patients undergoing extensive en bloc resection of carcinoma of the stomach invading the adjacent organs

We retrospectively examined the long-term results of adjuvant chemotherapy with mitomycin-C (MMC) in 50 patients with gastric carcinoma invading the adjacent organs. All patients underwent gastrectomy and en bloc multiple resection of the invaded organs, with the intent of a potential cure. Evidence of direct invasion was confirmed histologically. These patients were classified into 3 groups, according to the dose schedule of MMC: 12 received prolonged, intermittent administration of the drug, in a total dose of 40 mg or more (group A); 19 were given a bolus injection at the time of surgery and/or on the following day, in a total dose of less than 40 mg (group B), and 19 were given no anticancer drugs (group C). These 3 groups were comparable with regard to various prognostic factors. The 5-year survival rates were 50, 32 and 17% in groups A, B and C, respectively. There was a statistical difference in survival between groups A and C (p less than 0.05). These results indicate that extensive en bloc resection plus intensive adjuvant chemotherapy prolong the survival time for those with gastric carcinoma invading the adjacent organs.

Influence of bestatin on production of granulocyte-macrophage colony-stimulating factor from human peripheral blood mononuclear cells in vitro

Bestatin, (25, 3R)-3-amino-2-hydroxy-4-phenylbutyryl-L-leucine, enhanced proliferation of normal human bone marrow granulocyte-macrophage progenitor cells to form CFU-GM colonies in viscous methylcellulose medium in vitro. To elucidate the mechanisms of this effect, the levels of colony-stimulating factor (CSF) in culture supernatant of 1 x 10(6)/ml peripheral blood mononuclear cells (PBMC) cocultured with various concentrations of bestatin were determined using our newly developed sandwich enzyme-linked immunosorbent assay (ELISA). The level of granulocyte/macrophage-CSF (GM-CSF) in the supernatant in the presence of 0.1 microgram/ml bestatin was 312 pg/ml by this ELISA. The production of GM-CSF increased with increasing amounts of added bestatin.

Increased therapeutic gain of combined cis-diamminedichloroplatinum (II) and whole body hyperthermia therapy by optimal heat/drug scheduling

To maximize therapeutic gain, the timing sequence of whole body hyperthermia (WBH) and cis-diamminedichloroplatinum (II) (DDP) was examined. Normal tissue injury as well as growth of a s.c. transplanted fibrosarcoma were measured in F344 rats treated with variable schedules of WBH and DDP. Simultaneous application of DDP (2 mg/kg i.v.) with WBH (120 min at 41.5 degrees C) resulted in severe renal injury, body weight loss, and mortality; while sequential use of the modalities caused minimal to no toxicity. DDP or WBH alone produced only minimal tumor growth delay, whereas supraadditive antitumor effects occurred with all tested schedules of DDP combined with WBH, regardless of sequence or interval between the two modalities. We designated the ratio of antitumor effect to nephrotoxicity as specific therapeutic efficacy (STE). DDP given simultaneously with WBH produced the lowest STE (0.6-1.2), which was less than or equal to either DDP (STE = 1.2) or WBH (STE = 1.5) alone. On the other hand, schedules of DDP prior to and after WBH resulted in a STE of 1.8-3.0, a supraadditive effect. These results indicate that an optimal scheduling of DDP with WBH significantly improves therapeutic gain by reducing normal tissue injury while maintaining enhanced antitumor activity.

Width of serosal invasion and prognosis in advanced human gastric cancer with special reference to the mode of tumor invasion

We studied the influence of the width of serosal invasion on the prognosis, in relation to the mode of invasion, in 142 patients who had curative resection for gastric carcinoma that invaded beyond the muscularis propria. The mode of invasion was classified into infiltrative and expanding types. Average diameter of tumor at the serosal or subserosal layer for the infiltrative type was 4.2 +/- 3.2 cm, a value significantly greater than that of 2.5 +/- 2.0 cm for the expanding type (P less than 0.01). The 5-year survival rate of patients with the infiltrative type carcinoma was significantly lower (36.8%) than that with the expanding type carcinoma (50.0%) (P less than 0.05). In the infiltrative type, the survival time of patients with a serosal invasion exceeding 2 cm was significantly shorter than when the serosal invasion was less than 2 cm (P less than 0.05). In the expanding type, however, the prognosis was good until the width of serosal invasion extended to 4 cm or greater. The difference in survival according to the width of serosal invasion did not always depend on the incidence of positive lymph nodes in both types of carcinomas. Therefore, influence of the width of serosal invasion on the prognosis for advanced gastric carcinomas differs between infiltrative and expanding types.

Hypercalcemia related to the poor prognosis of patients with squamous cell carcinoma of the esophagus

A review of 208 cases of surgically treated squamous cell carcinoma of the esophagus revealed 16 (7.7%) with hypercalcemia. There was no evidence of bone metastases in 13 (6.3%) of the patients with hypercalcemia. Pathogenesis of this hypercalcemia without bone metastases was suggested to be multifactorial. Anastomotic leakage and malnutrition because of fasting were the most possible causes of mild hypercalcemia, and moderate to severe hypercalcemia was thought to be due to subclinical and clinical recurrence of the tumor, probably with PTH-like hormonal activity. Overall survival rates in the groups with and without hypercalcemia were 18.2 and 61.7% at the 12th postoperative month and 9.1 and 37.8% at the 24th month, respectively. Thus hypercalcemia is a significant prognostic factor linked to an unfavorable clinical course even in patients with no evidence of bone metastases.

Anti-GM1 ganglioside antibodies with differing fine specificities in patients with multifocal motor neuropathy

Antibodies to gangliosides were detected in sera from three of 19 patients with chronic inflammatory polyneuropathy (CIP) by a thin-layer chromatogram overlay technique. All three of the patients fell into a clinical subset of the group that had multifocal motor neuropathy, and in all three patients the antibodies reacted with GM1 ganglioside. However, the fine specificities of the antibodies differed as demonstrated by cross-reactivity with different gangliosides in each of the three patients. The antibodies in patient 1 reacted with GM1, GD1b, and asialo-GM1 suggesting that the terminal Gal(beta 1-3)GalNAc moiety that is common to these three glycolipids is an important part of the epitope(s). This was confirmed by showing reactivity of the antibodies with Gal(beta 1-3)GalNAc conjugated to bovine serum albumin. Patient 2 had antibodies that did not react with GD1b, but cross-reacted with GM2 ganglioside suggesting that the epitope(s) involved the inner portion of the oligosaccharide moiety that is shared between GM1 and GM2. Patient 3 had antibodies that reacted with GM1 and asialo-GM1, but they did not cross-react with either GD1b or GM2. These results provide further evidence for a relationship between motor nerve syndromes and anti-GM1 antibodies and also suggest that GM1 could be a principal target antigen since other reactive gangliosides differed among the patients. However, the possible pathogenic effects of anti-GM1 antibodies on motor nerves remain to be established.

[Angiographic positions for thoracic outlet syndrome]

Thirty four patients (18 males and 16 females, 54 lesions) with thoracic outlet syndrome (TOS) were studied with conventional angiography. Angiography in the supine position did not confirm subclavian artery compression in 43.4% of patients. Lordotic position or upright position was useful for demonstration of subclavian artery compression in patients who did not show any findings in conventional techniques.

[Hypothalamic glioma with diencephalic syndrome and following precocious puberty--a case report]

A 1-year 11-month-old girl was admitted for losing her weight and gait disturbance. At 4 months of age, she began to become emaciated inspite of normal food intake. Physical and neurological examinations were normal except for a marked lack of subcutaneous fat, irritability and nystagmus. CT scans demonstrated a large tumor occupied in the third ventricle and marked dilatation of the lateral ventricles. Endocrinological studies revealed high levels of plasma growth hormone (GH) in contrast with normal levels of somatomedin-C. The basal value of GH returned to normal with a subnormal response to insulin subsequently after VP-shunt. Then, a pilocytic astrocytoma was partially resected with transcallosal approach. Postoperative course was uneventful and her growth rate returned to normal range. CT scans after radiation therapy of 49 Gy showed marked decrease in size of the tumor. At 3 years and 6 months of age, enlargement of her breast was pointed out although MRI indicated no enlargement of the tumor. Basal value of LH, FSH, E 1 and E 2 elevated and LHRH test showed over-response of LH and FSH. Other hypothalamic-pituitary functions were partially preserved. Case of precocious puberty following diencephalic syndrome associated to the hypothalamic and/or optochiasmatic glioma is quite rare in the previous literature. Mechanisms of diencephalic syndrome and following puberty are unclear. However, endocrinological and radiological findings observed in the present case suggest that hormonal disfunction might be due to the failure of inhibition on GH and LHRH secretion mechanism in the anterior hypothalamus.

Supplementary motor area kindling in the photosensitive baboons

Two Senegalese baboons (Papio papio) were subjected to daily electrical stimulation at the SMA. When compared with the results of kindling at different frontal cortical sites, ADT and GST at the SMA were lower than those at other sites. On the other hand, the number of stimulations required for Stage 4 asymmetrical generalization was much greater at the SMA (mean of 78.0) than that for the PMA (22.5). These findings suggest that partial seizure originating from the PMA rather than the SMA seems to have a better access to the mechanisms underlying secondarily generalized convulsive seizure despite exquisite susceptibility to AD generation at the latter.

Prognostic factors in gastric cancer with serosal invasion. Univariate and multivariate analyses

Univariate and multivariate analyses of possible prognostic factors were carried out on data from 142 patients who had undergone curative resection for a carcinoma of the stomach invading beyond the muscularis propria. In the univariate analysis, factors including age, size of cancer, gross form, depth of penetration, lymph node metastasis, lymphatic invasion, width of serosal invasion, mode of invasion, volumetric shape of invasion, and stage had an individual prognostic significance. The multivariate analyses indicated that stage, lymph node metastasis, and depth of penetration were the most significant prognostic factors and that the prognosis in cases of obvious serosal invasion, or those with secondary or tertiary nodal involvement, was poor. For such patients, we prescribe postoperative intensive chemotherapy, even when a "curative" operation is done.

[A case of leiomyoblastoma of the jejunum]

Reported is a submucosal tumor of the jejunum that had developed in a 46-year-old man who manifested general fatigue and anemia. The tumor measured 3.0 x 3.0 cm and was composed of polygonal and/or round cells with a clear zone surrounding the nucleus. Five mitotic figures per 50-power fields were present. The light microscopic appearance was consistent with those of a Leiomyoblastoma. Follow-up evaluations approximately 2 years after the resection showed no evidence of metastasis or recurrence.

[Extraocular muscle aspects of the treatment in dysthyroid ophthalmopathy]

The Maximum width of four rectus muscles (MR, LR, IR, SR) was measured on CT films and followed for 1-2 years in 304 eyes of 160 patients with dysthyroid ophthalmopathy. Based on these parameters, steroid therapy with 100-150 mg betamethasone, intravenously and orally, 1.5 Gy Lineac radiation therapy was given to the retrobulbar tissue from two directions repeated for 10 days and combination therapy consisting of the above two therapies given at the same time were evaluated. Combination therapy yielded the best results. Steroid therapy showed little effect on MR, but remarkable effect on SR. It was speculated that different portions of the rectus muscles may be related to different responses of rectus muscles to different treatment regimen.

[Aspects of exophthalmos in relation to treatment for dysthyroid ophthalmopathy]

257 eyes of 135 patients with dysthyroid ophthalmopathy were treated with steroids and/or radiation. Steroid therapy consisted of 100-150 mg betamethasone given intravenously and orally. Radiation therapy was conducted with 1.5 Gy Lineac delivered to the retrobulbar tissue from two directions once a day for a period of 10 days. In combination therapy, the above two therapies were performed simultaneously. Exophthalmos and the new index of the c/o ratio (c/o ratio; defined as the content of the orbit divided by the capacity of the bony orbit) were measured on CT films and followed for 1 or 2 years in order to evaluate the effectiveness of these therapeutic modalities. Combination therapy yielded the best results among these therapies. Steroid therapy yielded good results for 3 or 6 months, but rebound phenomenon was recognized after a course of 1-2 year.

["Drop hand" resulting from cerebral infarction--case report]

A 52-year-old male was admitted with the progressive weakness of the right 3rd, 4th and 5th fingers on three days after the onset. On admission, his right hand and all of right fingers were flexed. Any extension of the right hand and any movement of right fingers were not accomplished. The sensory deficit in the right wrist joint was not observed. Initial computed tomography (CT) scan of the brain carried out on the day of admission could not detect any abnormal findings. However, the follow-up CT scans demonstrated the localized low density lesion in the left frontoparietal area. MR imaging also revealed abnormality attributable to cerebral infarction. Diagnosis of "Pseudoradial nerve palsy" was made. The mechanisms of these neurological deficits and the problems in differential diagnosis between central and peripheral nerve involvements were discussed.

Prognostic significance of DNA content with special reference to age in gastric cancer

The authors studied 93 patients who had undergone curative resection for advanced gastric cancer to assess the prognostic significance of DNA ploidy in relation to patient age. The cancers were classified as low and high-ploidy carcinomas and the patients were grouped by age (22-44 years, 45-64 years, 65-79 years). The incidence of high ploidy cancers increased with age. The 5-year survival rate increased with patient age in the low ploidy group whereas it decreased with patient age in the high ploidy group. There was a statistically significant difference (P less than 0.05) in the 5-year survival between our oldest patients with low (100%) and high ploidy (25.7%) gastric cancer. High ploidy cancers manifested a higher incidence of vessel invasion and lymph node metastasis. Our findings indicate that analysis of the DNA distribution pattern in gastric carcinoma is of prognostic value especially in older patients.

Postoperative adjuvant chemotherapy inhibits early recurrence of early gastric carcinoma

Data on 300 patients with early gastric carcinoma who underwent curative resection were analyzed for the suppressive effects of postoperative adjuvant chemotherapy on early recurrences. Retrospective grouping was done as follows: no chemotherapy (NC) group (169 patients), mitomycin C (MMC) group (108), and another group (23). In all, 24 patients (16 in the NC, 6 in the MMC, and 2 in the other group) who died of other diseases within 5 years after surgery were excluded. Therefore, data on 153 individuals in the NC and 102 in the MMC group were analyzed. The recurrence rate in patients with Pen A type carcinoma, with a propensity toward an early recurrence in the liver, was 37.5% in the NC and 9.1% in the MMC group. Among 27 Pen A type patients, 3- and 4-year survival was significantly higher in those receiving MMC (100%) than in those given NC (62.5%). Recurrences in the liver occurred in 6/14 of the NC patients within 3 years after surgery, whereas there were no recurrences in 11 MMC patients. Thus, the postoperative adjuvant chemotherapy with mitomycin-C has an inhibitory effect on early recurrence in patients with Pen A type early gastric carcinoma.

[A case of primary hypothalamic malignant lymphoma with diabetes insipidus]

A case of primary malignant lymphoma involving the hypothalamus is reported. A 31-year-old man was admitted with progressive disorientation. A computed tomography (CT) scan demonstrated a normodense, homogenously enhanced, and nodular shaped mass lesion involving the suprasellar region and extending to the third ventricle. In view of marked cerebral edema, dexamethasone was intravenously administered, at a dose of 4 mg/4 hr, and gradually tapered off. CT scans obtained 10 days after the admission revealed dramatic regression of the lesion, which corresponded with the clinical remission. However, on the 4th day after the discontinuance of corticosteroid, a CT scan demonstrated the recurrence of the mass lesion. Because of the rapid deterioration of consciousness and the progressive enlargement of the mass and dilatation of the ventricles, partial removal of tumor and ventricular drainage were carried out on the 24th day after admission. Dexamethasone was intravenously administered again at a dose of 4 mg/4 hr. A CT scan obtained five days after the operation showed complete disappearance of the lesion, and the patient had became almost alert. CT scans obtained on the 18th day and the 35th day after the operation showed complete disappearance of the mass. However, Magnetic Resonance Imaging revealed a localized area of abnormal signal intensity in the hypothalamus. Diabetes insipidus was continuously observed from the time of admission. A concomitant change of beta-2-microglobulin (beta-2-MG) and immunoglobulin (IgA, IgG, IgM) concentrations in serum and cerebrospinal fluid (CSF) with clinical profiles and CT findings were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Total (anterior and posterior) decompression of the spinal cord: surgical treatment for combined ossification of the posterior longitudinal ligament and yellow ligament of the thoracic spine

The ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the yellow ligament (OYL) in the thoracic spine can compress the spinal cord from the anterior and posterior direction, resulting in serious myelopathy. For these cases we devised a treatment consisting of two steps, total decompression of the spinal cord. The first step is removal of ossified yellow ligament posteriorly following wide laminectomy and the second step is removal of ossified posterior longitudinal ligament anteriorly, followed by interbody fusion. As the final procedure of the first step, two parallel deep gutters, covering the complete length of the ossified ligament to be removed anteriorly, are drilled from the posterior direction into the vertebral body along both sides of the dura. This pretreatment makes removal of the ossified ligament from the anterior, during the second stage, much easier and safer. This operation appears to be a promising operative procedure from our seven case experiences so far.

Eighteen-year survival of unresected leiomyoblastoma of the stomach with liver and lymph node metastases

A case of gastric leiomyoblastoma with liver and lymph node metastases occurring in a 31-year-old man, who has been alive with the tumor but without symptoms for more than 18 years after only an exploratory laparotomy without resection, is reported. On laparotomy, the liver metastasis and paragastric and para-aortic lymphadenopathies made it impossible to resect the stomach with the tumor. A diagnosis of malignant leiomyoblastoma was confirmed by incision of the liver and paragastric lymph nodes. Postoperative chemotherapy with mitomycin C and cyclophosphamide was performed for 6 months. As demonstrated by roentgenography, echography and computed tomography, the size of the tumor has remained almost identical for an 18-year period. Histologically, the low mitotic rate of the tumor in this case is considered primarily responsible for the long survival of the patient. A review of the records has revealed that our patient is the longest survivor to have unresectable gastric leiomyoblastoma with liver and lymph nodes metastases.

Thoracoabdominal approach for cure of patients with an adenocarcinoma in the upper third of the stomach

In 134 patients with an adenocarcinoma in the upper third of the stomach and involving the lower esophagus, the authors retrospectively assessed the significance of a thoracoabdominal approach (TAA). Nineteen (48.7%) of 39 with TAA had major postoperative complications, while 25 (26.3%) of 95 with the abdominal approach (AA) had similar complications (P less than 0.02). The most frequent complication was anastomotic leakage. In the case of TAA, seven (18.0%) experienced this, and nine (9.5%) did so after AA. However, deaths resulting from complications were few for both TAA (five, or 12.8% and AA nine, or 9.5%). There was one (2.6%) patient with histologically positive cancer cells at the proximal stump of the resected specimen in patients with TAA, while there were seven (7.7%) such patients with AA. In the histologically curative cases without palliative factors, patients with TAA had a significantly better prognosis than did those with AA (P less than 0.05). In the histologically noncurative cases and in cases with palliative factors, the prognosis was poor for both TAA and AA patients. These results suggest that the surgeon should perform the TAA in order to obtain tumor-free margins at the proximal stump and a better prognosis in patients without palliative factors, while the surgeon need not consider doing the TAA in patients with palliative factors.

[Reversibility of glaucomatous defects of the central visual field]

We analyzed more than 4 consecutive measurements of the central area of the visual field in 1,004 eyes of 533 subjects with various types of glaucoma as diagnosed by the Octopus 201 and its examination program No. 31. We used a non-repeated analysis of variance to determine the statistical relationship between the mean sensitivity measurements for individual quadrants of the central visual field. We made the series of measurements used in this statistical analysis during repeated examinations that took place over a follow-up period of 1 year. Out of 1,004 eyes, 53 eyes (5.3%) were shown to have an improved mean sensitivity of the central 30 degrees of the visual field. We adopted the degree of sensitivity improvement [(final mean sensitivity - initial mean sensitivity)/follow-up period] as the indicator of the degree of reversibility in the central visual field to determine which factors might influence changes in the visual field. In patients under 50 years of age, who were at an early stage of the disease, as opposed to those over 50 years of age, who were at an intermediate or advanced stage of this disease or who had undergone reduction of intraocular pressure, a relatively high degree of sensitivity improvement was more frequently observed. In the cases with primary open angle glaucoma which includes low tension glaucoma, we think treatment for abnormality in the aqueous humor dynamics is very important. We concluded, that the reversibility of the central visual field defect in glaucomatous eyes is possible, though it can only be clearly detected by careful follow-up examinations employing computerized perimetry.

DNA ploidy and tumor invasion in human gastric cancer. Histopathologic differentiation

The relationship between DNA ploidy and tumor invasion in 254 patients with gastric carcinoma was studied, with particular emphasis on histopathologic features. In the differentiated type of adenocarcinoma, there were aneuploid lesions characterized by a relatively high incidence of lymph node metastasis and hematogenous recurrence, even when the invasion was limited to the submucosa. In the undifferentiated type, aneuploid lesions were rarely seen at the early stage, but the frequency remarkably increased with invasion into the deeper layers. Nodal involvement and disseminating metastasis were evident with serosal invasion. Analyzed by a multivariate Cox model, DNA ploidy significantly correlated with prognosis. Thus, DNA ploidy is a major determinant of survival, and the behavior of an aneuploid carcinoma is apparently controlled by individual histologic type.

[New quantitative parameters for CT evaluation of orbitopathy in dysthyroid ophthalmopathy]

The new index (c/o ratio) is defined as the content of the orbit divided by the capacity of the bony orbit on the mid-orbital axial CT slice showing the medial and the lateral rectus muscles and optic nerve. Other quantitative parameters such as for exophthalmos and the capacity of bony orbit were also obtained on CT films. These parameters were measured in 474 eyes of patients with dysthyroid ophthalmopathy. The capacity of bony orbit showed large variations among all patients. The average for males was 17.8cm3 and that for females was 16.1cm3. Exophthalmos measurement on CT is more reliable than that by the Hertel exophthalmometer. The new index (c/o ratio) is a very reliable parameter for evaluating orbitopathy in dysthyroid ophthalmopathy. A large c/o ratio (greater than 1.6) was of clinical significance, because approximately 70% of the enlargement of the extraocular muscle observed in older patients (greater than 40 yrs old) was associated with a large c/o ratio (greater than 1.6).

Reactive changes in the esophageal epithelium and predictability of survival for patients with adenocarcinoma of the upper third of the stomach

In 93 patients with an adenocarcinoma in the upper third of the stomach and involving the lower esophagus, the authors examined the histopathologic changes of the esophageal epithelium at the involved lesion, and the prognosis. Changes in the esophageal epithelium were histologically divided into four groups: hyperplastic (34 cases), atrophic (26 cases), hyperplastic and atrophic (mixed, 20 cases), and no change (13 cases) types. The hyperplastic type was closely related with the expanding mode of invasion and depth of the invasion was less than seen with the atrophic type (P less than 0.05). The rate was significantly higher in cases of a curative resection and the outcome was better than seen with the other types (P less than 0.01-0.001). The atrophic type was related with Borrmann type IV of the gross type and infiltrative mode of invasion, and had a significantly longer length of esophageal invasion than did the hyperplastic and the no change types (P less than 0.01). The prognosis was significantly poorer than seen with the hyperplastic (P less than 0.001) or the mixed types (P less than 0.01). Our study shows that histopathologic changes in the esophageal epithelium provide the surgeon with useful prognostic indicators in cases of an adenocarcinoma in the upper third of the stomach and involving the lower esophagus.

Premotor cortical kindling interferes with subsequent hippocampal kindling

Interaction between the neocortical motor system and the limbic system was investigated in terms of the transfer of kindling. Premotor cortical kindling induced limbic seizures accompanied by dissociated hippocampal afterdischarges (AD) which outlasted the premotor AD. Subsequent kindling of the hippocampus was markedly retarded despite prolonged hippocampal AD. These results suggest that premotor cortical kindling induces a neuronal mechanism which prevents limbic access to the motor system.

DNA ploidy is closely linked to tumor invasion, lymph node metastasis, and prognosis in clinical gastric cancer

DNA ploidy microspectrophotometrically determined in 254 patients with gastric carcinoma was investigated from the standpoint of tumor invasion, lymph node metastasis, and prognosis. DNA distribution patterns were grouped into low and high ploidies. The 24.0% frequency in the high ploidy group, at the mucosal stage, increased in proportion to invasion into the deeper layers. There was a high incidence of lymph node metastasis in the high ploidy group, compared with the low ploidy group, in case of invasion beyond the mucosa. Widespread nodal involvement was frequent in the high ploidy group. The 5-year survival rate was 73.7% in patients of high ploidy, with a statistical difference compared to the 90.6% in those of low ploidy (P less than 0.01). In the multivariate analysis of 226 patients undergoing curative surgery, the DNA ploidy proved to be a major independent prognostic factor. These findings indicate a close correlation among DNA ploidy, tumor invasion and nodal involvement, and the significant clinical value of DNA analysis for predicting the prognosis in patients with gastric carcinoma.

DNA ploidy is closely linked to tumor invasion, lymph node metastasis, and prognosis in clinical gastric cancer

DNA ploidy microspectrophotometrically determined in 254 patients with gastric carcinoma was investigated from the standpoint of tumor invasion, lymph node metastasis, and prognosis. DNA distribution patterns were grouped into low and high ploidies. The 24.0% frequency in the high ploidy group, at the mucosal stage, increased in proportion to invasion into the deeper layers. There was a high incidence of lymph node metastasis in the high ploidy group, compared with the low ploidy group, in case of invasion beyond the mucosa. Widespread nodal involvement was frequent in the high ploidy group. The 5-year survival rate was 73.7% in patients of high ploidy, with a statistical difference compared to the 90.6% in those of low ploidy (P less than 0.01). In the multivariate analysis of 226 patients undergoing curative surgery, the DNA ploidy proved to be a major independent prognostic factor. These findings indicate a close correlation among DNA ploidy, tumor invasion and nodal involvement, and the significant clinical value of DNA analysis for predicting the prognosis in patients with gastric carcinoma.

IgM binding to sialosyllactosaminylparagloboside in a patient with polyradiculoneuropathy due to Mycoplasma pneumoniae infection

IgM in serum without paraprotein in a patient with polyradiculoneuropathy due to a Mycoplasma pneumoniae infection reacted specifically with a ganglioside, sialosyllactosaminylparagroboside (SLPG), in a human peripheral nerve on a thin-layer chromatogram plate by an immunostaining technique. This finding suggests the possibility that anti-SLPG antibody in the patient's serum may play a role in the pathogenesis of neuropathy.

A treatable multifocal motor neuropathy with antibodies to GM1 ganglioside

We report 2 patients with a treatable, immune-mediated motor polyneuropathy associated with antibodies to defined neural antigens. In these patients asymmetrical weakness developed in one arm and progressed over 2 to 3 years to involve the other arm, legs, and trunk. Both patients were initially diagnosed as having lower motor neuron forms of amyotrophic lateral sclerosis. However, repeated electrophysiological testing eventually showed multifocal conduction blocks in motor but not sensory fibers compatible with patchy selective demyelination. Serum testing by thin-layer chromatography and enzyme-linked immunosorbent assay revealed that both patients had high titers of antibody directed against GM1 and other gangliosides. Initial therapeutic trials of prednisone (100 mg daily for 4 to 6 months) and plasmapheresis were unsuccessful. Treatment with cyclophosphamide, however, was followed by marked improvement in strength in both patients.

Endoscopic intratumoral injection of OK-432 and Langerhans' cells in patients with gastric carcinoma

OK-432, a compound composed of penicillin-G-treated, attenuated Streptococcus pyogenes of human origin, was administered by intratumoral injection (IT) to 15 of 49 patients with Stage III gastric carcinoma, at the time of preoperative endoscopic examination. The 5-year survival rate of patients given IT was 73.3%, whereas the rate was only 36.5% in those not given IT (P less than 0.05). A study of recurrent cases revealed a significantly low incidence of peritoneal recurrence in the group on OK-432 IT (P less than 0.01). In previous work, the authors noted a favorable prognosis of patients with Stage III gastric carcinoma and with a marked infiltration of Langerhans' cells (LC) in the tumor tissues. All of the 49 in the current study were thus examined immunohistochemically, using anti-S-100 protein antibody, the objective being to clarify the relationship between OK-432 IT and the density of LC. The density of LC among those given IT was significantly increased as compared with those not given IT (P less than 0.05). The results of this study suggest that OK-432 IT may lead to augmentation of the density of LC in tumor tissues and hence prevent peritoneal recurrences in patients with Stage III gastric carcinoma.

Cervical laminoplasty to enlarge the spinal canal in multilevel ossification of the posterior longitudinal ligament with myelopathy

We studied 23 patients with severe myeloradiculopathy involving multiple (more than three) levels of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who were treated with laminoplasty to enlarge the spinal canal. The resected spinous processes were used as bone grafts to support the opened laminae. These patients were analyzed pre- and postoperatively with a neurological evaluation according to the Japanese Orthopedic Association (JOA) score system for cervical myelopathy. Follow-up was from 2.0 to 5.3 years with an average of 31.5 months. The results were compared with those in 31 patients with the same degree (multilevel) of OPLL who had been operated upon previously by laminectomy (14 cases) or anterior resection (17 cases). Postoperative neurological recovery by improvement ratio of the JOA score was observed in 81.2% of those who had undergone expansive laminoplasty, in 72.4% of those with laminectomy, and in 63.6% of those with anterior decompression. We concluded that expansive laminoplasty is a safer procedure with fewer complications. Stability is achieved by fixing the expanded laminae permanently with a bone graft. The neurological recovery following our technique of laminoplasty and fusion appears to be superior to that with laminectomy or anterior decompression.

Suppressive effect of camostat mesilate (FOY 305) on acute experimental allergic encephalomyelitis (EAE)

Camostat mesilate (FOY305), a synthetic serine protease inhibitor and has been developed as a drug for pancreatitis, is effective in suppressing acute experimental allergic encephalomyelitis in Lewis rats. Loss of weight, clinical score and yield of myelin protein from brain stem were improved by daily injection of FOY305 compared with saline from day 6 after inoculation with homogenate of guinea pig spinal cord. A significant decrease of yield of myelin has been shown here for the first time in acute EAE in Lewis rat. This is in accord with myelin breakdown demonstrated morphologically. Our study also demonstrates a significant improvement of yield of myelin protein by FOY305. Our results suggest the possibility of a clinical application of this protease inhibitor for human demyelinating diseases such as multiple sclerosis.

Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis

The anatomic distribution, size, and histologic mode of involvement of 98 metastatic lymph nodes in 49 of 370 patients were examined to determine to what extent lymphadenectomy should be performed in addition to gastrectomy in patients with early gastric cancer. Nodal involvement in the marginal sinus (30 nodes) and partial medullary sinus (37 nodes) were commonly seen, and the lymph nodes of those types were enlarged compared with 1,086 patients with no metastatic lymph nodes (control group). Lymph nodes of the wide medullary sinus (11 nodes), small nodule (3 nodes), and massive involvement types (17 nodes) did not enlarge compared with those of the other types and those of the control group. Most of the metastatic sites (76.6 percent) were in the perigastric lymph nodes along the lesser and greater curvatures, about a fifth were in the extraperigastric nodes along the left gastric, common hepatic, celiac, and splenic arteries, and the least were in the extraperigastric nodes (3.1 percent) along the hepatoduodenal ligament. Since the rate of macroscopic diagnosis during operation was so poor, regardless of the histologic modes of nodal involvement, and also in cases of metastatic lymph nodes less than 15 mm in widest diameter, for curative operation of patients with early gastric cancer, perigastric and extraperigastric lymph nodes along the main arteries near the stomach should be completely dissected, in addition to resection of the stomach.

Results of resection of gastric cancer extending to adjacent organs

We report the late results of resection in 281 patients with gastric carcinoma extending to adjacent organs. In 92 without incurable factors (peritoneal dissemination, liver metastasis and widespread nodal involvement) the 5-year survival rate was 36.7 per cent in those treated by gastrectomy and complete removal of the invaded organ. This value is significantly higher than the 17.4 per cent recorded in those undergoing gastrectomy alone or with incomplete removal of the invaded organs (P less than 0.05). In 189 patients with incurable factors, the 5-year survival rates were 5.4 and 2.8 per cent respectively in cases of complete and incomplete excisions. This tendency was similar in patients with a single invaded organ and also in those with plural organ involvement. In potentially curable patients treated by complete excision, the probability of long-term survival was statistically better than that following incomplete excision only when the pancreas was involved (P less than 0.05). We recommend complete excision of invaded organs, irrespective of the number or site of organs involved, provided that there is no evidence of incurable factors.

[Experimental study on the pathophysiology of endotoxin shock as analysed by alterations in thromboxane B2 and 6-keto-PGF1 alpha levels]

To evaluate the pathophysiological role of thromboxane A2 (TXA2) in endotoxin shock, plasma concentrations of TXA2 and PGI2 following E. coli endotoxin (ET) administration were measured in dogs and rats by radioimmunoassay of their stable metabolites TXB2 and 6-keto-PGF1 alpha, respectively. Also, the effects of TXA2 synthetase inhibitor (OKY046) on eicosanoid levels, haemodynamics and survival were assessed. The following results were obtained: 1) Survival rates of the rats given 50 mg/kg of ET were 31% at 12 hrs and 17% at 24 hrs. Pretreatment with OKY046 markedly improved the survival rates. 2) Plasma concentrations of TXB2 were rapidly elevated in untreated control dogs and rats following ET administration, whereas plasma 6-keto-PGF1 alpha levels were gradually elevated. TXB2/6-keto-PGF1 alpha ratio showed an early elevation at 15 minutes after ET administration. The ratio became lower than base line, thereafter. 3) In contrast to the controls, animals pretreated with OKY046 did not exhibit significant elevations in plasma TXB2 levels. On the other hand, plasma levels of 6-keto-PGF1 alpha were not altered by OKY046 treatment. 4) In the control dogs given ET, the early elevations in pulmonary artery pressure (PAP) and reduction in lung compliance correlated with the early elevation in plasma TXB2/6-keto-PGF1 alpha ratio. 5) In OKY046-treated dogs, the early elevation in TXB2/6-keto-PGF1 alpha ratio was not seen and PAP increase and lung compliance reduction were prevented. The results suggest that TXA2 plays an important pathophysiological role in the development of endotoxin shock.

Ultrastructural visualization of selective peanut agglutinin binding sites in rat osteoclasts

We investigated the distribution of concanavalin A (ConA)-reactive alpha-D-mannosyl and alpha-D-glucosyl groups and peanut agglutinin (PNA)-reactive beta-D-galactose-(1----3)-N-acetyl-D-galactosamine residues on the surface of osteoclasts with pre-embedment ultrastructural lectin cytochemistry after aldehyde fixation of the metaphyses of the rat tibiae. By routine morphology, the plasma membrane of the ruffled border of the osteoclast was distinguished from the rest of the cell membrane, with the exception of the membrane of coated pits, by its characteristic thick coat at its cytoplasmic surface. Cytochemistry, using ConA in combination with horseradish peroxidase (ConA-HRP) and PNA conjugated to HRP, showed that binding of ConA was distributed over the entire cell surface of osteoclasts. In contrast, intense binding of PNA was limited to the membranes of the ruffled border and coated pits, whereas the remainder of the cell membrane stained weakly or not at all. These results demonstrate that preferential PNA binding sites of the cell surface correspond to coated membranes associated with osteoclastic endocytosis.

Partial purification and properties of neutral PTHase from the cytosolic fraction of rat renal cortex

A possible new enzyme, a cytosolic neutral PTH-degrading enzyme previously described by us, was purified by ammonium sulfate fractionation, Sephadex G-200 column chromatography and DEAE cellulose column chromatography from the 100,000 x g supernatant of rat kidney. Three active peaks (designated P-I, P-II and P-III) were obtained through a DEAE cellulose chromatographic column. These three activity peaks were interchangeable on rechromatography. Further characterization of the major P-II fraction was attempted. When PTH was used as the substrate, this enzyme preparation (P-II) was inhibited by Ca2+, ATP and glutathione (GSH), but not by trypsin inhibitor, PMSF, E-64, leupeptin, chymostatin or pepstatin. This enzyme preparation could hardly hydrolyze several synthetic analogs containing MCA but not Leu-MCA and Z-Phe-Arg-MCA. When Z-Phe-Arg-MCA was used as the substrate, this enzyme preparation was activated by ATP and GSH, while no activation was induced when PTH was used. These results indicate that the neutral PTH-degrading enzyme seems to represent a new PTHase capable of specifically splitting PTH at certain locations.

Transcallosal response (TCR) in the chronic photosensitive baboon preparation, Papio papio. II. Effect of premotor cortical kindling

The chronological pattern of transcallosal response (TCR) and its recovery cycle were studied by single or paired stimulation of the homotopic primary and the secondary (contralateral) cortical site before, during and after primary site premotor cortical kindling in Papio papio. Prior to kindling, the sequential pattern of TCR was early positive (P1), negative (N1), late small positive (P2) and large negative (N2) components. The recovery cycle of both P1 and N1 showed a marked supernormal phase at an inter-stimulus interval of 15-200 msec with a peak at about 30 msec, showing maximal facilitation up to 300%. Kindling, with or without prior low frequency cortical stimulation, resulted in a long-lasting amplitude potentiation of both P1 and N1 and a significant modification of the late components. However, a transient amplitude reduction was noted immediately following completion of stage 5 kindling, presumably due to repeated generalized convulsions. These changes occurred only during primary (kindling), but not secondary, homotopic site stimulation. These findings suggest that a persistently increased callosal transmission is probably due to primary site kindling-induced functional alteration of the synaptic site at the homotopic secondary site cortex. In contrast, the supernormal phase of the TCR recovery cycle was suppressed significantly at the secondary site cortex. Since a similar suppressive effect was observed with a small dose of pentobarbital in naive baboons, kindling is considered to produce enhancement of the inhibitory mechanism. However, a diminished suppressive effect on the supernormality 20 days after the termination of kindling suggests that this suppressive effect is transient. It is probably related to the repeated kindled convulsive seizures rather than to the kindling process itself.

A role of the striatum in premotor cortical seizure development

Striatal function in partial seizure development induced by low frequency cortical stimulation of the ipsilateral premotor cortex was investigated by either electrolytic lesion placement or microinjection of putative neurotransmitter-related drugs into the ipsilateral striatum. Unilateral striatal lesioning and intrastriatal injection of muscimol, a GABA-agonist, and glutamic acid diethylester, a presumed antagonist for glutamatergic neurotransmission, were effective in suppressing seizure development, whereas intrastriatal injection of a subconvulsive dose of carbamylcholine chloride (carbachol), a cholinergic agonist, decreased the seizure threshold. In contrast to the ipsilaterally dominant metabolic activation in the intact animal, an inverse asymmetry due to a considerable reduction of deoxyglucose uptake in the ipsilateral thalamus, entopeduncular nucleus, substantia nigra, striatum and surrounding cortex of the focus was found in those brains with striatal lesion. Altogether, the findings suggest that experimental reduction of the inhibitory striatal outputs to both the entopeduncular nucleus and the substantia nigra enhances tonic activities of the projection GABAergic neurons in those nuclei, thereby inhibiting seizure development.

Transcallosal response (TCR) in the chronic photosensitive baboon preparation, Papio papio. I. Premotor cortical stimulation, recovery cycle and neurotropic drug effect

Transcallosal response (TCR) and its recovery cycle were studied in the chronic photosensitive baboon, Papio papio. Bipolar premotor intracortical stimulation evoked early positive (P1) and negative (N1) sequences followed by late small positivity (P2) and large negativity (N2) in the contralateral homotopic site. The sequential pattern of P1 and N1 was similar to that previously described in acute preparations. The recovery cycle as measured by means of paired stimuli with varying inter-stimulus intervals (ISI) showed a marked supernormality of P1 and N1 at an ISI of 15-200 msec with maximal facilitation up to 250-300% of the conditioning response at an ISI of 30-50 msec. Pentobarbital (10 mg/kg) suppressed this supernormality without causing a constant TCR amplitude change. In contrast, a significant increase in both the TCR amplitude and the supernormality of the recovery cycle was observed with a subconvulsive dose (3 mg/kg) of Megimide, a presumed antagonist of pentobarbital. Our results suggest that (a) the recovery cycle is a more sensitive measure than amplitude for assessing the effect of neurotropic drugs on TCR, and (b) the P1, N1 amplitudes and the supernormality may represent different neuronal processes involved in the TCR.

Antitumor activity of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothec in, a novel water-soluble derivative of camptothecin, against murine tumors

The search for new water-soluble analogues of camptothecin (CPT) with higher activity and less toxicity has led to the development of a novel compound, 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin (CPT-11), which showed significant antitumor activity against a broad spectrum of experimental tumor models by i.p., i.v., or oral administration. When its activity against L1210 was compared with that of CPT and known derivatives, CPT-11 was most effective, giving the highest maximum increase in life span (ILS) and showing good activity over a wide dose range. The antitumor activity of CPT-11 was shown against tumors not only in the ascites form but also in the solid form. Included among the more susceptible murine tumors are S180, Meth A fibrosarcoma, Lewis lung carcinoma, Ehrlich carcinoma, MH134 hepatoma, mammary carcinoma of C3H/HeN mice, L1210, and P388 leukemia. Probable cures of these tumors were induced frequently by CPT-11. The antitumor activity of CPT-11 against i.p.-implanted L1210 was superior to that of Adriamycin in maximum ILS, the number of cured mice, and the therapeutic ratio. CPT-11 at a dose of 100 mg/kg produced an ILS in excess of 300% with five of six mice surviving tumor free, and effected 100% tumor regression at 200 mg/kg, whereas the optimum dose of Adriamycin, 12.5-25 mg/kg, brought about 114-129% ILS with one of six mice surviving. The acute toxicity of CPT-11 was extremely low, particularly in the case of oral administration. CPT-11 is expected to be clinically useful.

Reciprocal inhibition between seizures induced by intermittent light stimulation and premotor cortical stimulation in Senegalese baboons, Papio papio

The temporal relationship between the degree of photosensitivity and the intensity of kindling stimulus response was examined in four Senegalese baboons, Papio papio, kindled at the premotor cortical area. When fully kindled, the intensity of photosensitivity diminished significantly in all the animals. With successive daily intermittent light stimulation, two animals showed partial recovery and the other two showed complete recovery to the prekindling level of photosensitivity. When premotor cortical kindling stimulation was subsequently reapplied, three-quarters of the animals failed to respond with kindled seizures and additional stimulations were necessary to reestablish kindled seizure. Two of these three animals also required increased stimulus intensity before the previously established generalized seizure threshold could be reinstated. The frontorolandic cortex is known as the most epileptogenic area in photosensitive Papio papio. In this species, spontaneous generalized convulsive seizures, intermittent light stimulation-induced seizures, and kindled generalized convulsive seizures are all known to share a common electroclinical phenomenology. The reciprocal inhibition observed in this study between generalized seizures induced by either intermittent light stimulation or by premotor cortical kindling stimulation further strengthens the possibility that they also share a common neuronal mechanism.

[A case of carcinoma in the lower abdomen treated successfully with oral administration of bestrabucil]

A 72-year-old female was admitted because of a palpable hard tumor, 15 X 7 cm in size, in the left lower quadrant of the abdomen. According to a diagnosis of retroperitoneal tumor, laparotomy was performed, revealing a large tumor extending between the descending colon and the pelvic cavity, which could not be separated from the retroperitoneum, uterus, left ovary, urinary bladder or rectum. A number of metastatic nodules were disseminated to the peritoneum and mesenterium. The pathological diagnosis of the nodules was poorly differentiated carcinoma of transitional cell type, origin unknown. After discharge, oral administration of bestrabucil (100-200 mg/day), the benzoate of an estradiol-chlorambucil conjugate, was given to the patient at an outpatient clinic. The tumor ceased to be palpable when the total amount administered reached at 14 g. Ultrasonography and computed tomography demonstrated significant reduction in tumor size. A decrease in the peripheral leukocyte count was observed after every consecutive administration and it took about 2 months to recover to the normal level. No other side effects were observed in this case. Although administration was stopped at a total amount of 16.1 g, reenlargement of the tumor has not been observed for 9 months.