Spontaneous pneumothorax following partial resolution of total bronchial obstruction

Spontaneous pneumothorax following chest irradiation is thought to occur in patients with radiation fibrosis several months or more after the completion of therapy. In the four patients presented herein, spontaneous pneumothorax was seen during or immediately after therapeutic radiation of lung cancer. All patients had bronchoscopic findings of bronchial obstruction by the tumor before treatment and radiographic improvement of atelectasis was observed during therapy. The interval between the improvement of atelectasis and the development of pneumothorax varied by less than three weeks. These common findings suggest that rupture of alveoli or emphysematous bullae and subsequent pneumothorax might be due to overinflation of the affected lung caused by partial bronchial obstruction. We should be aware of the occurrence of spontaneous pneumothorax following partial resolution of total bronchial obstruction.

Use of a dual chamber pacemaker with a novel fallback algorithm as an effective treatment for sick sinus syndrome associated with transient supraventricular tachyarrhythmia

A dual chamber pacemaker having a fallback (FB) mode was utilized in nine patients with sick sinus syndrome (SSS) associated with transient supraventricular tachyarrhythmia (atrial fibrillation [Af] in three patients, atrial flutter [AF] in two, and paroxysmal atrial tachyarrhythmia [PAT] in four). Various degrees of abnormality of atrioventricular (AV) conduction were observed at the time of pacemaker implantation in five patients. In this pacemaker, a DDD mode was active during sinus rhythm, but the mode changed, through a given cycle of high rate tracking at an upper rate limit (URL), to VDI only during intrinsic atrial rate increases that were either normally or abnormally above the URL. The VDI mode automatically returned to DDD when the atrial rate fell below the URL. At follow-up periods of 7-12 months, this pacemaker appeared to be especially effective in those SSS patients with transient Af or AF. In the SSS patients with PAT, however, the FB mode was not active because the PAT rhythm was conducted to the ventricle without block (1:1 conduction) and thus the given cycles of ventricular tracking at the URL did not occur. From the repetitive FB starting tests that were performed during an Af period in one patient with transient Af, a 2:1 point setting of a given URL plus 30-50 ppm was required to quickly start the FB algorithm. Moreover, an atrial sensitivity setting that was less than half of the P wave amplitude was desirable.(ABSTRACT TRUNCATED AT 250 WORDS)

[Systemic chemotherapy for brain metastasis from small cell lung cancer]

Small cell lung cancer (SCLC) is rapidly progressive, but is sensitive to chemotherapy. The incidence of brain metastasis is high in patients with this disease. The management of brain metastases is an important problem in SCLC patients, because brain tumors have been regarded as being inaccessible to anti-cancer agents due to the blood-brain-barrier (BBB). Of 15 SCLC patients with brain metastasis at diagnosis who were treated with chemotherapy, 3 achieved a complete response (CR) and 4 had a partial response (PR), giving a response rate of 47%. Of 17 SCLC patients with brain metastasis at relapse, 1 achieved a CR and 6 had a PR by chemotherapy, with a response rate of 30%. The response rate of brain metastasis in SCLC patients treated with chemotherapy was similar to those of primary lesions and other metastatic lesions. SCLC patients with brain metastasis at diagnosis had the same response rate and median survival time as other ED-SCLC patient. The BBB may not be an impending factor in systemic chemotherapy of brain metastasis in SCLC. Systemic chemotherapy may be the treatment of choice for SCLC patients with brain metastasis.

[Catheter-induced thrombosis of the inferior vena cava--case report]

A 47-year-old woman was admitted for bleeding from gastric ulcer for which a central venous catheter was placed through the right femoral vein. Seven days later, abdominal echograms unexpectedly revealed a large thrombus along the catheter in the inferior vena cava. Because the echograms also disclosed the thrombus immobile even in postural change, the catheter was pulled out. Within two weeks following the catheter removal, the thrombus spontaneously disappeared with no evidence of pulmonary embolism. Although thrombolysis therapy may be the treatment of choice for catheter-induced thrombosis, simple removal of the catheter is effective in case that the thrombus is immobile.

Rapid degradation of cucumber cotyledon lipoxygenase

The lipoxygenase activity from cucumber cotyledons grown with their embryonic axis was separated into two fractions having M(r)s of 90,000 and 96,000, respectively, by hydrophobic chromatography. However, from de-embryonated cucumber cotyledons, only one form of lipoxygenase having a M(r) of 90,000 was purified. The three lipoxygenases could not be distinguished from each other either immunologically or by their enzymatic properties. Furthermore, peptide maps of the 90,000 and 96,000-lipoxygenases were identical. In a crude homogenate of cucumber cotyledons, the 96,000-lipoxygenase was rapidly degraded to the 90,000-form. Thus, it was inferred that the 90,000-lipoxygenase was probably the 96,000-form which had lost a peptide fragment of 6,000. It is suggested that there is a specific proteolytic activity for the degradation of 96,000-lipoxygenase. Estimation of changes in the proteolytic activity during seedling growth suggests that the activity at least partly contributes to the rapid in vivo degradation of cucumber cotyledon lipoxygenase.

Naturally occurring 5-lipoxygenase inhibitor. II. Structures and syntheses of ardisianones A and B, and maesanin, alkenyl-1,4-benzoquinones from the rhizome of Ardisia japonica

New alkenyl-1,4-benzoquinones, ardisianones A (1) and B (2), and the known maesanin (3) as 5-lipoxygenase inhibitors have been isolated from the rhizome of Ardisia japonica. Their structures have been elucidated as 2-methoxy-6-[(Z)-10'-pentadecenyl]-1,4-benzoquinone and 5-hydroxy-2-methoxy-6-[(Z)-8'-tridecenyl]-1,4-benzoquinone, respectively, on the basis of spectroscopic data and chemical degradation. Ardisianone A (1), maesanin (3) and belamcandol A (7) have been synthesized starting from belamcandol B (6), readily prepared by Wittig reaction between 9-(2-tetrahydropyranyloxy)nonanal and 3,5-dimethoxybenzyltriphenylphsophonium bromide followed by selective demethylation with sodium thioethoxide.

Biopsy study of polyps in the duodenal bulb

To clarify the clinical and histological features of polyps in the duodenal bulb (DB), we studied, clinicopathologically, a total of 263 patients (179 male, 84 female) with polyps in the DB. The patients were 13-86 yr of age (average age, 57.1 yr). On endoscopy, a semipedunculated or pedunculated polyp with a relatively large size was seen in 33 patients, and small polyps, either single or multiple, were incidentally discovered in 230 patients. Histological examination of the biopsied specimens from polyps revealed gastric tissue in 182 cases (69.2%), cyst formation in 51 (19.4%), and other miscellaneous lesions (tubular adenoma, Brunner's gland hyperplasia, etc.) in 30 (11.4%). With regard to the gastric tissue, a "full-thickness" or "incomplete" body-type mucosa was identified in 27 cases of polyps, and hyperplastic surface epithelium was recognized in 155. Forty cases of hyperplastic surface epithelium-type polyps were subclassified as "pyloric"-type mucosa, because pyloric gland-like components seen under the surface epithelium were identical to those of the gastric antrum. It was reconfirmed that small polyps with little or no clinical significance could be produced by various histological features.

Enhanced antitumor efficacy of a combination of CPT-11, a new derivative of camptothecin, and cisplatin against human lung tumor xenografts

The objective of this study was to evaluate the antitumor efficacy of combined use of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxycamptothecin (CPT-11) and cisplatin (CDDP). The antitumor activities of CPT-11, CDDP and their combination against 3 human lung tumor xenografts were estimated using congenitally athymic BALB/c (nu/nu) mice. The doses were 47 mg/kg for CPT-11 and 6 mg/kg for CDDP on days 1, 5 and 9. In combination therapy, half of the single dosage of each agent was used. The doses were administered intraperitoneally. The antitumor activity and toxicity were evaluated in terms of the tumor volume and body weight change of mice, respectively. The combination therapy resulted in a statistically significant tumor regression compared to the use of only CPT-11 or CDDP in two tumor xenografts out of three. The toxicity of the combination therapy was no higher than that of CPT-11 or CDDP alone. These results suggest that the antitumor activity of the combination of CPT-11 and CDDP is superior to that of CPT-11 or CDDP alone.

Heavy ion-induced chromosome breakage studied by premature chromosome condensation (PCC) in Syrian hamster embryo cells

We have studied induction and repair of chromosome damage induced by high linear energy transfer (LET) heavy ions in G1/G0 interphase Syrian golden hamster embryo (SHE) cells as revealed by the premature chromosome condensation (PCC) technique. The number of chromosome breaks in condensed chromosomes induced by high LET heavy ions was higher than those induced by 137Cs gamma-rays. Compared with 137Cs gamma rays, the relative biological effectiveness (RBE) for PCC breaks was 1.5 for 35 keV/microns 4He ions, 1.9 for 77keV/microns 4He ions, and 2.5 for 530keV/microns 14N ions. Although 95% of the PCC breaks induced by gamma-rays rejoined during 8 h post-irradiation incubation, only 35-45% of fragments induced by high LET radiations rejoined in the same time. These results suggest that there is a difference, spatial or qualitative, in the initial chromosome damage produced by high LET radiations and low LET radiations.

Effects of lipid peroxidation on surface charge density of the porcine intestinal brush-border membranes

The effects of lipid peroxidation on the surface charge density of the porcine intestinal brush-border membranes were studied using an oxygen-radical-generating system consisting of ascorbic acid, ferrous ion and tert-butyl hydroperoxide (tert-BuOOH). Changes in the membrane surface charge density were monitored using a fluorescent dye, 8-anilino-1-naphthalenesulfonate (ANS). The incubation of the membranes with ascorbic acid/Fe2+/tert-BuOOH resulted in a decrease of the fluorescence intensity of the ANS-membrane complex with a red-shift in the emission maximum, depending on the hydroperoxide concentration and the incubation time. The kinetic studies on ANS-binding showed that the apparent dissociation constant of ANS-membrane complex decreased by treatment with ascorbic acid/Fe2+/tert-BuOOH. Similar results were also obtained by treatment of the membranes with other oxidizing systems, hematin/tert-BuOOH and dipyridyl/Fe2+/tert-BuOOH. These results proposed the possibility that lipid peroxidation of the membranes causes an increase of the positive charge on the membrane surface. The results of the dependence of the ionic strength with increasing KCl concentrations in the medium upon the ANS-binding affinity for the membranes further supported this interpretation.

Levels of somatostatin and cholecystokinin in the brain of ataxic mutant mice

Changes in immunoreactive somatostatin (SOM) and cholecystokinin (CCK-8) levels in the cerebellum and cerebrum were investigated in three types of genetically-determined ataxic mutant mice: rolling mouse Nagoya (RMN), weaver, and Purkinje cell degeneration (PCD) mice. The cerebellar pathology in each of these types differs. The concentration of both SOM and CCK-8 (ng/mg weight) was significantly higher in the cerebellum and the cerebrum of the three types of ataxic mutant mice than in these regions in the respective controls. SOM and CCK-8 content (ng/organ) was significantly higher in PCD and RMN than in controls but this was not in the weaver mice. The possible involvement of both peptides in manifestations of ataxia is discussed.

[An oxidation enzyme for hydrogen sulfide from Hyphomicrobium neptunium ATCC15444]

We described in our previous paper that the cell-free extract from Hyphomicrobium neptunium ATCC 15444 oxidized hydrogen sulfide to sulfur. We tried to purify the enzyme used for this oxidation to determine the molecular nature of this enzyme. The 40% ammonium sulfate precipitate from the supernatant of cell sonicate of H. neptunium was chromatographed on a column of Phenyl Sepharose CL-4B and its active fractions were collected. These fractions were further purified through Superose 12 and then TSK gel G3000SW column chromatographies. A protein of molecular weight about 54,000 and isoelectric point pI 6.8 was isolated. However, this final protein was found to reduce its activity to less than one-tenth of those of ammonium sulfate precipitate and of the fraction from Phenyl Sepharose CL-4B column chromatography. This might be caused either by the loss of accessory component or by its requirement of low molecular factors necessary for its activation at the stage of gel filtration. The neutral isoelectric point of this enzyme could be suitable as the function of H. neptunium because its final product was S0, and it grows at neutral pH. In contrast, the final oxidative product of hydrogen sulfide by Thiobascillus is sulfuric acid, and they grow at acidic pH.

Cocaine suppresses proliferation of phytohemagglutinin-activated human peripheral blood T-cells

Cocaine has been reported to modulate the immune system of experimental animals. Also, we observed that the drug suppresses the phytohemagglutinin (PHA)-induced proliferation of human peripheral blood mononuclear cells (PBMCs) but at concentrations extremely high relative to those seen in the blood of drug abusers. This suggested that cocaine had a relatively weak effect when tested under conditions of optimum proliferation. We, therefore, decided to examine the effect of lower concentrations of cocaine on suboptimum PHA-induced proliferation. At 0.09-12 microM, cocaine had no effect on the proliferation of PBMC in response to 0.2 micrograms/ml PHA. However, depleting the population of B-cells and monocytes resulted in a drug-induced suppression of the residual T-cells. Maximum suppression by cocaine was observed at 3 microM with both higher and lower concentrations of the drug causing less suppression. Suppression of proliferation was not influenced by either the age or sex of the peripheral blood lymphocytes (PBL) donors. The suppression of T-cell-enriched PBLs induced by cocaine could be eliminated by increasing the dose of the mitogen but was enhanced by preincubating the cells with the drug for 24 h. Also, the drug suppressed cytosolic free calcium mobilization in Fura 2/AM loaded enriched T-cell populations. These results show that cocaine moderately but consistently suppresses PHA-induced proliferation of T-cells from random blood donors at drug concentrations observed in drug abusers. The suppression is only evident under conditions of suboptimum proliferation and is accompanied by a corresponding decrease in the mobilization of cytosolic free calcium. It is suggested that the weak suppressive effect of cocaine is reversed by either helper factors produced by accessory cells or increasing concentrations of mitogen. These factors when present possibly overcome a drug-induced reduction in calcium mobilization and lymphocyte activation.

[New antitumor antimetabolites--gemcitabine and DMDC]

Gemcitabine (dFdC) and DMDC are new antimetabolites with good antitumor activities against various tumors which include human leukemic cell lines and a number of rodent and human solid tumors and human tumor. They are structurally related to cytarabine (Ara-C) which is known as one of the most effective drugs against adult acute leukemia, but many solid tumors are insensitive not been found to the drug. Gemcitabine acts as an inhibitor of ribonucleoside diphosphate reductase and inhibits DNA synthesis. Biochemically Gemcitabine is rapidly phosphorylated to dFdCTP which has a comparatively longer half-life than that of Ara-C, showing a therapeutic activity against tumors. In the phase I trials, the reported maximum-tolerated doses were 790 mg/m2 to 1370 mg/m2 at the schedule of 30 minutes i.v. infusion once a week for three weeks but higher dose levels (2,500 mg/m2 to 4,800 mg/m2) were reported in the schedule of prolongation of the infusion time. Reported toxicities were myelosuppression, fatigability, fever, appetite loss and skin rash. Toxicities were seemed to be mild. In USA, Europe and South Africa, phase II trials of Gemcitabine at the schedule of 30 minutes infusion once a week for three weeks followed by one week rest were performed against solid tumors (breast cancer, ovarian cancer, renal cancer, colorectal cancer, pancreas cancer, head and neck cancer, and lung cancer) and showed good responses to those tumors. DMDC was developed in Japan, and a phase I trial is currently on-going.

Lung carcinoma with spindle cell components: sixteen cases examined by immunohistochemistry

Sixteen cases of lung carcinoma with spindle cell components were studied by conventional histochemistry and immunohistochemistry. The epithelial components were squamous cell carcinoma in six cases, adenocarcinoma in four, adenosquamous carcinoma in five, and large cell carcinoma in one. In every case sarcomatous areas were distinctly observed and, in general, neoplastic spindle cells proliferated in close proximity to the epithelial elements. Some of the histochemical procedures suggested mesenchymal features in the stroma of the exophytic portions of three cases, but heterogeneous elements, such as bone or striated muscle, were not observed. By immunohistochemical examination the epithelial elements showed positive reactions for keratin, epithelial membrane antigen, and/or carcinoembryonic antigen to a varying degree according to the histologic types. The spindle cell elements revealed a positive immunoreaction for keratin in all but one case. Epithelial membrane antigen was demonstrated in sarcomatous areas of only five cases and carcinoembryonic antigen was not expressed at all. In contrast, vimentin was distinctly demonstrated in sarcomatous areas of five cases, although other mesenchymal markers, such as desmin, actin, and myosin, were negative. These findings indicate that the spindle cell components in these 16 cases may represent mesenchymal features with partial or complete loss of epithelial features.

CPT-11 in combination with cisplatin for advanced non-small-cell lung cancer

PURPOSE

The purpose of this study was to determine the maximum-tolerated dose and the dose-limiting toxicities of CPT-11, a new derivative of camptothecin, in combination with a fixed dose of cisplatin in patients with non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Twenty-seven previously untreated patients with stage IIIB or IV NSCLC were assessable for toxicity, and 26 were assessable for response. The initial dose of CPT-11 was 30 mg/m2 given as a 90-minute intravenous (IV) infusion on days 1, 8, and 15 in combination with cisplatin (80 mg/m2 IV on day 1) given every 4 weeks. The dose of CPT-11 was escalated in increments of 10 mg/m2 until severe or life-threatening toxic effects were observed.

RESULTS

Significant toxicity was infrequent up to 60 mg/m2 of CPT-11. The maximum-tolerated toxicity was reached at a dose of 70 mg/m2. Three of six patients either had leukocyte count nadirs of less than 2,000/microL or experienced grade 4 diarrhea during the first cycle of therapy at 70 mg/m2. The major toxic effects were leukopenia and diarrhea. There were 14 partial responses (54%) among the 26 patients.

CONCLUSIONS

A combination of CPT-11 and cisplatin seems to be effective against NSCLC with acceptable toxicities. The recommended dose for phase II studies is 60 mg/m2 of CPT-11 on days 1, 8, and 15, and 80 mg/m2 of cisplatin on day 1 every 4 weeks.

[Prostate cancer after subcapsular prostatectomy diagnosed as benign prostate hypertrophy--clinico-pathological analysis]

Of 160 newly diagnosed cases of prostate cancer during last 11 years, six (3.75%) had a prior subcapsular prostatectomy. Digital rectal examination in these six cases revealed a significant prostatic abnormality and multiple bone metastases were showed. Histological examination by step-section technique was done retrospectively using surgical materials from subcapsular prostatectomy. Two cases of incidental carcinoma were detected histologically. One showed stage A1 and another stage A2. Continuous observation should be performed after prostatectomy, even if the surgical specimens revealed no carcinoma.

[Effects of open-heart surgery on renal function in patients with chronic renal failure--is hemodialysis during cardiopulmonary bypass really required?]

In 300 consecutive adult patients who underwent open-heart surgery in our department, 16 patients (ischemic heart disease in 8 patients, valvular heart disease in 7 and congenital heart disease in 1) were preoperatively complicated with chronic renal failure (CRF); creatinine clearance (Ccr) < 40 ml/min and serum creatinine (Scr) > 1.6 mg/dl. The effects of open-heart surgery on renal function were studied in these CRF patients who were divided into the following 3 groups according to their preoperative Ccr values: Group 1 (6 patients), 30 < Ccr < 40 ml/min; Group 2 (5 patients), 20 < Ccr < 30 ml/min; and Group 3 (5 patients, 4 of whom were on dialysis preoperatively), Ccr < 10 ml/min. In addition, Group C (38 patients, Ccr > 50 ml/min) was set up as normal controls. Instead of hemodialysis, the extracorporeal ultrafiltration method (ECUM) was employed for all patients during the cardiopulmonary bypass (CPB). The Ccr in Group 1 showed the lowest value of 24.2 +/- 12.0 ml/min on postoperative day (POD) 0 which then recovered to the preoperative level on POD 1. This quick recovery of the Ccr in Group 1 was similar to that in Group C. In contrast, the Ccr in Group 2 showed the lowest value of 13.0 +/- 6.0 ml/min on POD 1, followed by a delayed recovery that did not reach the preoperative level until POD 5. The Ccr in Group 3 was quite low (< 5 ml/min) throughout the test period.(ABSTRACT TRUNCATED AT 250 WORDS)

Partial seizures in two cases of metachromatic leukodystrophy: electrophysiologic and neuroradiologic findings

This report concerns two cases of metachromatic leukodystrophy presenting partial seizures. One was a 2-year-old boy with a late infantile type and the other a 17-year-old girl with a juvenile type. The former had tonic-clonic seizures on the left with concomitant twitching of the left side of the face and adversive conjugate deviation of the eyes. After a while, his interictal sleep electroencephalogram (EEG) showed spikes in the right central area. The second case had hemiconvulsions on the right side, consisting mainly of tonic flexion of the upper limb followed by clonic flexions, and accompanied by adversive conjugate deviation of the head and eyes. Her ictal EEG showed rhythmic 6- to 7-Hz wave bursts in the left frontal area. To this date, no report has given a detailed discussion of the type of seizures and ictal EEG in metachromatic leukodystrophy. In addition, there have been few detailed reports of magnetic resonance imaging (MRI) in the juvenile type. It is interesting that typical partial seizures were observed in a hereditary metabolic disorder characterized by diffuse demyelination of the white matter, and the pathophysiology is discussed here mainly in relation to MRI findings of the case with the juvenile type.

Cocaine augments proliferation of human peripheral blood T-lymphocytes activated with anti-CD3 antibody

Previously we observed that cocaine can suppress the phytohemagglutinin-induced proliferation of cultured, purified human T-lymphocytes. However, because the receptor activation pathways stimulated by this mitogen are not fully understood, we decided in the present study to examine the effects of cocaine on T-lymphocyte cultures stimulated with the anti-CD3 antibody which is known to stimulate these cells through the T-cell receptor complex. The results show that cocaine augments T-lymphocyte proliferation to anti-CD3 stimulation at drug concentrations observed in the blood of cocaine abusers. This augmentation was dose dependent reaching a plateau at a concentration above 0.75 microM. The amount of interleukin-2 (IL-2), as measured by ELISA, in the supernatants of T-cell cultures and the level of cytosolic free-calcium (Ca2+) mobilization in the T-cells were also increased at approximately the same concentrations that increased proliferation. Cocaine treatment alone had no effects on proliferation, IL-2 production, or Ca2+ mobilization. These results suggest that cocaine augments proliferation of human T-lymphocytes when the cells are activated through the T-cell receptor complex by increasing cytosolic Ca2+ mobilization and subsequent IL-2 production.