Effect of rebamipide, a novel antiulcer agent, on Helicobacter pylori adhesion to gastric epithelial cells

Helicobacter pylori is a major etiological agent in gastroduodenal disorders. The adhesion of H. pylori to human gastric epithelial cells is the initial step of H. pylori infection. Inhibition of H. pylori adhesion is thus a therapeutic target in the prevention of H. pylori infection. Experiments were performed to evaluate the effect of rebamipide, a novel antiulcer agent, on H. pylori adhesion to gastric epithelial cells. MKN-28 and MKN-45 cells, derived from human gastric carcinomas, were used as target cells. Ten H. pylori strains isolated from patients with chronic gastritis and gastric ulcer were used in the study. We evaluated the effect of rebamipide on H. pylori adhesion to MKN-28 and MKN-45 cells quantitatively using our previously established enzyme-linked immunosorbent assay. The adhesion of H. pylori to MKN-28 and MKN-45 cells was significantly inhibited by pretreatment of these cells with 100 microg of rebamipide per ml. However, the adhesion was not affected by the pretreatment of H. pylori with rebamipide. On the other hand, the viabilities of H. pylori, MKN-28 cells, and MKN-45 cells were not affected by rebamipide. Our studies suggest that rebamipide inhibits the adhesion of H. pylori to gastric epithelial cells.

[Transient mitral regurgitation induced by vagal stimulation in rabbits: a Doppler echocardiographic study]

Cervical vagal stimulation in rabbits frequently causes systolic murmur with bigeminy due to premature ventricular contractions. The bigeminy disappears in a few minutes, but the systolic murmur persists for a few days. The present study used Doppler echocardiography to examine whether or not this systolic murmur is due to mitral regurgitation. Electrocardiographic monitoring was performed on anesthetized rabbits forced into the supine position. Doppler echocardiography was performed in the animals which showed systolic murmur 6 hours, 3 days, and 1, 2, 3 and 4 weeks after vagal stimulation. Six hours after vagal stimulation, phonocardiography detected systolic click and late systolic murmur, and Doppler echocardiography detected marked mitral regurgitation. The systolic murmur and mitral regurgitation were attenuated and the papillary muscle was swollen 3 days after vagal stimulation. The mitral regurgitation disappeared within a week and swelling of the papillary muscle improved 3 weeks after vagal stimulation. Doppler echocardiography confirmed that the systolic murmur observed in rabbits after vagal stimulation is due to transient mitral regurgitation.

Promoters of the phycocyanin gene clusters of the cyanobacterium Synechococcus sp. strain PCC 7942

The cyanobacterium Synechococcus sp. strain PCC 7942 has duplicated phycocyanin subunit gene clusters cpcB1A1 and cpcB2A2, which are identical to each other and to those of Synechococcus sp. strain PCC 6301 (Anacystis nidulans). Nucleotide sequences of the 428 and 286 bases of the 5' non-coding regions of the cpcB1A1 and cpcB2A2 clusters, respectively, of strain PCC 7942 were identical to those of strain PCC 6301. As in strain PCC 6301, cpcB1A1 yielded two major transcripts of 1.4 and 1.3 kb and cpcB2A2 yielded a single transcript of 1.3 kb in strain PCC 7942. Thus, the structure and expression of cpcBA gene clusters in the two strains are essentially the same. Using bacterial luciferase encoded by luxAB as a reporter, cpcB1A1 was shown to have two promoters corresponding to the two major transcripts. Luminescence from the Synechococcus reporter strains carrying the fusions of the cpcBA promoters to luxAB showed circadian oscillation. Similar to the promoter of psbA1 encoding the D1 protein of PSII, the two cpcB1A1 promoters and the cpcB2A2 promoter showed the peak of activity at the end of the subjective day and the trough at the end of the subjective night.

Experimental and clinical evaluation of cisplatin-containing microspheres as intraperitoneal chemotherapy for ovarian cancer

BACKGROUND

We aimed to evaluate the in vitro and in vivo effects of poly [L-lactic acid] microsphere containing cisplatin (CDDP-MS) for intraperitoneal (i.p.) chemotherapy for ovarian cancer.

METHODS

We initially examined the in vitro and in vivo profile of cisplatin release from the CDDP-MS, then this drug delivery system was evaluated in 15 patients.

RESULTS

The in vitro study showed that cisplatin was released constantly over a 3-week period. Rats in the CDDP-MS group had a significantly lower peak serum concentration of platinum compared with rats in the aqueous cisplatin solution (CDDP-S) group; the serum concentration of platinum showed a gradual decline. The ascitic fluid concentration of platinum also gradually decreased in the CDDP-MS group. We treated 15 patients with recurrent ovarian cancer with CDDP-MS containing 200 mg of cisplatin (n = 5) or CDDP-S containing 100 mg of cisplatin (n = 10) administered i.p. The peak serum and ascites concentrations of platinum were lower immediately after administration of CDDP-MS than after administration of CDDP-S, but increased over time in the CDDP-MS group, reflecting the slow-release effect of CDDP-MS. Grade 1 to 2 leukopenia and/or neutropenia occurred in 2 of 5 patients. No thrombocytopenia or renal or neurologic toxicity was observed;

CONCLUSION

These findings indicate that the i.p. administration of CDDP-MS increased the dose intensity of cisplatin and appeared to be safe and effective for the treatment of ovarian cancer.

Expression of vascular endothelial growth factor gene and its receptor (flt-1) gene in urinary bladder cancer

We investigated expression of the vascular endothelial growth factor (VEGF) gene and its receptor gene (flt-1) in 30 patients with transitional cell carcinoma (TCC) of the urinary bladder by Northern blot hybridization analysis. The VEGF transcript was observed in all of the tumors and the normal mucosae. Of the 20 tumors in which a comparative study was done, eight (40.0%) overexpressed the gene with a tumor versus normal ratio of equal to and greater than 3.0. Invasive TCCs expressed significantly more VEGF gene than superficial TCCs. Cytoplasm of tumor cells was positively stained by immunohistochemistry with an anti-VEGF monoclonal antibody, while the intratumoral endothelial cells and the vascular smooth muscle cells were weakly positive for the staining. TCCs, normal mucosae and human umbilical endothelial cells expressed flt-1 gene, while leucocytes from peripheral blood did not. The expression level of flt-1 gene significantly correlated with that of the VEGF gene in the tumor. These results indicate that the VEGF gene is frequently overexpressed in TCC of the urinary bladder, especially in muscle invasive tumors, and that a paracrine system including VEGF and flt-1 exists between the TCC cells and the adjacent endothelial cells so as to regulate the angiogenesis in this tumor.

[Echocardiographic and hematological variables as a risk factor for stroke in chronic nonvalvular atrial fibrillation]

The relationship between echocardiographic variables and the incidence of ischemic stroke in patients with atrial fibrillation was investigated by transthoracic and transesophageal echocardiography in 67 patients with chronic nonvalvular atrial fibrillation. Hematologic variables were also measured simultaneously, including plasma levels of D-dimer and thrombin-antithrombin III complex in these patients. There was a prior history of ischemic stroke in 13 patients (stroke group), but not in the other 54 patients (nonstroke group). There were no significant differences in age, sex, left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter or hematologic parameters between the groups. The left atrial appendage emptying flow velocity was lower in the stroke group than in the nonstroke group (21 +/- 5 vs 32 +/- 3 cm/sec, p < 0.05), and the incidence of left atrial spontaneous echo contrast was significantly higher in the stroke group than in the nonstroke group (69% vs 26%, p < 0.01). There was no significant difference in the incidence of left atrial thrombi between the groups (23% vs 12%). These findings suggest that transesophageal echocardiographic variables are correlated with the risk of ischemic stroke in patients with chronic nonvalvular atrial fibrillation.

[Usefulness of 123I-MIBG scintigraphy for prediction of effect of beta-blocker therapy in dilated cardiomyopathy]

To determine whether 123I-MIBG (MIBG) scintigraphy is useful for predicting the effect of beta-blocker therapy in patients with dilated cardiomyopathy (DCM), we studied MIBG scintigraphy in 11 controls and 9 patients with DCM before starting beta-blocker therapy. First, initial and delayed heart-to-mediastinum ratios (H/M ratio) of MIBG activity in patients with DCM were significantly lower than those in 11 controls, respectively (initial H/M; 1.8 +/- 0.3 vs. 2.1 +/- 0.3, p < 0.02, delayed H/M; 1.6 +/- 0.3 vs. 2.4 +/- 0.2, p < 0.0001), and MIBG washout rate from the heart was significantly higher in patients than in controls (washout rate; 33 +/- 7% vs. 22 +/- 4%, p < 0.0005). Second, beta-blocker therapy improved LVEF in 7 patients (improved group), while it resulted in deterioration of heart failure, followed by death in 2 patients (deteriorated group). Although initial and delayed H/M ratios in the improved group were not significantly different from those in the deteriorated group, respectively, MIBG washout rate was significantly higher in the deteriorated group than in the improved group (45 +/- 8% vs. 30 +/- 3%, p = 0.04). Our study suggests that DCM patients with markedly rapid MIBG clearance may be deteriorated by beta-blocker therapy. In contrast, there were no differences in LVEF and plasma norepinephrine between improved and deteriorated groups. In conclusion, 123I-MIBG scintigraphy is useful for predicting the effects of beta-blocker therapy in patients with DCM.

Detection of DNA Fragmentation in Human Breast Cancer Tissue by an Antibody Specific to Single-stranded DNA

While there have been many reports concerning the clinical significance of bcl-2 expression in human breast cancer, little is known about apoptosis in primary breast cancers. We immunohistochemically examined DNA fragmentation in 107 primary human breast cancers from Japanese women using an antibody specific to single-stranded DNA. The apoptosis index calculated as the product of the positive cell number and the cellularity coefficient, ranged from 0 to 48. The average incidence of apoptosis was calculated as 0.1% of tumor cells. No relationships were observed among the apoptosis index, expression of bcl-2, and the histological grade of the tumors. Almost all apoptotic cells were phagocytosed by surrounding tumor cells immediately after DNA fragmentation. Apoptotic body formation was rare. The apoptotic cells seemed to be degraded within phagocytes, leaving no trace of apoptosis except the tiny shells of nuclei. The intensive phagocytic reaction might be one of the main reasons for the low incidence of apoptosis in human breast cancers.

Irinotecan (CPT-11) combined with cisplatin in patients with refractory or recurrent ovarian cancer

Irinotecan hydrochloride (CPT-11) is reportedly effective for the treatment of refractory or recurrent ovarian cancer. We investigated the antitumor efficacy and toxicity of combination therapy with CPT-11 and cisplatin in 25 patients (mean age 55 years, range 35-73 years) with refractory or recurrent ovarian cancer who had previously undergone platinum-based combination chemotherapy. Patients received two or more courses of treatment consisting of 50 or 60 mg/m2 of CPT-11 on days 1, 8 and 15 and 50 or 60 mg/m2 of cisplatin on day 1 administered intravenously. All patients were evaluable for the response and the toxicity profile. Complete responses were obtained in two (8.0%) patients and partial responses were obtained in eight (32.0%) patients, giving an overall response rate of 40% (10 of 25 patients) (95% CI 23.0-59.0%). The median duration of response was 5.5 months (range 2-27 months), the median time to tumor progression was 6 months (range 3-28 months) and the median overall survival was 12 months (range 3-39+ months). Grade 3 or 4 neutropenia, which was the most frequent and severe toxic effect, occurred in 36 (54.5%) of the 66 treatment courses and in 16 (64.0%) of 25 patients. The nadir of the leukocyte count occurred on days 18-19. Neutropenia was reversed by short-term administration of granulocyte colony-stimulating factor for 2-10 days. Less serious hematologic effects and non-hematologic effects, such as diarrhea, were also observed. This preliminary study showed that this regimen of CPT-11 and cisplatin was effective in patients with recurrent ovarian cancer.

Expression of Arabidopsis response regulator homologs is induced by cytokinins and nitrate

We examined cytokinin and nitrate responsiveness in gene expression of five distinct response regulator homologs (ARR3-ARR7) in the leaves of nitrogen-starved Arabidopsis plants. The transcripts accumulated after spraying the shoots with t-zeatin. The induction of accumulation was highly specific for cytokinins. The transcripts also accumulated by supply of nitrate to the culture medium. These findings suggest that ARRs are involved in inorganic nitrogen signal transduction mediated by cytokinin as in the case of ZmCip1, a response regulator homolog recently identified in maize.

Mouse forkhead (winged helix) gene LUN encodes a transactivator that acts in the lung

Many transcription factors involved in the determination and maintenance of cell fates share DNA-binding motifs to form gene families. The most recently discovered evolutionarily conserved DNA-binding domain of 100 amino acids, termed the forkhead domain, emerged from a sequence comparison of the rat transcription factor HNF-3 alpha and the homeotic gene fork head of Drosophila. Here we describe the isolation of a new mouse forkhead gene named LUN. Of a total of five forkhead genes in the lung, the LUN gene was uniquely expressed in the bronchiolar epithelium and in type II pneumocytes. We found that the LUN protein has forkhead domain that is identical to the HFH8 gene and a C-terminal region that is very similar to the HFH8 gene. Based on the structural similarity of the two proteins, we investigated the structure-function relationship of the LUN protein in two kinds of promoters and found that regions C and D work differently as activation domains, namely that region C acts autonomously but region D cannot work without region C. These results suggest that the LUN gene may play an important role as a transactivator in the determination and maintenance of some types of cells in the lung.

Activation of human liver 3alpha-hydroxysteroid dehydrogenase by clofibrate derivatives

The NADP+-dependent dehydrogenase activity of a predominant isoenzyme of human liver 3alpha-hydroxysteroid dehydrogenase was activated by antihyperlipidemic drugs, such as bezafibrate and clinofibrate, and by clofibric acid and fenofibric acid (active metabolites of clofibrate and fenofibrate, respectively). The optimal pH of the activation by the drugs was about 7.5, and the concentrations giving maximum stimulation (1.8- to 2.4-fold) were 100, 50, 400 and 50 microM for bezafibrate, clinofibrate, clofibric acid and fenofibric acid, respectively. Clofibrate and fenofibrate acted as weak inhibitors, and the clofibric acid derivatives that lack the chloro group, methyl group on the alpha-carbon or carboxyl group greatly decreased the stimulatory effects. The activation by the drugs increased both Km and kcat (turnover number) values for the coenzyme and substrates. Kinetic analysis with respect to NADP+ showed that bezafibrate, clinofibrate, clofibric acid and fenofibric acid were nonessential activators showing dissociation constants of 32, 6, 103 and 11 microM, respectively. The combined activators experiments with one of the above drugs and sulfobromophthalein, a known activator specific for this enzyme, and comparison of their effects on the activities of mutant enzymes (with Met replacing Lys-270 or Arg-276) indicated that sulfobromophthalein and the drugs bind to an identical site on the enzyme. These results suggest that the long-term therapy with the antihyperlipidemic drugs influences the metabolism of steroid hormones, bile acids and several ketone-containing drugs mediated by the enzyme.

Distribution of scattered radiation during intraoral radiography with the patient in supine position

OBJECTIVE

The purpose of this study was to investigate the spatial distribution of scattered radiation during intraoral radiography with the patient in a supine position to determine the exposure to an operator without a suitable barrier.

STUDY DESIGN

A phantom was placed in the supine position on a dental chair with the occlusal plane perpendicular to the floor, and four intraoral periapical radiographic examinations in the anterior and posterior regions of the maxilla and mandible were performed. The scattered radiation was measured with an ionization chamber at distances ranging from 25 to 200 cm at 25 cm increments and at intervals of 45 degrees. Measurements were made at two different heights: level with the occlusal plane and 30 cm below it. The exposure was converted to an air-kerma/absorbed dose in air.

RESULTS

The distribution of scattered radiation was symmetric during examinations of the anterior region. Circular iso-exposure curves of up to 0.5 microGy were observed at the level of the occlusal plane, and curves of up to 0.1 microGy were observed 30 cm below the plane. The lowest exposures were measured 30 cm below the occlusal plane and behind the chair. The distribution of scattered radiation was not symmetric during examinations of the posterior region. Iso-exposure curves of up to 0.25 microGy were observed at the level of the occlusal plane during exposure of the maxilla, and curves of up to 0.5 microGy were observed during exposure of the mandible. Circular iso-exposure curves of up to 0.1 microGy were observed 30 cm below the occlusal plane. Lower values for scattered radiation were observed 30 cm below the occlusal plane between 135 and 180 degrees behind the phantom.

CONCLUSION

The spatial distribution of scattered radiation with the patient in a supine position was not the same in eight directions around the chair. Although the preferred position for the operator is behind a suitable barrier, the preferred position in the absence of a barrier is 200 cm behind the patient.

Remission of hypertension: retrospective observations over a period of 20 years

To clarify the background and outcome of hypertensive patients who have remission of their elevated blood pressure (BP) after a course of antihypertensive drug therapy, we designed a retrospective observational study. The clinical records of 106 hypertensive men and women (BP, 164.3/104.4 mmHg) given antihypertensive drug treatment and subsequently examined every 1 to 3 mo for more than 20 yr were reviewed. The patients were divided into two groups: those who had remission (R-group) and those who did not have remission (N-group). Patients were considered in remission if no significant elevation in BP was observed for more than 1 yr after withdrawing their medication. Remissions ranging in duration from 1.6 to 21.7 yr (average duration, 6.3 yr) occurred in 19 of 106 patients (17.9%). However, anti-hypertensive drug treatment was eventually restarted in 17 of the 19 patients. Before treatment, comparison of the R-group and N-group revealed no differences with respect to age, body weight, BP, or serum creatinine. In contrast, the proportion of patients who lacked high-voltage deflections in their electrocardiograms (ECG) as well as that of patients whose BP was well-controlled by a single medication was significantly greater in the R-group than in the N-group (12/19 vs. 22/87, p < 0.05 and 10/19 vs. 13/87, p < 0.001, respectively). In addition, body weight in the R-group decreased significantly by the time drug therapy was withdrawn (p < 0.01). Finally, significantly more patients (14 of 19 patients) entered remission in the spring and summer (p < 0.05) than at other times of the year. We conclude that remission occurs in a subset of well-controlled hypertensive patients and may persist for several years or more. However, in the majority of patients, antihypertensive drug treatment will usually need to be restarted at some point. Patients who lack ECG high-voltage deflections and who are successfully treated with a single therapeutic agent are most likely to experience remission. Moreover, it appears that withdrawing patients from drug therapy in the spring or summer is more likely to yield a favorable outcome than at other times of the year.

Analysis of functional domains of Wilson disease protein (ATP7B) in Saccharomyces cerevisiae

Wilson disease is a genetic disorder of copper metabolism characterized by the toxic accumulation of copper in the liver. The ATP7B gene, which encodes a copper transporting P-type ATPase, is defective in patients with Wilson disease. To investigate the function of ATP7B, wild type or mutated ATP7B cDNA was introduced into a yeast strain lacking the CCC2 gene (delta ccc2), the yeast homologue of ATP7B. Wild type and the H1069Q mutant could rescue delta ccc2, however, the N1270S mutant could not, reflecting phenotypic variability of Wilson disease. In addition, the mutant containing only the sixth copper binding domain could rescue delta ccc2, indicating its functional importance.

DNA annealing by RAD52 protein is stimulated by specific interaction with the complex of replication protein A and single-stranded DNA

Homologous recombination in Saccharomyces cerevisiae depends critically on RAD52 function. In vitro, Rad52 protein preferentially binds single-stranded DNA (ssDNA), mediates annealing of complementary ssDNA, and stimulates Rad51 protein-mediated DNA strand exchange. Replication protein A (RPA) is a ssDNA-binding protein that is also crucial to the recombination process. Herein we report that Rad52 protein effects the annealing of RPA-ssDNA complexes, complexes that are otherwise unable to anneal. The ability of Rad52 protein to promote annealing depends on both the type of ssDNA substrate and ssDNA binding protein. RPA allows, but slows, Rad52 protein-mediated annealing of oligonucleotides. In contrast, RPA is almost essential for annealing of longer plasmid-sized DNA but has little effect on the annealing of poly(dT) and poly(dA), which are relatively long DNA molecules free of secondary structure. These results suggest that one role of RPA in Rad52 protein-mediated annealing is the elimination of DNA secondary structure. However, neither Escherichia coli ssDNA binding protein nor human RPA can substitute in this reaction, indicating that RPA has a second role in this process, a role that requires specific RPA-Rad52 protein interactions. This idea is confirmed by the finding that RPA, which is complexed with nonhomologous ssDNA, inhibits annealing but the human RPA-ssDNA complex does not. Finally, we present a model for the early steps of the repair of double-strand DNA breaks in yeast.

Neoadjuvant intraarterial chemotherapy followed by radical hysterectomy and/or radiotherapy for locally advanced cervical cancer

OBJECTIVES

We assessed neoadjuvant intraarterial chemotherapy (NAC) followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer.

METHODS

Over 5 years, 48 consecutive women with International Federation of Gynecology and Obstetrics stage IIb-IVa cervical cancer were enrolled. Treatment consisted of bilateral internal iliac artery infusion of cisplatin (100 mg/m2, day 1) or carboplatin (400 mg/m2, day 1) and peplomycin (20 mg/m2, day 1) for two courses separated by 3 weeks. Doxorubicin (30 mg/m2, day 1) was added for patients with adenocarcinoma. Stage III patients who responded to NAC and Stage IIb patients underwent radical hysterectomy with pelvic lymphadenectomy. Stage III patients not responding to NAC and all stage IVa patients were treated with pelvic radiotherapy.

RESULTS

Complete response was achieved in 5 (10.4%) of 48 patients, while a partial response was noted in 32 (66. 7%) and stable disease in 11 (22.9%). Of 25 patients with stage IIIb disease, 16 (64.0%) were able to undergo surgery. The 4-year disease-free survival (DFS) was 80.0% in patients with stage IIb and 62.3% in patients with stage III. In stage IIIb, the 4-year DFS in patients receiving surgery (75.2%) was higher than the DFS for those receiving radiotherapy (44.4%) (P < 0.05). Grade 3 or 4 leukopenia developed in 17 (35.4%) patients. Nausea and vomiting of grade 2 or higher occurred in 34 (70.8%). Creatinine clearance transiently decreased (>/= grade 2) in 16.6%. Patients negative for serum squamous cell carcinoma-associated antigen (SCC) responded better to NAC than to SCC-positive cases, and SCC-negative survival was significantly better than SCC-positive survival (P < 0.05).

CONCLUSIONS

Neoadjuvant intraarterial chemotherapy with platinum was safely performed, and a survival benefit followed radical surgery with or without radiotherapy after response to NAC.

Ovarian mixed germ cell tumor comprising polyembryoma and choriocarcinoma

Both polyembryoma and choriocarcinoma are exceedingly rare germ cell tumors of the ovary, and a mixed germ cell tumor containing both neoplastic components has not been described. Recently we encountered such a case.

Adhesive and bone resorptive activities of isolated osteoclasts from hen medullary bone

In the present study, osteoclasts were isolated from hen medullary bones at the formative and resorptive phases. The cells were cultured on glass culture dishes and bone slices. After culturing, the adhesion activity of the isolated osteoclasts with the substrates was estimated with a light microscope, and the surfaces of the bone slices were observed with a scanning electron microscope. The results showed that the adhesion activity of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts is higher at the bone resorptive phase than at the bone formative phase, and this tendency in isolated osteoclasts was observed more frequently on the bone slices than on the glass culture dishes. Furthermore, scanning electron microscopy showed that the isolated osteoclasts in the bone resorptive phase adhered to the bone surface with developed-cytoplasmic projections and formed broad pits where collagen fibrils were exposed. On the other hand, isolated osteoclasts in the bone formative phase adhered to the bone slice with board-shaped cytoplasmic projections and did not form any pits. These results suggest that isolated osteoclasts in the bone resorptive phase have a high level of adhesion activity and actively resorb the bone, whereas isolated osteoclasts in the bone formative phase have a low level of adhesion activity and cease bone resorption. The procedure reported here is useful for studying the bone-resorptive mechanism of authentic osteoclasts.

Long-term follow-up study of penile cancer

BACKGROUND

We reviewed the outcomes for patients with penile cancer to determine factors predictive of their survival.

METHODS

Between 1966 and 1996, 59 patients with penile cancer were treated at Kobe University Hospital. The median follow-up period was 109 months (range, 4 to 240 months). The prognostic factors were determined by multivariate analysis. Disease progression rates, according to stage and the type of surgery, were studied.

RESULTS

The 5- and 10-year, cause-specific survival rates were 75.9% and 73.8%, respectively. Lymph node involvement, tumor stage, and tumor differentiation were the independent risk factors identified by multivariate analysis. Among the patients at stage 1 and 2, none of the 29 patients treated with early lymphadenectomy showed recurrence in the inguinal region, while 4 (27%) of 15 patients without lymphadenectomy showed such recurrence.

CONCLUSION

Our results suggest that tumor stage, lymph node involvement, and tumor differentiation are significant prognostic factors for survival, and that early inguinal lymphadenectomy would improve the prognosis of patients with stage 1 or 2 penile cancer.