Numerical chromosome aberrations in hepatocellular carcinoma detected by fluorescence in situ hybridization

AIMS/METHODS

Numerical aberrations of chromosomes 7,8,9,10,12,17,18, X and Y were examined in 38 hepatocellular carcinoma specimens using centromere-specific DNA probes by the fluorescence in situ hybridization method.

RESULTS

Numerical aberrations in more than one of the chromosomes examined were found in 27 of 38 (71%) specimens; 6 of 15 (40%) well-differentiated hepatocellular carcinomas; 15 of 17 (88%) moderately differentiated hepatocellular carcinomas; and all of 6 (100%) poorly differentiated hepatocellular carcinomas. Of 6 early hepatocellular carcinomas, numerical chromosome aberrations were detected in 2. The incidence of numerical chromosome aberrations was 93.8% in patients with portal vein thromboses and/or intrahepatic metastases, 52.4% without portal vein thromboses and/or intrahepatic metastases (p < 0.05), while 89.5% of patients with a tumor more than 3 cm in diameter and 50.0% with a tumor less than 3 cm in diameter had chromosome aberrations (p < 0.05).

CONCLUSIONS

These results suggest that numerical chromosome aberrations start to occur in the early stage of hepatocellular carcinoma and to accumulate during tumor progression.

Use of a rapid HPLC assay for determination of pharmacokinetic parameters of ibuprofen in patients with cystic fibrosis

High doses of ibuprofen have been shown to delay the progression of lung disease without serious adverse effects in patients with cystic fibrosis. To be effective, peak ibuprofen concentration of 50 to 100 mg/L has to be achieved. We developed an HPLC assay to rapidly determine plasma ibuprofen concentration. We used this assay to determine the pharmacokinetics of ibuprofen in patients with cystic fibrosis. The assay possessed linearity up to 500 mg/L, sensitivity to 1 mg/L, average recovery of 98%, and run-to-run precision (n = 23) of 3%. Furthermore, the assay proved to be free of interference from 51 medications. Observed time to peak concentration varied significantly between those receiving ibuprofen tablets (mean + SD, 94 +/- 29 min, n = 16) and syrup (30 +/- 0 min, n = 4) (P &lt; 0.0001). We conclude that the method described here is ideal for therapeutic monitoring of ibuprofen.

Aggressive non-Hodgkin's lymphoma with massive involvement of the right ventricle

A 69-year-old women with malignant lymphoma (diffuse large:Working formulation) had associated with intracavital involvement of the right ventricle. The patient was referred to us for further examination with a diagnosis of heart failure. A tumor mass was detected by magnetic resonance imaging in the right ventricular outflow tract. While in the hospital the patient experienced cardiogenic shock due to neoplastic pulmonary embolism. The tumor was surgically resected and the patient was then treated with systemic chemotherapy. She went into complete remission and has continued in this state for six months. This case demonstrates that early diagnosis and intensive chemotherapy contribute to a good prognosis of patients with malignant lymphoma associated with massive involvement of a cardiac chamber. A review of the Japanese literature is presented.

Cancer cell morphology at the invasive front and expression of cell adhesion-related carbohydrate in the primary lesion of patients with colorectal carcinoma with liver metastasis

BACKGROUND

Liver metastasis from colorectal carcinoma is an important problem in surgical treatment and profoundly affects the prognosis of patients. If it were possible to identify characteristic features in the primary lesion strongly related to liver metastasis, these could be used as prognostic markers for liver metastasis. To search for such features, the primary lesions of patients with colorectal carcinoma with liver metastasis were investigated.

METHODS

Three groups of colorectal carcinoma were examined: Group A with synchronous liver metastases; Group B with only lymph node metastases without recurrence for 5 years; and Group C with recurrence of liver metastases. Groups A and B included 24 cases and Group C, 20. We focused on cancer cell morphology at the invasive front and expression of sialyl Lewis X (sialyl Lex) in the primary cancer.

RESULTS

At the invasive front in Group A it was frequently found that polygonal, not columnar, cancer cells with a single or solitary trabecular form with indistinct polarity, showed an infiltrative growth pattern. This type of morphology was termed "focal dedifferentiation" and graded four levels. Eleven of 24 cases (46%) had severe focal dedifferentiation in Group A, 1 of 24 (4%) in Group B, and 6 of 20 (30%) in Group C. Sialyl Lex staining was positive in 12 of 24 cases (50%) in Group A, in 3 of 24 cases (13%) in Group B, and in 7 of 20 cases (35%) in Group C in the primary carcinoma. In respect to the staining of (sialyl Lex) at focal dedifferentiation, it was positive in 17 of 24 cases (71%) in Group A, in 4 of 24 cases (17%) in Group B and in 11 of 20 cases (55%) in Group C. Focal dedifferentiation and sialyl Lex staining in the primary cancer showed a significant difference between Groups A and B. Sialyl Lex staining at focal dedifferentiation showed a significant difference between Groups A and B and Groups B and C. Other adhesion related molecules, sialyl LeA and CEA, showed no difference among Groups A, B, and C.

CONCLUSIONS

Both focal dedifferentiation and expression of sialyl Lex antigen in the primary lesion are considered good markers for assessing the metastatic proclivity of colorectal cancer.

Bone uptake of vanadium in mice: simultaneous tracing of V, Se, Sr, Y, Zr, Ru and Rh using a radioactive multitracer

The radioactive multitracer technique, which enables simultaneous tracing of a number of elements in a variety of bio-systems and an accurate comparison of their biobehavior, was employed in a study on uptake behavior of trace elements in various mice tissues, focusing on uptake of V by bone. We found that the bone uptake behavior of trace V closely resembles that of trace Sr and Y. It is suggested that V is a bone-seeking element which probably plays an important role in bone formation. The multitracer technique was thus shown to be useful for comparative studies of behavior of trace elements in living organisms.

Inactivation of p16INK4 in hepatocellular carcinoma

We analyzed the p16INK4 status of 6 hepatocellular carcinoma (HCC) cell lines and 32 primary HCC tumors, including 9 early-stage tumors, to determine whether p16INK4 tumor-suppressor gene inactivation participates in hepatocarcinogenesis. p16INK4 was studied at its protein level through Western blotting, at its messenger RNA (mRNA) level through reverse-transcriptase polymerase chain reaction analysis (RT-PCR) and Northern blotting, and at its genomic level through Southern blotting and PCR-single-strand conformation polymorphism analysis. The p16 protein was absent from 3 of 6 cell lines (50%) and 11 of 32 primary tumors (34%), but present in noncancerous tissues, indicating that p16INK4 is involved in hepatocarcinogenesis. Furthermore, we suggest that the p16 protein loss may contribute to the following: (1) early-stage hepatocarcinogenesis, because it was observed in 22% of early stage tumors; and (2) tumor progression, because it occurred approximately twice as often in advanced rather than in early stage tumors (40%). It was striking that neither p16INK4 homozygous deletion and mutation nor loss of p16INK4 mRNA expression were observed in HCC cell lines and primary tumors, including those specimens from which the p16 protein was absent except the Li7HM cell line, in which p16INK4 mRNA was not detected. These results suggest that p16INK4 in HCC is inactivated predominantly by posttranscriptional regulation rather than by genomic aberrations and lack of transcription.

Side effects of high-dose interferon therapy for chronic hepatitis C

BACKGROUND/AIMS

Various side effects have been reported in patients treated with alpha interferon, but their incidence and prognosis remain unknown.

METHODS

Nine hundred and eighty-seven patients with chronic active hepatitis C received 6 to 10 MU of alpha interferon per day for 2 weeks and 3 times per week for 22 weeks. Autoantibodies, thyroid function tests, and fasting plasma glucose concentrations were evaluated prior to alpha interferon therapy.

RESULTS

Of the 987 patients, 310 were required reduction in the dose of alpha interferon to 3 MU/day or cessation of alpha interferon therapy because of adverse reactions such as flu-like symptoms, leukopenia, and thrombocytopenia. Of the remaining 677, five developed diabetes mellitus, 12 had hyperthyroidism, and six acquired hypothyroidism. Of the 18 with thyroid disorders, five demonstrated antimicrosomal antibodies before therapy. Forty-four patients revealed high or low concentrations of thyroid stimulating hormone at the end of alpha interferon therapy. Three patients developed interstitial pneumonia, one acquired systemic lupus erythematosus-like syndrome, two had autoimmune hepatitis, two developed rheumatoid arthritis, and one developed autoimmune thrombocytopenic purpura. No patients had a history of an autoimmune disorder. One patient experienced sudden hearing impairment and one had retinal detachment. Melena was seen in three patients; two of these cases were compatible with ischemic colitis. Symptoms of depression were seen in 23 patients, and one patient manifested memory loss.

CONCLUSION

High-dose alpha interferon therapy induces various adverse effects. Most of the side effects cannot be predicted, but are reversible.

[A clinical study of chronic lower respiratory infection with Haemophilus influenza by transtracheal aspiration]

We have performed a clinical study on chronic lower respiratory tract infection (CLRTI) with Haemophilus influenzae (H. influenzae) by transtracheal aspiration (TTA) and analyzed clinical factors of the acute exacerbation. In 40 episodes (38 cases) of H. influenzae isolated from CLRTI, monobacterial infection with H. influenzae were 21 episodes and polymicrobial infection were 19 episodes. We classified the disease into acute exacerbated (27 episodes) and stable (13 episodes) phase and the former episodes were divided into bronchitis type (7 episodes) and pneumonia type (20 episodes). Polymicrobial infections were seen more in the pneumonia type (13 episodes) than in the bronchitis type (2 episodes). The principal organism detected with H. influenzae were alpha-Streptococcus and Neisseria sp. in the bronchitis type and S. pneumoniae in the pneumonia type. The acute exacerbated cases were divided into the following 4 patterns; 1. polymicrobial infection with continuous infection of P. aeruginosa, 2. monomicrobial infection after acute upper respiratory tract infection, 3. polymicrobial infection with S. pneumoniae after continuous infection of H. influenzae, 4. bacterial replacement by P. aeruginosa after acute exacerbation. The results of the study suggests that polymicrobial infection is an important chronic lower respiratory tract infection when caused H. influenzae.

Effect of heavy alcohol intake on long-term results after curative resection of hepatitis C virus-related hepatocellular carcinoma

We studied the effect of heavy alcohol intake (ethanol intake > or = 80 g/day for > or = 5 yr) on long-term results in 53 patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) who had undergone curative hepatic resection. Cell proliferative activity in the tumor and non-tumorous liver was also assessed by counting argyrophilic nucleolar organizer region-associated proteins (Ag-NOR) in the resected specimens. Twenty patients (20 males, 0 females) were positive for heavy alcohol intake [AI(+)] and 33 (28 males, 5 females) were not [AI(-)]. All patients were positive for HCV antibody and negative for hepatitis B surface antigen. Carcinoma recurred within 3 to 51 postoperative months in 42 (79.2%) of the 53 patients. The median disease-free survival time was 12.6 mo in the AI(+) group and 25.4 mo in the AI(-) group (P < 0.01). The AI(+) group also had significantly poorer survival than the AI(-) group (P < 0.05, 3-year survival rate: 66.7% vs. 93.5%). HCC tumor in the AI(+) group showed significantly increased proliferative activity compared with that in the AI(-) group (P < 0.05, Ag-NOR number: 2.3 +/- 0.8 vs. 1.9 +/- 0.4). However, there was no significant difference between the numbers of Ag-NORs in non-tumorous liver from these two groups (1.5 +/- 0.2 vs. 1.5 +/- 0.2). Patients with heavy alcohol intake should be followed particularly closely, even if they have received curative surgery, since heavy alcohol intake is closely related to a poor postoperative prognosis.

[A clinical features of acute respiratory infection with Haemophilus influenzae by transtracheal aspiration]

We performed a clinical study of 26 cases (27 episodes) of acute respiratory infection with H. influenzae by trans tracheal aspiration (TTA) from May 1987 to April 1995. 15 episodes (14 cases) were bronchitis and 12 episodes (12 cases) were pneumonia. 8 episodes were monomicrobial infection and 19 episodes were polymicrobial infection. Compared to the group of patients of monomicrobial infection, the number of elderly patients and the levels of WBC and CRP were higher in the group of patients of monomicroibal infection. In bronchitis cases, monomicrobial infections of H. influenzae were 7 episodes and polymicrobial infection containing H. influenzae were 8 episodes. In the latter group, PaO2 level was lower and CRP was higher on average. All patients recovered, but the period for treatment was longer in the latter group. In the pneumonia group, only one episode was monomicrobal infection and 11 episodes were polymicrobial infection. Inspite of treatment, one patient died. It was considered that polymicrobial infection was an important factor of acute respiratory infection with H. influenzae.

Treatment of rupture of a liver metastasis from esophageal leiomyosarcoma

We describe a case of rupture of a liver metastasis from esophageal leiomyosarcoma which was treated successfully by hepatic arterial embolization, thus facilitating hepatectomy. A 59-year-old woman who had previously undergone esophagectomy for leiomyosarcoma was admitted in a state of hypovolemic shock. Ultrasonography revealed multiple tumors in the left lobe of the liver and massive intraperitoneal hemorrhage, confirmed by paracentesis, possibly due to spontaneous rupture. Subsequent hepatic angiography showed extravasation from the tumor, and embolization of the feeding left hepatic artery was performed. After achieving hemostasis, a left hepatic lobectomy was carried out just beneath the reconstructed stomach tube. The patient made an uneventful recovery and remains well after one year. Emergency arterial embolization followed by hepatectomy is an appropriate treatment for patients with spontaneous rupture of liver metastases.

Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection

BACKGROUND

Percutaneous ethanol injection (PEI) therapy is now widely used for small hepatocellular carcinomas (HCC). However, only limited information is available regarding local tumor recurrence after PEI treatment.

METHODS

We investigated the relationship of pretreatment clinicopathologic variables (tumor size, tumor cell differentiation and tumor staining) to local recurrence in 170 PEI-treated HCC nodules (measuring 5-39 mm in greatest dimension) in 84 patients.

RESULTS

Local recurrence was observed in 17 of 170 PEI-treated nodules. Among these, 13 local recurrences were observed as the first event of progression after PEI. Local recurrence rates at 1, 2, and 4 years were 6.6%, 14.2%, and 14.2%, respectively, and all recurrences were observed within 2 years after PEI. Of the 3 variables investigated, large tumor size (31 mm or larger in greatest dimension) was significantly associated with a higher local recurrence rate.

CONCLUSIONS

This study demonstrated that tumor size influences the local efficacy of PEI for small HCC. Therefore, we recommend that a reasonable indication for PEI therapy is HCC lesions measuring less than 30 mm in greatest dimension.

Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection

BACKGROUND

Percutaneous ethanol injection (PEI) therapy is now widely used for small hepatocellular carcinomas (HCC). However, only limited information is available regarding local tumor recurrence after PEI treatment.

METHODS

We investigated the relationship of pretreatment clinicopathologic variables (tumor size, tumor cell differentiation and tumor staining) to local recurrence in 170 PEI-treated HCC nodules (measuring 5-39 mm in greatest dimension) in 84 patients.

RESULTS

Local recurrence was observed in 17 of 170 PEI-treated nodules. Among these, 13 local recurrences were observed as the first event of progression after PEI. Local recurrence rates at 1, 2, and 4 years were 6.6%, 14.2%, and 14.2%, respectively, and all recurrences were observed within 2 years after PEI. Of the 3 variables investigated, large tumor size (31 mm or larger in greatest dimension) was significantly associated with a higher local recurrence rate.

CONCLUSIONS

This study demonstrated that tumor size influences the local efficacy of PEI for small HCC. Therefore, we recommend that a reasonable indication for PEI therapy is HCC lesions measuring less than 30 mm in greatest dimension.

The prognosis of patients with hepatocellular carcinoma of multicentric origin

BACKGROUND/AIMS

The characteristics of patients with multicentric hepatocellular carcinoma (HCC) differ from those of patients with intrahepatic metastatic HCC. However, there are few reports regarding the long-term results in patients with HCC of multicentric occurrence. The purpose of this study was to clarify the prognosis of a group of patients with multicentric HCCs.

MATERIALS AND METHODS

We evaluated the outcome in 28 patients with multiple hepatocellular carcinoma (HCC) suggestive of multicentric occurrence, all of whom underwent hepatic resection. The disease-free survival, recurrence pattern and survival were analyzed in the two subgroups of 12 patients with single advanced HCC (AdHCC) nodule and an early HCC (eHCC) or early advanced HCC (eAdHCC) nodule [Group A] and 16 patients with two AdHCC lesions [Group B]. These data were also compared with those of 58 patients with solitary AdHCC [Group C].

RESULTS

Both the disease-free survival and survival periods for Groups A and C were significantly longer than those for Group B, while no significant difference was seen between Group A and C. No significant differences among the three groups were recognized in the incidence of various types of recurrence pattern.

CONCLUSIONS

The long-term results in patients with multicentric HCC apparently vary depending on the pathological condition at the time of operation. Among patients with multicentric HCC, those with AdHCC combined with an eHCC or eAdHCC are likely to show improved prognosis as a result of hepatic resection.

Cerebral adenosine triphosphate-sensitive K+ channels may be impaired during acute cerebral ischemia in spontaneously hypertensive rats

To elucidate the role of cerebral adenosine triphosphate (ATP)-sensitive K+ channels (KATP) on arterial pressure regulation during acute cerebral ischemia in spontaneously hypertensive rats (SHR), intracerebroventricular (i.c.v.) injections of either glibenclamide, a specific blocker of KATP, or pinacidil, a KATP opener, were performed in SHR and Wistar-Kyoto rats (WKY). Intracerebroventricular injections of glibenclamide elicited a vasopressor response in WKY with bilateral ligation of the carotid arteries, whereas the response was smaller in SHR. It increased plasma AVP, but decreased pituitary AVP in WKY with ligation, but not in SHR. Systemic administration of an AVP V1 receptor antagonist, OPC-21268, abolished the vasopressor responses to i.c.v. injections of glibenclamide in WKY. Bilateral ligation of the carotid arteries augmented the vasodepressor responses to i.c.v. injections of pinacidil in WKY, but not in SHR. Cerebral KATP may play a role in buffering a rise in arterial pressure by inhibiting the release of AVP from the pituitary glands during acute cerebral ischemia in WKY, but this mechanism might be deranged in SHR, probably due to impaired responsiveness of cerebral KATP to ischemia.

Aqueous flare in eyes with senile disciform macular degeneration: correlation with clinical stage and area of neovascular membrane

BACKGROUND

The aim of the present study was to investigate the aqueous flare in eyes with senile disciform macular degeneration (SDMD), divided into different clinical stages, and the correlation between the aqueous flare and the area of the neovascular membrane.

METHODS

Eighty-six eyes of 44 patients with SDMD were examined using a laser flare meter. The area of the neovascular membrane was measured by means of a digitizer in images obtained using indocyanine green videoangiography.

RESULTS

The mean value of the aqueous flare was 5.91 +/- 2.51 (photon count/ms) in 7 predisposing stage eyes, 5.68 +/- 1.64 in 15 initial stage eyes, 9.09 +/- 7.65 in 24 advanced form eyes, 5.40 +/- 1.42 in 11 disciform scar eyes, and 5.36 +/- 1.72 in 29 fellow eyes. The aqueous flare value was significantly (P < 0.01) higher in eyes with the advanced form of SDMD than in the fellow eyes. There were no significant differences in aqueous flare values between eyes with predisposing stage, initial stage, and disciform scar and fellow eyes. The aqueous flare value increased significantly with increasing area of neovascular membrane (R = 0.68, P < 0.01).

CONCLUSION

The present results suggest that the aqueous flare increases with increasing neovascular membrane area in eyes with SDMD, and decreases with scarization of the neovascular membrane.

Intrahepatic cholangiocarcinoma presenting intrabile duct tumor growth: report of a case

A case of intrahepatic cholangiocarcinoma with intrabile duct tumor growth is presented. A 70-year-old female with prolonged obstructive jaundice and cholangitis was diagnosed with a mass lesion in the left lobe of the liver accompanied by an intrabile duct component which caused hilar bile duct obstruction. Percutaneous transhepatic biliary drainage (PTBD) was performed via three routes with intensive care of the drainage catheters over a 2-month period to alleviate jaundice and cholangitis. Extended left hepatic lobectomy with combined resection of extrahepatic bile duct and regional lymph nodes were carried out curatively. Macroscopically, a tumor formed a 8 x 6 cm mass with a scalloped margin in the left lobe and had an intraductal component with a round smooth surface protruding from the lumen of the left hepatic duct into the common bile duct. The histologic type of the tumor was well differentiated tubular adenocarcinoma. The intraluminal tumor grew expansively without invasion to the bile duct wall. The postoperative course was uneventful and the patient has remained in good health without recurrence for 1 year and 3 months since surgery. This case report discusses a rare extension pattern in ICC and the management of malignant hilar obstruction during radical surgery.

A new method for theoretical analysis of static indentation test

A new mathematical method was developed to study the indentation problem of an infinite elastic layer overlaid on a rigid foundation. Rigid, flat-ended cylindrical or spherical indenters are pressed onto the upper surface of the elastic layer causing a small deformation mode. Shear stresses between the indenter and the layer are assumed negligible and the layer is assumed to be either bonded or unbonded to the rigid foundation. The problem is equivalent to a mixed boundary-value problem of the theory of elasticity. Instead of using the Fredholm integral equation reported in the literature, the new approach obtained closed-form solutions through an infinite series. Convergence can be achieved using less than 10 terms of the series.

[Two cases of gram-positive sepsis successfully treated with vancomycin in combination with imipenem or cilastatin]

Against gram-positive sepsis, vancomycin (VCM) was administered in combination with imipenem or cilastatin (IPM/CS). Its excellent efficacy was confirmed in 2 cases, one affected with methicillin resistant Staphylococcus aureus and another with Gemella morbillorum. By calculating the FIC index according to a checkerboard technique, the in vitro synergistic effect was also demonstrated. At the present state multi-drug resistant gram-positive infections prevailed, the combination of VCM with IPM/CS can be expected as an effective measure for treating these diseases.

Local recurrence of hepatocellular carcinoma after percutaneous ethanol injection

BACKGROUND

Percutaneous ethanol injection (PEI) therapy is now widely used for small hepatocellular carcinomas (HCC). However, only limited information is available regarding local tumor recurrence after PEI treatment.

METHODS

We investigated the relationship of pretreatment clinicopathologic variables (tumor size, tumor cell differentiation and tumor staining) to local recurrence in 170 PEI-treated HCC nodules (measuring 5-39 mm in greatest dimension) in 84 patients.

RESULTS

Local recurrence was observed in 17 of 170 PEI-treated nodules. Among these, 13 local recurrences were observed as the first event of progression after PEI. Local recurrence rates at 1, 2, and 4 years were 6.6%, 14.2%, and 14.2%, respectively, and all recurrences were observed within 2 years after PEI. Of the 3 variables investigated, large tumor size (31 mm or larger in greatest dimension) was significantly associated with a higher local recurrence rate.

CONCLUSIONS

This study demonstrated that tumor size influences the local efficacy of PEI for small HCC. Therefore, we recommend that a reasonable indication for PEI therapy is HCC lesions measuring less than 30 mm in greatest dimension.