Prostate cancer-induced oncogenic hypophosphatemic osteomalacia

A 65-year-old male with prostate carcinoma showed mild hypocalcemia of 7.9 mg/dl, marked hypophosphatemia of 1.7 mg/dl, hyperphosphaturia (tubular reabsorption of phosphorus 43% and tubular threshold for phosphorus of 0.6 mg/dl), low serum 1,25 (OH)2D level of less than 5 pg/ml and osteomalacia indicated by a marked increase of relative osteoid volume and fractional formation rate in the undecalcified section. Oncogenic osteomalacia due to prostatic carcinoma with suppression of 1,25 (OH)2D production and phosphaturia was suggested.

Comparison of antibody titer to human and rat acetylcholine receptor in myasthenia gravis

Antibody titer to acetylcholine receptor (AChR Ab) was measured in 34 patients with myasthenia gravis (MG) using an immunoprecipitation method with human and rat AChR as antigens, to study the reliability of these assay systems and the cross-reactivity between human and rat AChR. There was a good correlation in the titer of Ab to AChR between human and rat (P < 0.01) when Ab titers were expressed logarithmically. The titer of Ab to human AChR was higher in a group of patients with a high concentration of AChR Ab and lower in a group with a low concentration of AChR Ab than that to rat AChR. This indicates that there may be distinctive characteristics in AChR Ab between groups of patients with high and low concentrations of AChR Ab.

Reinforced cytotoxicity of lymphokine-activated killer cells toward glioma cells by transfection of the killer cells with the gamma-interferon gene

Lymphokine-activated killer (LAK) cells generated from peripheral blood lymphocytes incubated with recombinant interleukin-2 were transfected with the human gamma-interferon (HuIFN-gamma) gene by means of liposomes having a positive charge on their surface. The cells secreted significant amounts of HuIFN-gamma (reaching more than 5 U/ml) into the culture medium. The HuIFN-gamma produced by the cells induced intercellular adhesion molecule-1 (ICAM-1) and enhanced the expression of Fas antigen on the surface of human glioma cells. Also, LAK cells transfected with HuIFN-gamma gene exhibited reinforcement of cytotoxicity toward human glioma cell lines (U251-MG and SK-MG-1). Furthermore, the reinforcement was significantly quenched by anti-ICAM-1 and/or anti-TNF-alpha monoclonal antibody.

[Idiopathic interstitial pneumonia that responded to intermittent intravenous administration of high-dose cyclophosphamide]

A 78-year-old man was admitted to the hospital with exertional dyspnea and fever. Chronic idiopathic interstitial pneumonia (IIP) had been diagnosed a year before. Follow-up chest X-ray examination showed diffuse reticular shadows and progressive shrinkage of both lower lobes. Chest CT scan revealed honeycomb appearance of both lower lung fields. Moderate hypoxemia was found by arterial blood gas analysis. The patient responded to an orally administered corticosteroid. Because tapering of the medicine caused exacerbation of the hypoxemia, methylprednisolone pulse therapy was given with poor response. Then high-dose (750 mg) of cyclophosphamide (CPM) were given intravenously 6 times, every 3 or 4 weeks. After the second administration of CPM, decreases in hypoxemia and in blood LDH levels were observed. This treatment allowed as to taper the dose of oral corticosteroid from 60 mg/day to 15 mg/day. This case suggests that intravenous administration of high-dose CPM may be effective against IIP.

Transfection-induced tumor necrosis factor-alpha increases the susceptibility of human glioma cells to lysis by lymphokine-activated killer cells: continuous expression of intercellular adhesion molecule-1 on the glioma cells

To develop more effective adoptive immunotherapy, we transfected the human tumor necrosis factor-alpha (TNF-alpha) gene into human glioma cells (U251-SP), which were used as target cells. TNF-alpha is known to increase both the expression of intercellular adhesion molecule-1 (ICAM-1) on the surface of glioma cells and the susceptibility of glioma cells to lymphokine-activated killer (LAK) cell cytolysis. We compared the expression of ICAM-1 induced by TNF-alpha generated by the TNF-alpha gene-transfected cells with that induced by exogenously added TNF-alpha. When the TNF-alpha gene was transfected into U251-SP cells, the expression of ICAM-1 was detected on the cell surface from 3 days after the transfection and continued until at least 9 days. In contrast, it was expressed only transiently in the case of exogenously added TNF-alpha. Also, the cytolytic activity of LAK cells induced by transfection-induced TNF-alpha was significantly stronger than that induced by exogenously added TNF-alpha. The increased susceptibility was quenched by anti-ICAM-1 monoclonal antibody. These data indicated that continuous expression of ICAM-1 induced by TNF-alpha gene transfection of glioma cells resulted in higher cytolytic activity of LAK cells.

[Mitral valve replacement through right thoracotomy in a patient with a functioning ITA graft]

A 51-year-old male was admitted to our Institution with a complaint of dyspnea on effort. He had undergone coronary artery bypass grafting and mitral valve annuloplasty three years previously. The left ventriculograms showed severe mitral regurgitation. The coronary angiograms revealed an ITA graft and two SVG grafts were fully functioning. Considering the risk of injury of ITA/SVG graft during redo median sternotomy, we approached the heart through right anterolateral thoracotomy. Mitral valve replacement was performed under profound hypothermia without aortic cross clamping. Temporary reduction of perfusion flow was useful in order to obtain a better visual field. His postoperative course was uneventful. Right thoracotomy has an advantage over median sternotomy when reoperation is to be done for patients with a functioning ITA graft.

[Pulmonary root reconstruction with a cryopreserved pulmonary allograft for mechanical pulmonary valve thrombosis]

A 58-year-old woman suffering from congestive heart failure caused by a mechanical pulmonary valve thrombosis was operated on with a pulmonary allograft. She had experienced pulmonary valvotomy and resection of infundibular stenotic muscle for congenital pulmonary stenosis at the age of 23 years old. She got congestive heart failure caused by pulmonary regurgitation, and underwent pulmonary valve replacement with a St. Jude Medical (SJM) valve when she was 48 years old. She suffered from episodes of a thrombosed SJM valve in 1984 and 1993. Each time, thrombolytic treatment with urokinase or recombinant tissue-type plasminogen activator was effective. She suffered from the third episode of SJM valve thrombosis in January 1994. As thrombolytic treatment was not effective this time, the thrombosed SJM valve was resected and her pulmonary root was reconstructed with a cryopreserved pulmonary allograft. Postoperative course was uneventful, and she now enjoys her life without anticoagulant therapy.

[Detection of HTLV-I proviral DNA by PCR method from bronchoalveolar lavage cells of HTLV-I carriers]

To elucidate whether or not human T-lymphotropic virus type I (HTLV-I) infected cells exist in the lungs of HTLV-I carriers, we examined bronchoalveolar lavage (BAL) cells for the presence of HTLV-I proviral DNA by the polymerase chain reaction (PCR) method. The cells were harvested from HTLV-I seropositive individuals with or without various respiratory diseases. The HTLV-I pX region was detected from separated BAL cells by dot blot hybridization after PCR in all 14 HTLV-I seropositive individuals tested. Four out of these 14 individuals were asymptomatic HTLV-I carriers, while the other ten had symptoms, including those of bacterial pneumonia, chronic respiratory tract infection, interstitial pneumonia, atypical mycobacterial infection, bronchitis, mediastinal lymphadenitis and bronchial asthma. HTLV-I proviral DAN was detected in BAL cells from patients with a normal proportion of lavage lymphocytes and a normal CD4/CD8 ratio. These findings suggest that HTLV-I infected cells may commonly exist in the lower respiratory tract and alveolar space without producing characteristic symptoms/signs, and that any causal relation to the pulmonary lesion must therefore be carefully elucidated, in HTLV-I carriers.

Liposomal transfection of human gamma-interferon gene into human glioma cells and adoptive immunotherapy using lymphokine-activated killer cells

The authors evaluated the effect of liposomal transfection of human gamma-interferon (HuIFN-gamma) gene into human glioma cells and lymphokine-activated killer (LAK) cells, alone and in combination. An HuIFN-gamma gene inserted in a eukaryotic expression vector was entrapped in liposomes bearing positive surface charges. Liposomal gene transfection induced production of HuIFN-gamma and its secretion in culture medium of human glioma cell lines (SK-MG-1 and U-251 MG). At 4 days after transfection, the cells produced 10 to 50 U/ml of HuIFN-gamma in the medium, whereby the major histocompatibility complex (MHC) class I and II antigens, as well as intercellular adhesion molecule-1 (ICAM-1), were induced on the glioma cell surface. The growth-inhibiting effect of transfection-induced HuIFN-gamma was much stronger in comparison with control cultures exposed to 500 U/ml of exogenously added HuIFN-gamma. In addition, 20% to 40% growth inhibition was obtained in the glioma cells when they were treated with LAK cells alone at a 5:1 ratio of effector to target cells. Liposomal transfection of HuIFN-gamma gene into human glioma cells combined with immunotherapy using LAK cells was more effective than either technique alone. The reinforcement of growth inhibition in the case of combined therapy was quenched by anti-ICAM-1 monoclonal antibody, but not by anti-MHC class I or II monoclonal antibodies. These results suggest that the combined effect of liposomal transfection of HuIFN-gamma gene plus LAK cells into human glioma cells is a potentially useful therapy for malignant glioma, and that the mechanisms of the reinforcement of growth inhibition are closely related to the expression of ICAM-1 on the glioma cell surface.

Purification and Characterization of Membrane-Bound Inositol Phospholipid-Specific Phospholipase C from Suspension-Cultured Rice (Oryza sativa L.) Cells (Identification of a Regulatory Factor)

A membrane-bound inositol phospholipid-specific phospholipase C was solubilized from rice (Oryza sativa L.) microsomal membranes and purified to apparent homogeneity using a series of chromatographic separations. The apparent molecular mass of the enzyme was estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to be 42,000 D, and the isoelectric point was 5.1. The optimum pH for the enzyme activity was approximately 6.5, and the enzyme was activated by both Ca2+ and Sr2+. The chemical and catalytic properties of the purified membrane-bound phospholipase C differed from those of the soluble enzyme reported previously (K. Yotsushima, K. Nakamura, T. Mitsui, I. Igaue [1992] Biosci Biotech Biochem 56: 1247-1251). In addition, we found a regulatory factor for the phosphatidylinositol-4,5-bisphosphate (PIP2) hydrolyzing activity of phospholipase C from rice cells. The regulatory factor was dissociated from the catalytic subunit of phospholipase C during the purification. The regulatory factor was necessary to induce PIP2-hydrolyzing activity of both membrane-bound and -soluble phospholipase C; these purified enzymes had no activity alone. Because the plasma membranes isolated from rice cells could also act as a regulatory factor, the regulatory factor seems to be localized in the plasma membranes. Regulation of inositol phospholipid turnover in rice cells is discussed.

[Anomalous origin of the left coronary artery from the pulmonary artery: a case report in an adult]

A 37-year-old female with anomalous origin of the left coronary artery from the pulmonary artery was surgically treated by creation of intrapulmonary aorto-coronary tunnel. Postoperative cardiac catheterization showed a minimal pulmonary stenosis at the baffle. But the remarkable preoperative ST-depression in a treadmill exercise test disappeared completely after operation and the normograde blood flow of the left coronary artery was detected from the ascending aorta.

Heme-biosynthetic enzyme activities and porphyrin accumulation in normal liver and hepatoma cell lines of rat

The activities of four heme-biosynthetic enzymes, delta-aminolevulinic acid (ALA) synthase, ALA dehydratase, porphobilogen (PBG) deaminase, and ferrochelatase, were studied in five epithelial cell lines of normal rat liver origin (RL, RLC-10, RLC-24, M, Culb-TC) and five cell lines derived from Yoshida ascites hepatoma (JTC-1, JTC-2, JTC-15, JTC-16, JTC-24). The JTC series of hepatoma-derived cell lines exhibited decreased ALA synthase activity and increased ALA dehydratase activity, although the activities of all four enzymes and the Km values for their respective substrates varied widely from one cell line to another, a finding suggesting that specific regulatory mechanisms for porphyrin metabolism might operate in each cell type. M cells, which were transformed by 4-dimethylaminoazobenzene in vitro, gave the most abnormal Km values of heme-biosynthetic enzymes among all the cell lines studies, and were found to accumulate hematoporphyrin derivative (HpD).

[A case report of surgical treatment in acute aortic dissection: efficacy of retrograde cerebral perfusion and pitfall of image diagnosis]

A 76-year-old man with acute aortic dissection of Stanford type A underwent aortic arch replacement using retrograde cerebral perfusion for 105 minutes. By the preoperative IADSA an entry was detected in the distal arch. There were no neurological complications. But the postoperative IADSA showed that the surgically closed entry was another one from that diagnosed before operation. This case shows us efficacy of retrograde cerebral perfusion which allows more time for arch repair than the technique of deep hypothermia with circulatory arrest and importance of careful and precise evaluation by preoperative image diagnosis.

Prevention of posttransfusional non-A, non-B hepatitis by a screening test for hepatitis C virus antibody of donor bloods

The preventive effect on posttransfusional non-A, non-B hepatitis (PTH) of screening out HCV-Ab positive blood and the prevalence of HCV-Ab-positive donor blood were examined. The incidence of HCV-Ab-positivity in donor blood A was 0.9% and that in donor blood B was 1.35%. The mean ALT and guanase levels were 11.5 +/- 5.8 and 0.58 +/- 0.24 IU/l in HCV-Ab negative blood and 17.3 +/- 7.9 and 0.84 +/- 0.23 IU/l in HCV-Ab-positive blood. Both levels were significantly higher in HCV-Ab-positive blood. These differences were considered to be nonspecific, but there may be some relationship between the levels of ALT and guanase in donor blood and the HCV carrier status. After adoption the screening test for HCV-Ab positive blood, there was no case of a definite diagnosis of PTH, although 4 patients (6.6%) suspected of developing PTH. So, the incidence of PTH was clearly lower than the lowest incidence before adoption of this test. Therefore, we conclude that screening for HCV-Ab in donor blood should be routinely used for prevention of PTH.

Cytosol type electrolyte medium suitable for long term growth of human cells with very low membrane potential

Culture media for mammalian cells contain electrolytes at concentrations that approximate those of the extracellular fluid (ECF). However, we observed that HeLa strain cells can grow in a cytosol type, serum-free, high amino acid medium (KN13) in which the concentrations of K+, Mg2+ and Pi were increased to about 10 times those in ECF by replacing NaCl. The Ca2+ concentration of KN13 is 10% of that in ECF. The additions of Mg2+ and Pi are essential to prevent the harmful effect of a high concentration of K+ in the medium. Even an increase in the K/Na ratio to 7 and 9 permitted growth for at least 2 weeks and 4 days, respectively. HeLaP3 cells adapted to KN13 (HeLaK cells) have proliferated (4 fold/week) for 4 years in this medium. The Na,K-ATPase of HeLaK cells was the alpha 1 isoform. HeLaK cells in KN13 medium have a lower membrane potential (-3.0 +/- 6.1 mV) than that of the original HeLaP3 cells in DM160 (-26 +/- 10 mV).

High-efficiency transpeptidation catalysed by clostripain and electrostatic effects in substrate specificity

Clostripain catalyses the transpeptidation between benzoylarginin ethyl ester and amino acid amides, oligopeptides, insulin A- and B-chains and tryptic peptides of myoglobin at millimolar substrate concentrations. The reactions proceed with temporary accumulation of the products, followed by hydrolytic decomposition. The yield was not affected significantly by the type of N-terminal amino acid, but was diminished markedly by the negative charges of the amine components. The yields for natural peptides were linearly related to the charge density of the peptides.

Postoperative infection prophylaxis for upper gastrointestinal tract surgery--a prospective and comparative randomized study of cefoxitin and ceftizoxime

A prospective and randomized clinical study was conducted in order to compare cefoxitin (CFX) and ceftizoxime (CZX) as prophylactic antibiotics. Two hundred and three consecutive cases of elective upper gastrointestinal tract surgery, performed at our institute between January, 1983, and March, 1986, were entered in the trial. The patients were assigned randomly, before surgery, to the CFX or to the CZX group. Two grams of the assigned antibiotic was first administered during surgery and then continued at a dose of 1 gram, every 8 hrs for a total of 4 days. One patient was withdrawn from the study due to an allergic reaction. Both groups were comparable in sex, age, underlying disease, diagnosis, operation, and preoperative laboratory data. There were 18 infections related to the operation in the CFX group, while there were only 3 in the CZX group (p less than 0.001). The number of unrelated infections in each group was 6 and 6 respectively (NS). No special differences were found between the two groups regarding the kinds of microorganisms isolated, and no significant differences were seen in the adverse effects of either antibiotic. Our study demonstrated that ceftizoxime was more efficient than cefoxitin in preventing postoperative infection, following upper gastrointestinal tract surgery.

[Multidisciplinary treatment of head and neck cancer]

This presentation deals with multidisciplinary treatment of head and neck cancer, especially focusing on maxillary sinus carcinoma (MSC) and nasopharyngeal carcinoma (NPC). Since 1982, a new multidisciplinary treatment incorporating neo-adjuvant chemotherapy has been introduced in the treatment of MSC. The Neo-adjuvant chemotherapy includes cisplatin (CDDP) + peplomycin (PEP), adriamycin (ADR) analogs + CDDP + PEP, and CDDP +5-FU. Two courses of chemotherapy were given intraarterially with the interval of 2 weeks. Routinely, radiotherapy of 40 Gy by Linac was given to the primary tumor site, concomitantly combined with 5-FU intraarterial injections only during the first 10 days, 2 weeks after the end of chemotherapy. Additional treatment was performed according to the extent of the residual tumors. The 5-year survival rate for the 28 patients treated with this therapy was 55%. The 5-year survival rate by T classification was 100% for T2, 76% for T3 and 0% for T4 cases. The preservation rate of maxillo-facial structures and functions was 82%. Concerning NPC, neo-adjuvant chemotherapy included CDDP + PEP, ADR + CDDP + PEP and ADR + cyclophosphamide + PEP. Two courses of chemotherapy were performed, followed by radiotherapy of 60 Gy by Linac. Then intracavitary 60Co therapy was performed, followed by adjuvant chemoimmunotherapy. The 5-year survival rate for 21 patients treated with this therapy was 44%.

CONCLUSIONS

(1) The 5-year survival rate was better for patients with MSC who were treated with multidisciplinary treatment incorporating intraarterial neo-adjuvant chemotherapy than that for patients who received other treatment so far. Furthermore, the highest preservation rate of maxillo-facial structures and functions was achieved in the neo-adjuvant chemotherapy group. However, survival rates for T4 cases were very poor, so another approach should be taken. (2) The 5-year survival rate was also better for patients with NPC who were given multidisciplinary treatment than for patients who received other treatment to date. However, there was no decrease of distant metastases, which we aimed initially, despite the introduction of neo-adjuvant chemotherapy.

Secretion of a novel cell-adhesive protein distinct from fibronectin by mouse L.P3 cells growing in protein- and lipid-free synthetic medium

Several cell lines growing in protein- and lipid-free synthetic medium secreted cell-adhesive protein(s) into the medium. The conditioned medium (CM) of one of these cell lines, mouse L.P3, showed the highest cell attachment-promoting activity (CPA) among them. Cell-adhesive protein(s) in the CM of L.P3 cells (L.P3-CM) were separated into two types by sequential affinity column chromatography employing gelatin-Sepharose 4B and heparin-Sepharose 4B. One was a gelatin- and heparin-binding cell-adhesive protein (GCP), and was identified as a cellular form of mouse fibronectin. The other was a gelatin-non-binding and heparin-binding cell-adhesive protein (GNCP). The CPA of GNCP preparation was effective for the cell-attachment and spreading of both epithelial and fibroblastic cells. The CPA of GNCP preparation was not blocked by the antiserum and scarcely inhibited in the presence of the synthetic cell attachment-promoting peptide Gly-Arg-Gly-Asp-Ser-Pro, a competitive inhibitor of fibronectin. This suggests that the structure of the cell-attachment site of GNCP is different from that of fibronectin. The GNCP preparation showed little cross-reactivity with anti-mouse laminin antiserum in enzyme-linked immunosorbent assay (ELISA). These results demonstrate the possibility that GNCP in L.P3-CM is a novel cell-adhesive protein distinct from fibronectin or laminin. The secretion of the two types of cell-adhesive proteins by L.P3 cells is discussed.

A new approach to the modification of cell membrane glycosphingolipids: ganglioside composition of JTC-12 P3 cells altered by feeding with galactose as a sole carbohydrate source in protein- and lipid-free synthetic medium

A significant difference in the glycosphingolipid composition of JTC-12 P3 cells established from monkey kidney tissue was observed when cells cultured in a protein- and lipid-free synthetic medium containing glucose (DM-160) as a sole carbohydrate source were transferred and cultured in the same medium containing galactose and pyruvic acid (DM-170) in place of glucose. In particular, the amounts of gangliosides GM3, GM2, and GD3 in the cells cultured in DM-170 were 5.3-, 17.8-, and more than 8-fold those in the cells cultured in DM-160, respectively, indicating that anabolism of gangliosides is greatly enhanced in cells cultured in the presence of galactose and pyruvic acid, as compared with cells cultured in the presence of glucose. In fact, after cultivation of cells in the medium with N-acetyl-D-[14C]mannosamine for 96 h, the radioactivity incorporated into the gangliosides of the cells in DM-170 was 10-fold that of the cells in DM-160. Among the gangliosides of the cells in DM-170, highly sialylated molecules such as GD3, GD1a, GD1b, and GT1b were preferentially labeled, indicating that the sialyltransferases responsible for the synthesis of gangliosides are significantly more activated in cells cultured in DM-170 than in DM-160. These observations reveal that the glycosphingolipid composition of the plasma membrane can be modified epigenetically under well-defined conditions and provide important clues for clarifying the roles of glycosphingolipids associated with particular cell functions.

[Combined radiotherapy and chemotherapy for head and neck cancer]

There are 4 modalities of combined radiotherapy and chemotherapy which include (1) concurrent radiotherapy and chemotherapy, (2) sequential use of radiotherapy and chemotherapy (pre-radiation chemotherapy), (3) pre-radiation chemotherapy followed by concurrent radiation and chemotherapy, and (4) alternating use of radiotherapy and chemotherapy based upon Looney's hypothesis. We studied concurrent use of radiotherapy and UFT by means of animal experimentation and clinical trials. The results obtained revealed that UFT was a most suitable agent together with 5-fluorouracil for concurrent application of radiotherapy and chemotherapy. Neoadjuvant chemotherapy including pre-radiation chemotherapy was also studied in cases of maxillary sinus carcinoma and nasopharyngeal carcinoma. From the results, it seemed desirable to use cisplatin and bleomycin analogs sequentially in combined chemotherapy and radiotherapy. Neo-adjuvant chemotherapy should be studied successively to improve local tumor control rates and prevent distant metastases. For future perspectives, new trials of alternating radiotherapy and chemotherapy based upon Looney's hypothesis seem necessary.

[Radical excision followed by reconstruction of recurrent cancers of the head and neck]

Various modalities of treatment for recurrent cancers of the head and neck were studied and discussed, focusing especially on radical excision followed by reconstruction. Thirty-two patients with recurrent cancer of the head and neck were given this treatment over a 12-year period. Pectoralis major myocutaneous flap was most commonly used for reconstruction, while free latissimus dorsi myocutaneous flap with microneurovascular anastomosis was used for total cheek defect after surgery for cancer of the maxillary sinus. Five-year survival was 62% in cases of radical excision followed by reconstruction. Simple resection of recurrent lesions was conducted in 36 cases and the 5-year survival was also 62%. Radical neck dissection was performed in 22 cases in which cervical node metastases developed after control of the primary tumor, and the 5-year survival was 52%. On the other hand, the 5-year survival was not obtained in cases treated with radiotherapy alone in this series, while the 5-year survival was only 1% in cases treated with chemotherapy alone. It was concluded that surgery was the most reliable treatment for recurrent cancers of the head and neck, and that radical excision followed by reconstruction played an important role as salvage surgery.

Requirement of serum pretreatment for induction of alkaline phosphatase activity with prednisolone, butyrate, dibutyryl cyclic adenosine monophosphate and NaCl in human liver cells continuously cultured in serum-free medium

A cell line (HuL-1) derived from normal fetal human liver was adapted to grow continuously in a modified Eagle's minimum essential medium without serum or hormones. The population doubling time of this adapted cell line (HuL-1-317) was about 72 h and the modal number of chromosomes was 54. The morphology of HuL-1-317 cells was round in the absence of serum, but at 37 degrees C with the addition of serum (1-10%), the cells flattened. HuL-1-317 cells had a low level of alkaline phosphatase activity. However the enzyme activity was slightly enhanced by the combination of prednisolone, butyrate, dibutyryl cyclic adenosine monophosphate and a hypertonic concentration of NaCl after 3 days of incubation at 37 degrees C. The increase in alkaline phosphatase activity with the four agents was further amplified dose-dependently by the pretreatment of the cells with serum. The stimulatory effect of the serum was evident at concentrations as low as 1%, and was maximal at 20%. The half life of the effect of serum on alkaline phosphatase induction was 48 h at 37 degrees C. Serum alone could not enhance the enzyme activity without the four agents. The present results indicate that serum contributes to the regulation of alkaline phosphatase induction by the combination of prednisolone, butyrate, dibutyryl cyclic adenosine monophosphate and NaCl in fetal human liver cells (HuL-1-317).

Unsaturated fatty acids in mammalian cell strains cultured for more than 10 years in serum-free synthetic media

In cultured cells, essential lipids are usually supplied by the serum added to the culture medium. However, in a serum-free medium, essential lipids would need to be synthesized by the cells. Cell strains derived from kidney, spleen, uterine carcinoma and fibroblasts were cultured in serum-free synthetic media for more than 10 years and their fatty acids were analyzed capillary column gas-liquid-chromatography. The following conclusions were drawn: 1. Polyunsaturated fatty acids were not detected. Thus, prostaglandins are not appear to be essential for initiation of DNA synthesis in these cells. 2. A compensatory increase of the content of monounsaturated fatty acids was detected. 3. A large difference in vaccenic/oleic acid ratio was found among several strains of cells, but the ratio does not reflect that of the original tissues.

Stimulation of prostaglandin E2 production by phorbol esters and epidermal growth factor in porcine thyroid cells

Effects of phorbol esters and epidermal growth factor (EGF) on prostaglandin E2 production by cultured porcine thyroid cells were examined. Both phorbol 12-myristate 13-acetate (PMA) and EGF stimulated prostaglandin E2 production by the cells in dose related fashion. PMA stimulated prostaglandin E2 production over fifty-fold with the dose of 10(-7) M compared with control. EGF (10(-7) M) also stimulated it about ten-fold. The ED50 values of PMA and EGF were respectively around 1 X 10(-9) M and 5 X 10(-10) M. Thyroid stimulating hormone (TSH), however, did not stimulate prostaglandin E2 production from 1 to 24-h incubation. The release of radioactivity from [3H]-arachidonic acid prelabeled cells was also stimulated by PMA and EGF, but not by TSH. These results indicate that both PMA and EGF are potent stimulators of prostaglandin E2 production, associated with the activity to stimulate arachidonic acid release in porcine thyroid cells.

[Multimodality treatment of nasopharyngeal carcinoma]

In the treatment of nasopharyngeal carcinoma (NPC), radiation has been the treatment of choice, because it is effective for locoregional disease. However, the results of radiotherapy for NPC have revealed that local relapse and/or distant metastases occur frequently, and consequently the five-year survival rate is as low as around 30%. Since 1982, we have adopted chemotherapy initially applied prior to radiotherapy (= pre-radiation chemotherapy) for the treatment of NPC in order to achieve better results. The chemotherapy mainly consists of a combination of cisplatin and peplomycin. Twenty-one previously untreated patients with NPC were evaluable. Three complete and fifteen partial remissions were achieved, with an 86% response rate to the chemotherapy. The treatment involving a combination of pre-radiation chemotherapy and radiotherapy resulted in local relapse in one patient and distant metastases in two patients with an 87.5% survival rate according to the Kaplan-Meier method. Immunotherapy is also indispensable in the treatment of NPC. Our present multimodality treatment for NPC consists of a combination of pre-radiation chemotherapy and radiotherapy followed by long-term administration of a biologics such as OK-432.

[Multidisciplinary treatment of carcinoma of the oropharynx]

From 1963 through 1986, we examined 91 patients with carcinoma of the oropharynx. Of these 91 patients, the primary treatment modality was chosen for 75 patients. The patients were divided into 2 groups according to the periods of treatment. In group I (1963-1973), 33% of the patients were applied combined radiotherapy and chemotherapy, and 28% chemotherapy followed by surgery as their initial treatment. In group II (1974-1986), 65% of the patients were applied combined radiotherapy and chemotherapy, and 21% a multimodal treatment consisting of radiotherapy combined with chemotherapy followed by composite resection. Five-year survival rate was 36% in group I and 51% in group II, which indicated a progress in the treatment of carcinoma of the oropharynx. The role of surgical treatment for carcinoma of the oropharynx was discussed. It appears that composite resection and reconstructive surgery produced a great benefit in the treatment of residual diseases after radiotherapy or recurrent diseases. Then our new treatment modality incorporating neo-adjuvant chemotherapy was presented. The literatures in terms of neo-adjuvant chemotherapy were reviewed.

Combination chemotherapy with cisplatin and peplomycin in squamous cell carcinoma of the head and neck

Ninety-three patients with head and neck cancer were treated with combined cisplatin-peplomycin chemotherapy (CP therapy). Cisplatin (CDDP) 50 mg/m2 i.v. (intravenous) or i.a. (intraarterial) over 2 hr was given with hydration and mannitol diuresis on day 1. From day 2 through day 6, peplomycin (PEP) 5 mg/day was administered by 5-hr i.v. or i.a. infusion, or 24-hr continuous hypodermic injection. Of 85 who were evaluable, there were 22 complete responses or CR (26%) and 36 partial responses or PR (42%), with an overall response rate of 68%. Concerning of the route of administration, i.a. infusion obtained the higher CR and overall response rates than i.v. infusion. Effectiveness was clearly greater in previously untreated cases than in cases that had received some previous therapeutic modality. Looking at response in relation to the number of the courses, at least 2 courses of CP therapy are required. Side effects were recognized in 68 out of 87 evaluable cases (78%). Nausea and vomiting were the most common (62%). Renal toxicity was observed in 24% and was mostly transient. From the above results, it is considered that the CP therapy is effective, not only for the palliative treatment of advanced and recurrent cancer of the head and neck, but also as neo-adjuvant chemotherapy of stage III and IV cases.

[Humoral and cellular immunodepression following surgery and postoperative infection]

The correlation between humoral and cellular immunodepression and postoperative infection was studied. Our previous study showed that the incidence of postoperative infection was significantly higher in the patients with malignant disease than in those with benign disease. In order to assess the difference, serial determinations of humoral immuno-factors and cellular immuno-functions were performed on 60 patients with benign disease (group A) and 20 patients with malignant disease (group B) before and following surgery. In the group B, the reductions of complement levels, haptoglobulin and transferrin were observed on the 1st and 3rd postoperative days, but in group A, the reductions of these parameters were not so low as those in group B and these parameters recovered progressively. In both groups, patients who had serious reductions of humoral immuno-factors developed postoperative infection. There was no close correlation between the depression of cellular immuno-functions and postoperative infection. Our data suggest that the higher incidence of postoperative infection in group B is responsible for the depression of humoral immuno-factors in the early period of postoperative day.

[Preoperative chemotherapy for head and neck cancer]

The authors have studied preoperative chemotherapy for head and neck cancer since 1963, focusing on intra-arterial chemotherapy. The results obtained revealed that preoperative chemotherapy played an important role in the improvement of 5-year survival in maxillary sinus carcinoma and tongue carcinoma. However, functional and cosmetic damage after radical surgery has newly energed as problems to be resolved. The appearance of cisplatin has raised an important the level of effectiveness of cancer chemotherapy in recent years. Since the combination of cisplatin and bleomycin analogs revealed a remarkable synergistic effect in experimental chemotherapy, it has been used clinically as preoperative or preradiation chemotherapy for advanced Stage III and IV head and neck cancer. Under the above-mentioned circumstances, treatment for head and neck cancer has undergone various changes over the past twenty years. At present it is no exaggeration to say that the period in which dependence was placed on only surgery and/or radiation is over. The authors would like to emphasize that preoperative chemotherapy should be carried out as a part of multidisciplinary approach under a new concept of neo-adjuvant chemotherapy which includes not only preoperative chemotherapy but also preradiation chemotherapy. The role of preoperative chemotherapy, its current status and future prospects are discussed in this paper, looking back on the history of chemotherapy for head and neck cancer.

Ouabain-resistant cells cultured in a synthetic medium

Several strains of kidney and liver cells cultured in a synthetic medium were found to be resistant to ouabain. These cell strains were characterized because this resistance may serve as a good marker in genetic studies on somatic cells in chemically defined conditions in the absence of Na+ related growth factors and hormones. The phenotype was stable in the absence of selection for at least two years, and the original strains before adaptation to the synthetic medium were found to have ouabain sensitivity equal to the corresponding cells in the synthetic medium. The resting membrane potential, Na+,K+-ATPase activity, and growth rate of the resistant cells were similar to those of ouabain-sensitive cells. The resistance of the cells was not affected by serum or antibodies against some cytoskeletal proteins and the sensitivity of the Na+,K+-ATPase was not restored by partial purification of the membranes. Western blotting of the Na+,K+-ATPase of the ouabain-resistant cells showed that the molecular weights of its two subunits and its immunoreactivity were similar to those of the enzyme from the ouabain-sensitive strain. Thus the ouabain resistance is caused not by ouabain-like hormone produced by the cells or change in the cytoskeletal system, but by a mutation resulting in expression of an ouabain-resistant ATPase gene.

Clinical trials on UFT in the treatment of head and neck cancer

A new anticancer agent, UFT which is a mixture of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1:4 was administered orally at a dose of 600 mg/day every day. Forty-three patients were evaluable. Eight patients achieved a complete response and eight achieved a partial response with an overall response rate of 37.2%. In terms of response by histology, a response rate was 32.4% (11/34) in cases of squamous cell carcinoma and 75% (3/4) in cases of adenocarcinoma. A response rate by primary site was 57.1% in the nose and paranasal sinuses, 50.0% in the oropharynx and 30.0% in the oral cavity. A response rate was 36.1% in patients with prior treatment and 42.9% in patients with no prior treatment, but there was no statistical significance. Eight of 43 patients developed toxic effects. Most of them were mild such as anorexia, nausea, and stomatitis, but in one case of maxillary sinus carcinoma, severe bone marrow suppression was observed. UFT is a considerably effective and useful drug in the treatment of head and neck cancer. It is possible to increase cure rate by examining various usages of UFT.

Neoadjuvant chemotherapy in maxillary sinus carcinoma with cisplatinum and peplomycin intraarterial infusion

The purpose of this paper is to present our preliminary assessment of a new multimodal treatment including neoadjuvant chemotherapy with cisplatinum and peplomycin for maxillary sinus carcinoma. Fifteen patients with squamous cell carcinoma of the maxillary sinus carcinoma seen at Keio University Hospital, with Stage III and IV disease, were enrolled in this trial between January 1982 and January 1985. Regimen of chemotherapy was as follows: day 1, 50 mg/m2 of cisplatinum, intraarterial infusion over 2 hr, days 2-6, peplomycin at a dose of 5 mg/day, intraarterial infusion over 5 hr. Routinely, radiotherapy of 40 Gy by Linac was given to the primary site, concomitantly combined with 5-fluorouracil intraarterial injections only during the first 10 days, 2 weeks after the end of initial chemotherapy. Additional treatment was performed according to the extent of residual tumor. Response to initial chemotherapy revealed that complete response was achieved in 7 and partial response in 6 out of 15 patients with a response rate of 87%. Nine patients required no surgical intervention while 6 underwent a surgical resection. Median follow-up in this group of patients is 20 months. Thirty-month survival rate calculated by Kaplan-Meier's method was 83%. Chemotherapy toxicity was mild in most cases. This pilot study does not provide conclusive survival information, but the results obtained are encouraging.

[High dose methotrexate with CF rescue therapy in patients with head and neck cancer]

A clinical trial of high dose methotrexate (MTX)-CF rescue was conducted in 17 institutions. Forty-seven patients with head and neck cancer entered this trial, of which 29 were evaluable. In this series, the patients were divided into 2 groups (Arm I, Arm II), according to physician's selection. MTX was administered 700 mg/m2 (1000 mg/body) in Arm I and 1750 mg/m2 (2500 mg/body) in Arm II by i.v. drip over 6 hours. Twenty-four hours after initiation of MTX infusion, CF rescue was started. There was no complete response in 29 patients. Four patients showed partial response with an overall response rate of 13.8%. There were 4 partial responders out of 21 patients in Arm I, with a response rate of 19%, whereas there was no partial responders out of 8 patients in Arm II. These results showed no apparent dose response. MTX concentrations in plasma were determined at 6, 24, 48 and 72 hours after initiation of MTX infusion. The assay results revealed a safe range in Arm I, but exceeded in 3 cases of Arm II. GI disturbances were seen at the rate of 78%. Bone marrow suppression was remarkable and hepatic toxicity was observed as the rate of 41%. No renal toxicity was observed. The results of high dose MTX-CF rescue therapy were not better than those of moderate dose therapy, so that we concluded that MTX should be used as one agent at low or moderate dose in combination chemotherapy as far as Japanese patients with head and neck cancer are concerned.

[Cancer of the maxillary antrum--a new multidisciplinary treatment containing neo-adjuvant chemotherapy]

During the period 1957-1982, 227 patients with maxillary carcinoma were treated. These cases were divided into 4 groups according to periods and methods of treatment. Five-year determinate survival figures for each group are as follows: I (1957-1966) 22%, 20/91, II (1967-1973) 40%, 27/67, III (1974-1978) 37%, 13/35, IV (1979-1982) 56%, 9/16 (3-year survival). The incorporation of intraarterial chemotherapy into the treatment of maxillary carcinoma has much contributed to an improvement of 5-year survival. Since 1982, a new multidisciplinary treatment containing neo-adjuvant chemotherapy has been introduced into the treatment of this type of carcinoma. Neo-adjuvant chemotherapy: day 1, cisplatin ( CPDD ) 50 mg/m2 or 80 mg/body i.a. over 2 hr., day 2-6, peplomycin (PEP) 5 mg/day i.a. over 5 hr. Two courses of chemotherapy were given with an interval of 2 weeks. Radiotherapy combined with intraarterial chemotherapy: Linac. 40 Gy/4 wks., 5-FU i.a. 250 mg/day q.d. (for 10 days). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 9 patients who completed this therapy. At the completion of CPDD and PEP treatment, complete response was achieved in 5 cases and partial response in 3 cases with a response rate of 89%. In 2 out of the 9 cases, no cancer cells were detected by histological examination after chemotherapy. No cancer cells were detected in 2 other cases after 40 Gy by Linac. combined with 5-FU i.a. infusion, and in 3 other cases after 60 Gy by Linac. combined with 5-FU. Two patients had radical surgery because of uncontrolled tumors. Periods of follow-up are too short, but it is expected that this new multidisciplinary treatment results in the higher survival.

[Studies on a neo-adjuvant chemotherapy for head and neck cancer]

A neo-adjuvant chemotherapy as a preoperative and preradiation chemotherapy was studied in 60 cases of the head and neck cancers. Out of 60, 29 cases were treated with peplomycin (PEP) and 31 with combination chemotherapies which include vincristine (VCR), methotrexate (MTX), bleomycin (BLM), mitomycin C (MMC); VCR, MTX, BLM (Mathé); VCR, MTX, BLM, 5-FU, hydrocortisone (Price-Hill A); hydoxyurea, adriamycin, BLM; VCR, MTX, PEP; cisplatin (CPDD), PEP. In the group treated with PEP, CR was achieved in one case and PR in 14 cases with a response rate of 52%. Five-year survival by Kaplan-Meier's method after all treatment was 34%. In the group treated with combination chemotherapy, CR was achieved in 5 cases and PR in 19 cases with a response rate of 77%. Three-year survival of this group was 82%. Responders to PEP as well as combination chemotherapy were more often rendered disease-free after all treatment than non-responders. We concluded that two courses of VMP therapy (VCR, MTX, PEP) would be appropriate for the outpatients with advanced stage I or stage II, meanwhile two courses of CP therapy (CPDD, PEP) was inpatients with stage III or stage IV as a neo-adjuvant chemotherapy.

Clinical value of the determination of serum guanase activity. Studies on patients and experimental data from mongrel dogs and cultured rat hepatocytes

Serum guanase activity was measured by a new method and compared with serum glutamic oxalacetic transaminase and glutamic pyruvic transaminase levels in 150 patients with various disorders, 21 dogs with experimental myocardial infarction, and 2 CCl4-treated dogs. Additionally, studies of the effect of CCl4 on enzyme release were undertaken using cultured rat hepatocytes. Glutamic oxalacetic transaminase, glutamic pyruvic transaminase, and guanase activities were found to be significantly elevated in patients with various liver disorders, those with acute myocardial infarction with prominent congestion of the liver, and also in CCl4-treated dogs. However, serum guanase activity was normal in patients with a variety of non-liver-related diseases including acute myocardial infarction, and in dogs with experimental myocardial infarction without liver damage, even when the serum glutamic oxalacetic transaminase and glutamic pyruvic transaminase activities were increased. The glutamic oxalacetic transaminase, glutamic pyruvic transaminase, and guanase activities in the culture medium of rat hepatocytes indicated in the presence of 0.5 mM CCl4 were elevated. These findings indicate that serum guanase activity is a more specific indicator of liver damage than serum glutamic oxalacetic transaminase and glutamic pyruvic transaminase.