[Response and pharmacokinetics of cisplatin instilled into the pleural cavity]

The response and pharmacokinetics of cisplatin instilled into the pleural cavity were studied in 11 patients with malignant pleural effusion; 10 patients had primary lung cancer and one had breast cancer. All of them were adenocarcinoma histologically. In five of the 11 patients effusion disappeared and its cytology became negative for malignancy after four weeks. In the other six patients effusion was reduced and its cytology became negative for malignancy after four weeks. Toxicity was almost similar to that in systemic administration of cisplatin but a few patients had chest pain and fever possibly due to local irritation. The pharmacokinetics showed that a high concentration of cisplatin (free-form, 48.9 micrograms/ml) was maintained over a long period (free from (t 1/2) beta = 33.6 hours) in the pleural cavity. This was regarded as the reason for the high response to this therapy. The intrapleural instillation of cisplatin into the pleural cavity therefore seems to be an effective modality for malignant pleural effusion.

[Brain lipid metabolism during early period of global ischemia--with reference to the enzymes related to membrane phospholipid metabolism]

It is generally known that free fatty acids (FFA) are liberated from membrane phospholipids in the brain tissue during the early period of ischemia. However, the precise mechanism of FFA liberation from phospholipids is still unclear, even though it is a central topic of neurosurgery. As an initial step toward a better understanding of the molecular mechanism, we have investigated the effects of global ischemia upon brain lipid metabolism. Brain ischemia was evoked by rat decapitation without anesthesia. Removed brains were incubated for 1, 5, 15 or 30 min at 37 degrees C and then quickly frozen in liquid nitrogen. After extraction of total lipids from the brains by Bligh & Dyer's method, the compositions of neutral lipids and phospholipids were analyzed by thin-layer and gas-liquid chromatography. For assaying deacylating enzyme (phospholipase A) activity, the brain homogenate was used as a crude enzyme. The reaction mixture including radioactive substrate, buffer (pH 7.3 & 4.0) and enzyme was incubated for 1 hour at 37 degrees C. Lipids were extracted from reaction mixture and separated by TLC. The enzyme activity was estimated by measuring the radioactivity in FFA or lysophosphatidylcholine liberated from L-alpha-di [1-14C] palmitoyl phosphatidylcholine. The reaction mixture for the assay of reacylating enzyme (acyl CoA: lysophospholipid acyltransferase) activity, contained acyl CoA, lysophosphatidylcholine, DTNB and microsomes, and the enzyme activity was determined by the amount of released CoA-SH detected spectrophotometrically. The results demonstrated that FFA, either unsaturated or saturated, rapidly accumulated in the brain during the early period of ischemia. Di-acylglycerols were also produced in the ischemic brain.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phase II study of cis-dichlorodiammineplatinum (II) for non-small cell lung cancer]

A phase II study of cis-dichlorodiammineplatinum (II) (CDDP) was performed in 83 patients with inoperable non-small cell lung cancer (21 squamous cell carcinomas, 57 adenocarcinomas and 5 large cell carcinomas). CDDP was given by i.v. infusion at a dosage of 50 mg/m2 (low-dose regimen) or 80-100 mg/m2 (high-dose regimen) every 3 to 4 weeks. Seventy-nine out of 83 patients were evaluable for tumor response. Sixteen of these evaluable patients achieved complete or partial response, and the overall response rate was 20.3%. The response rates were 27.8% in patients with squamous cell carcinoma and 19.6% in those with adenocarcinoma. None of the patients with large cell carcinoma responded. The high-dose regimen was superior to the low-dose regimen in response rate (25.6% versus 5.8%). The responders survived significantly longer than patients with NC (p = 0.02) or PD (p = 0.003). Leukopenia of less than 3000/mm3 occurred in 12.1% of cases, and thrombocytopenia of less than 7 X 10(4)/mm3 occurred in 7.6%. A transient elevation of serum creatinine value was observed in 9 patients (10.8%). Moderate to severe nausea and/or vomiting occurred in almost all patients. It was therefore considered that CDDP was one of the most effective agents for non-small cell lung cancer with tolerable toxic effects.

Characterization of extramedullary tumors in a case of Ph-positive chronic myelogenous leukemia: possible involvement of immature T lymphocytes

A 42-year-old male with chronic myelogenous leukemia (CML) developed acute transformation associated with subcutaneous tumors. Histopathologic examinations of the tumors were done on two occasions; the first study revealed reticulum cell sarcoma-like features, and the second suggested a blastoma. Chromosomal analysis showed that the cells of the tumors originated from the CML clone. The cells had a negative reaction for myeloperoxidase by electron microscopy. Furthermore, biochemical and surface marker studies revealed that the tumor cells contained a significant terminal transferase activity. However, they did not express E- or EAC-rosette receptors, Ia-like antigens, or common ALL antigens.

[Familial occurrence of intracranial arteriovenous malformation]

It is beyond that cerebral arteriovenous malformation (AVM) is a congenital disease based on abnormal vascular formation in the embryonic stage. Nevertheless, familial occurrence of cerebral AVMs has been previously reported only in five families throughout the world, when complications of specific diseases such as Sturge-Weber-Dimitri disease, von Hippel-Lindaeu disease, and Osler-Rendu-Weber disease were ruled out. We have recently encountered four cases of two familial AVMs. In this paper, we review nineteen cases of nine familial AVMs from literature including our four cases from two families. Case 1: A 50-year-old male was admitted in June, 1975, for clonic convulsion. Cerebral angiography showed an AVM situated in the left parietal region, which was supplied from callosomarginal and central arteries. Total excision of the AVM was performed. The patient was completely cured and discharged without abnormal neurological deficits. Case 2: A 16-year-old male was admitted in May, 1978, with about ten years history of general convulsions. This patient was the third child of Case 1. Cerebral angiography revealed an AVM situated in the right parietal region, which was supplied from callosomarginal and precentral arteries. Total resection of the AVM was performed. The patient was completely cured. Case 3: An 11-year-old boy was admitted to our hospital in a comatose state in January, 1978, and soon died. Cerebral angiography showed only presence of internal hydrocephalus. The autopsy revealed a hematoma in the right cerebellar hemisphere with bilateral intraventricular hematomas, and AVM was histologically found in the cerebellum.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic and ultrastructural studies on ten patients with acute promyelocytic leukemia, including one case with a complex translocation

Chromosomal banding analyses and ultrastructural studies were performed on ten cases of acute promyelocytic leukemia (APL-M3). A reciprocal translocation, t(15q + ;17q-), was found in six of them, and the possible breakpoints of these chromosomes were assigned at bands 15q22 and 17q12. In addition, trisomy 8, trisomy 8 and 21, and an isochromosome of the long arm of the translocated #17, i(17q-), were observed in addition to the 15;17 translocation in three cases, respectively. Furthermore, one patient was found to have a complex translocation in the marrow cells, i.e., 47,XX,+X,t(1p+;5q-;15q+;17q-). Ultrastructural studies demonstrated that the leukemic cells obtained from six of the seven patients with the chromosomal changes involving 17q12 and from two of the three with normal karyotypes contained stellate rough surface endoplasmic reticulum (stellate rER) complexes and/or inclusion bodies in part of the dilated rER.

[Delayed radiation necrosis in the optochiasmatic region--report of two cases and review of the literature]

Two cases with delayed radiation necrosis of the chiasmatic region following irradiation of the hypophysis for treatment of Cushing's disease were presented. Case 1 was a 36-year-old female who had reduction of visual acuity and bitemporal hemianopsia 2 years after 60Co-irradiation therapy (total 8000 rads) for Cushing's disease. CT scans showed low density in the pituitary fossa and irregular contrast-enhanced suprasellar mass, and metrizamide CT cisternography revealed the pituitary fossa filled with contrast medium. From those findings, secondary empty sella syndrome was suspicious. Case 2 was a 35-year-old male who had progressive visual disturbance 3 years after 60Co-irradiation therapy (total 9050 rads) for Cushing's disease. The right visual acuity was 0.05 and the left one was 0.1. Examination of visual field showed left homonymous hemianopsia. CT scans showed the contrast enhanced suprasellar mass extending to the right anterior thalamic region, and metrizamide CT cisternography detected secondary empty sella as same as that of Case 1. Both cases were treated by administration of steroid hormone intrathecally and orally which was not effective. Right frontotemporal craniotomies were performed. Intraoperative findings of the chiasmatic region revealed diffuse adhesions and thickening of arachnoid membrane with mesh-work of fine vascular proliferations and adhesiotomies were performed in both cases. On the postoperative course, visual disturbance did not improved in both cases. Histological examinations of the thicked arachnoids obtained intraoperatively showed the fibrous connective tissues with round cells infiltrations in both cases, and in Case 2, the small vessel in the arachnoid was occluded by organized thrombi. Authors reviewed and analyzed literatures of delayed radiation necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic and in vitro culture studies on chronic myelomonocytic leukemia

Six cases of chronic myelomonocytic leukemia were studied with cytogenetic and colony-formation techniques. Chromosome studies on bone marrow cells with the Q-banding method revealed cytogenetic changes in three of the six patients; +5, +8, +21, -13, -X, +1q, and 7q-. Chromosome changes among cases showed no particular correlation with survival or with the tendency to develop the acute phase. In vitro culture studies in the three cases showed that most of the hematopoietic precursors in the patients were considered to be myelomonocytic cells, with a variable number of colonies. Adherent cells from the patient's marrow had inhibitory effects for colony formation; on the other hand, patient serum showed elevated colony-stimulating activity.

Stimulation of human and murine bone marrow cell colony formation by colony-stimulating factors obtained from the urine of mice bearing leukocytosis-inducing fibrosarcoma

Dialyzed urine of mice bearing leukocytosis-inducing fibrosarcoma stimulated granulocyte colony formation in semisolid agar culture of human bone marrow cells. Removal of phagocytic cells prior to stimulation did not interfere with the formation of these colonies in the culture. On the other hand, macrophage colonies were predominantly produced when murine bone marrow cells were stimulated by the dialyzed mouse urine. The activity of colony-stimulating factor (CSF) in the urine of normal mice was less than 1/100 of that in the urine of tumor-bearing mice. DEAE-cellulose column chromatography separated the activity stimulating human granulocyte colony formation from that stimulating murine macrophage colony formation. Further purification showed that a sialoglycoprotein with an apparent molecular weight of 80,000 corresponded to the macrophage CSF, which was devoid of activity toward human cells. The molecular properties of the human-active granulocyte CSF could not be studied further, because it was quite unstable.

Carcinoembryonic antigen (CEA) levels in pleural effusions and sera of lung cancer patients

For determining the value of carcinoembryonic antigen (CEA) levels in diagnosis of malignant tumors of the lung, the CEA levels in 187 specimens of pleural fluid and sera obtained simultaneously from patients with pleural fluid were measured. In all 70 patients with benign diseases, the CEA levels in the effusions were less than the cut-off value of 5 ng/ml (mean +/- SD: 1.44 +/- 1.01 ng/ml). In contrast, in 88 of 117 patients (75.2%) with malignant diseases, the CEA levels in the effusions were over 5 ng/ml (25.3 +/- 24.5 ng/ml) and in 58 of the 117 patients (50.4%), the CEA levels in the serum were values of 5 ng/ml or more (11.9 +/- 18.4 ng/ml). There was a significant correlation between the CEA levels in the effusions and in the sera. The CEA levels in effusions in patients with malignant lung tumors were usually much higher than those in their sera. The incidence of CEA levels of 5 ng/ml or more in both the serum and effusion was highest in the patients with adenocarcinoma. These data indicate that determination of the CEA level in effusions, when done in combination with cytological examinations, may have additional value in diagnosis of lung cancer.

Cytochemical changes in lactate dehydrogenase isoenzymes in human brain tumours

The lactate dehydrogenase (LDH) isoenzyme patterns in benign and malignant brain tumours were determined by means of electrophoresis of the cell extracts and selective cytochemical stain of the smears. The LDH isoenzyme distribution of the cell extracts showed a pronounced cathodal shift in the malignant gliomas and metastatic carcinomas. Normal brain tissues and histologically benign gliomas, however, showed an anodal pattern with a dominance of the H-type LDH. Schwannomas and meningiomas had a midzone isoenzyme pattern with a dominant LDH3 fraction. Pituitary adenomas usually showed the LDH pattern similar to that of the normal cerebrum. The LDH M fraction could be cytochemically verified using an inhibitory effect by 2.6 M urea in staining. Astrocytomas grades 3-4 and metastatic carcinomas were characterized by loss or marked reduction of stainability by urea treatment, while astrocytomas grades 1-2 and oligodendrogliomas were resistant to urea inhibition.

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

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

[A family of von Recklinghausen's disease associated with bilateral acoustic neurinomas and falx meningiomas]

A familial or inherited occurrence of von Recklinghausen's disease has been reported hitherto, some of which were associated with intracranial tumors such as gliomas, neurinomas, meningiomas or others. Authers report a family (case 1: father, case 2: son, case 3: daughter) of von Recklinghausen's disease associated with both bilateral acoustic neurinomas and falx meningioma. Case 1. A 41 year-old male was admitted to our hospital with complaints of bilateral hearing disturbance, headache and loss of visual acuity. On admission, neurological examination revealed left papilledema, right cataracta, impairment of bilateral cranial nerves V, IX, X, bilateral deafness, cerebellar ataxia, motor weakness of lower extremities and sensory disturbance of peripheral region of extremities. Twelve subcutaneous nodules were noted over the entire body and Café-au-lait spots were found slightly to be scattered over the chest and the back. Craniogram and vertebral angiography demonstrated bilateral CP angle tumors, and the diagnosis of bilateral acoustic neurinomas was made. Subtotal removal of bilateral tumors and Torkildsen's shunting were carried out. Histological diagnosis was neurinoma. Post-operative course was good. But 6 years later, he complained of gait disturbance. Computed tomography revealed falx meningioma in the frontal lobe and recurrence of bilateral acoustic neurinomas. So meningioma was totally removed. Eight months after surgery he died of aspiration pneumonia aged 47. Case 2. A 15 year-old male, son of case 1, was admitted with complaints of bilateral deafness, gait disturbance and visual disturbance. Neurological examination disclosed left papilledema, right congenital cataracta, impairment of bilateral cranial nerves V, IX, X, ataxic gait and sensory disturbance of right lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Cooling-induced contraction in ileal longitudinal smooth muscle of guinea-pig

The ileal longitudinal smooth muscle developed a transient contraction on cooling from 37 degrees C to 1 degree C in normal Ca2+ (2.5 mM) medium. The transient contraction was not inhibited by pretreatment with the Ca2+ antagonist, D-600 (1 X 10(-6)M). The contractions were sustained by cooling to 1 degree C in the presence of added Ca2+ greater than 10 mM. After the pretreatment with D-600, when the muscle incubated in normal medium with added 20 mM Ca2+ had been cooled to 1 degree C, a phasic response was only seen. However, D-600 did not inhibit the sustained contraction at 1 degree C after incubation in the presence of added 20 mM Ca2+. It is suggested that the transient and sustained contraction at 1 degree C is maintained by Ca2+ release from a cellular site, probably the cell membrane and it requires more calcium for the sustained tension.

Macrophage colony-stimulating factor and granulocyte colony-stimulating factor separated from fibrosarcoma tissue in mice

Large increases of granulocytes and monocytes were found in the blood of mice bearing fibrosarcoma. Extraction of the tumor tissue with isotonic saline yielded a colony-stimulating factor (CSF). Further extraction of the saline-insoluble materials with 0.1% sodium dodecyl sulfate afforded another pool of CSF. Incubation of the tumor cells in vitro resulted in the accumulation of CSF activity in the culture medium. The CSF from these sources produced both granulocyte colonies and macrophage colonies in murine bone marrow cell culture. Subsequently, the activity producing granulocyte colonies was separated from that producing macrophage colonies by isoelectrofocusing and repeated gel-filtration chromatography. It was also shown that anti-L cell CSF antiserum neutralized the macrophage CSF activity but not the granulocyte CSF activity. These results show that the granulocytosis-inducing tumor produces two types of CSF.

[Postoperative treatment for malignant intracranial tumors--especially concerning intermittent intra-carotid administration of adriamycin]

Seventeen patients, aged 9 to 63 years (mean age 38.2 years), with 6 recurring malignant glioma, 5 malignant meningioma, 4 metastatic brain tumor, one endodermal sinus tumor and one embryonal carcinoma were postoperatively treated with adriamycin (ADM). As a rule, 20 mg of ADM (to 960 mg in a total dosis) were given by means of intra-carotid administration every two weeks (to 250 months in duration). According to Karnofsky's evaluation, 4 of 6 glioblastoma patients(66.7%), 4 of 5 malignant meningioma (80%), 2 of 4 metastatic brain tumor (50%) and one embryonal carcinoma had improvement of clinical condition, at least during two months after the beginning of the treatment, and/or remission of more than 50% of the enhanced area on CT scan. Consequently, allover response rate was 64.7%. Tumor tissue concentration of ADM administered intraoperatively by the same regimen, was estimated by fluorescence assay, twenty times in sixteen patients. The level of the concentration was higher in malignant tumor (3.6 to 6.2 micrograms/g) than in low grade astrocytoma (1.5 microgram/g in maximum) during sixty minutes after ADM administration. On the other hand, when ADM of same dosis was given intravenously, maximum serum level was 2.8 microgram/ml, which was less than half in comparison with tissue level of intracarotid administration. There was a serious myelosuppression in two cases in our series, but no cardiomuscular damage was observed in any cases. In conclusion, ADM concentration of brain tissue such as malignant meningioma, metastatic brain tumor and, even glioblastoma, was highly obtained. Further, intermittent intra-carotid administration of ADM was more effective than intravenous dripping in treating malignant intracranial tumor, although side effects should be carefully avoided.

[Meningioma following irradiation for vascular nevus. A case report]

A case of meningioma that developed 37 years after irradiation therapy for vascular nevus of the scalp over the right frontoparietal region was reported. A 49-year-old male was admitted to the hospital of Gifu University on October 26, 1979, because of a generalized seizure. He had been born with a vascular nevus affecting the right frontoparietal scalp, for which he began receiving local irradiation at the age of 12. The total dose was not known because the only source of information regarding this treatment was the patient's memory. From the age of 17, the suffered from occasional attacks of dysesthesia in the left side of his body without consciousness disorder. He otherwise remained well for the intervening 37 years. Upon admission, he had a vascular nevus remaining with post irradiation skin changes over the right frontoparietal region. General and neurological examination were not remarkable. Right carotid angiogram and CT scan disclosed the presence of a right frontal tumor. A right frontotemporal craniotomy was performed on December 4, 1979 and a hard tumor was found firmly attached to the dura and bone at the right site. All visible tumor and involved bone were completely removed without difficulty. Histological examination of the surgical specimen showed the characteristic features of a transitional meningioma. There was no evidence of malignancy in the sections examined. Since Mann et al reported a malignant meningioma following irradiation therapy for optic nerve glioma, there have been many reports, over seventy cases of so-called radiation-induced meningioma. However, a meningioma following irradiation therapy for vascular nevus of scalp or face is exceedingly rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic myelogenous leukemia with a complex Ph1 translocation in an XYY male

We encountered a 38-year-old Japanese male patient with chronic myelogenous leukemia (CML), whose bone marrow and peripheral blood cells during the chronic and blastic phases contained a complex Ph1 translocation and an extra Y chromosome [i.e., 47,XYY,t(9;22;13)(q34;q11;q14)]. A karyotypic analysis of PHA-stimulated lymphocytes showed the constitutional karyotype to be 47,XYY. Thus, it was considered that CML with a complex Ph1 translocation developed in an XYY male; such a case has not been reported, so far. A B-lymphocyte cell line with the complex Ph1 translocation was established by the procedure of Epstein-Barr virus transformation. The presence of the complex Ph1 translocation in the B-lymphocyte cell line suggests that some of the B lymphocytes in this patient originated from the CML clone.

[Experimental studies on the effect of perfluorochemicals in tumor irradiation]

The effects of radiation therapy with Fluosol-DA on rat mammary tumors were studied. The tissue oxygen tension values of tumors in breathing mixed gas (5% carbon dioxide and 95% oxygen) with Fluosol-DA (25 ml/kg, i.v.) were significantly higher than those in room air without Fluosol-DA. The rats were divided into three groups: Group I received Fluosol-DA but no irradiation, Group II was treated with 1000 rads of irradiation using 60Co without Fluosol-DA in room air and Group III received the same irradiation and Fluosol-DA in breathing mixed gas. In the latter group we observed a prolongation of the survival time and suppression of the tumor growth.

Occurrence of a monocyte/macrophage colony-stimulating factor in the continuous ambulatory peritoneal dialysis fluids and its chromatographic behaviors and antigenicity compared with human urinary colony-stimulating factor

Continuous ambulatory peritoneal dialysis (CAPD) fluid from three patients with chronic renal failure exhibited the activity of colony-stimulating factor (CSF) in amounts varying from 5 to 40 units per ml. Like the CSF obtained from normal human urine, the peritoneal CSF predominantly produced monocyte/macrophage colonies in soft-agar culture of mouse bone marrow cells. Semipurified peritoneal CSF showed its isoelectric point at pH 3.6 and 4.9 before and after the treatment with neuraminidase. Under the same conditions, the urinary CSF was focused at pH 3.1 and 4.6. The position of elution of the peritoneal and urinary CSF in ordinary gel-filtration chromatography corresponded to a molecular weight of 62,000 and 117,000, whereas both CSFs exhibited a molecular weight of 28,000 upon gel-filtration in the presence of 6 M guanidine HCl. Furthermore, the two CSFs from the human sources were neutralized by antimouse L cell CSF serum in the same manner. We conclude that the peritoneal CSF is a sialoglycoprotein which is nearly identical with the urinary CSF despite processing of the latter through kidneys.

[Conditions suitable for chemotherapy of lung cancer]

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

[Cervical spondylolysis--a case report and review of the literature]

Spondylolysis of the sixth cervical vertebra was reported in a thirty-seven-year-old man. He complained of sleeplessness and had no history of trauma. Plain cervical spine films and CT scan showed separation of the bilateral pars interarticularis and hypoplasia of the superior and inferior articular processes of C6. And they showed compensated hyperplasia and upward deviation of the right superior articular process of C7, but there was no instability of cervical vertebra. Spina bifida occulta at C6 and deviation of the spinous process of C7 to the left side were observed clearly on CT scan. We gave him no surgical treatment because of his normal neurological state and absence of instability. Cervical spondylolysis is very rare disease, so only 48 cases have been reported in literature. Our case is the first case that reports findings of CT scan. Radiographic findings and the absence of history of trauma suggest a congenital etiology of this illness. In the 49 patients including our case, 35 patients were males and 14 were females. 35 patients complained of neck and/or occipital pain, 12 of pain and/or sensory disturbance of upper extremities, and 8 of shoulder pain and/or stiffness. The prevalent site of involvement appears to be C6 with only 14 cases involving another level, C2, C3, C4 or C5. 36 patients had spina bifida occulta and it was most frequently detected at the level of C6.

Arteriovenous malformation of the spinal cord and cauda equina fed by branches of the internal iliac artery and associated with vertebral hemangiomas

A rare case of an arteriovenous malformation (AVM) of the spinal cord is presented. The patient was a 35-year-old man who experienced progressive paraparesis and rectovesical disturbances. In this patient a spinal AVM was fed by branches of the left internal iliac artery and was associated with a sacral hemangioma. An additional hemangioma of the third lumbar vertebral body was also found. On reviewing the literature, only 4 cases, including ours, of spinal AVM with feeding vessels originating from the internal iliac artery were found. One of these patients had an associated vertebral hemangioma.

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

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

[Scotomatous defects in the central visual field, associated with pituitary tumor--a case report (author's transl)]

A rare case which showed scotomatous defects in the left central visual field was presented. A 51 year-old man was admitted to our clinic because of the visual deterioration. In neuroradiological examinations the left carotid angiography showed elevation of both A1 portions and CT suggested pituitary tumor. On February 5, 1980 radical operation was carried out, in which it was confirmed that part of the optic nerve was concave and split longitudinally with a compression of the pituitary adenoma. Postoperative course was uneventful and recovery from the defects in the central visual field was quickly. In this case longitudinal splitting of unilateral optic nerve, caused by gradual compression of supra- or parasellar tumor, was considered as one cause of scotomatous defects in the central visual field. In addition, visual status of forty six cases of pituitary adenoma which had been operated at our clinic during the past fourteen years was analysed both pre- and post-operatively, compared with the case described above.

Effects of phenobarbital on plasma concentration of phenytoin and mortality of mice treated with phenytoin after electroshock

THe effects of phenobarbital on the plasma concentration of phenytoin and mortality of the phenytoin-treated mice were mainly studied. The plasma concentration of phenytoin estimated in the live mice after electroshock was significantly higher than that in the dead mice, suggesting that biological activity of phenytoin is dependent on its plasma concentration where individual difference seems to be large. Though the pretreatment of mice with phenobarbital lowered the plasma concentration of phenytoin, all the mice were alive after electroshock with further treatment with phenobarbital and phenytoin. These results suggest that combination of phenobarbital with phenytoin for the treatment of epileptic patients may be feasible.