Vascular endothelial growth factor in cervical carcinoma

OBJECTIVE

To quantitate vascular endothelial growth factor of cervical carcinoma and elucidate its clinical correlation.

METHODS

Intratumoral protein levels of vascular endothelial growth factor were measured in 104 cervical cancer patients and in 30 cervical tissue specimens of benign gynecologic diseases as controls. The concentrations were correlated with clinical and pathologic characteristics.

RESULTS

The median concentrations of vascular endothelial growth factor in cervical cancer tissues were higher than those in benign cervical tissues (180.0 versus 0.0 pg/mg of protein, P < .001). Tumors larger than 4 cm (1030.0 versus 118.0 pg/mg of protein, P < .001) and with deep stromal invasion (364.0 versus 111.0 pg/mg of protein, P = .016) had higher levels than those smaller than 4 cm or with superficial stromal invasion. Higher levels were also found in tumors with lymphovascular emboli (568.0 versus 118.0 pg/mg of protein, P = .006), parametrial invasion (582.0 versus 117.0 pg/mg of protein, P = .04), and pelvic lymph node metastasis (759.5 versus 121.0 pg/mg of protein, P = .002) than in those without. The protein levels of vascular endothelial growth factor correlated positively with tumor sizes (r = 0.340, P < .001). Tumors with overexpressed VEGF were larger (3.35 +/- 1.17 versus 2.13 +/- 1.28 cm, P < .001) and had higher incidence of deep stromal invasion (20 of 57 versus 6 of 47, P = .009), lymphovascular emboli (15 of 33 versus 11 of 71, P = .011), parametrial invasion (15 of 32 versus 11 of 72, P = .002), and lymph node metastasis (10 of 20 versus 16 of 84, P = .004).

CONCLUSION

Intratumoral protein level of vascular endothelial growth factor in cervical cancer tissue correlates well with local tumor progression and tumor metastasis. Vascular endothelial growth factor might be a marker for evaluating disease severity.

Influence of histologic type and age on survival rates for invasive cervical carcinoma in Taiwan

OBJECTIVE

The aim of this study was to assess survival rates and to evaluate histologic type and age as prognostic factors for cervical carcinoma in an ethnically homogenous population in Taiwan.

METHODS

A retrospective analysis was conducted of 3678 cases of squamous cell carcinoma and adenocarcinoma that were diagnosed and treated for invasive cervical carcinoma between 1977 and 1994. Observed survival rates were estimated using the Kaplan-Meier method, and prognostic factors were assessed using Cox's proportional hazards regression analysis.

RESULTS

Correlating both FIGO stage and age with histologic type revealed a higher proportion of cases with adenocarcinoma in the lower FIGO stages (P = 0.0417). Further, we found that the younger the age group the higher the proportion of cases of cervical adenocarcinoma (P = 0.0006). The 5-year survival rate was lower for patients with adenocarcinoma than for patients with squamous cell carcinoma (66.5 vs 74.0%, P = 0.0009). The 5-year survival rates for FIGO stages I, II, III, and IV squamous cell carcinoma were 81.3, 75.2, 42.7, and 26.1%, respectively, while for adenocarcinoma they were 75.9, 62.9, 29.2, and 0%, respectively. The difference in survival rates between squamous cell carcinoma and adenocarcinoma was found mainly in stage I (P = 0.0039) and stage II (P = 0.0103), where radiotherapy was used as the primary treatment. Age also affected the overall Kaplan-Meier estimate of survival. The younger the age group, the better the survival rate (P < 0.0001). Multivariate analysis confirmed a highly significant association between survival rate and both histologic type (P < 0.0001) and age (P = 0.0037).

CONCLUSIONS

Early stage cervical cancer (stages I and II) with a glandular component had a lower 5-year survival rate than squamous cell carcinoma in cases where radiotherapy was the primary treatment. We speculate that this difference in survival rates between cervical adenocarcinoma and squamous cell carcinoma was due to the relative ineffectiveness of radiotherapy as a primary treatment in cases of adenocarcinoma.

Pregnancy with primary tubal placental site trophoblastic tumor--A case report and literature review

Placental site trophoblastic tumor (PSTT) is a rare trophoblastic neoplasm with malignant potential. The diagnosis and prognosis of this rare disease remain difficult. A case of tubal PSTT with the primary manifestation of internal bleeding at 30 weeks' gestation is presented. Emergency exploratory laparotomy and right partial salpingectomy were performed initially. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were done immediately after cesarean section at 34 weeks' gestation. No further adjuvant therapy was given after surgery. No evidence of tumor recurrence or signs of metastasis were noted during 12 months of follow-up. Heterotopic pregnancy, one with intrauterine normal pregnancy and the other with implanting in the right fallopian tube and placental site trophoblastic tumor transformation, was proposed. To our knowledge, this is the first such case in the English literature.

Vascularity index as a novel parameter for the in vivo assessment of angiogenesis in patients with cervical carcinoma

BACKGROUND

The importance of angiogenesis now is well recognized. Conventionally, tumor angiogenesis is assessed by determination of microvessel density (MVD) in the surgical specimen. This study examines tumor angiogenesis using power Doppler ultrasound and a quantitative image processing system. The authors hope to develop an in vivo and noninvasive method for quantitating tumor angiogenesis.

METHODS

Thirty-five patients with FIGO Stage IB-IIA cervical carcinoma exhibiting visible cervical tumors by transvaginal ultrasound were included in this study. All patients underwent radical abdominal hysterectomy and pelvic lymph node dissection. Transvaginal power Doppler ultrasound was performed before surgery to search for blood flow signals from the tumor. The intratumoral vascularity index (VI) and resistance index (RI) were calculated. The VI was defined as the number of colored pixels divided by the number of total pixels in the defined tumor section. Maximal VI and minimal RI of a certain tumor were used for analysis. Clinical and pathologic data also were recorded. The MVD of the excised tumor was assessed immunohistochemically using a monoclonal antibody against CD34.

RESULTS

Significantly higher VI values were noted in Stage II tumors compared with Stage 1 tumors (19.01+/-10.90% vs. 9.09+/-6.59%; P = 0.008), tumors invad-ing+/-50% of the cervical stroma compared with tumors invading < 50% of the cervical stroma (13.20+/-8.20% vs. 5.72+/-5.00%; P = 0.003), tumors with lymphovascular emboli compared with tumors without lymphovascular emboli (17.28+/-8.26% vs. 6.98 +/- 5.09%; P = 0.001), and tumors with pelvic lymph node metastases compared with tumors without pelvic lymph node metastases (26.16+/-7.88% vs. 8.00+/-4.95%; P = 0.021). None of the variables mentioned earlier showed a significant difference in terms of the RI values. No correlation was noted between intratumoral RI and VI in respective tumors (P = 0.53). Analysis of VI revealed linear regression with regard to tumor size (P < 0.001, correlation coefficient [r] = 0.586) and depth of stromal invasion (P = 0.002, r = 0.497). In addition, the MVD exhibited a linear relation with VI (P = 0.006, r = 0.454), tumor size (P = 0.005, r = 0.465), and depth of stromal invasion (P = 0.009, r = 0.436) using simple regression analysis. No correlation could be found between MVD and RI.

CONCLUSIONS

In cervical carcinoma, intratumoral VI assessment by power Doppler ultrasound and quantitative image processing system showed better correlation with tumor stage, tumor size, and pathologic findings including depth of stromal invasion, lymphovascular emboli, and pelvic lymph node metastases than intratumoral RI. The in vivo indicator of angiogenic activity (VI) is well correlated with the conventional indicator of tumor angiogenic activity (MVD). Thus, VI could be a useful parameter for the in vivo assessment of global tumor angiogenesis.

Preoperative ultrasound study in predicting lymph node metastasis for endometrial cancer patients

OBJECTIVE

The objective of this study was to evaluate the efficacy of preoperative ultrasound (US) findings such as tumor size, status of myometrial invasion, and intratumoral "resistance index" (RI) in predicting lymph node metastasis in endometrial carcinoma patients.

METHODS

Forty-two patients with endometrial cancer were enrolled. All patients underwent total abdominal hysterectomy, pelvic lymph node dissection or sampling, and para-aortic lymph node sampling. Two-dimensional and color Doppler US were performed before surgery to measure tumor size, depth of myometrial invasion, and intratumoral arterial RI. Formalin-fixed, paraffin-embedded pathologic slides from surgical specimens were reviewed by a senior pathologist to evaluate histologic type and grade, depth of myometrial invasion, cervical involvement, lymph-vascular emboli, and status of lymph node metastasis.

RESULTS

There were 12 patients with pelvic and/or para-aortic lymph node metastases and 30 patients without nodal metastases. Patients with tumors larger than 2.5 cm by US (11/12 vs 14/30, P = 0.008), more than half myometrial invasion by US (9/12 vs 5/30, P < 0.001), and intratumoral RI values less than 0.4 by US (12/12 vs 4/30, P < 0.001) had a significantly higher incidence of nodal metastases as compared with patients with tumors smaller than 2.5 cm, no or superficial myometrial invasion, and RI values higher than 0.4, respectively. Multiple regression analysis showed that only intratumoral RI values less than 0.4 were significantly correlated with nodal metastasis (P < 0.001, r2 = 0. 650). We used the intratumoral RI value as the parameter to evaluate nodal metastasis in endometrial cancer patients. Twelve of sixteen patients with intratumoral RI values <0.4 had a high incidence of nodal metastases. None of the 26 patients with intratumoral RI values >0.4 had nodal metastases.

CONCLUSIONS

Preoperative ultrasound features can offer important information for predicting lymph node metastasis in endometrial cancer patients. Patients with tumors with intratumoral RI values less than 0.4 should be highly suspected of having lymph node metastases and further management such as pelvic lymph node dissection or postoperative pelvic radiotherapy would be needed for these patients.

Megestrol acetate antagonizes cisplatin cytotoxicity

Megestrol acetate (MGA) is being widely used for the improvement of appetite and performance status in patients receiving chemotherapy, especially cisplatin-containing therapy. However, little is known about whether MGA has an effect on cisplatin cytotoxicity. We have investigated this using two transitional carcinoma cell lines, i.e. the cisplatin-sensitive parental line NTUB1 and the resistant daughter line NTUB1/P. Combined effects of MGA and cisplatin were assayed with a microculture chemosensitivity method. We explored the level changes of several cisplatin detoxification mechanisms, including metallothionein (MT), glutathione S-transferase-pi (GST-pi) and glutathione (GSH) levels in cells treated with or without MGA. After treatment with 10 microns MGA for 24 h, the cisplatin IC50s of NTUB1 and NTUB1/P increased 1.4- (p = 0.03) and 1.6- (p = 0.02) fold, respectively. By median effect analysis, the combinations of MGA and cisplatin in the two cells appeared to produce an antagonistic interaction. By Northern analysis, MT transcript levels in both cells were significantly upregulated after treatment with MGA, as compared to those without treatment. Exposure to MGA in either sensitive or resistant cells did not alter GST-pi levels as shown by immunoblotting analysis. Cellular GSH content was increased only in NTUB1/P (p = 0.0036) but remained unchanged in NTUB1 cells (p = 0.29) after MGA exposure. In conclusion, MGA may antagonize cisplatin cytotoxicity by upregulating cellular MT and GSH levels. Use of MGA in cisplatin-containing chemotherapy may impair tumor response by antagonizing cisplatin antitumor activity.

Estrogenic effects of genistein on the growth of estrogen receptor-positive human breast cancer (MCF-7) cells in vitro and in vivo

Genistein, found in soy products, is a phytochemical with several biological activities. In the current study, our research focused on the estrogenic and proliferation-inducing activity of genistein. We have demonstrated that genistein enhanced the proliferation of estrogen-dependent human breast cancer (MCF-7) cells in vitro at concentrations as low as 10 nM, with a concentration of 100 nM achieving proliferative effects similar to those of 1 nM estradiol. Expression of the estrogen-responsive gene pS2 was also induced in MCF-7 cells in response to treatment with a concentration of genistein as low as 1 microM. At higher concentrations (above 20 microM), genistein inhibits MCF-7 cell growth. In vivo, we have shown that dietary treatment with genistein (750 ppm) for 5 days enhanced mammary gland growth in 28-day-old ovariectomized athymic mice, indicating that genistein acts as an estrogen in normal mammary tissue. To evaluate whether the estrogenic effects observed in vitro with MCF-7 cells could be reproduced in vivo, MCF-7 cells were implanted s.c. in ovariectomized athymic mice, and the growth of the estrogen-dependent tumors was measured weekly. Negative control animals received the American Institute of Nutrition (AIN)-93G diet, the positive control group received a new s.c. estradiol (2 mg) pellet plus the AIN-93G diet, and the third group received genistein at 750 ppm in the AIN-93G diet. Tumors were larger in the genistein (750 ppm)-treated group than they were in the negative control group, demonstrating that dietary genistein was able to enhance the growth of MCF-7 cell tumors in vivo. Increased uterine weights were also observed in the genistein-treated groups. In summary, genistein can act as an estrogen agonist in vivo and in vitro, resulting in the proliferation of cultured human breast cancer cells (MCF-7) and the induction of pS2 gene expression. Here we present new information that dietary genistein stimulates mammary gland growth and enhances the growth of MCF-7 cell tumors in ovariectomized athymic mice.

Clinical application of intratumoral blood flow study in patients with endometrial carcinoma

BACKGROUND

The objective of this study was to evaluate the correlation between intratumoral blood flow as assessed by color Doppler ultrasound with stage, tumor grade, depth of invasion, and lymph node metastasis in endometrial carcinoma and determine its clinical usefulness.

METHODS

Sixty-six patients with endometrial carcinoma were enrolled. All patients received surgical treatment. Transvaginal color Doppler ultrasound was performed before surgery to detect the arterial blood flow signals within the tumors and the lowest resistance index (RI) was recorded. Formalin fixed, paraffin embedded pathology slides were reviewed by a senior pathologist to evaluate the histologic grading, tumor size, depth of myometrial invasion, and presence of lymph node metastasis.

RESULTS

Intratumoral RI correlated well with surgical staging, histologic grading, the depth of myometrial invasion, and the presence of lymph node metastasis. Significantly lower RI was noted in tumors of advanced stage (> than International Federation of Obstetrics and Gynecology [FIGO] Stage I) (0.38 +/- 0.09 vs. 0.54 +/- 0.11; P < 0.001), tumors with higher histologic grade (Grade 3) (0.36 +/- 0.08 vs. 0.53 +/- 0.11; P < 0.001), tumors with deep myometrial invasion (> 50% myometrial thickness) (0.38 +/- 0.07 vs. 0.54 +/- 0.11; P < 0.001), and tumors with lymph node metastasis (0.34 +/- 0.07 vs. 0.52 +/- 0.11; P < 0.001) compared with tumors with Stage I, Grade 1/2 histology, no or superficial myometrial invasion, and absence of lymph node metastasis, respectively.

CONCLUSIONS

Intratumoral blood flow analysis assessed by color Doppler ultrasound correlates well with surgical stage, tumor grade, myometrial invasion, and lymph node metastasis in patients with endometrial carcinoma. Assessment of tumor angiogenesis using color Doppler ultrasound provides useful information for the preoperative prediction regarding stage, histologic grade, depth of myometrial invasion, and presence of lymph node metastasis in patients with endometrial carcinoma. The authors believe routine pelvic lymph node dissection should be performed for those patients whose lowest RI values of intratumoral blood flow are < or = 0.4 because those patients are at very high risk for pelvic lymph node involvement.

Prognostic factors of primary adenocarcinoma of the uterine cervix

OBJECTIVE

To determine which clinicopathological factors influence the prognosis of cervical adenocarcinoma.

METHODS

Three hundred and two cases of primary adenocarcinoma of the uterine cervix, treated between 1977 and 1994, were studied retrospectively. Clinical data and pathological findings with respect to primary therapy were reviewed and evaluated.

RESULTS

The 5-year survival rates for stages I, II, and III/IV were 75.9, 62.9, and 25.1%, respectively. International Federation of Gynecology and Obstetrics stage (P < 0. 0001), cell type (P = 0.0176), tumor grade (P = 0.023), lymph node status (P = 0.018), and bulky tumor (P = 0.007) were found to be independent factors using the stepwise Cox proportional hazards model. Old age (P = 0.0581), presence of hypertension (P = 0.46), diabetes mellitus (P = 0.18), obesity (P = 0.15), and oral contraceptive use (P = 0.42) were not found to adversely influence survival rates for cervical adenocarcinoma after adjusting for other covariates. Adenosquamous adenocarcinoma had a better prognosis than endocervical columnar cell adenocarcinoma in stages I and II (P = 0. 0235). Also, in cervical adenocarcinoma's early stages, multivariate modeling revealed that chances of survival were significantly better for patients treated by radical surgery than for patients treated by radiation therapy (P < 0.001).

CONCLUSIONS

Survival rates for cervical adenocarcinoma were significantly influenced by stage, histologic subtype, tumor grade, the presence of a positive lymph node, and tumor size. Although a randomized prospective study is needed, our data imply that radical surgery may be considered a better primary modality of treatment than radiation therapy for the early stages of cervical adenocarcinoma. Further, the presence of hypertension, diabetes mellitus, or obesity may not adversely influence survival rates.

Stability of curcumin in buffer solutions and characterization of its degradation products

The degradation kinetics of curcumin under various pH conditions and the stability of curcumin in physiological matrices were investigated. When curcumin was incubated in 0.1 M phosphate buffer and serum-free medium, pH 7.2 at 37 degrees C, about 90% decomposed within 30 min. A series of pH conditions ranging from 3 to 10 were tested and the result showed that decomposition was pH-dependent and occurred faster at neutral-basic conditions. It is more stable in cell culture medium containing 10% fetal calf serum and in human blood; less than 20% of curcumin decomposed within 1 h, and after incubation for 8 h, about 50% of curcumin is still remained. Trans-6-(4'-hydroxy-3'-methoxyphenyl)-2,4-dioxo-5-hexenal was predicted as major degradation product and vanillin, ferulic acid, feruloyl methane were identified as minor degradation products. The amount of vanillin increased with incubation time.

The expression of the human chorionic gonadotropin beta subunit gene depends on negative control

Transcription of the human chorionic gonadotropin (hCG) genes begins in the very early embryo stage and decreases or even disappears in nonplacental tissues. We have studied the regulation of hCG-beta genes by cell fusion and by the reverse transcription-polymerase chain reaction (RT-PCR). The choriocarcinoma cell lines, JAR and JEG-3, express high levels of the hCG-beta subunit while HeLa cells express extremely low levels of it. Most HeLa x JAR and HeLa x JEG-3 fusion clones expressed only a trace of the hCG-beta subunit mRNA, while JAR x JEG-3 fusion clones still expressed high levels of the hCG-beta subunit. Most transcripts of the hCG-beta subunit genes in JAR and JEG-3 came from the hCG-beta 5 subunit. Even the trace amount of hCG-beta transcripts from fusion clones came mainly from the beta-5 gene. The results suggest that the expression of the hCG-beta subunit genes depends on negative control. Probably when embryonic cells differentiate to form nonplacental tissues, specific inhibitors may appear and inhibit the expression of the hCG-beta subunit genes.

Borderline malignant tumors of the ovary: study of prognostic factors

A 16-year review of borderline tumors of the ovary was carried out to study the clinical features and outcomes of patients and to assess the value of color Doppler ultrasound in preoperative diagnosis. The records of 53 patients with borderline tumors of the ovary were retrospectively analyzed for clinical features, sonographic findings and survival. Twenty-three of 44 patients with stage I disease were treated conservatively without recurrence. Seven of eight (87.5%) patients with stage III disease developed recurrent or persistent tumors within 3 years. Overall, eight of 53 (15.1%) patients had recurrent or persistent disease. Twenty-three of 44 (52.3%) patients with borderline ovarian tumors showed morphologic malignancy by gray-scale sonography. Ten of 13 (76.9%) patients who had color Doppler ultrasound examination had detectable intratumoral blood flow. The mean resistance index value was 0.47 (range, 0.3-0.6). Three of these patients (30%) had a resistance index value < 0.4. The results indicated that the extent of disease as reflected by the clinical stage was the main factor for prediction of recurrence, and borderline tumors of the ovary were not efficiently differentiated from benign or malignant tumors by resistance index values obtained from color Doppler ultrasound.

Factors influencing tumor cell kinetics in cervical cancer

Fresh tumor tissues instead of paraffin-embedded sections were used to study the clinical significance of the tumor cell kinetics in cervical carcinomas by flow cytometry. We analyzed specimens from 153 women with cervical cancer, and DNA aneuploidy was found in 61 cases (39.9%). The mean age of patients with aneuploid tumors was significantly higher than the age of patients with diploid tumors (P < 0.001). The mean proliferation index for aneuploid tumors was significantly higher than those for diploid tumors. There was a significant correlation between the proliferation index and age. However, tumor cell kinetics is not related to the status of human papillomavirus, herpes simplex virsuses I and II, lymph nodes, histology or tumor size. The mean age and S-phase fraction for stage-II tumors were significantly higher than those for stage-I tumors (P < 0.01). The tumors of menopausal patients exhibited a relatively higher rate of lymph node metastasis, and significantly higher aneuploidy rate and proliferation index than tumors of premenopausal patients. In summary, age and, what is more important, menopausal status may significantly influence DNA ploidy and cell kinetics of tumors, and subsequently influence clinical stage and lymph node metastasis. However, tumor cell kinetics is of limited value in the prediction of lymph node metastasis and prognosis.

Endometrial stromal sarcoma of twenty cases

BACKGROUND

Endometrial stromal sarcoma is a rare neoplasm. We reviewed twenty cases to study the characteristics of this disease.

METHODS

Twenty cases of endometrial stromal sarcoma were treated at our hospital. The clinical stage, treatment and outcome were retrospectively analyzed.

RESULTS

Endometrial stromal sarcoma comprised 4.3% of corpus cancers and 46.4% of uterine sarcomas at our hospital. Seven cases were stage I, one was stage II, ten were stage III, and two were stage IV at the time of diagnosis. Histopathologically, seventeen cases were classified as low-grade sarcoma and three were high-grade sarcoma. Seven patients had recurrence and five of them had already died of disease. Among these recurrent patients, one was stage II and six were stage III. All three patients with high-grade sarcoma and four with low-grade sarcoma had recurrence.

CONCLUSIONS

We think mitotic count is an important prognostic factor in low-grade endometrial stromal sarcoma and high-grade endometrial stromal sarcoma has a poor prognosis even with post-operative adjuvant treatment.

Expression of MDR-1 gene in transitional cell carcinoma and its correlation with chemotherapy response

PURPOSE

Expression of the mdr-1 gene has been correlated with the chemoresistance mechanisms of some cancer models. In the present study, we tried to evaluate mdr-1 gene expression in transitional cell carcinoma (TCC) in both cultured cells and clinical tumors. The expression status of mdr-1 was further correlated with the response to chemotherapy in both systemic and intravesical models.

MATERIALS AND METHODS

We evaluated mdr-1 expression levels by reverse transcription polymerase chain reaction and Southern blotting (RT-PCR-SB) and the activity of P-glycoprotein (P-gp) by flow cytometric rhodamine-123 retention and efflux study in 10 TCC cell lines, 2 doxorubicin-resistant sublines (RLs), T24/A and NTUB1/A, and 2 cisplatin-RLs, T24/P and NTUB1/P. Eighty-eight clinical tumors with their benign counterparts were also assayed by RT-PCR-SB to determine mdr-1 expression status. Of the 88 TCC cases, 28 were treated with systemic and 60 with intravesical chemotherapy. Response to chemotherapy in either form was correlated with mdr-1 expression status.

RESULTS

By RT-PCR-SB, mdr-1 expression signals were observed in only 2 of the 10 TCC cell lines; only 1 of these had a strong signal and active P-gp function. The other, bearing a weak signal, was negative for active P-gp function. All of the 4 RLs studied showed elevated mdr-1 transcript levels as compared with their mdr-1 negative parental cell lines. Doxorubicin-RLs showed much stronger expression signals than cisplatin-RLs. Active P-gp functions were observed in the 2 doxorubicin-RLs but not in the 2 cisplatin-RLs. The efflux of rhodamine-123 in cells with active P-gp function can be significantly inhibited by 10 microM. verapamil. Of the 88 clinical tumors, 62 (70.5%) were positive and 26 (29.5%) were negative for mdr-1 expression by RT-PCR-SB. All benign counterparts of the 88 tumors were positive for mdr-1 expression. However, no differences in chemotherapy responses were found between the positive and negative mdr-1 expression groups in either systemic chemotherapy (p = 0.32, one-tailed Fisher's exact test) or intravesical chemotherapy (p = 0.52, Cox-Mantel log rank test).

CONCLUSIONS

Expression of mdr-1 was not commonly seen in TCC cell lines but can be significantly induced by chronic exposure to doxorubicin. Benign transitional cell epithelia seemed to universally express the mdr-1 gene. However, clinical TCCs lost mdr-1 transcript expressions in about 30% of cases. Most important, it appeared that mdr-1 expression status did not correlate with the response to chemotherapy in either systemic or intravesical models.

Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports

Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low-resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible.

Intrathecal morphine for neuropathic pain in a pregnant cancer patient

Although they have been documented, opioid treatments in obstetrics are mostly limited to methadone maintenance treatment in pregnant addicts or analgesia/anesthesia for labor. A literature search revealed no previous studies describing analgesic techniques for relief of severe cancer pain in pregnant patients. As response to morphine is dose-dependent, its conventional use can be problematic in pregnant women suffering from severe cancer pain because it is important to prevent opioid intoxication of the fetus. Furthermore, long-term exposure to morphine may result in physical dependence on the drug by the fetus, causing acute withdrawal syndrome and growth retardation after delivery. We report our experience in treating a 35-year-old pregnant female, in her 32nd gestational week, suffering from neuropathic pain due to advanced ovarian cancer. Using a microcatheter technique, we administered small doses of morphine intrathecally and successfully controlled the pain before delivery without complications in the mother and fetus. Treatment options of systemic vs spinal and epidural vs intrathecal opioids under such unique circumstances are discussed.

Combined cytotoxic effects of tamoxifen and chemotherapeutic agents on bladder cancer cells: a potential use in intravesical chemotherapy

OBJECTIVE

To evaluate whether tamoxifen enhances the cytotoxicity of chemotherapeutic agents on bladder cancer cells, and the possible mechanism(s) of action.

MATERIALS AND METHODS

The in vitro inhibition of cell growth was examined in a model simulating intravesical chemotherapy using two bladder cancer cell lines (TSGH-8301, HTB9) and three commonly used intravesical cytotoxic agents (doxorubicin, mitomycin C, and thiotepa) in the presence or absence of tamoxifen or verapamil as modulators. The expression of the multi-drug resistance-related gene mdr-1 was evaluated by reverse-transcription polymerase chain reaction and Southern blotting (RT-PCR-SB) to determine its transcript level, by flow cytometric analysis of the P-glycoprotein (P-gp) product level with C-219 monoclonal antibody and by the rhodamine-123 retention and efflux assay for P-gp activity. Transforming growth factor beta-1 (TGF beta-1) levels in tamoxifen-conditioned culture medium were determined with enzyme-linked immunosorbant assay (ELISA).

RESULTS

Tamoxifen at concentrations > or = 30 microM significantly enhanced the cytotoxicity of the three chemotherapeutic agents to both cell lines, as shown by a marked reduction in the drug concentration which inhibited growth by 50% (IC50). The enhancement of cytotoxicity was significantly dependent on the concentration of tamoxifen. However, tamoxifen alone caused significant toxic effects to TSGH-8301 at > or = 40 microM and to HTB9 at > or = 30 microM. Median-effect analysis showed additive or less-than-additive combination effects between tamoxifen and chemotherapeutic agents and only a minimal synergism in a narrow range of maximal cytotoxicity (fraction affected > 0.9). Thus, the reduction of IC50s by tamoxifen was mostly because it was cytotoxic to the bladder cancer cells used. No enhancement of cytotoxicity was observed in verapamil-modulated cells. Transcripts of mdr-1 could not be detected by RT-PCR-SB, nor was P-gp detected by flow cytometric analysis in the two cell lines. Furthermore, no active P-gp function was detected by the rhodamine-123 retention and efflux study, indicating that the primary chemoresistance mechanisms of the two cell lines were not mediated by mdr-1, nor could tamoxifen or verapamil act through modulation of the mdr-1 pathway in the two cell lines. Tamoxifen at 3 and 10 microM down-regulated the secretion of TGF beta-1 from TSGH-8301 in a concentration-dependent manner, in contrast to the findings that tamoxifen was cytotoxic to the bladder cancer cells used and that tamoxifen up-regulated TGF beta-1 in a breast cancer model, suggesting that there may be a different mechanism of response to TGF beta-1 in these bladder cancer cells.

CONCLUSION

Tamoxifen enhanced the cytotoxicity of chemotherapeutic agents largely through its toxic effects on the bladder cancer cells. The mode of action of tamoxifen was not through the regulation of TGF beta-1 or the function of mdr-1. Although cytotoxic levels of tamoxifen (> 50 microM) can be achieved easily in the intravesical model, further study is necessary before tamoxifen can be used clinically in intravesical chemotherapy.

Comparison of detection of human papillomavirus 16 DNA in cervical carcinoma tissues by Southern blot hybridisation and nested polymerase chain reaction

An association between human papillomavirus (HPV) and cervical neoplasia has been widely reported and HPV DNA is commonly detected in cervical carcinoma tissues. However, estimates of the prevalence of HPV infection differs among various detection methods. Seventy cases of cervical carcinoma were screened for HPV 16 infection by Southern blot hybridisation (SBH) and nested polymerase chain reaction (PCR). According to SBH, the prevalences of HPV 16 DNA in stage I (n = 40) and stage II (n = 30) cervical carcinomas were 52.5 and 63.3%, respectively, and the overall prevalence was 57.1% (40 of 70). By nested PCR, the prevalences of HPV 16 infection in stage I and II cervical carcinomas were 87.5 and 93.3%, respectively, and the overall prevalence was 90.3%. The prevalence of HPV DNA detected by nested PCR was significantly greater than that detected by SBH. The combined concordance of positive and negative results between SBH and nested PCR was 61.4%. The discrepancy resulted mainly from 25 cases (35.7%) that were positive by PCR but negative by SBH. A small copy number of HPV DNA in the these 25 cases was documented by a semi-quantitative PCR method. The nested PCR was more sensitive than SBH and detected cases with low amounts of HPV DNA. The detection of HPV infection varied between these two prevailing detection methods and this should be kept in mind in assessing various epidemiological data concerning HPV infection.

Human papillomavirus and cervical neoplasia: a case-control study in Taiwan

As part of a large-scale, community-based cervical neoplasia screening project in rural Taiwan, a case-control study was undertaken to evaluate the etiologic role of human papillomavirus (HPV) infection in this mainly monogamous (2% reported having multiple sexual partners) female population. A total of 88 biopsy-confirmed cases and 261 cytologically normal controls were selected for the study. The case group included 40 cases of cervical intraepithelial neoplasia (CIN) 1, 9 of CIN 2, 36 of CIN 3 and 3 cases of invasive cancer. Cervical swabs collected at screening from study subjects were tested for HPV DNA by an LI consensus primer polymerase chain reaction (PCR)-based technique. HPV DNA was found in 92% of high-grade cases (CIN 2-3 and invasive cancer); 54% of low-grade cases (CIN 1); and 9% of controls. HPV was significantly associated with both high-grade and low-grade cervical neoplasia. As reported in Western countries, HPV 16 was the predominant type among HPV-positive high-grade cases. However, HPVs 52 and/or 58 combined were the most common types among HPV-positive low-grade cases and controls. Among women without any high-risk HPV infection (types 16, 18, 31 or 45), those with multiple-type HPV infection had a higher risk for high-grade cervical neoplasia than those with single-type infection. Overall, 91% of high-grade cases and 50% of low-grade cases could be attributed to HPV infection. Our results show that, even in this monogamous population, HPV is the major risk factor for high-grade cervical neoplasia.

Independent clinical factors which correlate with failures in diagnosing early cervical cancer

Our aim was to identify independent factors that correlated with colposcopically directed biopsy's reliability as a method for diagnosing early cervical cancer. One hundred ninety-one of a total of 2265 patients who had colposcopic examinations because of abnormal Papanicolaou smears were included in this study. These patients had all undergone a hysterectomy after being diagnosed as having cervical intraepithelial neoplasia grade III by colposcopically directed biopsy. By univariate analysis, old age (P = 0.0195), achievement of menopausal status (P = 0.0046), large lesion size (P = 0.0021), and unsatisfactory colposcopy (P = 0.0017) were found to be associated with the nondiagnosis of early cervical cancer. However, multivariate analysis using stepwise logistic regression revealed that large lesion size (P = 0.003) and unsatisfactory colposcopy (P = 0.0008) were the only independent factors that correlated with nondiagnosis. Our findings indicate that in order to reach a clear-cut diagnosis, cases with either unsatisfactory colposcopy or satisfactory colposcopy with large lesions (despite a lack of histologic evidence of invasions) should undergo a diagnostic conization.

Tamoxifen enhances the chemosensitivity of bladder carcinoma cells

PURPOSE

Chemosensitizers, which enhance cellular chemosensitivity and reduce chemoresistance, are expected to substantially improve response rates of systemic chemotherapy for patients with metastatic bladder cancer. Tamoxifen is a nonsteroidal antiestrogen that has been shown to reverse drug resistance in vitro in some cancer models through pathways not related to its antiestrogenic effect. In this study we tried to evaluate its possible effect on chemosensitization of bladder cancer cells.

MATERIALS AND METHODS

In vitro chemosensitivity tests were done with 3 bladder cancer cell lines and 4 cytotoxic agents (methotrexate, vinblastine, doxorubicin and cisplatin) in the presence or absence of graded concentrations of tamoxifen. Verapamil was used in parallel experiments to compare the degrees of chemosensitization. The transcript and protein product [P-glycoprotein, (P-gp)] levels of the mdr-1 gene were also examined in the 3 cell lines by reverse-transcription polymerase chain reaction (RT-PCR) and flow cytometric assay, respectively.

RESULTS

Tamoxifen at 5 and especially 10 microM. concentrations, which were minimally toxic to the 3 bladder cancer cell lines used, enhanced the chemosensitivity of bladder cancer cells in most drug combinations in a dose-dependent manner. In some combinations 10 microM. tamoxifen did better than 5 microM. in chemosensitization. The effect of chemosensitization was more evident in cells treated with 10 microM. tamoxifen plus methotrexate and vinblastine in which 12.9 to 95.4-fold and 12.4 to 21.3-fold IC50 reduction was observed, respectively. A less prominent, but still significant, effect could be seen in doxorubicin- and cisplatin-treated cells. Verapamil, although used at concentrations up to 10 microM. which are higher than systemically tolerable, was not able to enhance chemosensitivity of the 3 bladder cancer cell lines. By flow cytometric analysis of the P-gp level and by RT-PCR assay of the mdr-1 gene transcript level, it was shown that little if any mdr-1 gene expression could be detected in the 3 cell lines. This implies that the mdr-1 gene function may play a minimal role in drug resistance mechanisms of bladder cancer cells and that tamoxifen exerts its chemosensitization effect through pathways other than mdr-1 gene function modulation.

CONCLUSIONS

Tamoxifen was shown to be a good chemosensitizer in a bladder cancer cell model and may well be tried in combination with systemic chemotherapy for metastatic human bladder cancers in the clinical setting.

Systemic lymphadenopathy as the primary symptom of serous surface papillary carcinoma of the ovary

Serous surface papillary carcinoma (SSPC) is a distinct type of ovarian cancer; most of the patients present with extensive intraabdominal disease at the time of diagnosis. In a 48-year-old patient with 6-month history of inguinal and then scalene lymphadenopathy, although series workup did not disclose any primary tumor, an exploratory laparotomy was performed because of the abnormally high serum CA-125 level (1024 U/ml) and the pathologic examination of the inguinal node suggesting an ovarian origin. At exploration, there was only a discernible SSPC lesion on the right ovary; no intraperitoneal spread but extensive lymph node metastasis was found. The patient died of disease 30 months after surgery, although adjuvant and salvage chemotherapy was given. Ovarian cancer should be part of the differential diagnosis in a woman with systemic lymphadenopathy but without any evidence of intraabdominal disease.

Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound

BACKGROUND

Much evidence has suggested that vascular density reflects the clinical behavior of cancer. In this study, the intratumoral blood flow in cervical carcinomas was assessed by transvaginal color Doppler ultrasound, and its clinical significance was evaluated.

METHODS

Sixty-five patients with Stage Ib-IIb cervical carcinoma exhibiting visible cervical tumor by transvaginal ultrasound were enrolled. All patients were scheduled for radical hysterectomy and pelvic lymph node dissection. Transvaginal color Doppler ultrasound was performed before surgery to search for blood flow signals from the tumor and the main uterine artery. The corresponding arterial resistance index (RI) was calculated. Clinical and pathologic data were recorded. A cytokinetic study was performed by propidium iodide staining and flow cytometry. The human papillomavirus (HPV) status was assessed by polymerase chain reaction.

RESULTS

Intratumoral blood flow was detected by color Doppler ultrasound in 46.2% (30/65) of the tumors. Patients with detectable intratumoral blood flow exhibited significantly more pelvic lymph node metastasis (10/30 vs. 2/35, P = 0.005), a higher percentage of cancer cells in the S- + G2M-phase (30.02 +/- 18.54% vs. 19.35 +/- 11.21%, P < 0.005), and a higher prevalence of HPV infection (30/30 vs. 25/35, P = 0.001) when compared with those without intratumoral blood flow. No significant difference was observed concerning the patient's age, tumor size, clinical staging, histologic type, and DNA ploidy status between these two groups. Regression analysis of the intratumoral RI value on the S- + G2M-phase fraction showed linear regression (n = 30, r2 = 0.501, P < 0.01). The RI values of the main uterine artery showed no significant difference between these two groups.

CONCLUSION

The intratumoral blood flow by transvaginal color Doppler ultrasound correlated well with a higher proliferation index, higher incidence of HPV infection, and pelvic lymph node metastasis in cervical carcinoma.

Immunoelectrophoretic differentiation of alpha-fetoprotein in disorders with elevated serum alpha-fetoprotein levels or during pregnancy

Our study aims to make differential diagnosis by immunoelectrophoresis for some common conditions with elevated levels of serum alpha-fetoprotein (AFP). One hundred and nine cases with elevated AFP levels were included in this study: yolk sac tumor (n = 8), hepatocellular carcinoma (n = 26), gastric cancer (n = 12), chronic hepatitis (n = 27) and normal pregnancy (n = 36). Lectin agarose gel electrophoresis, antibody-affinity blotting, and immunoreaction were used to identify the specific patterns of AFP in the respective conditions. The results showed that there were three possible bands: L1, L2 and L3. Yolk sac tumor produced a prominent L2 band and a light L3 band. Hepatocellular carcinoma produced a prominent L1 band and a light L3 band. Gastric cancer produced only an L1 band. Chronic hepatitis had a light L1 band and a pronounced L3 band. In pregnancy, the AFP pattern is similar to that of hepatocellular carcinoma. Immunoelectrophoresis is a useful method facilitating the differentiation of AFP origins.

A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain

STUDY DESIGN

A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain.

OBJECTIVES

The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS.

SUMMARY OF BACKGROUND DATA

Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and Biering-Sorensen fatigue test. The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group.

RESULTS

After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension.

CONCLUSION

None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.

Human papillomavirus DNA and p53 status in stage IB bulky cervical cancer

We used the polymerase chain reaction (PCR) to study the presence and typing of human papillomavirus (HPV) DNA, and PCR/single-strand confirmation polymorphism to survey the mutations of the p53 gene in exons 5-9 in 26 bulky stage IB cervical cancers. The HPV DNA was present in 20 out of the 21 (95%) squamous-cell carcinoma tissues, including 13 cases of HPV-16, 0 case of HPV-18, and 7 cases of other HPV types. In the other 5 adenocarcinoma tissues, 3 had HPV type-18 DNA and 2 had no detectable HPV DNA. The distribution of HPV DNA in bulky tumors was not statistically different from that in the other 228 squamous-cell carcinomas and 23 adenocarcinomas of smaller size operated upon during the same period. Out of the 26 patients, 9 (35%) had lymph node metastasis at the time of operation. During the follow-up period ranging from 19 to 48 months, 9 patients had recurrence and 7 of them died of disease. The distribution of HPV types was not related to the prognosis in these patients. There were no p53 mutations detected in all the 26 samples. Thus, HPV type and the status of p53 could not serve as additional prognostic factors in stage IB bulky cervical cancers.

Measurement of human chorionic gonadotropin by carboxyl terminal peptide assay in patients with cervical neoplasm

The aim of this study was to investigate whether human chorionic gonadotropin (hCG) is produced by preinvasive cancer and the early stages of invasive cancer. One hundred and fifty-two patients with either various grades of preinvasive cervical carcinoma or microinvasive carcinoma, and 46 normal women used as controls, were enrolled in this study. A carboxyl terminal peptide beta-hCG (CTP-beta-hCG) assay with a sensitivity of 0.2 mIU/mL was used to measure serum levels. The results showed that the serum beta-hCG levels among normal control, preinvasive carcinoma and microinvasive carcinoma patients were not statistically different. Among the factors tested, including the interval since the last menstrual period, age, menopausal status, contraception method and diagnosis, serum hCG levels only correlated with the first factor. Preinvasive cervical carcinoma and microinvasive carcinoma did not result in significantly increased hCG secretion. At present, the CTP-beta-hCG assay is of limited value in the diagnosis of these diseases.

Vascular patterns of gestational trophoblastic tumors by color Doppler ultrasound

BACKGROUND

Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance.

METHODS

Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis.

RESULTS

The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions.

CONCLUSION

Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.

Factors contributing to the accuracy in diagnosing ovarian malignancy by color Doppler ultrasound

OBJECTIVE

To determine whether resistance index values obtained by color Doppler ultrasound contribute to the accuracy in diagnosing ovarian malignancies.

METHODS

Four hundred ten patients with ovarian neoplasms referred for color Doppler ultrasound evaluation were enrolled, excluding patients examined during the luteal phase. Resistance index of the intra-tumor arteries was measured by color Doppler ultrasound. The corresponding clinical and histopathologic information was recorded. For statistical determinations, we used the Yates corrected chi 2 analysis, Fisher exact test, Student t test, and linear regression analysis.

RESULTS

Satisfactory intra-tumor artery waveforms were obtained in 96.1% (99 of 103) of ovarian malignancies. Resistance index values varied at 0.23-0.82. Regression analysis of resistance index values on tumor size and amount of ascites demonstrated a linear association (R = 0.498 and 0.362, respectively; P < .01 in both). If we regard a resistance index of 0.4 as a cutoff value, the overall sensitivity and specificity in detecting malignancy were 68.0 and 97.4%, respectively. Primary ovarian malignancies exhibited significantly more false negatives (30 of 79) than malignancies metastasized to the ovary (three of 24) (P = .018). Malignancies containing mainly cystic components exhibited more false negatives (20 of 41) than did tumors with primarily solid components (13 of 62) (P < .01). Significantly more false negatives were encountered in malignancies with larger diameters (greater than 10 cm) compared to smaller ones (27 of 63 versus six of 40; P < .01), and in malignancies accompanied by considerable ascites (greater than 1000 mL) (13 of 25 versus 20 of 78; P < .05).

CONCLUSIONS

Tumor origin, size, component nature, and amount of ascites contributed to the accuracy in diagnosing ovarian malignancies using resistance index values obtained by color Doppler ultrasound.

Infrequent mutation in tumor suppressor gene p53 in gestational trophoblastic neoplasia

In order to determine the p53 status of gestational trophoblastic neoplasia, 24 cases of molar pregnancies and two choriocarcinoma cell lines (JAR and JEG-3) were evaluated for the presence of mutations. The evaluation involved the whole coding sequence (i.e. exons 2-11) of the p53 gene with polymerase chain reaction (PCR) amplification of genomic DNA, followed by single strand conformation polymorphism (SSCP) and sequencing. Only one case of hydatidiform mole was found to have a missense point mutation (codon 295, CCT-->CTT, i.e. proline to leucine) of the p53 gene. The results suggest that p53 mutation is rarely involved in the pathogenesis of gestational trophoblastic neoplasia.

Cell kinetics and radiosensitivity of cervical squamous cell carcinoma

Flow cytometry analyses of tumors from 12 patients with cervical squamous cell carcinoma under radiotherapy were performed in this preliminary study. Six patients with a high (> 10%) G2/M fraction before treatment showed greater than 50% tumor reduction after initial 2000 cGy radiotherapy. Only two out of six patients with a low (< 10%) G2/M fraction before treatment responded favorably and three of them already had recurrence during the follow-up period of 33-40 months. Hyperploidy (DNA index > 1.1) was observed in 5 patients; all of them responded well to radiotherapy in contrast to three out of seven diploid tumors.

Range of motion of the lumbar spine required for four activities of daily living

OBJECTIVE

To assess the range of motion of the lumbar spine required for four activities of daily living.

DESIGN

Descriptive study.

SETTING

Chiropractic college research laboratory.

SUBJECTS

Forty-eight young and healthy subjects.

INSTRUMENTATION

OSI CA-6000 computerized spinal motion analyzer.

RESULTS

The intraclass correlation coefficient ranged from .99-.95 for peak flexion measurements. Stand-to-sit and sit-to-stand activities required approximately 56-66% of lumbar flexion. Putting on socks required about 90% of lumbar flexion. Picking an object off the floor required almost full lumbar flexion (95%). Analysis of variance showed significant differences among all four activities (p < .001). Scheffe tests revealed that the differences were found between sit/stand activities and picking up an object from the floor, and also between sit/stand activities and putting on socks.

CONCLUSION

We showed that four activities of daily living could be reliably measured by an OSI CA-6000 motion analyzer. Putting on socks and picking up an object off the floor were found to require more lumbar flexion motion than sit/stand activities. Also, different strategies were observed in performing these activities. Future research shall address these activities and their changes in low back pain patients.

Correlation of uterine hemodynamics with chemotherapy response in gestational trophoblastic tumors

OBJECTIVE

To assess the uterine hemodynamics in gestational trophoblastic tumors and to correlate them with response to chemotherapy.

METHODS

Using transvaginal color Doppler ultrasound, we measured the peak systolic velocity and the resistance index (RI) of the uterine arteries in 23 women with gestational trophoblastic tumors before each course of chemotherapy. Fifty-five nonpregnant women and another 15 women who had uneventful molar evacuation were enrolled as controls. Two-tailed Student t test was used for statistical analysis.

RESULTS

A hyperdynamic uterine circulation was noticed at diagnosis in all gestational trophoblastic tumors, manifested as higher peak systolic velocity (mean +/- standard deviation 57.5 +/- 20.4 cm/second) of the uterine arteries compared to nonpregnant (28.3 +/- 3.41 cm/second; P < .0001) and uneventful post-mole uteri (26.8 +/- 3.08 cm/second; P < .0001). The RI values of the uterine arteries in gestational trophoblastic tumors at diagnosis ranged from 0.21-0.80. However, the mean value (0.56 +/- 0.19) was lower than those of nonpregnant (0.80 +/- 0.05; P < .0001) and post-mole uteri (0.75 +/- 0.06; P < .0001). A higher pre-treatment uterine artery RI (mean 0.71 +/- 0.09) was noted in ten patients with gestational trophoblastic tumors requiring fewer than five courses of chemotherapy, compared with the mean in 13 patients requiring longer courses of treatment (0.47 +/- 0.14; P < .0001). There was a marked decrease of peak systolic velocity during the first three courses of treatment in the former group (54.2 to 23.6 cm/second; P < .001), in contrast to no change in the latter group (60.1 to 60.5 cm/second).

CONCLUSION

Uterine hemodynamic characteristics assessed by color Doppler ultrasound might predict and monitor the response to chemotherapy in gestational trophoblastic tumors.

The genotypes and prognostic significance of human papillomaviruses in cervical cancer

An integrated study on the role of human papillomaviruses (HPV) in cervical cancer has been conducted. Out of a total of 433 cases of cervical cancer, HPV-DNA was detected in 342 (79%) using the polymerase chain reaction (PCR). The incidence of HPV infection was not significantly related to histological types, although a lower incidence was noted in adenocarcinoma cases. The incidence of lymph node (LN) metastasis in adenosquamous carcinoma (55.6%) was significantly higher than in squamous cell carcinoma (SCC) and adenocarcinoma. HPV 16 was detected significantly more often in SCC than in adenocarcinoma. In contrast, HPV 18 was detected more often in adenocarcinoma than in SCC. As a whole, pelvic LN metastases were found in 24.3% of HPV+ cases, significantly higher than 11% of HPV- cases. However, the significant association of HPV-DNA with LN metastasis was only noted in stage I but not stage II. As far as histological types were concerned, the incidence of positive LN was: HPV+ SCC > HPV- SCC (p < 0.01), whereas HPV- adenocarcinoma > HPV+ adenocarcinoma (p = 0.12). Genotypes of HPV did not have any effect on nodal status. The presence of types of HPV were not associated with tumor size and distribution of clinical stage. Our results suggest that the prognostic significance of HPV-DNA on nodal status is dependent on histological types while the genotypes of HPV cannot account for prognostic significance in cervical cancer.

Persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy

OBJECTIVE

A 16 year review of persistent gestational trophoblastic tumour when the antecedent pregnancy was a partial hydatidiform mole.

DESIGN

Cases of persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy were reviewed for the period 1976 to 1992. DNA ploidy was analysed by flow cytometry.

SETTING

A University Hospital which is a reference centre for gestational trophoblastic tumour.

SUBJECTS

The case notes of 207 women with persistent gestational trophoblastic tumour were reviewed.

MAIN OUTCOME MEASURES

A rise (or failure to fall) of beta hCG titre, or sign of metastasis.

RESULTS

Six (2.9%) women had partial hydatidiform mole as the antecedent pregnancy and all were initially judged to be low risk. However, two developed pulmonary metastasis; one woman developed persistent gestational trophoblastic tumour shortly after a hysterotomy, and none developed choriocarcinoma. The geometric mean of serum beta hCG concentrations at the initiation of chemotherapy was 868 mIU/ml (95% CI 114-1524). Of the six women, one achieved remission after total abdominal hysterectomy, and five after chemotherapy. The mean interval from starting treatment to remission was 68 days (95% CI 27.9-108.0). The initial beta hCG titre and interval were not statistically different from those found in cases of persistent gestational trophoblastic tumour when the antecedent pregnancy was not partial hydatidiform mole. Of the six, the DNA content was triploid in three and diploid in two. One of the two diploid cases required multiple courses of chemotherapy to achieve remission.

CONCLUSION

Partial hydatidiform mole can have malignant sequelae and can develop very soon after treatment. Its DNA content can be either diploid or triploid, the lungs being the most common site of metastasis. After evacuation of partial hydatidiform mole, immediate chest X-ray and regular follow up of the serum beta hCG level is necessary.

Incremental angiogenesis assessed by color Doppler ultrasound in the tumorigenesis of ovarian neoplasms

BACKGROUND

The crucial role of angiogenesis in tumor behaviour has been studied extensively in vitro. The authors assessed the in vivo angiogenesis in ovarian neoplasms by color Doppler ultrasound and waveform analysis.

METHODS

The intratumor artery resistance index (RI) of 222 ovarian neoplasms referred for color Doppler ultrasound evaluation was measured, and the corresponding histopathologic diagnosis was recorded.

RESULTS

Satisfactory intratumor artery waveforms were obtained at an average of 1.12 sites in 44.7% (68 of 152) of benign tumors and at 6.28 sites in 97.1% (68 of 70) of the malignant group. Great heterogeneity in RI values existed. The RI of the intratumor artery in the benign group during the follicular phase (mean, 0.678) was significantly higher (P < 0.001) than that of the luteal phase (mean, 0.414), epithelial ovarian carcinoma (n = 34; mean, 0.402), malignant germ cell tumor (n = 6; mean, 0.413), malignancy metastasized to the ovary (n = 18; mean, 0.357), and other rare malignancies (n = 4; mean, 0.435). The RI of primary ovarian malignancy (n = 41; mean, 0.411) was significantly higher than that of malignancy metastasized to the ovary (P < 0.05). The RI values of epithelium-originated neoplasms showed a significant incremental decrease from benign tumors (n = 48; mean, 0.695) toward borderline malignancy (n = 6; mean, 0.535; P < 0.01), early-stage ovarian carcinoma (n = 10; mean, 0.485; P < 0.01), and, finally, to advanced-stage ovarian malignancies (n = 29; mean, 0.398; P < 0.05).

CONCLUSIONS

Angiogenesis is a common phenomenon in malignant ovarian neoplasms, but the intensity of neovascularization may depend on individual tumor characteristics. The authors documented the incremental decrease of the resistance index in ovarian neoplasms, which may reflect the increase in angiogenesis intensity as an indication of malignant potential.

Increased sister chromatid exchange frequency in peripheral lymphocytes of nasopharyngeal carcinoma and cervical cancer patients

The specific aim of this study was to compare the frequency of sister chromatid exchange (SCE) in peripheral lymphocytes using it as a biomarker of integral exposures to carcinogens in 14 untreated newly-diagnosed nasopharyngeal carcinoma (NPC) patients, 16 untreated newly-diagnosed cervical cancer patients, and 30 healthy controls matched with patients on age, sex, cigarette smoking and alcohol drinking. Peripheral lymphocytes were cultured in RPMI 1640 medium containing 20% fetal calf serum and 6 microM phytohemagglutinin. After culture for 24 hours, 20 microM 5-bromo-2-deoxyuridine was added into the medium. Colcemid solution was further added after 70 hours. Harvested cells were stained with Hoesch 33258, illuminated, and restained with Giemsa. The SCE frequency was scored by two readers independently and blindly. The results showed a significantly increased SCE frequency in lymphocytes for NPC patients (mean +/- standard error = 14.7 +/- 1.7 SCEs/cell) compared with their matched controls (10.1 +/- 0.7 SCEs/cell) and for cervical cancer patients (12.0 +/- 0.9 SCEs/cell) compared with their matched controls (9.2 +/- 0.7 SCEs/cell). These results suggest that NPC and cervical cancer patients have a higher integral exposures to both viral and chemical carcinogens than matched controls.

Serum neuron-specific enolase levels in patients with small cell carcinoma of the uterine cervix

Serum neuron-specific enolase (NSE) is a tumor marker for neuroendocrine tumors or tumors of neuroepithelial origin. While the clinical application of NSE in small cell lung cancer has been established, its role in small cell carcinoma of the uterine cervix is unknown. We examined serum NSE in six patients with cervical small cell carcinoma and 13 patients with cervical squamous cell carcinoma. Elevated serum NSE was noted in four of six patients (67%) with small cell carcinoma, but none of the 13 patients with squamous cell carcinoma. An extremely high NSE serum level (154.7 ng/mL) was found in one patient with recurrence of small cell carcinoma, suggesting its correlation with disease extension. Although further studies to evaluate its relevance to prognosis, treatment effect, and early detection of recurrence are in progress, this preliminary result seems promising.

The state of p53 in primary human cervical carcinomas and its effects in human papillomavirus-immortalized human cervical cells

Wild-type (wt) p53 acts as a tumor suppressor, while certain mutant type (mt) p53 may exhibit 'oncogenic' function. We have recently demonstrated that human papillomavirus type 18 (HPV-18) E6 can partially overcome the growth-suppressive effects of wt p53, but it remains unclear what role p53 plays in cervical carcinogenesis. In this report, we have examined nine HPV-immortalized human cervical epithelial cell lines and 13 HPV-positive and two HPV-negative primary cervical cancers for p53 mutations by polymerase chain reaction--single-strand conformation polymorphism (PCR-SSCP). None of them contained p53 mutations in exons 5-9 where most p53 mutations in human tumors have been found. The entire p53-coding region of the two HPV-negative cervical cancers was sequenced and no mutations were noted. In order to examine the effects of wt p53 and mt p53 on HPV-immortalized human cells, we transfected HPV-immortalized cell lines with wt p53 and a mt p53 (mtp53Val-135). The results indicate that HPV-immortalized cells cannot tolerate large amounts of exogenous wt p53, while mt p53Val-135 can enhance transformation of these cells. The results support the notion that inactivation of wt p53 by E6 may be important for HPV-associated transformation and also suggests that mt p53 can act as an oncogene in HPV-immoralized human cells.

Clinical study of 381 postmenopausal bleeding patients

In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interval between menopause and the onset of abnormal vaginal bleeding in postmenopausal women, 381 cases with a complete medical history and available histologic findings were enrolled in this study at the National Taiwan University Hospital from 1989 to 1991. The results showed that 212 (55.6%) of these women had normal histologic findings and 83 (21.9%) had benign pathologic findings, whereas 14 (3.6%) had cervical intraepithelial neoplasia (CIN), 42 (11%) had endometrial hyperplasia, 19 (5%) had cervical cancer and 11 (2.9%) had endometrial cancer. Twenty-nine (7.6%) of the cases suffered from either CIN III or cervical cancer; this number was twice as high as those with endometrial atypical hyperplasia and endometrial cancer (n = 13, 3.4%). In addition, various risk factors, especially obesity, were found to be significantly correlated with malignancy. Fractional curettage should be performed for postmenopausal bleeding patients to ensure accurate diagnosis and correct management.

Human chorionic gonadotropin pattern in maternal circulation. Amniotic fluid and fetal circulation in late pregnancy

This study had two purposes. One was to investigate the placental gradients and the relationship of human chorionic gonadotropin (hCG) concentrations in maternal serum (MS), amniotic fluid (AF) and fetal serum (FS). The other was to study the fetal sex effect. This study included 93 patients with normal singleton term pregnancies. AF samples contaminated with blood were excluded. Fetuses did not have any abnormalities. We measured hCG by double antibody beta hCG radioimmunoassay. We found that there were conspicuous hCG slopes in MS, AF and FS levels. The hCG level in MS was 12.9 +/- 1.3 IU/mL (mean +/- SE, n = 93). It was much higher than levels in AF or FS. AF (0.461 +/- 0.053 IU/mL, n = 25) also had higher hCG level than FS (0.038 +/- 0.0056 IU/mL, n = 93). The hCG concentrations in AF and FS were highly correlated with those in corresponding MS (P < .001 and P < .05, respectively). The concentrations in AF were also positively correlated with those in corresponding FS (P < .05). The mean of MS/AF ratios for hCG was 413.6 +/- 23.4 (+/- SE); of MS/FS, it was 37.8 +/- 9.2; of AF/FS, it was 15.3 +/- 2.6. At late pregnancy, higher hCG levels of MS, AF or FS may result in female fetuses than in male fetuses. The results revealed that there were hCG concentration gradients on both placental and fetal membranes. It also implied that hCG levels in AF may decline as gestation ages advance. For biochemical studies in FS, using pure cord venous blood may have more consistent results than using mixed blood.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of blocking factors and antipaternal lymphocytotoxic antibodies in the success of pregnancy in patients with recurrent spontaneous abortion

OBJECTIVE

To elucidate the role of mixed lymphocyte reaction blocking factors (BF) and complement-dependent antipaternal lymphocytotoxic antibodies on the outcome of pregnancy in unexplained recurrent spontaneous aborters.

DESIGN

A controlled study of immunotherapy in which the treated group was immunized with the husband's or a third party donor's lymphocytes and the control group received autologous lymphocytes.

SETTING

Tertiary care institution.

PATIENTS

Forty-three patients in the control group and 48 patients in the treated group.

INTERVENTION

The before and after immunization levels of BF and antipaternal lymphocytotoxic antibodies were measured.

MAIN OUTCOME MEASURES

The existence or changing pattern of BF and antipaternal lymphocytotoxic antibodies levels before and after immunization had no influence on the pregnancy outcome in either group of patients.

CONCLUSION

Neither BF nor antipaternal lymphocytotoxic antibodies is essential for successful pregnancy. They probably reflect the immunological response of the mother to exposure to fetal antigens.

Binding and growth-stimulation of cervical cancer cell lines by prolactin

Two cervical cancer cell lines CC7-T and Si-Ha were employed to observe the relationship between cervical cancer and prolactin. By immunocytochemical and indirect immunofluorescent assays using two prolactin monoclonal antibodies PRL-149 and PRL-151, both cell lines with added prolactin (10 ng/mL) were noted to be positive for PRL-151, but negative for PRL-149. The control cell lines from ovarian cancer and the myeloma lines were both stained negative. By using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, it was noted that CC7-T and Si-Ha grew better in the presence of various added concentrations of prolactin, ranging from 0.1 to 1,000 ng/mL, suggesting that prolactin may enhance the growth of cervical cancer. The degree of stimulation appears to depend on cell differentiation. However, prolactin levels in the cultured supernatant were undetectable by the enzyme immunoassay (EIA) method. We postulate that prolactin can bind and stimulate the growth of some cervical cancer cell lines, probably through the prolactin receptor rather than by autocrine regulation.