Mannose-binding protein recognizes glioma cells: in vitro analysis of complement activation on glioma cells via the lectin pathway

The lectin pathway is a novel pathway for activation of the complement cascade, which is initiated by the binding of mannose-binding protein (MBP) to its carbohydrate ligands. We investigated whether the complement system was activated in vitro by glioma cells through this pathway to the C3 level. MBP was found to bind to all six glioma cell lines tested by using flow cytometric analysis. Binding of a complex of MBP-associated serine protease and MBP was observed in two of the cell lines examined, thereby resulting in C4 consumption. Activation of C3 was hemolytically evaluated in these two lines. C3 consumption was also observed in one. Based on these results, it is likely that recognition by MBP followed by complement activation occurs in certain glioma cell lines.

[Chronic subdural hematoma with bleeding tendency; clinical analysis of 11 surgical cases]

Eleven patients with chronic subdural hematoma (CSDH) with bleeding tendency (BT) were surgically treated in the last 12 years. To study the clinical problem of CSDH with BT, 11 surgical cases were divided into 3 groups, Group A; CSDH with primary BT (1 case of hemophilia A), Group B; CSDH with BT secondary to a basic disease (3 cases of leukemia, 2 cases of malignant tumor with DIC, 1 case of chronic renal failure and 1 case of liver cirrhosis), Group C; CSDH with BT by anticoagulants (warfarin) (2 cases of replacement of mitral valve, 1 case of A-C bypass). Evacuation of the hematoma was performed by means of one or two burr holes with irrigation of the hematoma cavity and a drainage tube was placed in the subdural space. The outcome was excellent in Groups A and C. In Group B, two patients with DIC due to gastric cancer and prostatic cancer died, and 3 patients with leukemia recovered dramatically from CSDH, but the poor course of the disease itself resulted in death. The outcome of other patients in Group B was excellent. Since CSDH with BT is often fatal, those patient had usually been treated conservatively. However, from this analysis, we stress that CSDH with BT should be surgically treated after checking the blood conditions carefully to determine whether or not the patient has need for surgery.

[Recent changes in the management of advanced non-small cell lung cancer]

The value of chemotherapy in advanced non-small cell lung cancer (NSCLC) has been shown in combination chemotherapy with cisplatin, which yields only marginal survival benefits. Chemoradiotherapy with cisplatin improves the survival of patients who have unresectable, locally advanced NSCLC when compared with the treatment by radiation therapy alone. The 2- and 3-year survival rates are nearly doubled on average. Neoadjuvant chemotherapy is more effective than surgery alone for the treatment of stage IIIA NSCLC in the randomized phase III trials. It is suggested that neoadjuvant chemotherapy will be a standard therapy for stage IIIA NSCLC which is marginally resectable. There are many studies about radiation methods such as hyperfractionated radiation therapy and CHART, irradiated dose, and timing of radiation. There is a need to develop new, more active anti-cancer agents, and to find more effective regimens.

Pulmonary clearance and inflammatory potency of intratracheally instilled or acutely inhaled nickel sulfate in rats

Rats were exposed to nickel sulfate (NiSO4) either by intratracheal (IT) instillation or by acute aerosol inhalation, and pulmonary clearance of Ni and pulmonary inflammatory responses were studied. The half-time of Ni in the lung (initial lung burden = 50 micrograms Ni/rat) was about 32 h in both the IT instillation and inhalation groups. Ni retention in the lung tissue following IT instillation of NiSO4 was saturable with reference to dose, suggesting that clearance rate of Ni from the rat lung depends on lung burden of Ni. Lung inflammatory responses were evaluated by biochemical, elemental and cytological indicators in bronchoalveolar lavage fluid (BALF) following IT instillation of NiSO4. Activities of lactate dehydrogenase and beta-glucuronidase, contents of lysozyme, protein, sulfur and calcium, and the number of polymorphonuclear leukocytes were increased with a peak at 2-3 days post-instillation, while BALF alkaline phosphatase (ALP) activity was significantly decreased after IT instillation of NiSO4. Lung tissue ALP activity was also decreased by NiSO4. Because Ni does not inhibit ALP directly, the decrease in ALP activity is probably due to functional changes of type II cells (a major source of BALF ALP). Thiobarbituric acid reacting substances in the lung tissue were not changed by NiSO4, suggesting that lipid peroxidation plays a minimal, if any role, in the Ni-induced inflammation in the rat lung.

Role of radiotherapy in combined modality treatment of locally advanced non-small-cell lung cancer

PURPOSE

For patients with locally advanced (stage III) non-small-cell lung cancer (NSCLC), radiotherapy (RT) has been used conventionally for many years. Few prospective trials have determined the role of RT. Recently, chemotherapy (CT) has been shown to produce excellent responses in regionally advanced disease. We therefore conducted a randomized trial using cisplatin (P)-based CT regimens with or without thoracic irradiation.

PATIENTS AND METHODS

We randomly assigned 92 patients with locally advanced NSCLC to receive one of three arms of P-based combination chemotherapy: vindesine (V) plus P, mitomycin (M) plus V plus P, or etoposide (E) plus P alternating with V plus M. After two cycles of CT, patients were reevaluated and those with stage III were again randomized to receive RT or not. RT consisted of 50 to 60 Gy in 5 to 6 weeks; 2 Gy was delivered once daily in conventional fractions.

RESULTS

Sixty-three patients were included in the second randomization. The patients in the CT/RT group (n = 32) and CT-alone group (n = 31) were comparable in terms of age, sex, performance status, histologic features, stage of disease, and induction CT regimen. The median durations of survival were similar for the two groups (461 days in CT/RT group and 447 days in CT-alone group). The survival rate in the CT/RT group was 58% at 1 year, 36% at 2 years, and 29% at 3 years, as compared with 66%, 9%, and 3% at 1, 2, and 3 years, respectively, in the CT-alone group. One patient in the CT/RT group died of pneumonitis, but there were no CT-related deaths.

CONCLUSION

In locally advanced NSCLC, P-based combination CT followed by chest irradiation significantly increases the number of long-term survivors as compared with CT alone. RT to bulky disease in the thorax is thus an important part of combined modality therapy, and a necessary part of further studies in locally advanced disease.

[Permanent pacemaker therapy in a community with many elderly people]

To clarify the utility of permanent pacemakers in a society composed largely of elderly people, clinical characteristics, pacemaker characteristics, outcome, and quality of life in a total of 116 patients in a community with many (19.6%) elderly people were evaluated after permanent pacemaker implantation. Patients above age 65 accounted for 88.8%, while those above 80 years accounted for 24.1%. Syncope was the most common observation before pacemaker implantation and emergency care was needed in 35% of patients. Sick sinus syndrome and complete AV block were seen in a majority, while atrial fibrillation with bradycardia was seen in a minority of patients. Although the physiological pacing and ventricular pacing mode (VVI) were used in about 50% each, recently the physiological pacing mode has markedly increased. During the mean follow-up of 26.1 +/- 16.2 months, only four patients died. NYHA 3 symptom improved to NYHA 1 after pacemaker implantation and 72.5% patients of all cases returned to their jobs. We conclude that the permanent pacemaker is effective in improving symptoms and reducing the death rate in elderly patients.

Coexistence of paraneoplastic sensory neuronopathy and Lambert-Eaton myasthenic syndrome in a small cell lung cancer patient

The present report is on a 72-year-old male patient with combined paraneoplastic sensory neuronopathy (PSN) and Lambert-Eaton myasthenic syndrome (LEMS) with small cell lung cancer. He noticed a painful paresthesia of the legs which advanced over seven days, and both hands became numb and painful. Three months later, he was found to have small cell lung cancer by mediastinoscopic examination. PSN was diagnosed by clinical symptoms and anti-Hu antibody, and LEMS was diagnosed by the waxing phenomenon on an electromyogram (incremental in compound muscle action potential up to 120%) and autoantibody against the presynaptic voltage-gated calcium channel. High titers of anti-Hu antibody were detected in the serum (1:12800) and cerebrospinal fluid (1:320). Although a partial response to chemoradiotherapy was obtained, the neurologic symptoms of PSN did not improve. The anti-Hu antibody titers obtained on five different occasions during the patient's clinical course did not change. The patient died from respiratory arrest six months after the initiation of therapy. To the best of the authors' knowledge, this combined form of disease, confirmed by both clinical and laboratory tests, is the rarest case ever to be reported.

Correlation between inflammatory cellular responses and chemotactic activity in bronchoalveolar lavage fluid following intratracheal instillation of nickel sulfate in rats

In a preceding study, we reported that the numbers of macrophages and polymorphonuclear leukocytes (PMN) were increased in bronchoalveolar lavage fluid (BALF) following the intratracheal instillation of nickel sulfate (NiSO4) in rats. In the present study, BALF chemotactic activities for both macrophages and PMN were measured to investigate if the increases of these inflammatory cells in BALF depend on increases in chemotactic activities in epithelial lining fluid (ELF) of the lung. Both the number of PMN and the PMN chemotactic activity peaked at 2 days post-instillation and they were significantly correlated. However, the PMN chemotactic activity was inversely correlated with concentration of leukotriene B4 (LTB4), a well-known chemotaxin. Although PMN were not observed in control BALF, LTB4 concentration in the control ELF (ca. 5 x 10(-7) M) was estimated to have a potential to attract PMN chemotactically through a membrane in in vitro migration assay. These results suggest that the presence of LTB4 in ELF itself does not trigger transpulmonary PMN infiltration. The rat BALF were fractionated by high performance liquid chromatography (HPLC), and PMN chemotactic activity of each fraction was measured. The elution profiles of PMN chemotactic activity showed that there were at least two different chemotaxins in BALF obtained from the NiSO4-exposed rats. Macrophage chemotactic activity in BALF also peaked at 2 days post-instillation. However, the number of macrophages was not significantly correlated with the chemotactic activity for macrophage in BALF.(ABSTRACT TRUNCATED AT 250 WORDS)

[Brain abscess ruptured into the lateral ventricle: the usefulness of treatment by intraventricular irrigation with antibiotics. A case report]

A case is reported of a brain abscess, which ruptured into the lateral ventricle and was treated using intraventricular irrigation with antibiotics. A 37-year-old man was suffering from a headache and high fever. Precontrast CT scan revealed a heterogeneous low density area in the left temporal lobe, and postcontrast CT scan showed a multilobular ring-like enhanced mass. Diagnosed as a brain abscess, intravenous administration of antibiotics was performed. On the sixth day the patient suddenly became drowsy. Postcontrast CT scan revealed an enhanced effect in the left lateral ventricular wall. Drowsiness was attributed to increased intracranial pressure and severe ventriculitis. Bilateral continuous ventricular drainage via the anterior horn of the lateral ventricle was performed. The drainage fluid from the left lateral ventricle was just like pus. Intraventricular irrigation with antibiotics between the bilateral anterior horns of the lateral ventricle, was performed in order to save the patient. The infusion fluid, Lactate Ringer's solution containing Cefazolin sodium, was infused into the right ventricle and CSF-like pus was drained from the left ventricle. The CSF reading gradually improved, and on the 14th day postoperatively irrigation was terminated. The postoperative course was uneventful. The diagnosis, treatment, and prognosis of patients with brain abscesses have improved dramatically as a result of more reliable methods of identifying infecting organisms, more effective antibiotic regimens, the development of microsurgical techniques and CT scan. However, despite these advances, the prognosis for brain abscess ruptured into the ventricle is usually very pessimistic.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vibratory perception threshold in normal volunteers]

A feasibility study on the vibratory perception threshold (VPT) in normal volunteers was conducted to detect anti-cancer drug induced peripheral neuropathy. The VPT was found to increase with age. The mean VPT in the main hand in 25 normal volunteers was significantly higher than in the other hand. No variation of VPT was observed in one day or one week. Variation of VPT in the lower extremities was detected between two examiners. In conclusion, the measurement of VPT was expected to be useful for the detection of anti-cancer drug induced peripheral neuropathy, if there is one examiner and the examined hand is specified.

A prospective phase II study on photodynamic therapy with photofrin II for centrally located early-stage lung cancer. The Japan Lung Cancer Photodynamic Therapy Study Group

PURPOSE

A phase II study was conducted between June 1989 and February 1992 to evaluate the activity and toxicity of photodynamic therapy (PDT) with photofrin II in centrally located early-stage lung cancer and to determine the complete response (CR) rate as the primary end point.

PATIENTS AND METHODS

Patients had histologically proven lung cancer and endoscopically superficial thickening or small protrusions. All lesions were located in subsegmental or larger bronchi. All patients had a performance status (PS) of 0 to 2 and arterial oxygen pressure tension (PaO2) > or = 60 mm Hg. No lymph node or distant metastases were present. All patients received photofrin II (2 mg/kg) intravenously 48 hours before PDT. Tumor lesions were superficially photoradiated by an argon dye laser or an excimer dye laser.

RESULTS

Of 54 patients with 64 carcinomas, 51 with 61 carcinomas were eligible for toxicity evaluation and 49 with 59 carcinomas were assessable for response. Of the 59 assessable carcinomas, 50 (84.8%; 95% confidence interval, 73.0% to 92.8%) showed a CR after initial PDT. The median duration of CR was 14.0+ months (range, 2.0+ to 32.4+). The multiple regression model indicates that estimated length of longitudinal tumor extent was the only independent prognostic factor for CR (P = .002). Five carcinomas that had a CR had a local recurrence at 6, 10, 12, 16, and 18 months after initial PDT, respectively. Toxicity assessment (World Health Organization [WHO] grade 2) showed transient elevation of ALT (1.9%), pulmonary toxicity (7.7%), and allergic reaction (7.7%), as well as sunburn (1.9%).

CONCLUSION

PDT with photofrin II has an excellent effect on patients with centrally located early-stage lung cancer who have limited tumor invasion extending over a small area (< or = 1 cm).

Treatment of extensive cranial bone defects using computer-designed hydroxyapatite ceramics and periosteal flaps

We performed cranioplasty using hydroxyapatite ceramics and periosteal flaps in three patients with extensive cranial bone defects. These defects were left after post-brain surgery infection forced the removal of cranial bone. Hydroxyapatite ceramics made by using computer-aided design from three-dimensional computed tomographic image data were implanted in these patients. The defects were relatively large (the largest was 16.5 x 7.5 cm) and had a high degree of curvature. Three pieces were required in one patient, although one piece was sufficient in the other two patients. The surgical technique consisted of removal of the epidural granulation tissue, exposure of the cranial bone defect site, and shaping of the hydroxyapatite ceramics to fit the defect entirely, followed by the implantation of the hydroxyapatite ceramics. In anticipation of induction of the bone to hydroxyapatite, we covered the hydroxyapatite ceramics with periosteal flaps of cranial bones; however, based on only these three patients, our knowledge of the ossification-promoting effect is incomplete. More clinical cases should be investigated to evaluate further the clinical efficacy of this method for treatment. As we have reported here, the treatment of cranial bone defects by using computer-designed hydroxyapatite ceramics and a periosteal flap is safe and highly effective.

Metabolism and toxicity of intravenously injected yttrium chloride in rats

Although radioactive yttrium (Y) has been used for medical treatment, little attention has been directed toward the toxicity of Y. We report time-course and dose-related changes in tissue distribution, subcellular localization, clearance, and acute toxicity of iv-injected yttrium chloride (YCl3) in rats. Intravenously injected Y was predominantly distributed to plasma in the blood. At doses more than 0.2 mg Y/rat, most plasma Y appears to be in colloidal material which was composed of proteins and some minerals. Electron microscopic analyses revealed that the colloidal material was taken up by phagocytic cells in the liver and spleen. The liver Y was slowly cleared with a half-time of 144 days at a dose of 1 mg Y/rat. Glutamic-oxaloacetic and glutamic-pyruvate transaminase activities in blood plasma were increased with a peak at 20 hr postinjection at a dose of 1 mg Y/rat and returned to their control values at 170 hr postinjection, indicating that iv-injected YCl3 caused acute hepatic injury. Some of the plasma Ca was translocated to the colloidal material and plasma Ca concentration was increased transiently following injection of YCl3, probably because of resorption of bone. At a dose of 1 mg Y/rat, a significant and tremendous amount of Ca was deposited in the liver (over 10-fold) and spleen (over 100-fold), while Ca concentration was only slightly increased in the lung and kidney (less than 1.5-fold). These results indicate that the liver and spleen are primary target organs of iv-injected YCl3.

Pulmonary clearance and toxicity of intratracheally instilled cupric oxide in rats

Pulmonary clearance and toxicity of cupric oxide (CuO) dusts, which are probably formed in refining and smelting factories, were investigated. Groups of three rats received intratracheal (i.t.) instillation of CuO at a dose of 20 micrograms Cu/rat in time-course experiments (up to 7 days post-instillation). Other groups of three rats received i.t. instillation of CuO at doses of 2.5, 5, 10, 30, 50 and 100 micrograms Cu/rat and were killed at 2 days post-instillation in dose-effect experiments. Intratracheally instilled CuO particles were cleared from the lung with a half-time of 37 h. Copper binding metallothionein (MT) was induced in a dose-dependent manner and detected at 12 h to 3 days post-instillation. Rapid clearance of CuO from the lung and induction of MT at 12 h post-instillation suggest that CuO particles were solubilized and then cleared from the lung. The acute pulmonary toxicity of CuO was evaluated by cytological (numbers of macrophages and polymorphonuclear leukocytes), biochemical and elemental inflammatory indices (lactate dehydrogenase and beta-glucuronidase activities and protein, sulfur, phosphorus and calcium contents) in the bronchoalveolar lavage (BAL) fluid. These inflammatory indices peaked at 12 h to 3 days post-instillation, and increased with dose over the dose range, except for phosphorus content. Dose-effect relationships in BAL inflammatory indicators of CuO-injected (i.t.) groups were compared to those of CuSO4-injected (i.t.) groups. The results of the comparison indicated that there was no significant difference in acute inflammatory potency between CuSO4 (soluble form of Cu) and CuO (insoluble form of Cu) in the rat lung.

[Delayed cerebral dysautoregulation after recirculation of cerebral ischemia]

Sequential changes of cerebral autoregulation were studied in 20 cats after recirculation of cerebral ischemia. The cerebral autoregulation was evaluated by autoregulation index (A.I.), calculating % delta cerebral blood flow (CBF)/delta cerebral perfusion pressure (CPP), with changing the mean arterial blood pressure (MABP) within 80-130 mmHg. Duration of ischemic insult was 15 min after disappearance of direct cortical response (DCR). Following recovery of cerebral circulation, MABP, CBF and intracranial pressure (ICP) were observed sequentially for at least 48 hours. In 6 of 20 cats the autoregulation was disturbed early after recirculation, and the ICP was increased, resulting in no cerebral blood flow (early deteriorated group). In the other 14 cats the autoregulation was restored immediately, but in 7 of the 14 cats it was disturbed again after 24 hours following recirculation (delayed deteriorated group), finally the ICP was elevated and the CBF became 0 as same as early deteriorated group. In another 7 cats it was not disturbed until 5 days. The changes in CBF following insult were five patterns. These were classified into type A (Gradual decrease), type B (Transient increase), type C (Constant maintenance), type D (Relatively rapid decrease) and type E (Rapid decrease). The delayed cerebral dysautoregulation occurred in the types except for type A and type E. These results suggested there was close relation between delayed dysautoregulation and delayed neuronal dysfunction that we reported previously. Moreover, we considered the delayed dysautoregulation could be speculated from the value of ICP/CBF immediately after recirculation and the pattern of the changes in CBF during ischemic insult.

Behavioral development and strain differences in perinatal mice (Mus musculus)

The perinatal development of spontaneous body movements and reflexes was examined in Slc:ICR, C3H/He, and BALB/c mice (Mus musculus). Mice were observed from Day 18.0 (a day before normal parturition) to Day 21.5 of gestation. The developmental changes of spontaneous body movements and reflexes occurred quickly. Strain differences in behavioral development were detected in the duration of spontaneous body movements but not in the occurrence of reflexes. Hybrid mice were more active than their parental strains with regard to duration of spontaneous body movements. The rooting reflex and crossed extensor reflex in hybrid mice occurred more frequently on Day 18.0 than in their parental strains. There was no maternal effect between reciprocal hybrid mice. These results indicate that the perinatal period is characterized by quick qualitative and quantitative changes in behavioral development and by the appearance of these genetic differences.

Time courses of PIVKA-II and AFP levels after hepatic artery embolization and hepatic artery infusion against hepatocellular carcinoma: relation between the time course and tumor necrosis

We examined 35 untreated patients with unresectable hepatocellular carcinoma who exhibited positivity for both plasma PIVKA-II and serum AFP, and studied the weekly course of these markers from the pre-TAE or -HAI period to the third week of treatment. We correlated changes in these markers with the tumor necrosis rate and the time course on X-ray CT images. One week after TAE, the tumor necrosis rate and the time course of PIVKA-II showed a significant correlation (r = 0.7), while the correlation was between the time course of AFP and the tumor necrosis rate was insignificant (r = 0.2). At two and three weeks after TAE, both the time course of AFP and PIVKA-II showed significant correlations with the tumor necrosis rate. In 16 patients with tumor necrosis rates of not less than 90%, the mean of the actual half-life (AHL) of PIVKA-II was 3.2 days, the shortest was 1.83 days, and 75% of all AHLs clustered from two days to four days, while the mean and shortest AHLs of AFP were six days and 2.98 days, respectively, exhibiting a broader distribution. On the other hand, in three out of the nine cases of hepatocellular carcinoma complicated with portal tumor thrombi, PIVKA-II increased after HAI in spite of a reduction in tumor size. It was suggested that the PIVKA-II level requires careful interpretation in cases of portal vein obstruction after intensive hepatic arterial infusion of anticancer agents.

High sensitivity to peripheral blood lymphocytes and low HLA-class I antigen expression of small cell lung cancer cell lines with diverse chemo-radiosensitivity

Three cell lines of small cell lung cancer (SCLC), which were established from specimens of untreated primary tumors biopsied by diagnostic bronchofiberscopy, were analyzed for immunological characteristics. These cell lines showed considerable heterogeneity in chemo-radiosensitivity, which was well correlated with clinical responses of the respective tumors, but their HLA-class I antigen expressions were equally depressed and they were susceptible to peripheral blood lymphocytes (PBL) and lymphokine-activated killer (LAK) cells, irrespective of their diverse chemo-radiosensitivity. Treatment of the cell lines with recombinant immune interferon (rIFN-gamma) increased their HLA-class I antigen expression and conversely depressed PBL sensitivity but not LAK sensitivity. This inverse relationship between HLA-class I expression and PBL susceptibility was also demonstrated using other pairs of autologous PBL and SCLC cell lines. rIFN-gamma changed neither HLA-class II antigen nor SCLC-specific antigen expression under the same experimental conditions. In vitro immunization of allogeneic peripheral blood lymphocytes with rIFN-gamma-treated SCLC cells induced allo-specific killer cells which lysed rIFN-gamma-treated more strongly than non-treated SCLC cells. These results suggest that reduced HLA-class I antigen expression of SCLC could protect the cancer from attack of killer T cells in spite of the higher sensitivity to PBL or LAK cells.

[Photodynamic therapy of roentgenographically occult lung cancer]

Between December 1983 and August 1990 25 patients (a total of 29 carcinomas) with roentgenographically occult lung cancer were treated by PDT at National Kinki Central Hospital for Chest Diseases. A complete remission (CR) occurred in 21 carcinomas (72%). Of 19 carcinomas with tumor length of 1 cm or less, 17 ones (89.5%) achieved a CR. Of 21 carcinomas with visible tumor of the peripheral area, 17 ones (85.7%) achieved a CR. Five carcinomas relapsed from 7 to 18 months after PDT. The length of tumor and the visibility of peripheral area of tumor are important factors for CR and relapse. Fourteen patients (56%) had double, triple or quadruple cancers. Until now, 10 patients died. The main causes of death were metachronous secondary cancers and respiratory or heart failure. PDT have a potential to become an alternative to surgical resection as the primary treatment for early stage roentgenographically occult lung cancer.

Presence of human papillomavirus 6/11 DNA in condyloma acuminatum of the urinary bladder

A Japanese woman with condyloma acuminatum of the urinary bladder is presented. The condyloma acuminatum lesion was resected endoscopically and human papillomavirus 6/11 DNA was detected. After treatment, there has been no recurrence of the disease.

Placebo-controlled double-blind comparative study on the preventive efficacy of mesna against ifosfamide-induced urinary disorders

In order to evaluate the preventive efficacy, safety and usefulness of mesna (Sodium 2-mercaptoethane sulfonate) against ifosfamide-induced urinary disorders, a placebo-controlled double-blind comparative study was performed. Ifosfamide was administered by intravenous drip infusion at a daily dose of 2 g/m2 for 5 consecutive days, and mesna was intravenously administered at 20% of the ifosfamide dose, three times daily for 5 consecutive days. The results obtained are as follows. (a) Of 101 accrued patients, 91 patients were evaluated consisting of 45 for the mesna group and 46 for the placebo group. There was no intergroup difference in the number of the evaluated cases and patient characteristics. (b) Micturition pain and feeling of residual urine graded as moderate or severe were not observed for the mesna group, but were observed for the placebo group with incidences of 19.6% (9/46) for micturition pain and 15.2% (7/46) for feeling of residual urine; the intergroup differences in the appearance of these urinary symptoms were statistically significant (P = 0.0003 for micturition pain; P = 0.0009 for feeling of residual urine). The incidence of hematuria graded as moderate or severe was 6.7% (3/45) in the mesna group, which was significantly lower than the 32.6% (15/46) in the placebo group (P = 0.0008). (c) No side-effect attributable to mesna was observed. (d) A judgment of "useful" was obtained in 80.0% (36/45) of the patients treated with mesna, which was significantly higher than the 34.8% (16/46) of the patients treated with placebo (P = near 0). On the basis of the above results, we conclude that the preventive efficacy, safety and usefulness of mesna against ifosfamide-induced urinary disorders have been well demonstrated in this study.

A randomized study of cisplatin versus cisplatin plus vindesine for non-small cell lung carcinoma

Between August 1983 and March 1985, a randomized study was conducted that compared cisplatin (CDDP) (80 mg/m2 on day 1) alone with CDDP plus vindesine (VDS) (3 mg/m2 on days 1, 8, and 15) in 160 consecutive patients with inoperable non-small cell lung cancer (NSCLC). There were no complete responses. The response rate for CDDP plus VDS (22 of 77 patients, 29%) was significantly higher than that for CDDP alone (9 of 78 patients, 12%) (P less than 0.05). However, no difference existed in the median duration of response (20 weeks for CDDP plus VDS versus 20 weeks for CDDP alone) or the median survival time (45 weeks for CDDP plus VDS versus 39 weeks for CDDP alone). No significant differences in toxicity were detected between the two arms; myelosuppression, alopecia, and peripheral neuropathy occurred more frequently with CDDP plus VDS and there was one lethal episode of hepatorenal syndrome in the CDDP plus VDS arm. Among the variables Eastern Cooperative Oncology Group (ECOG) performance status (PS), age, sex, stage, weight loss, serum lactate dehydrogenase (LDH) level, albumin level, histologic cell type, and chemotherapy arm, only chemotherapy arm was a significant factor leading to a major response (P = 0.019, multiple logistic regression analysis). The significant predictors of survival were PS (P = 0.000), sex (P = 0.000), and stage (P = 0.002) (Cox's proportional hazards model), with a PS of 0 or 1, female sex, and lower stage yielding the best survival. Although a significantly higher response rate was obtained in the combination arm than in the single agent arm, the survival benefit to patients receiving such combination chemotherapy was not determined and more effective chemotherapy regimens are required.

Typing of Rhodococcus equi isolated from submaxillary lymph nodes of pigs in Japan

Isolation of Rhodococcus equi from the submaxillary lymph nodes of pigs, with or without caseous lymphadenitis, and typing of the isolates by two serological methods were carried out. The rate of isolation of the organisms from the lymph nodes of pigs was 5 times higher in the lymph nodes with caseous lymphadenitis than in those without the lesion. Of 219 isolates, 146 (66.7%) were typable by the method of Prescott, while all the 219 isolates (100%) were typable by the method of Nakazawa et al. The most frequently isolated were serotype 2 of Prescott (identical to serogroup 16 of Nakazawa et al.), and serogroup 3 of Nakazawa et al., which did not correspond with any serotypes of Prescott. Serotypes/serogroups of R. equi from pigs were thus first clarified in Japan.

[Experimental study on destruction of the third ventricle floor in the midline:--examination for the trans-third ventricle approach]

Surgery of a basilar bifurcation aneurysm is a very difficult operation in neurosurgery. For the treatment of this lesion, two methods are widely used at present: one is the subtemporal approach developed by Drake and the other is the pterional approach by Yasargil. With either approach, however, the treatment of a basilar bifurcation aneurysm accompanied by megadolichobasilar anomaly is difficult and hazardous due to the necessity for excessive retraction of the brain, nerves and vessels. Recently we successfully treated two cases of ruptured basilar bifurcation aneurysm complicated with megadolichobasilar anomaly by the trans-third ventricle approach. The floor of the third ventricle was already partly destroyed by aneurysmal rupture in both cases. It was required to make a small split in the third ventricle floor in order to get a wider operative field. Postoperatively, however, no influence from the splitting of the floor was seen. An experimental study was carried out in dogs to determine the influence from the destruction of the floor of the third ventricle. Using microsurgical techniques, the third ventricle floor was opened along the midline. Dogs were sacrificed 30 days after surgery. The following items were evaluated before, during, and after surgery: clinical symptom, blood pressure, pulse, body temperature, serum electrolytes, serum osmotic pressure, pituitary hormones (anterior lobe), cortisol, ADH (2.5mol NaCl loading test), electroencephalogram, cerebral blood flow and pathological change. No significant abnormalities could be detected in endocrine and metabolic functions, and no histological changes were seen around the hypothalamus. In conclusion, it is justified to split the third ventricle floor along the midline if it is indicated.

Prevention by nicardipine of dog basilar artery spasm caused by oxyhemoglobin in vivo and in vitro

Intravenous infusions of nicardipine in a dose insufficient to lower blood pressure prevented the generation of the basilar artery spasm provoked by oxyhemoglobin (oxyHb) injected intracisternally in anesthetized dogs. The plasma concentration of nicardipine was comparable to that sufficient to suppress the oxyHb-induced contraction in isolated dog basilar arteries. Nicardipine appears to be similarly effective in antagonizing the vasoconstrictor action of oxyHb in vivo and in vitro.

Suppression of the cerebral vasospastic actions of oxyhemoglobin by ascorbic acid

Oxyhemoglobin (Oxy-Hb) produced a concentration-dependent contraction of monkey, dog, and bovine cerebral artery strips. Treatment of Oxy-Hb with ascorbic acid suppressed the ability of Oxy-Hb to contract the arteries, especially in the monkey arteries. The ability of intracisternally applied Oxy-Hb to constrict the basilar artery in anesthetized dogs was diminished when Oxy-Hb was treated previously with ascorbic acid (AsA-Hb). The contraction caused by Oxy-Hb was suppressed by treatment with indomethacin and aspirin in isolated bovine cerebral arteries. Endothelium-dependent relaxations elicited by substance P and relaxations induced by stimulation of the vasodilator nerves with nicotine were suppressed by treatment with Oxy-Hb and AsA-Hb; however, the inhibitory effect of AsA-Hb was markedly less. Oxy-Hb attenuated nitroglycerin-induced relaxations in a dose-dependent fashion, whereas AsA-Hb in concentrations up to 1.6 x 10(-5) M did not significantly influence the relaxations. It is concluded that incubation of Oxy-Hb with ascorbic acid alters markedly the biological activity of Oxy-Hb; the vasoconstrictor activity is suppressed, and the ability to diminish vasodilator actions is minimized. These findings provide a rationale for the use of ascorbic acid in cisternal irrigation to prevent the development of cerebral vasospasm after a subarachnoid hemorrhage.

Metabolism and pulmonary toxicity of intratracheally instilled cupric sulfate in rats

Though copper (Cu)-handling workers are known to be at risk to develop metal fume fever and acute respiratory failure, very little is known about the metabolic fate and pulmonary toxicity of Cu compounds deposited in the lung. We have investigated time-course and dose-related changes in Cu contents, the production of metallothionein (MT) and inflammatory responses in the rat lung following intratracheal instillation of cupric sulfate (CuSO4). Intratracheally instilled Cu was cleared rapidly from the lung with a half-time of 7.5 h. Copper-binding MT was induced in the lung tissue following Cu instillation and the amount of MT increased with the dose of CuSO4. However, the production of MT contributed little to the accumulation of Cu in the lung. The pulmonary toxicity of CuSO4 was evaluated by examining time-course and dose-effect profiles of cytological and biochemical inflammatory indices (enzymes, protein and elements) retrieved in bronchoalveolar lavage fluids. These results revealed that the inflammatory indices reached maximum values in their activities and contents at 12 h to 3 days after instillation and a dose of 5 micrograms Cu/rat was sufficient to produce acute inflammatory responses in the rat lung.

[Epidemiological and therapeutic study on urethritis of male and cervicitis from viewpoint of STD--a study using NY-198. Sapporo Clinical Research Group for STD]

Urethritis in males and cervicitis in females, which were sexually transmitted diseases, were treated with NY-198, a new quinolone antibiotic, and its efficacy was studied. Seventeen male patients with gonorrheal urethritis were administered a single 300 mg dose of NY-198. The efficacy rate on the 3rd day after administration was 100%, but it was 85.7% on the 7th day due to recurrence in 1 patient. The results of treatment of non-gonorrheal infections were as follow. In this treatment, NY-198 was administered in a daily dose of 600 mg in 3 divided doses for 14 consecutive days. In the treatment of chlamydial urethritis of males, the efficacy rate in 26 patients was 84.6% on the 7th day and 84.0% on the 14th day in 25 patients. In the treatment of chlamydial cervicitis, the efficacy rate was 100% on both the 7th (3/3) and 14th (6/6) days. In the treatment of non-gonorrheal and non-chlamydial cervicitis, the efficacy rate was 100% on the 7th day (1/1) and 50% (1/2) on 14th day. The efficacy rate in all 40 males with non-gonorrheal urethritis was 85.0% on the 7th day and 88.9% for 36 patients on the 14th day, while that in all 4 females with cervicitis was 100% on the 7th day and 87.5% on the 14th day. No side effects were seen in any of the patients. Overall, NY-198 had an efficacy rate of 80% in the treatment of chlamydial infections. NY-198 was found to be a useful drug which is efficacious in the treatment of all STD-related microbes such as gonococci and chlamydia.

Distribution, localization, and pulmonary effects of yttrium chloride following intratracheal instillation into the rat

Metabolic behavior and pulmonary toxicity of yttrium chloride (YCl3) deposited in the lung was investigated. Yttrium chloride was instilled intratracheally into rats and the time-course and dose-related changes in distribution of Y between lung tissue and bronchoalveolar lavage fluid (BALF) and pulmonary inflammatory responses were investigated. Pulmonary clearance of Y was very slow and the half-life was estimated to be 168 days. Yttrium content in the supernatant of BALF did not exceed 5 micrograms Y/lung even when a dose of 200 micrograms Y/rat was administered, suggesting that the alveolar surface fluid could retain at most 5 micrograms Y. On the other hand, Y content in the pellet of BALF changed with the number of macrophages retrieved in BALF in both time-course and dose-response experiments. Transmission electron microscopy and X-ray microanalysis suggested that Y was localized in lysosomes of alveolar and interstitial macrophages, and basement membranes. These results clearly explain the long pulmonary half-life of Y. beta-Glucuronidase activity and calcium and phosphorous contents in the supernatant of BALF increased significantly even at the lowest dose (10 micrograms Y/rat). Comparative dose-effect profiles of lactate dehydrogenase activity in BALF supernatant revealed that 1 mol of YCl3 is equivalent to about one-third mole of cadmium compounds and about 3 mol of zinc oxide in the potency for acute pulmonary toxicity.

[Combination chemotherapy of CDDP and etoposide in advanced non-small cell carcinoma of the lung]

Twenty-seven patients with advanced and previously untreated non-small cell carcinoma of the lung received combination chemotherapy with CDDP (100 mg/m2 iv on day 1) and etoposide (100 mg/m2 iv on day 2, 4 and 6). Eleven partial responses were observed (response rate of 40.7%), and the median survival of patients was 44.4 weeks. Toxicity was tolerable with moderate myelosuppression. This combination chemotherapy should be recommended for further clinical trials.

[Combined radiotherapy and chemotherapy modalities in the treatment of lung cancer]

The aim of combined modality treatment of lung cancer is to improve control of both local and metastatic disease. Retrospective reviews of the combined RT and CT modality in limited-stage small cell lung cancer (SCLC) showed an improvement of median survival and long term survival compared with CT alone. Among reports of 7 prospective trials in which patients were randomized so as to receive CT alone or CT with chest irradiation, combined modality treatment significantly increased the CR rate in 3/3, and the overall survival was significantly prolonged in 3/7. Concurrently combined modality treatment has a modest survival benefit in limited stage SCLC. Our phase 2 study combining RT with cisplatin-containing CT showed better improvement of response and survival than CT alone in non-small cell lung cancer (NSCLC). Four reports of prospective randomized studies have been performed to determine whether combined RT and combination chemotherapy might be better than RT alone in limited-stage NSCLC. Two of these studies demonstrated a survival and response advantage for the combined modality treatment. However, this approach for NSCLC reported so far has been disappointing, because of relative lack of effectiveness of the present CT.

[Cyclophosphamide, adriamycin and vincristine (CAV) in the treatment of small cell lung cancer]

Thirty-nine previously untreated small cell lung cancer patients received cyclophosphamide (CTX) + adriamycin (ADM) + vincristine (VCR) (CAV). The doses initially used were CTX 1,000 mg/body day 1, ADM 50 mg/body day, VCR 1 mg/body day, 8, 15 or 2 mg/body day(group A). Later, CTX 1,000 mg/m2 day, ADM 60 mg/m2 day, VCR 1.4 mg/m2 day were used. All patients had PS 0-3, 24 had limited disease (LD) and 15, extensive disease (ED). The overall response rate and the complete response (CR) rates were 63% (15/24) and 21% (5/24) for LD, and 21% (3/14) and 0% (0/14) for ED, respectively. The median response durations were 22 weeks for LD and 33 weeks for ED. The median CR duration in LD patients was 23 weeks. Twelve LD and 1 ED patient received thoracic radiotherapy (RT) optionally after 2-4 courses of CAV therapy. Eventually, 8 patients achieved CR. The median survival for LD, ED and all cases were 43 weeks, 37 weeks and 41 weeks, respectively. The 1, 2 and 3-year survival rates were 42, 25 and 21% for LD, and 40, 7 and 0% for ED. Three patients were long-term disease-free survivors (greater than 3 years), and these had LD and received RT. There were 3 chemotherapy-related deaths (2 patients with leukopenia + infection, 1 patient with drug-induced pneumonitis). The survival results of CAV therapy in our hospital were comparable with the recent results of chemotherapies available against small cell lung cancer.

[Phase II studies of a single agent and a cis-platinum-based two-drug combination in patients with non-small cell lung cancer]

Phase II studies of single agent and CDDP-based two drug combination were performed in 189 patients with inoperable non-small cell lung cancer. Six drug regimens were performed: CDDP alone, VDS alone, Epi-ADM alone, CDDP + VDS, CDDP + CPA, CDDP + ADM. The response rates were 15.4% (6/39) with CDDP alone, 8.0% (2/25) with VDS alone, 6.1% (2/33) with Epi-ADM alone, 26.7% (8/30) with CDDP + VDS, 14.3% (4/28) with CDDP + CPA, 17.6% (6/34) with CDDP + ADM and one CR was performed with CDDP + ADM. In patients with no prior chemotherapy, the response rates were 20.0% (6/30), 11.8% (2/17), 12.5% (2/16), 26.7% (8/30), 16.0% (4/25) and 25.0% (3/12), respectively. The median survival times were 25, 27, 23, 33, 25, and 45 weeks, respectively. The efficacy of CDDP in non-small cell lung cancer patients was re-confirmed, and that of CDDP + VDS, CDDP + ADM was suggested. No death due to toxicity occurred and toxicity was generally tolerable.

[A case of prolactinoma associated with craniopharyngioma]

A surgical case of prolactinoma associated with craniopharyngioma is reported. A 47-year-old man was admitted to some neurosurgical clinic on October 12, 1982, because of visual disturbance, general fatigue and impotence. Laboratory study revealed hyperprolactinemia (360 ng/ml) and slight enlargement of sella turcica indicated the pituitary adenoma. Transsphenoidal surgery was performed to remove the tumor on November 20, 1982. Histopathological examination revealed chromophobe adenoma, and prolactin was stained in the tumor cells by means of immunoperoxidase staining. Though the clinical symptoms had been improved after surgery, visual disturbance became worse about one month later. At that time empty sella syndrome was suspected and the second operation (interhemispheric approach) was performed on January 21, 1983. No pathological changes were observed at all. On July 13, 1983, he was transferred to our clinic, because his visual acuity was deteriorating. At this time we reviewed the previous CT scan and noticed a suprasellar mass. It was supposed that the lesion had been overlooked and was the cause of the visual disturbance. On August 1, 1983, a bifrontal craniotomy was performed and the suprasellar tumor was removed. Pathological examination of the tumor revealed craniopharyngioma. So it was supposed that pituitary adenoma and craniopharyngioma had been coexisting since onset. Except for cases with von Recklinghausen's disease, multiple primary intracranial tumors of different cell types are relatively rare. A review of literature revealed 94 cases until 1986. The most frequent combination of multiple tumors was meningioma and glioma. But we could not find any case of pituitary adenoma associated with craniopharyngioma in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anti-emetic treatment with metoclopramide and other drugs during CDDP therapy]

The present trial was designed to compare the effect of metoclopramide(MCP) + dexamethasone(DM) (Method A) with that of MCP + DM + lorazepam(Lor) (Method B) in the treatment of CDDP (cis-diamminedichloroplatinum)-induced nausea and vomiting in a randomized fashion. The results were collected by questionnaire given to 50 patients. The dosage of CDDP was 80-100 mg/m2. In addition, MMC and VDS, or VP-16 were used concurrently. Within 24 hours after the administration of CDDP, vomiting was not observed in 72% and 88% of the patients treated with Method A and Method B, respectively, and nausea was not noted in 48% and 68%, respectively. Marked malaise was observed in 36% of patients in the Method A group and in 12% in the Method B group. With respect to the extent of comfort, 16% of patients in the Method A group and 56% in the Method B group felt good. Sixteen percent in the Method A group and 56% in the Method B group were satisfied with the anti-emetic treatment. Thus, Method B was significantly superior to Method A with regard to the degree of comfort and treatment satisfaction.

[Serum neuron-specific enolase (NSE) in patients with small cell lung cancer--comparison with carcinoembryonic antigen (CEA)]

Serum neuron-specific enolase (NSE) was determined by RIA in 102 lung cancer patients. Serum NSE was elevated (greater than 10 ng/ml) in 72% (21 of 29 cases) of small cell lung cancer (SCLC) patients, which was a significantly higher positive rate than those in normal adult controls (0%, 0/48), noncancerous lung disease (17%, 4/24), squamous cell carcinoma (19%, 6/31) and adenocarcinoma (16%, 4/25) (p less than 0.05, respectively). There were no NSE-positive cases in stage I-II lung cancer patients. In SCLC, cases of extensive disease had a significantly higher NSE-positive rate (100%, 8/8) than those of limited disease (62%, 13/21) (p less than 0.05), suggesting that NSE levels were related to the bulk of the tumor. There was an excellent correlation between serum NSE and clinical response. Raised NSE levels were identified significantly more frequently than those of CEA in SCLC before chemotherapy and on relapse (or progression) (p less than 0.025, p less than 0.005, respectively). Thus, serum NSE determinations may be more useful than those of CEA for the staging and monitoring of SCLC.

[High position basilar top aneurysm treated via third ventricle]

There are two major approaches to basilar top aneurysm: one is subtemporal by Drake, another is pterional by Yasargil. In either approach, however, it is hazardous and difficult to approach basilar top aneurysm with megadolichobasilar anomaly because strong retraction of brain, nerve and vessel is required. A successful case of ruptured basilar top aneurysm with megadolichobasilar anomaly treated directly through the third ventricle is reported. A 62-year-old woman was admitted with consciousness disturbance. Plain CT scan on admission demonstrated massive and diffuse subarachnoid hemorrhage and a clot in the third ventricle. The left vertebral angiography demonstrated a 5 X 5 mm basilar top aneurysm with megadolichobasilar anomaly 24 mm distant from dorsum sellae. The aneurysm was considered to be inaccessible by conventional approaches because of its high position. Therefore, we have applied a new approach mentioned below. Operation was performed 2 days after the onset, using a bifrontal craniotomy. Dissecting interhemispheric fissure, we approached the third ventricle via lamina terminalis. Evacuating the clot in the third ventricle, the basilar top aneurysm was visualized. After dissecting the neck of aneurysm and perforators, clipping was performed. The postoperative course was uneventful. Surgical key points and prospective view in approaching via lamina terminalis and through the third ventricle for a high position basilar top aneurysm are discussed.

[A phase II study of epirubicin in advanced lung cancer]

A phase II study of epirubicin (EPI) was performed on 65 eligible lung cancer patients. EPI was administered intravenously at the dosage of 60 mg/m2 for non-small cell lung cancer (NSCLC) and 75 mg/m2 for small cell lung cancer (SCLC) at the interval of three to four weeks. The response rate of 57 measurable patients was 7.0% (predicted true response rate was 1.9-17.0%). In SCLC, the overall response rate was as low as 8.3% (2/24), but a better response rate, 20% (2/10), was observed in patients given no prior therapy. In NSCLC, the response rate was 6.1% (2/33) as a whole and 12.5% (2/16) in patients given no prior therapy. We were able to conclude that EPI was a moderately active agent in SCLC and marginally effective in NSCLC. Although the dose limiting factor was leukopenia, its incidence and degree seemed low as compared with adriamycin (ADM). As for alopecia or GI tract side effects, those associated with EPI appeared less acute than those produced by ADM. No cardiac toxicities were observed, partly because of the low cumulative maximum dose of 311 mg/m2 used in our study.

[Surgery of acoustic neurinoma in a hemodialyzed patient]

Successful surgical treatment of acoustic neurinoma in a case of hemodialyzed patient is reported. A 42-year-old female patient, who had been treated by hemodialysis, was diagnosed as having a C-P angle tumor by CT scan. She was refered to our clinic on June 24, 1983. Laboratory examinations on admission showed severe anemia and renal dysfunction. Every possible treatment was done in order to improve the laboratory data preoperatively. Another big problem in this case of hemodialyzed patient was brain edema and bleeding tendency. In order to cope with brain edema, intravenous administration of glycerol and slow hemodialysis for three days were performed preoperatively. These treatments were thought to be effective to reduce bleeding tendency also. During operation, however, heavy swelling of the cerebellum forced us to resect one third of the hemisphere to remove the tumor totally. In addition to this, postoperative mild bleeding in the cavity after tumor resection, subcortical hemorrhage around the shunt tube and oozing from the wound were observed. The patient was discharged from the hospital four months after surgery without any neurological deficit. The way of recovery, however, was not uneventful, because the patient developed various kinds of postoperative complications as mentioned above. In the postoperative managements, we felt almost as if we were treading on thin ice. Neurosurgical management in hemodialyzed patients is not yet very common. We should improve the postoperative management by adding new experience with similar cases.