Effects of SN-38 (an active metabolite of CPT-11) on responses of human and rodent cells to irradiation

PURPOSE

Modulators of the DNA-unwinding enzyme, topoisomerase I (Topo I), inhibit DNA repair and have been reported to increase the lethal effects of X rays, which create breaks in DNA. CPT-11 is a derivative of camptothecin, a Topo I inhibitor, and is clinically available. In this study, we tested the in vitro combination effects of SN-38, an active form of CPT-11, and irradiation on several cell lines.

MATERIALS AND METHODS

Exponentially growing or confluent cultures of CHO cells were treated with SN-38 for 30 min. Cells were then irradiated. Thereafter, the cells were further incubated with the drug for 0 to 3 h. Exponentially growing other cell lines were exposed to 200 nM SN-38 for 30 min before, during, and 3 h after irradiation. The cell survival rate was determined using a conventional clonogenic assay.

RESULTS

SN-38 (200 nM to 4 microM) alone showed slight toxicity to CHO cells in the confluent culture after a 3.5-h incubation. When the cells were treated with the lower doses of SN-38 (50 to 800 nM) during the exponentially growing phase, the cell survival rates were much lower. In combination with irradiation, SN-38 showed only additive effects to irradiation when cells were treated in confluent cultures. However, higher combination effects of SN-38 and irradiation were observed in the cells treated in the exponentially growing phase. When cells were irradiated during the exponentially growing phase, a significant combination effect of 200 nM SN-38 and irradiation was also observed in some cell lines, but not in others.

CONCLUSION

SN-38 and irradiation showed supraadditive effects in some cell lines, when treated in the exponentially growing phase, but not in other cell lines or when cells were treated in the confluent phase.

Human ubiquitin-protein ligase Nedd4: expression, subcellular localization and selective interaction with ubiquitin-conjugating enzymes

BACKGROUND

Nedd4 is a ubiquitin-protein ligase containing a calcium/lipid-binding domain, multiple WW domains and a C-terminal Hect domain, which is required for both the ubiquitin transfer and the association with E2 ubiquitin-conjugating enzymes. Nedd4 has been reported to be involved in the selective ubiquitination of some regulatory proteins in transcription and membrane transport.

RESULTS

Three mRNA species for human Nedd4 were found to be 6.4-, 7.8- and 9.5-kb in size, and their expression patterns varied among normal tissues and cancer cell lines, indicating the tissue- and cell-specificities of Nedd4 expression. The Nedd4 protein, approximately 120 kDa in weight, was found in the cytoplasm, mainly in the perinuclear region and cytoplasmic periphery, of human cultured cells. Neural differentiation induced not only the down-regulation of Nedd4 but also the localization of the protein to both the cytoplasm and neurites. To identify the ubiquitination pathway that is linked to Nedd4, we demonstrated that specific E2 enzymes, including human Ubc4, UbcH5B, UbcH5C, UbcH6 and UbcH7, could transfer ubiquitin molecules to Nedd4 at the active cysteine residue, whereas E6AP accepted ubiquitins from Ubc4, UbcH5B, UbcH5C and UbcH7. Furthermore, nuclear localization of N-terminal deletion mutant Nedd4 enabled us to investigate the interaction between Nedd4 and E2 enzyme (Ubc4 or UbcH7) in the cell. The simultaneous expression of the full-length Nedd4 and E2 enzyme revealed the both proteins mostly colocalized in the cytoplasmic periphery, while the N-terminal deleted Nedd4 induced the nuclear and perinuclear colocalization with E2 enzyme.

CONCLUSION

Our findings suggested that Nedd4 plays an important role in the cell regulation, including neural differentiation through cooperation with specific E2 ubiquitination pathways.

Genetic analysis of Histoplasma capsulatum strains isolated from clinical specimens in thailand by a PCR-based random amplified polymorphic DNA method

Thirteen strains of Histoplasma capsulatum were isolated from clinical specimens, including those from AIDS patients, in Thailand. Random amplified polymorphic DNA (RAPD) analysis with three different PCR primers showed that the DNA fingerprint patterns of the Thai isolates were very similar to each other and homogeneous, with only one exceptional strain, although the patterns were clearly different from those of a reference North American strain with all primers tested. Although the difference in the DNA fingerprinting patterns was minor, Thai isolates could be classified into two to four groups. A common PCR band (about 700 bp) in the patterns of all H. capsulatum strains was extracted, and its DNA sequence was determined. A new PCR primer set for the identification of H. capsulatum species was developed based on this sequence information. This primer set was 100% successful in the identification of the reference strain as well as all Thai isolates. The results of specificity tests of the primer set for the identification of the fungus are also discussed.

Relationship between body mass index and transvaginal ultrasonographic endometrial thickness in postmenopausal women

OBJECTIVE

To investigate the relationship between body mass index (BMI) and transvaginal ultrasonographic endometrial thickness.

MATERIALS AND METHODS

Two hundred and twelve postmenopausal Japanese women (mean age, 62.1+/-8.0 years; range 47-85) with histologically proven normal endometrium and with endometrial thickness more than 1.0 mm were studied. Baseline characteristics including age, years since menopause, and BMI were recorded for each subject. The relationship between sonographic endometrial thickness and baseline characteristics was assessed in each subject.

RESULTS

BMI was significantly correlated with endometrial thickness (r=0.40, p<0.001), but age and years since menopause were not correlated. On stepwise regression analysis only BMI was still associated with endometrial thickness (R2=0.16, p<0.001).

CONCLUSION

Sonographic endometrial thickness differs with BMI in postmenopausal women. Higher BMI is associated with greater endometrial thickness.

Menstrual disorders in patients undergoing chronic hemodialysis

OBJECTIVE

To investigate the etiology of menstrual disorders in patients undergoing chronic hemodialysis (CHD).

METHODS

The menstrual histories, along with hormonal, biochemical, and hematological data, were investigated in 25 reproductive-aged CHD patients.

RESULTS

All subjects had had regular menstrual cycles before entering CHD therapy. Of the 20 women who developed amenorrhea after beginning CHD therapy, 8 showed a return to their regular cycles and 6 improved to oligomenorrhea, 3 months to 66 months later, while 6 remained amenorrheic. The serum prolactin (PRL) levels were significantly higher in the patients (n = 9) with normogonadotropic amenorrhea or oligomenorrhea than in patients (n = 13) with regular cycles (53.6 +/- 36.2 vs 27.8 + 15.2 ng/ml, p < 0.05). The serum LH levels were high in both groups. In a cross-sectional study, the serum PRL levels gradually decreased with longer duration of dialysis.

CONCLUSIONS

Patients undergoing CHD are likely to develop menstrual disorders. Hyperprolactinemia in part contributes to these menstrual disorders. However, menstrual disorders in CHD patients tend to improve during long-term follow-up, because of the gradual decrease in serum PRL levels during long-term CHD therapy.

Activation of p38 MAP kinase and JNK but not ERK is required for erythropoietin-induced erythroid differentiation

p38 MAP kinase (p38) and JNK have been described as playing a critical role in the response to a variety of environmental stresses and proinflammatory cytokines. It was recently reported that hematopoietic cytokines activate not only classical MAP kinases (ERK), but also p38 and JNK. However, the physiological function of these kinases in hematopoiesis remains obscure. We found that all MAP kinases examined, ERK1, ERK2, p38, JNK1, and JNK2, were rapidly and transiently activated by erythropoietin (Epo) stimulation in SKT6 cells, which can be induced to differentiate into hemoglobinized cells in response to Epo. Furthermore, p38-specific inhibitor SB203580 but not MEK-specific inhibitor PD98059 significantly suppressed Epo-induced differentiation and antisense oligonucleotides of p38, JNK1, and JNK2, but neither ERK1 nor ERK2 clearly inhibited Epo-induced hemoglobinization. However, in Epo-dependent FD-EPO cells, inhibition of either ERKs, p38, or JNKs suppressed cell growth. Furthermore, forced expression of a gain-of-function MKK6 mutant, which specifically activated p38, induced hemoglobinization of SKT6 cells without Epo. These results indicate that activation of p38 and JNKs but not of ERKs is required for Epo-induced erythroid differentiation of SKT6 cells, whereas all of these kinases are involved in Epo-induced mitogenesis of FD-EPO cells.

Increased heating efficiency of hyperthermia using an ultrasound contrast agent: a phantom study

It is known that there are large temperature elevations in proximity to air bubbles during US (ultrasound) heating. The existence of tiny air bubbles in the target tissue may enhance the temperature elevation in US hyperthermia. To examine this hypothesis, phantom tissue experiments using an US contrast agent consisting of tiny air bubbles surrounded by a 5% (w/v) human albumin shell (Alb) were performed. As a phantom tissue, a 2 cm cube of beef was used. The phantom tissue was heated with or without the US contrast agent by an US hyperthermia device for 3 min. The heating device was operated at 1.5 MHz with the US intensity of 0.9 W/cm2. Physiological saline solution, iodized oil, and ethanol were used for control experiments. The effect of multiple needle punctures to the beef phantom was also examined. The temperature elevation rate (TER) was defined as the ratio of temperature elevation by heating with Alb or control materials to the temperature elevation by US heating alone. The TER of Alb was 1.7, whereas the TERs of the control materials and of the multiple needle punctures were approximately 1. The administration of Alb significantly increased the temperature in US hyperthermia. In addition, the heating efficiency of Alb was compared to the effect of an increase in the US intensity. Phantom tissue was heated at various US intensities. When the US intensity was increased from 0.9 to 1.8 W/cm2, the temperature elevated by approximately 1.7-fold. Thus, the effect of the administration of Alb was almost equivalent to the effect of increase in US power intensities from 0.9 to 1.8 W/cm2 in the present experimental settings. The results suggest that the US contrast agent can be a potential enhancer in US hyperthermia.

Tumor response to neoadjuvant chemotherapy correlates with the expression of P-glycoprotein and PCNA but not GST-pi in the tumor cells of cervical carcinoma

OBJECTIVE

To identify the clinicopathological and chemoresistant factors predicting the response to neoadjuvant chemotherapy and the patient prognosis in high-risk cervical carcinomas.

METHODS

We retrospectively reviewed 47 patients with locally advanced or bulky cervical carcinoma treated with two courses of intraarterial infusion of cisplatin, doxorubicin, mitomycin C, and 5-fluorouracil (5-FU), followed by radical hysterectomy at our hospital between 1988 and 1995. Expressions of the chemoresistance-related proteins, such as P-glycoprotein, glutathione S-transferase pi (GST-pi), and proliferating cell nuclear antigen (PCNA) in the tumor cells, were examined by immunohistochemistry using pretreatment biopsy specimens. These results were compared with the chemotherapeutic response, which was evaluated by magnetic resonance imaging (MRI) and histopathology. Outcome of the patients was also studied.

RESULTS

Chemotherapeutic effect of either complete (CR) or partial (PR) response on MRI was obtained in 36 of the 47 (86%) patients. Poor response to chemotherapy was significantly correlated with P-glycoprotein expression (P < 0.005) and low PCNA labeling (P < 0. 05), but not GST-pi expression in the tumor cells. Independent prognostic factors for patient survival were parametrial involvement and lymph node metastasis. Neither the expression of GST-pi nor PCNA was correlated with the patient survival.

CONCLUSION

Assessment of the expression of P-glycoprotein and PCNA is potentially useful for the prediction of tumor response to neoadjuvant chemotherapy for cervical carcinomas.

D-serine content and D-[3H]serine binding in the brain regions of the senescence-accelerated mouse

An established senescence-accelerated model mouse strain, SAMP8, shows the deterioration of learning and memory compared with a normal control strain, SAMR1. D-Serine binds to strychnine-insensitive glycine binding sites of the N-methyl-D-aspartate (NMDA) receptor complex, and enhances glutamate binding to the receptor complex. To investigate the relationship of endogenous brain D-serine and the brain dysfunction caused by aging, the level of brain free D-serine and the D-[3H]serine binding to the brain samples were examined using the SAMP8 and SAMR1 mice. The free D-serine level was highest in the cerebral frontal and occipital cortices in both the SAMP8 and SAMR1; no difference in the D-serine level was shown between the two strains. A receptor autoradiographical analysis showed that the D-[3H]serine binding to the brain section was highest in the hippocampus, and the binding in the SAMP8 brains was lower than that of the SAMR1. The D-[3H]serine binding to the crude cerebral membranes indicated that the value of the total binding sites for the SAMP8 was lower than that for the SAMR1, whereas the value of the dissociation constant Kd for the SAMP8 was similar to that of the SAMR1. These results suggest that the number of D-[3H]serine binding sites was decreased in the SAMP8 compared to the SAMR1, but the affinity of D-[3H]serine to the binding sites was not altered. These results support the view that a decrease of NMDA receptor complex is involved in the age-related neural dysfunction of SAMP8 mice.

A novel hydrophobized polysaccharide/oncoprotein complex vaccine induces in vitro and in vivo cellular and humoral immune responses against HER2-expressing murine sarcomas

To elicit specific cellular immune responses against cancer, the development of efficient devices to deliver tumor antigen peptides to the MHC class I pathway constitutes a central issue. We report here a novel formula of hydrophobized polysaccharide nanoparticles, which can deliver a HER2 oncoprotein containing an epitope peptide to the MHC class I pathway. A protein consisting of the 147 amino-terminal amino acids of oncogene erbB-2/neu/HER2 (HER2) was complexed with two kinds of hydrophobized polysaccharides, cholesteryl group-bearing mannan (CHM) and cholesteryl group-bearing pullulan (CHP), to form nanoparticles (CHM-HER2 and CHP-HER2). CHM-HER2 and CHP-HER2 were able to induce CD3+/CD8+ CTLs against HER2-transfected syngeneic fibrosarcoma cell lines. In contrast, the oncoprotein alone failed to do so. These CTLs were Kd-restricted and specifically recognized a peptide (position 63-71) that was a part of a truncated HER2 protein used as an immunogen. In addition, vaccination by CHM-HER2 complexes led to a strongly enhanced production of IgG antibodies against HER2, whereas vaccination with HER2 proteins alone resulted in a production of antibodies at a marginal level. Mice immunized with CHM-HER2 or CHP-HER2 before tumor challenge successfully rejected HER2-transfected tumors. The complete rejection of tumors also occurred when CHM-HER2 was applied not later than 3 days after tumor implantation. In the effector phase of in vivo tumor rejection, CD8+ T cells played a major role. The results suggest that a sort of hydrophobized polysaccharide may help soluble proteins to induce cellular immunity as well enhance humoral immunity; hence, such a novel vaccine may be of potential benefit to cancer prevention and cancer therapy.

Peri-ovarian adhesions interfere with the diffusion of gonadotrophin into the follicular fluid

In previous studies, patients with severe peri-ovarian adhesions have been found to show low pregnancy rates and a poor response to gonadotrophin stimulation during in-vitro fertilization (IVF) treatment. The purpose of this retrospective pharmacokinetic study was to assess the diffusion of exogenous human chorionic gonadotrophin (HCG) in patients with peri-ovarian adhesions by examining the concentration of exogenous HCG in the follicular fluid in patients undergoing down-regulation and IVF due to infertility. The patients underwent laparoscopic examination for the scoring of peri-ovarian adhesions (using the classification of adnexal adhesions adopted by the American Fertility Society, a score of 0 means no adhesions, and a score of 32 represents bilateral expanded dense adhesions). Oocytes were recovered after human menopausal gonadotrophin-human chorionic gonadotrophin (HMG-HCG) stimulation with gonadotrophin-releasing hormone agonist. Serum and follicular fluid were collected at the time of oocyte recovery for measuring the HCG ratio (the follicular HCG concentration to the serum HCG concentration; a reflection of the diffusion of exogenous gonadotrophin) by time-resolved fluoroimmunoassay. A negative correlation was found between the number of oocytes recovered and the peri-ovarian adhesion score (r = -0.62, P < 0.01). In a given patient, the follicular HCG concentration was always lower than the serum HCG at the time of oocyte recovery. The HCG ratio in all samples was 0.9 or less (0.51 +/- 0.20; range, 0.09-0.90). Significant negative correlations were found between the peri-ovarian adhesion score and both the follicular HCG concentration (r = -0.80, P < 0.01) and the HCG ratio (r = -0.75, P < 0.01). In conclusion, severe peri-ovarian adhesions interfered with the diffusion of exogenous gonadotrophin into the follicular fluid during IVF treatment. Thus, the diffusion of exogenous gonadotrophin into the follicular fluid may represent a new parameter in the assessment of ovarian blood flow and IVF outcome.

[Treatment of cytomegalovirus retinitis in AIDS with an intraocular sustained-release ganciclovir implant]

Active cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) was treated with an intraocular sustained-release ganciclovir implant. A total number of 19 implants were performed in 15 eyes of 9 AIDS patients. The intraocular sustained-release ganciclovir was effective in preventing reactivation of CMV retinitis in 15 of the 19 implants, ineffective in 3, and undetermined in 1. All ineffective cases had been resistant to ganciclovir therapy before the implants. Vision after the therapy was maintained at better than 0.5 except for one eye. There were no serious ocular complications caused by the therapy. Among 5 patients with unilateral CMV retinitis, 2 unaffected eyes developed CMV retinitis during this therapy. In addition, another patient developed presumed CMV infection in other systemic organs. Based on these data, the intraocular sustained-release ganciclovir implant was considered to be useful for the treatment of CMV retinitis in AIDS.

Radiotherapy combined with transcatheter arterial infusion chemotherapy for locally advanced cervical cancer

Twenty-four patients with locally advanced cervical cancer were treated with radiation therapy (RT) and transcatheter arterial infusion (TAI) chemotherapy, while 22 patients were treated with RT alone. RT consisted of a combination of external irradiation and high-dose-rate intracavitary brachytherapy. TAI therapy consisted of two sessions using cisplatin and pirarubicin, performed concurrently during the periods of external irradiation. The local-regional control rates at 1 year for the patients treated with RT plus TAI and for those treated with RT alone were 87.5% and 58.3%, respectively (p < 0.05). The 3-year cause-specific survival (CSS) rates for RT plus TAI, and RT alone were 67.1% and 55.9%, respectively (p = n.s.). The 3-year CSS rate for the 14 patients treated with RT and TAI who had well- or moderately differentiated squamous cell carcinoma without pelvic lymph node swelling was 100%, while that for the 19 patients with the same background treated with RT alone was 49% (p < 0.01). Radiation therapy combined with TAI appears to be an effective and safe treatment modality for patients with locally advanced cervical cancer.

The effect of menopause on regional and total body lean mass

OBJECTIVES

To investigate the effect of menopause on regional and total body lean mass.

METHODS

Evaluation of 123 healthy premenopausal women (40.6 +/- 10.8 years) and 123 healthy postmenopausal women (61.8 +/- 7.5 years). All subjects were right side dominant. Regional (head, bilateral arms, trunk, and bilateral legs) and total body lean mass were measured using whole-body scanning by dual-energy X-ray absorptiometry. Baseline characteristics including age, height, weight, and menopausal state were recorded. These variables were compared between pre- and postmenopausal women. In all subjects, correlations between regional or total body lean mass and baseline characteristics were investigated using univariate and multiple regression analyses.

RESULTS

Height, and lean mass of the trunk, bilateral legs and total body were significantly lower in postmenopausal women than in premenopausal women, while lean mass of the bilateral arms did not differ between the two groups. On univariate regression analysis, bilateral arms lean mass was positively correlated with height (P < 0.001). Trunk, bilateral legs, and total body lean mass were inversely correlated with age and menopausal state (P < 0.001), but were positively correlated with height (P < 0.001). After adjusting for age and height, trunk lean mass was still correlated with menopausal state (P < 0.01).

CONCLUSIONS

Menopause induces lean mass loss, independent of aging and height. Trunk lean mass is more prone to decline with menopause than lean mass of other sites.

Transglutaminase activity in serum and cerebrospinal fluid in sporadic amyotrophic lateral sclerosis: a possible use as an indicator of extent of the motor neuron loss

The activity of transglutaminase (TGase), a marker enzyme for tissue degeneration, was examined in serum and cerebrospinal fluid (CSF) obtained from patients with sporadic amyotrophic lateral sclerosis (SALS), and compared to those from patients without SALS. When the serum TGase activity values from SALS patients were compared against the 'ALS-scale', which is used for clinical evaluation of the progression of ALS, the TGase activity values were higher at the initial stage of the disease than in non-ALS subjects, whereas they became extremely low at the late stage of ALS. The TGase activity in the CSF taken at later than middle stage from ALS patients with definite clinical motor dysfunctions was significantly lower than in that from non-ALS subjects. We have previously demonstrated marked reduction of tissue TGase activity in all regions of spinal cord tissue transections from ALS patients, not only in ventral but also lateral and dorsal regions, relative to that in non-ALS patients. These results suggest that some TGase may be leaked out of the spinal cord tissue into the CSF and then into the blood-stream during the progression of ALS, and the enzymic activity finally becomes depleted at the terminal stages of the disease when most of the spinal motor neuronal perikarya have been destroyed.

Ultrashort-time FISH for identification of the sex of peripheral-blood lymphocytes and preimplantation embryos

OBJECTIVE

The aim of this study was to shorten the time required for sex determination using peripheral-blood lymphocytes and blastomeres of human preimplantation embryos by fluorescence in situ hybridization (FISH).

METHODS

Peripheral-blood lymphocytes from a male and a female, and 8 blastomeres from 2 preimplantation embryos were analyzed by FISH. The probes used were DYZI and DXZI. The hybridization time was shortened from overnight to 30 minutes or 5 minutes, and the accuracy of FISH was compared between 5-minute, 30-minute and overnight hybridization.

RESULTS

The accuracy of the identification of the sex of lymphocytes by 5-minute hybridization FISH was more than 90%, and was the same as that achieved by 30-minute- and overnight hybridization FISH. In 5-minute hybridization FISH, the entire process was only 63 minutes. Of the 8 blastomeres, it was possible to identify the sex of 5 and was impossible to determine the sex of 1, with 2 being lost during the procedure.

CONCLUSIONS

We have established on ultrashort-time FISH method for sex determination that takes only 63 minutes.

Tec is involved in G protein-coupled receptor- and integrin-mediated signalings in human blood platelets

Tec is a non-receptor type tyrosine kinase which is tyrosine phosphorylated and activated upon stimulation of hematopoietic cells with various cytokines. The role of Tec in G protein-coupled receptor- and integrin-mediated signalings has not been elucidated. We therefore investigated the regulation of Tec in human blood platelets. Tec was rapidly tyrosine phosphorylated in response to platelet agonists which activate G protein-coupled receptors such as thromboxane A2 analog (U46619), thrombin, and thrombin receptor activating peptide (TRAP). TRAP-induced phosphorylation in Tec was significantly reduced under the conditions which abrogate fibrinogen binding to GP IIb-IIIa and subsequent platelet aggregation. However, TRAP induced significant levels of the phosphorylation even under these conditions and also in thrombasthenic platelets which lack functional GP IIb-IIIa molecules, suggesting that activation of G-protein-coupled receptor causes the phosphorylation. To clarify whether integrin engagement by itself causes the phosphorylation in Tec, we examined the state of the phosphorylation in platelets activated by integrin engagement. Platelet adhesion to immobilized fibrinogen or collagen induced significant levels of the phosphorylation. Furthermore, Tec was translocated to cytoskeleton in response to TRAP in a manner dependent on platelet aggregation, suggesting that Tec can be a component of integrin-mediated signalings. These results collectively indicate that Tec is involved in G protein-coupled receptor- and integrin-mediated signalings in human blood platelets.

Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results

PURPOSE

To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors.

METHODS

TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with metastatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20-40 mg of doxorubicin for primary and metastatic tumors and 50-100 mg of cisplatin only for primary tumors. In addition, 50-60 Gy of 10-MV radiotherapy with or without radiofrequency (RF)-capacitive hyperthermia in four sessions was administered before TAE for primary tumors only.

RESULTS

Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months.

CONCLUSION

TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors.

[Two cases of coronary artery aneurysm including one case of the left main coronary artery aneurysm]

We report two cases of coronary artery aneurysm including one case of the left main coronary artery aneurysm. The coronary angiogram of one patient, a 68-year-old male, having anterior chest pain on exertion, revealed left anterior descending coronary artery (segment 6) aneurysm of 7 mm in diameter with 90% stenosis distal to the aneurysm and 75% stenosis in the right coronary artery (segment 2). The coronary angiogram of another patient, a 69-year-old female, having chest pain unrelated to exertion, revealed left main coronary artery aneurysm of 25 mm in diameter and delayed filling of contrast medium into the left anterior descending coronary artery. We decided to operate by the reason of not only significant coronary artery stenosis but risks of myocardial infarction due to embolization into distal coronary arteries and rupture of the aneurysm. We performed coronary artery bypass graftings using the great saphenous veins and closure of the coronary arteries running into and out the aneurysm under cardiopulmonary bypass. It is recommended that ligation of the coronary arteries connecting to the aneurysm or resection of the aneurysm followed by coronary artery bypass grafting is performed before developing myocardial infarction or rupture of aneurysm.

Cholecystoduodenal fistula: a complication of inserted self-expandable metallic biliary stents

We encountered a case of hepatic hilar cholangiocarcinoma resulting in cholecystoduodenal fistula after insertion of self-expandable metallic biliary stents (EMBSs). To our knowledge, there has been no report of cholecystoduodenal fistula after insertion of EMBSs. This case suggests that immediate gallbladder decompression may be necessary if acute cholecystitis occurs after insertion of EMBSs.

Transcatheter arterial embolization for malignant osseous and soft-tissue sarcomas. I. A rabbit experimental model

PURPOSE

To evaluate the effect of transcatheter arterial embolization (TAE) on metastatic bone tumors in an experimental study.

METHODS

Fifteen Japanese white rabbits were transplanted with VX2 sarcoma cells into the iliac crest. In 10 rabbits, the arterial supply to the iliac bone tumors, internal iliac artery and iliolumbar artery were then embolized with particles of gelatin sponge. The therapeutic effect was evaluated by comparison with the natural course of control tumors in the other five rabbits.

RESULTS

After TAE, extensive necrosis, fibrosis, and vacuolization within the tumors were confirmed histologically. In the control rabbits, 19% +/- 7% of the entire tumor was found to be spontaneous tumor necrosis; in contrast, the tumors of the TAE group showed necrosis as 62% +/- 22% of the entire tumor. In one TAE group rabbit, no active tumor cell could be detected in the residual tumor.

CONCLUSION

TAE was found to be an effective treatment for bone tumors in an experimental model.

Limb salvage and survival rates among elderly patients with advanced limb ischemia

The purpose of this study was to clarify the incidence of limb salvage and patient survival rates among elderly patients with advanced leg ischemia. We reviewed the records of 159 patients treated for advanced ischemia over a 15-year period at Aichi Medical University, 74 of whom were aged over 75 years and 85, between 65 and 74 years. There was a collective total of 186 limbs; 82 in the older group and 104 in the younger group. The older group had a greater proportion of women, and a higher incidence of coronary heart disease, pulmonary dysfunction, and acute onset of advanced ischemia than the younger group. Limb salvage was achieved in 73% of the affected limbs in the older group and in 92% of the limbs in the younger group. The poor limb salvage rate in the older group was mainly related to the high initial amputation rate. Early recognition of the sentinel ischemic signs before the ischemia is essential, especially in the elderly. Timely revascularization should be attempted whenever possible, and it should not be abandoned simply because the patient is deemed too old. The 1-, 3-, and 5-year survival rates in the older group were 59%, 28%, and 23%, respectively, which were markedly poorer than the expected survival rates of the age- and sex-matched Japanese population at 1, 3, and 5 years, which were 93%, 79%, and 65%, respectively. Thus, advanced limb ischemia carries a poor prognosis to the point of being life-threatening, and further continuous systemic management with the collaboration of physicians and surgeons must be provided even after the patient has left the hospital.

Nonfunctional paraganglioma of the pancreas: report of a case

We report herein the case of a 61-year-old man found to have a rare nonfunctional paraganglioma of the pancreas. Interestingly, the preoperative data and images showed similar characteristics to neuroendocrine tumors of the pancreas. Both paragangliomas and neuroendocrine tumors of the pancreas belong to the category of Amine Precursor Uptake and Decarboxylation (APUD) tumors (APUDomas). Thus, it is important to examine the serum level of pancreatic endocrine hormones and a variety of peptides to differentiate paragangliomas of the pancreas from other pancreatic tumors. Paragangliomas of the pancreas grow slowly, so radical resection is recommended to achieve curability with a good prognosis.

cDNA cloning and predicted primary structure of scallop sarcoplasmic reticulum Ca(2+)-ATPase

Sarcoplasmic reticulum (SR) Ca(2+)-ATPase of the scallop cross-striated adductor muscle was purified with deoxycholate and digested with lysyl endopeptidase for sequencing of the digested fragments. Overlapping cDNA clones of the ATPase were isolated by screening the cDNA library with an RT-PCR product as a hybridization probe, which encodes the partial amino acid sequence of the ATPase. The predicted amino acid sequence of the ATPase contained all the partial sequences determined with the proteolytic fragments and consisted of the 993 residues with approximately 70% overall sequence similarity to those of the SR ATPases from rabbit fast-twitch and slow-twitch muscles. An outline of the structure of the scallop ATPase molecule is predicted to mainly consist of ten transmembrane and five 'stalk' domains with two large cytoplasmic regions as observed with the rabbit ATPase molecules. The sequence relationship between scallop and other sarco/endoplasmic reticulum-type Ca(2+)-ATPases is discussed.

A placebo-controlled, single-blind study to determine the appropriate alendronate dosage in postmenopausal Japanese patients with osteoporosis. The Alendronate Research Group

Alendronate (4-amino-1-hydroxybutylidene-1,1-bisphosphonate) is a potent inhibitor of bone resorption. The efficacy and safety of 36 weeks of treatment with alendronate were evaluated in Japanese women with osteoporosis, osteoporotic osteopenia or artificial menopause. The bone mineral density (BMD) of the lumbar vertebrae, markers of bone and calcium metabolism and clinical symptoms were monitored. A total of 113 randomly selected patients with osteoporosis or osteopenia were enrolled in the study, of whom 12 were excluded from the analyses because of lack of data. As a result, 101 patients were evaluated for the safety of the drug. Since eight patients were excluded from the efficacy analysis, 93 were evaluated. The incidence of adverse effects in the placebo (P), alendronate 2.5 mg/day (L) and alendronate 10 mg/day (H) groups increased with increasing dose of alendronate, being 6.1, 14.3 and 18.2%, respectively. The most common adverse effects were gastrointestinal symptoms, none of which was serious. Lumbar BMD increased after 36 weeks of drug administration to 5.21%, 5.64% and -0.90% in the L, H and P groups, respectively (P < 0.001, L vs. P and H vs. P). Serum alkaline phosphatase activity, serum osteocalcin and urinary deoxypyridinoline excretion were significantly decreased in a dose-related manner. Serum calcium and phosphorus were also significantly decreased after alendronate administration. Serum intact PTH was transiently increased. The present results indicate that alendronate effectively decreases bone turnover in a dose-related manner and increases lumbar BMD at a dosage of 2.5 mg/day, the lowest dose used in this study, in Japanese patients with osteoporosis.