The use of granulocyte colony-stimulating factor to shorten the interval between cycles of mitomycin C, vindesine, and cisplatin chemotherapy in non-small-cell lung cancer

We investigated the possibility of shortening the interval between courses of the commonly prescribed 28-day MVP (mitomycin C, vindesine, and cisplatin) regimen in patients with non-small-cell lung cancer (NSCLC). We conducted a nonrandomized phase II study using recombinant human granulocyte colony-stimulating factor (G-CSF, Chugai) to explore the possibility of shortening the cycle length to 21 days and compared the results with those obtained in historical controls who had received the standard 28-day regimen. A total of 40 patients, 37 of whom were evaluable, were entered in the 21-day treatment group of the trial and were compared with 38 historical controls who had received standard 28-day cycles of MVP at our institution. Patients in the 21-day group received mitomycin C at 8 mg/m2 on day 1, vindesine at 3 mg/m2 on days 1 and 8, and cisplatin at 80 mg/m2 on day 1, with the schedule being repeated every 21 days. Controls had received the same regimen, albeit at 28-day intervals. G-CSF was given s.c. to the patients in the 21-day group at a daily dose of 2 micrograms/kg from day 2 to day 21 of every MVP cycle. The administration of G-CSF to these patients accelerated neutrophil recovery as compared with that observed in the historical controls. Significant differences were found between the two groups in terms of mean neutrophil nadirs (2666/microliters in the first cycle and 1369/microliters in the second for the G-CSF group vs 416/microliters in the first cycle and 685/microliters in the second cycle for the control group; P < 0.0001) and the mean duration of neutropenia (< or = 1000/microliters; 1.0 day in the first cycle and 1.7 days in the second for the G-CSF group vs 8.0 days in the first cycle and 6.9 days in the second for the control group; P < 0.0001). This enabled 32 (86%) of 37 patients in the G-CSF group to complete > or = 2 cycles on schedule. In 10 patients, the bone marrow aspirates taken after G-CSF administration showed increases in band neutrophil and myelocyte percentages. In conclusion, MVP treatment of patients with NSCLC at 21-day intervals is possible with the support of G-CSF.

Usefulness of 31P-MRS as a method of evaluating the viability of preserved and transplanted rat liver

We used phosphorus-31 magnetic resonance spectroscopy (31P-MRS) to evaluate the viability of transplanted rat liver. Wistar rats were used as donors and recipients. The donor livers were preserved in saline (group 1), Euro-Collins solution (group 2), or in University of Wisconsin (UW) solution (group 3) for 3 and 6 h in groups 1, 2 and 3 and for 9 h in groups 2 and 3. Thereafter the livers were orthotopically transplanted. 31P-MRS spectra were measured after portal reperfusion. Finally, all the recipients were divided into survivors and non-survivors. Survival rates were better in group 3 than in groups 1 and 2. In the 9-h-preserved livers, the livers in group 3 showed a significantly higher beta-ATP/Pi ratio than those in group 2. Comparing survivors and non-survivors in the 6-h-preserved livers in group 2, survivors' livers showed significantly higher beta-ATP/Pi ratio than those of non-survivors. We concluded that 31P-MRS is a useful method for assessing viability of rat liver grafts.

Modified hemoglobin solution as possible perfusate relevant to organ transplantation

A modified hemoglobin solution (<pyridoxylated hemoglobin>-<polyoxyethylene> conjugate solution, PHP solution) has very interesting characteristics such as oxygen-carrying property without corpuscular components. Experimental use of the PHP solution has shown promising possibilities as a perfusate relevant to organ transplantations. 1) Elongation of warm ischemic time in canine kidneys: Dogs survived even with the unilateral kidneys which had been exposed up to 4.5 hour warm ischemia and, thereafter, perfused with the PHP solution. 2) Elongation of perfusion preservation period of canine livers: Dogs survived with the transplanted livers which had been perfused for 48 hours with the PHP solution. 3) Successful perfusion of rat small intestine: Lewis rat intestines perfused and preserved for 12 hours with the PHP solution showed a higher survival rate compared with those with Collins or UW solution. 4) Removal of antibodies: By exchange transfusion with a total of 30-60 ml of the PHP solution, a Lewis rat hematocrit lowered to 5% while IgG went down to nil from 8970 mg/dl, IgA to 28 mg/dl from 118 mg/dl and IgM to 190 mg/dl from 897 mg/dl. This technique is expected to be applicable for removal of the naturally existing antibodies in xenotransplantation.

The Japanese Interferon Study Group (JISG) has established the efficacy of human interferon-beta for serious CMV pneumonitis in kidney recipients. Japanese Interferon Study Group

The Japanese Interferon Study Group (JISG) is a research organization formed by 30 special hospitals for organ transplantation. A joint multi-centre, double-blind trial was conducted in order to investigate the efficacy of human interferon-beta (HuIFN-beta) against serious cytomegalovirus pneumonitis in kidney recipients.

Relationship between plasma levels of hyaluronic acid and amyloid-associated osteoarthropathy in chronic hemodialysis patients

Plasma levels of hyaluronic acid (HA) and acute-phase reactants were determined in chronic hemodialysis patients with or without carpal tunnel syndrome (CTS) and/or shoulder pain, which are characteristic symptoms of amyloid-associated osteoarthropathy. While levels of acute-phase reactants tended to be higher in the patients with CTS and/or shoulder pain than in patients without these symptoms, the difference was not significant. However, plasma levels of HA were significantly higher in the patients with these symptoms. Analysis of plasma levels of HA in age-matched patients also demonstrated a significant correlation between elevated levels of HA and the presence of CTS and/or shoulder pain. Among the patients with CTS and/or shoulder pain, those patients with bone cysts in the carpal bone or humeral head had significantly higher plasma levels of HA than patients without bone cysts. Thus, there appears to be a relationship between elevated plasma HA and amyloid-associated osteoarthropathy in chronic hemodialysis patients that is more specific than any correlation with levels of acute-phase reactants.

Effect of prostaglandin E1 on graft function of kidneys from living related donors

Prostaglandin E1 (PGE1) was used in renal transplant recipients with living related donors. The drug was given intravenously from day 1 to day 7 after transplantation at a dose of 40 microg/kg twice a day. A total of 45 patients were studied divided into two groups: 25 patients were treated with PGE1 (group B) and the remaining 20 patients did not receive the drug (group A). In group B, 24-h creatinine clearance (Ccr) was 66 +/- 12.8 ml/min compared with 40.3 +/- 13.4 ml/min in group A on the fifth postoperative day (P < 0.05). Urinary levels of N-acetyl-beta-D-glucosaminidase (NAG) and serum levels of platelet factor 4 (PF4) in group B were significantly lower than in group A. On the fourth postoperative day, the urinary excretion of thromboxan B2 (TxB2) in group A was higher than in group B, but not significantly (5.1 +/- 3.0 ng/day and 2.8 +/- 1.1 ng/day, respectively). Acute rejection occurred in four patients in group B and in 10 patients (40%) in group A. The percentage of Leu2a-positive lymphocytes in group B was higher than in group A. We conclude that postoperative administration of PGE1 improves graft function in kidneys from living related donors.

Evaluation of a pyridoxylated hemoglobin polyoxyethylene conjugate solution as a perfusate for small intestine preservation

A new type of artificial blood, pyridoxylated hemoglobin-polyoxyethylene conjugate (PHP) solution, (developed by PHP research group of the department of health and welfare of Japan, and produced by Ajinomoto Co., Inc. Tokyo) as an oxygen-carrying component, has been recently devised using hemoglobin obtained from hemolyzed human erythrocytes. Recently, the studies using this solution as a preservation solution were performed in some instances. To examine the mechanism of improved viability using this solution as a preservation solution, we developed a model of orthotopic small intestine transplantation (OIT) in the rat. As a baseline study, we compared parameters of viability of the grafts preserved in Collins and UW solution to those preserved in PHP solution including a survival rate, a serum level total protein and albumin, and a change in body weight after transplantation. In our study, the simple hypothermia storage together with intestinal perfusion preservation with PHP solution was performed. Animals were divided into 6, 12, and 24 hr preservation groups. All of the rats survived after 6 hr preservation following transplantation. However, in 12 hr storage, five of six rats in PHP solution preservation survived and recovery in body weight after grafting was better than those with Collins and UW solution. We conclude that the PHP solution is, therefore, considered to possibly be a more suitable perfusate for small intestine preservation than Collins and UW solution.

[Effects of 4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride (bifemelane) on deposition of calcium and magnesium in the central nervous system tissues of rats maintained on low-calcium diets]

Since the reduction of calcium (Ca) intake leads Ca and magnesium (Mg) to mobilize from their bone pool and to deposit Ca in the soft tissues, especially in the central nervous system (CNS) tissues, the effects of 4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride (bifemelane) on the deposition of Ca and Mg in the CNS tissues, heart, liver, kidney, muscle, abdominal aorta and bones were studied in rats maintained on low-Ca diets. Thirty-two male, 7-week-old Wistar rats, randomly divided into four groups, each consisting of 8 rats, were maintained for 90 days on the following diets: (A) standard, (B) standard with bifemelane (10 mg/100 g diet), (C) low-Ca, and (D) low-Ca with bifemelane (10 mg/100 g diet). Neither the A-B groups' nor the C-D groups' blood chemistry changed. However, Mg concentration in the cerebellum showed higher values in the B group than in the A group (p less than 0.05). And Mg concentration in pons, cerebellum, spinal cord, heart, liver and femur of the D group increased more than that of the C group (p less than 0.05-0.01), as determined by inductively coupled plasma emission spectrometry (ICP). On the other hand, Ca concentration in the liver was less in the D group than that of the C group (p less than 0.05). In general bifemelane had a tendency to decrease Ca deposition in the CNS and soft tissues of B and D groups. Bifemelane may possibly participate in activating the cerebral metabolism and in keeping an adequate Mg level in the CNS and soft tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum decreases the zinc concentration of soft tissues and bones of rats fed a low calcium-magnesium diet

The relationship between magnesium (Mg) and zinc (Zn) in soft tissues and bone of rats was studied after administration of unbalanced mineral diets. Minerals and metals in soft tissues and bone were determined using inductively coupled plasma emission spectrometry (ICP). There were significant positive correlations between serum Zn and Mg levels, between serum Zn and Zn content of soft tissues and bone, and between serum Mg levels and Zn content of bone and soft tissues in rats fed unbalanced mineral diets. A significant positive correlation was also found between Zn and Mg content in the lumbar spine and femoral bone of rats. It appears that altered bone mineralization induced by unbalanced mineral diets leads to mobilization of Mg and Zn from rat bones in similar ways.

Clinical application of modified polyurethane graft to blood access

Based on a study of 34 clinical implantations, a porous poly(ether-urethane) graft developed for blood access was evaluated. Although it became clear that the graft has several advantages over expanded polytetrafluoroethylene (E-PTFE), it was also revealed that the occlusion at the anastomotic site was more frequently observed than that with E-PTFE. To improve the patency rate, a small modification of the luminal surface was attempted to give a better anchoring of the neointima. The results so far are better than those with the unmodified graft. However, the number of cases is small and the period of observation is short. More work will be necessary to confirm these preliminary results.

[Burkitt's lymphoma with monoclonal pattern (IgG, kappa type) of cytoplasmic immunoglobulin--clinical report and review of Japanese literature]

A 52-year-old male was admitted to the hospital because of abdominal mass. Bone marrow examination revealed 26% blasts, which morphology was L3 in FAB criteria. Abdominal tumor was resected and histologic feature of the tumor was malignant lymphoma, small non-cleaved cell, Burkitt's. Lymphoma cells from the resected tumor were cultured and a cell line was established. Cytological studies of the original tumor cells and the cell line revealed that the lymphoma was negative both for EBNA and EBV DNA, and possessed t(8;14) (q24;q32) in chromosome analysis. Surface antigens were positive for HLA-DR, CD19 and CD20, but negative for CD10. The lymphoma also expressed a monoclonal pattern (IgG, kappa type) both of surface immunoglobulin and cytoplasmic immunoglobulin. Thus, the lymphoma was originated from mature B-lymphocyte. We analysed clinicopathological findings of 216 patients who were reported as Burkitt's lymphoma in Japan. Of 35 cases examined for cell EBNA, 7 (20%) were positive for EBNA. Of 86 cases tested for surface immunoglobulin of tumor cells, 67 expressed IgM alone and 10 IgG alone on tumor cells. Cytoplasmic immunoglobulin of tumor cells was positive in 61% of patients. Of 11 cases positive for cytoplasmic immunoglobulin, IgM was detected in 8 patients and IgG only in our patient.

[Expression of CD56 antigen on acute nonlymphocytic leukemia]

CD56 antigen (detected by NKH-1) is distributed on NK cells, monocytes, and ectodermal neural cells. In this study, the blasts of 29.2% of 27 patients with acute nonlymphocytic leukemia (ANLL) expressed CD56 antigen, but not CD16, CD2, or CD3 antigen. Leukemic cells isolated from 3 patients with CD56-positive ANLL did not have NK activity. There were no significant differences between CD56-positive and CD56-negative ANLL in CD13-positive cases, CD33-positive cases, and HLA-DR-positive cases. These results suggest that CD56-positive ANLL could be so-called mixed-lineage leukemia (lymphoid-associated antigen in ANLL).

[Autologous blood transfusion aided with erythropoietin in transurethral resection of the prostate]

Erythropoietin (EPO) with an established clinical efficacy in renal anemia has in recent years become applied as an aid to autologous blood transfusion in surgical patients. This report describes our experience with autotransfusion along with the use of EPO in transurethral resection of the prostate (TUR-P), indicating its usefulness. Ten patients with benign prostatic hypertrophy aged 60 to 74 years received 3000 units of EPO, with an iron preparation, nine times beginning 3 weeks prior to operation. Autologous blood of 300 ml was collected from the patient each at 2 and 1 week before operation and was used at TUR-P. Five other patients who underwent TUR-P with the same volume of autotransfusion accompanied by preparative medication with the iron alone served as controls. In the EPO treated group (mean age, 68.3 years) the mean value for hemoglobin concentration (Hb) was 14.0 +/- 1.6 g/dl on the day of operation, which showed a recovery rate of 94.9 +/- 5.4% (Hb recovery rate) as against the pre-EPO treatment value (mean: 14.8 +/- 1.3 g/dl). This Hb recovery rate was significantly greater (p less than 0.001) when compared to 82.2 +/- 2.5% in the control group (mean age, 68.2 years). Of the EPO treated patients, those in their sixties (n = 6; mean age, 66.3 years) exhibited a significantly higher Hb recovery rate (98.3 +/- 3.5%) than the rate (89.9 +/- 3.0%) for patients in their seventies (N = 4; mean age, 71.3 years) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of bifemelane on calcium and magnesium deposition in the central nervous system tissues of rats maintained on low-calcium diets

The effects of bifemelane [4-(o-benzylphenoxy)-N-methylbutylamine hydrochloride] on the deposition of calcium and magnesium in central nervous system (CNS) tissues, heart, liver, kidney, muscle, abdominal aorta and bones were studied in rats maintained on standard and low-calcium diets. Rats were maintained for 90 days on the following diets: standard calcium (12.5 g/kg diet); standard with 100 mg/kg bifemelane; low-calcium (30 mg/kg diet); and low-calcium with bifemelane. The presence of bifemelane did not affect blood chemistry, but the magnesium concentration in the cerebellum was significantly (P less than 0.05) higher in rats receiving standard diet after bifemelane treatment. Magnesium concentrations in the pons, cerebellum, spinal cord, heart, liver and femur of bifemelane-treated rats fed low-calcium diets were significantly (P less than 0.05) higher compared with the corresponding controls, whereas the calcium concentration in the liver was significantly (P less than 0.05) lower. In general, bifemelane tended to decrease calcium deposition in the CNS and soft tissues of rats fed standard or low-calcium diets. Bifemelane may activate cerebral metabolism and maintain magnesium concentrations in the CNS and soft tissues, and be implicated in metal metabolism in rats fed low-calcium diets.

[Zinc concentration in the central nervous system in a case of multiple sclerosis--comparison with other neurological diseases]

The possible role of trace elements in a pathogenesis of central nervous system (CNS) on degenerative and demyelinating diseases has been suggested. Simultaneous measurements of Zinc (Zn) and iron (Fe) concentration in CNS were undertaken by neutron activation analysis in CNS tissues: a patient with multiple sclerosis (MS), five patients with amyotrophic lateral sclerosis (ALS), five with spinocerebellar degeneration (SCD), and five with cerebral infarction (CVD) in non-invasive area of CNS as control. Although Zn and Fe concentration were present in white matter and gray matter of CNS in each disease, 1) Zn concentration showed no special pattern in gray matter among four diseases, but decreased more in white matter of MS and ALS than that of CVD (p less than 0.05); 2) Fe concentration in gray matter of SCD increased more than that in CVD (p less than 0.05), but Fe concentration in white matter of CVD was increased more than that of ALS (p less than 0.05); 3) Fe concentration of CNS in a patient with MS was not notable except for high Fe concentration in caudate nucleus and globus pallidus. The demyelinated pathological area in CNS of MS showed a decrease in Zn level but no change in Fe level. These results indicate that low Zn concentration in CNS tissues of MS seemed to be responsible for CNS demyelination, but not for undernutrition due to poor conditions of a patient with MS. It seems that Zn might be one pathogenetic factor of MS, but the action of Fe in MS can not be ruled out.

[Aluminum deposition in the central nervous system tissues of patients with Parkinson's disease]

Aluminum (Al) concentration in the 26 anatomic central nervous system (CNS) regions, liver, kidney, spleen and heart of our patients with Parkinson's disease, and five neurologically normal controls was measured by a non-destructive neutron activation analysis (NAA), in order to clarify the implication of Al on pathogenesis of Parkinson's disease. Al concentration in substantia nigra, caudate nucleus and globus pallidus increased in patients with Parkinson's disease more than that in controls (p less than 0.05). There was a significant difference in Al concentration of gray matter and basal ganglia in Parkinson's disease, compared with those of controls (p less than 0.01). It is likely that high Al deposition in pathological foci responsible for Parkinson's disease might be implicated in the pathogenesis of Parkinson's disease.