Asymmetric aldol reaction of enol trichloroacetate catalyzed by (S, S)-(EBTHI)TiCl(OMe)

(S,S)-Ethylenebis(tetrahydroindenyl)titanium chloride methoxide, (S, S)-(EBTHI)TiCl(OMe) (3) was synthesized from the corresponding titanium dichloride. The asymmetric aldol reaction of enol trichloroacetate of cyclohexanone 1 with aromatic aldehydes was studied in the presence of a catalytic amount of the chiral titanium complex 3, with the result that the optically active syn aldol adduct 2 was preferentially obtained with up to 91% ee.

Effects of repeated brief episodes of ischemia and reperfusion in isolated perfused rat hearts

The effects of ischemia and reperfusion on the coronary endothelium and myocardium as well as tolerance to ischemia/reperfusion injury were assessed using isolated retrogradely perfused rat hearts. Repeated brief episodes of myocardial ischemia followed by reperfusion is known to have a protective effect against subsequent myocardial infarction. However, no studies have been performed with perfusion in the absence of blood cells to determine the effect of repeated ischemia and reperfusion on the coronary endothelium and myocardium. Using the Langendorff perfusion technique, rat hearts were subjected to a 30-, 10-, 5-, or 2-min period of low-flow perfusion by reducing the coronary flow to 3 ml/min followed by reperfusion at 20 ml/min for the same period of time. Control perfusion was then performed at a constant flow rate of 20 ml/ min for 60 min. Acetylcholine-induced coronary vasodilation was significantly (P < 0.05) lower in hearts subjected to 30 min of ischemia and 30 min of reperfusion when compared with the control hearts. Myocardial creatinine kinase (CK) activity was significantly reduced (P < 0.01) in hearts subjected to ischemia and reperfusion for either 30, 10, or 5 min. To assess the effect of repeated episodes of ischemia and reperfusion, the following protocols were used: a control study with constant perfusion for 60 min (group A), 30 min of ischemia and 30 min of reperfusion (group B), three 10-min episodes of ischemia and reperfusion (group C), six 5-min episodes of ischemia and reperfusion (group D), and 15 2-min episodes of ischemia and reperfusion (group E). Acetylcholine-induced coronary vasodilation was significantly inhibited in group B (80% +/- 12%, P < 0.05) and group C (70% +/- 13%, P < 0.01), but did not change significantly in either group D (123% +/-19%) or group E (142% +/- 15%), compared with the control group (group A; 127% +/- 15%, mean +/-SEM). Nitroglycerin-induced coronary vasodilation was not altered by ischemia/reperfusion in any group. In contrast, myocardial CK activity was significantly lower in group B (3.6 +/- 0.6IU/mg protein, P < 0.01), group C (3.2 +/- 0.1 IU/mg protein, P < 0.01), and group D (3.3 +/- 0.21U/mg protein, P < 0.01) than in group A (47 +/- 6.7 IU/mg protein). The myocardial CK activity of group E was not significantly different from that of group A, but was significantly higher than in groups B, C, and D (P < 0.01). In isolated perfused rat hearts, both the coronary endothelium and myocardium are damaged by repeated episodes of ischemia and reperfusion. However, the coronary endothelium is more resistant to such damage than is the myocardium.

Prognostic significance of persistent right ventricular dysfunction as assessed by radionuclide angiocardiography in patients with inferior wall acute myocardial infarction

We evaluated cardiac hemodynamics and long-term prognosis in patients with right ventricular (RV) acute myocardial infarction (AMI) using Fourier phase and amplitude analysis of radionuclide angiocardiographic scanning. In 143 patients with RV AMI, delayed phase and low amplitude in radionuclide RV images persisted in 54 patients (persistent RV dysfunction group) 3 months after AMI, but disappeared in the remaining 89 patients (improved RV function group). No significant differences were present in RV dimensions, left ventricular (LV) wall motion, LV ejection fraction, or RV ejection fraction between these groups during the acute phase. At 3 months, RV dimension and LV and RV wall motion indexes were significantly higher (p = 0.0292, p = 0.0124, p<0.0001, respectively), and LV and RV ejection fractions were lower (p = 0. 0174 and p = 0.0008, respectively) in the persistent RV dysfunction group. Percutaneous transluminal coronary angioplasty in the acute phase was performed in a smaller group of patients (15% vs. 34%, p = 0.0223), and the degree of residual stenosis in the proximal right coronary artery was significantly greater in the persistent RV dysfunction group than in the improved RV function group (82+/-22% vs. 53+/-30%, p<0.0001). The 8-year survival rate was significantly lower in the persistent RV dysfunction group (p<0.0001). Persistent abnormality of phase and amplitude in radionuclide RV images was a significant independent predictor of long-term survival (odds ratio 10.42; 95% confidence interval 3.65 to 29.71; p<0.0001). Radionuclide angiocardiographic Fourier phase and amplitude scanning can detect persistent RV dysfunction in patients with RV AMI and can predict patient outcome.

Simvastatin enhanced sodium nitroprusside-induced apoptosis of smooth muscle cells. An involvement of geranylgeraniol

A decrease in serum cholesterol is one of the most beneficial effects in anti-atherogenesis. Nitric oxide is also an anti-atherogenic substance, inducing vasodilation and inhibits proliferation of smooth muscle cells (SMC). Therefore, we examined sodium nitroprusside (SNP)-induced apoptosis of vascular SMC with respect to cholesterol metabolism. Cultured vascular SMC from bovine carotid arteries and rat aorta were used. Apoptosis was determined by propidium iodide assay. Treatment of the SMC with SNP(100 micromol/l-1 mmol/l ) for 6 h induced a little nuclear fragmentation. SNP (1 mmol/l ) elicited apoptosis in 4.4+/-2.2% of cells. Pretreatment of SMC with simvastatin (1 microg/ml, 2 days), a hydroxymethylglutaryl Coenzyme A (HMG CoA) reductase inhibitor, synergistically enhanced SNP-induced apoptosis (% apoptosis =15. 9+/-3.3%). Either mevalonate (100 micromol/l) or geranylgeraniol (30 micromol/l) recovered the simvastatin (1 microg/ml)-enhanced SMC apoptosis induced by SNP. Neither squalene (10 mmol/l) nor farnesol (30 micromol/l) had a recovery effect on the simvastatin-enhanced SMC apoptosis induced by SNP. Pretreatment with simvastatin (1 microg/ml) reduced total cholesterol content in SMC. Mevalonate (100 micromol/l) restored a decrease in total cholesterol content. However, incubation with LDL deficient serum did not enhance SNP-induced apoptosis of SMC, although treatment with LDL deficient serum decreased the total cholesterol content in SMC. These data suggested that decrease in HMG CoA reductase metabolites, especially geranylgeraniol might enhance the SNP-induced apoptosis of SMC, and that, apoptosis was not involved in a decrease in cholesterol of SMC.

High frequency of K-ras mutations in biliary duct carcinomas of cases with a long common channel in the papilla of Vater

The frequency of K-ras mutation in biliary duct carcinomas in different locations and the relationship to the form of the junction of the pancreaticobiliary duct (JPBD) are not understood clearly. These points were investigated in the present study. Thirty-seven biliary duct carcinomas in patients without anomalous JPBD were investigated for K-ras mutations. Regarding location, 12 were hilar, 4 in the upper, 11 in the middle, and 10 in the lower portion of the duct. Furthermore, with 14 cases for which the form of the JPBD could be confirmed by endoscopic retrograde cholangiopancreatography or postoperative cholangiopancreatography, division was made into two types: those with a long common channel (>5 mm) in the papilla of Vater (type 1, n = 4), and the other with a shorter or nonapparent common channel (type 2, n = 10). The overall frequency of K-ras mutation was 30%, the incidence gradually increasing from upper to lower regions. K-ras mutations were significantly more frequent in biliary duct carcinomas associated with long common channels (P < 0.05). These results suggest that a long common channel may bear a relation to K-ras mutations in biliary duct carcinogenesis, presumably through its influence on pancreatic juice regurgitation.

Possible involvement of a chloride-bicarbonate exchanger in apoptosis of endothelial cells and cardiomyocytes

We examined the role of ion movement in staurosporine-induced apoptosis of vascular endothelial cells. Cultured vascular endothelial cells from bovine carotid arteries were used. Apoptosis was determined by propidium iodide assay. Treatment of the endothelial cells with staurosporine (10 nmol/l-1 micromol/l) for 6 h induced nuclear fragmentation in a dose-dependent manner. Staurosporine (1 micromol/l) elicited apoptosis in 70.5+/-1.5% of cells. Concomitant treatment of endothelial cells with 1 mmol/l of 4, 4-diisothiocyanatostilbene-2,2-disulfonic acid (DIDS), a chloride-bicarbonate exchange blocker, completely inhibited staurosporine-induced apoptosis. Other ion transporter inhibitors such as dimethyl amiloride and anthracene-9 carboxylic acid were less effective inhibitors of staurosporine-induced apoptosis of endothelial cells. DIDS prevented staurosporine-induced apoptosis of endothelial cells as well as cardiomyocytes. Next, we determined whether chloride ions or bicarbonate are involved in apoptosis. Incubation with a chloride ion removal buffer did not inhibit staurosporine-induced apoptosis of endothelial cells. However, endothelial cell apoptosis was completely suppressed by an inhibitor of caspase, benzyloxycarbonyl-Asp-CH(2)-O(C)O-dichlorobenzene (zD-dcb, 50 micromol/l). Staurosporine (1 micromol/l) increased the intracellular pH of endothelial cells, and DIDS (1 mmol/l), but not a caspase inhibitor, inhibited this increase in pH caused by staurosporine. Our findings suggest that endothelial cell apoptosis induced by staurosporine may be associated with the Cl(-)and bicarbonate (HCO-3) ions. Thus, Cl(-)efflux from cells or HCO-3 influx to cells (which increases pH) may play an important role in signal transduction leading events such as activation of caspase in staurosporine-induced apoptosis.

Enantioselective Addition of Allylic Trimethoxysilanes to Aldehydes Catalyzed by p-Tol-BINAP small middle dotAgF

Catalytic asymmetric allylation of aldehydes with allylic trimethoxysilanes was achieved with the p-Tol-BINAP small middle dotAgF complex as catalyst [Eq. (a); p-Tol-BINAP=2,2'-bis(di-p-tolylphosphanyl)-1,1'-binaphthyl)]. High anti and enantioselectivities were obtained in the reaction with crotyltrimethoxysilane, irrespective of the configuration at the double bond.

[Mesh and glue technique as a new sealing technique for the use of expanded polytetrafluoroethylene dura substitute: the experimental studies of its tolerance for pressure and long-term histological changes]

Expanded polytetrafluoroethylene (ePTFE) as a dural substitute is sometimes associated with leakage of cerebrospinal fluid through the suture line. We have developed a new technique to seal the suture line with an absorbable mesh and fibrin glue. It is named as the mesh-and-glue technique. In this paper, the basic background of the efficacy of this technique was examined using in vitro and in vivo experimental models. The sealing effect was estimated on water leakage through 1 cm of suture line on the ePTFE sutured with 4-0 braided nylon at intervals of 2mm. The burst pressure of the non-sealed, conventional fibrin glue, simple glue spray, mesh-and-glue, and mesh-and-glue combined with spray was 2.8 +/- 0.4, 4.3 +/- 1.2, 64.4 +/- 21.4, 142.7 +/- 22.2 and 406.1 +/- 29.7 cm H2O respectively. It was worth noting that mesh-and-glue combined with the spray method can tolerate even arterial pressure. It was also observed that mesh-and-glue can seal a small dural defect. Long-term pathological changes of the mesh-and-glue was examined in a murine craniotomy model. Implanted mesh and fibrin glue was gradually transformed into a tight connective tissue firmly adhering to the surrounding structure within two months. These experimental results well support the clinical efficacy of the mesh-and-glue technique. This technique can also be applied to seal the arachnoid membrane after spinal surgery or to seal the suture line of arteriotomy in carotid endoarterectomy.

Histological indications of a favorable prognosis with far-advanced gastric carcinomas after preoperative chemotherapy

PURPOSE

Although preoperative chemotherapy for advanced gastric cancer is now commonly applied with favorable results, convincing evidence for life prolongation and predictive markers for a good prognosis are both lacking. We report here 5 cases that have shown a distinct positive effect of preoperative chemotherapy together with the results of a precise histological examination of materials indicating features predicting a favorable outcome.

PATIENTS AND METHODS

A total of 18 patients with a far-advanced gastric carcinoma subjected to gastrectomy after FLEP (5-fluorouracil, leucovorin, etoposide, cisplatin) in the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, could be divided into two distinct groups: 5 surviving over 5 years (group A) and 13 who died within 13 months (group B). Histological features (subtypes) of the carcinomas and chemotherapeutic effects were studied with reference to biopsy materials and resected stomachs and lymph nodes.

RESULTS

In group A, 3 of 5 patients had solid-type poorly differentiated adenocarcinomas. In contrast, in group B, 9 had tubular adenocarcinomas (well or moderately differentiated) and 3 non-solid or diffuse-type poorly differentiated adenocarcinomas and there was only one solid-type tumor. In group A, remarkable therapeutic effects were apparent histologically in 4 of the 5 patients with almost complete disappearance of cancer cells from metastases in lymph nodes, whereas no such changes were evident in group B.

CONCLUSION

FLEP is distinctly beneficial for certain types of advanced gastric carcinoma, especially solid-type poorly differentiated adenocarcinomas, and favorable results can be predicted, to a certain extent, on the basis of findings for the material resected after chemotherapy.

Hepatic lymph node involvement in resected cases of liver metastases from colorectal cancer

PURPOSE

Lymph node metastasis in the hepatoduodenal ligament is known as one of the most significant prognostic factors after liver resection for colorectal metastasis. However, there have been very few articles on the clinical features of node-positive patients and on detailed distribution of positive nodes. Further, there has been no established strategy on how to handle hepatic lymph nodes during liver resection. To address these subjects, a retrospective study was conducted.

METHODS

During the period of 1980 through April 1998, 182 hepatic resections were performed for metastatic colorectal carcinoma. Of these, 78 cases had hepatic lymph node sampling during the operation. Distribution of positive nodes, location of liver metastasis, stage of the primary lesion, and outcome after liver resection were analyzed.

RESULTS

Nine cases (12 percent) had secondary lymph node metastases in the hepatoduodenal ligament. The incidence was slightly higher (13.5 percent) in the most recent 44 consecutive cases. There was a tendency for liver metastases in the right lobe to metastasize to No. 12b (or node of the foramen of Winslow, lymph nodes along the common bile duct) and liver metastases in the left lobe to metastasize to No. 8a (anterosuperior group of the lymph nodes along the common hepatic artery). Outcome of node-positive patients (n = 9) was extremely poor (P < 0.001) compared with that of node-negative patients (n = 66), and the most common site of recurrence in the node-positive patients was remnant liver and hepatic lymph nodes. Preoperatively, there were no significant predicting factors for positive hepatic lymph nodes.

CONCLUSIONS

No. 8a and No. 12b nodes are principal nodes that should be palpated and sampled during liver resection to check the secondary lymphatic spread from liver metastases. Hepatic nodal involvement indicates the progression of disease beyond simple liver metastases and may not be the indication for simple surgical removal. Further study, including hepatoduodenal dissection and systemic adjuvant chemotherapy, may elucidate the survival benefit, if any, of liver resection in node-positive patients.

Losses of heterozygosity on chromosomes 17p and 9p/18q may play important roles in early and advanced phases of gallbladder carcinogenesis

PURPOSE

This present study aimed to investigate the genetic changes in gallbladder carcinogenesis.

METHODS

Eleven intramucosal gallbladder carcinomas were compared with 31 invasive lesions for loss of heterozygosity (LOH) on chromosomes 5q, 9p, 17p and 18q, frame-shift mutations in a ten-adenine repeat site within the gene encoding the transforming growth factor beta type II receptor (TGFbetaRII) and an eight-guanine repeat site within BAX, and point mutations in codon 12 of Ki-ras.

RESULTS

The incidences of LOH in intramucosal and invasive carcinomas were 14% and 17% on 5q, 9% and 52% on 9p, 64% and 65% on 17p, and 13% and 32% on 18q. No frame-shift mutations were found at TGFbetaRII or BAX, and point mutations in codon 12 of Ki-ras were present in only 8% of the samples. Thus, LOH on 17p was by far the most frequent lesion with similar results in both intramucosal and invasive carcinomas. In contrast, the frequency of LOH on 9p and 18q was distinctly higher in invasive lesions.

CONCLUSION

The present data suggest that LOH on 17p may play an important role in the evolution of gallbladder carcinoma from a relatively early phase, while LOH on 9p and 18q may play roles in progression.

Non-polypoid colorectal neoplasias: a multicentric study

A total of 781 non-polypoid colorectal neoplasias harvested at 4 main Hospitals in Tokyo, Japan (n = 420) and at 4 different time-intervals at the Karolinska Hospital, Stockholm, Sweden (n = 361) were reviewed. By applying strict histologic definitions, the lesions were classified into adenomas with low grade dysplasia (LGD), with high grade dysplasia (HGD), intramucosal carcinomas (IMC) or submucosal carcinomas (SMC). Of the non-polypoid neoplastic lesions reviewed in Sweden, 82.8% (n = 299) had LGD. In Japanese patients only 42.6% (n = 179) had LGD (p < or = 0.001). On the other hand, as many as 42.4% (n = 178) of the non-polypoid lesions in Japanese patients had HGD, but only 14.1% (n = 51) of those in Swedish patients (p < or = 0.001). Whereas 15.0% (n = 63) of the non-polypoid neoplasias seen in Japan were IMC or SMC, only 3.0% (n = 11) of those seen in Sweden were IMC or SMC (p < or = 0.001). The cause(s) for these differences remains unclear. In Japan, however, a marked increased incidence of colonic cancer has been recorded in later years. Whether the "catching up phenomenon" by the Japanese with western colonic cancer incidence includes increased histologic aggressiveness of non-polypoid neoplastic polyps--as found in this survey--remains to be elucidated.

Physiological changes in Pachinko players; beta-endorphin, catecholamines, immune system substances and heart rate

Pachinko is a popular form of recreation in Japan. However, in recent years, along with Pachinko's popularity, "Pachinko dependence" has become topical news. The purpose of this study was to investigate beta-endorphin, catecholamines, immune system responses and heart rate during the playing of Pachinko. The following significant results were observed. (1) Plasma concentration of beta-endorphin increased before playing Pachinko and while in the Pachinko-center (p < 0.05). (2) Beta-endorphin and norepinephrine increased when the player began to win (i.e. at "Fever-start") compared to baseline (p < 0.05). (3) Beta-endorphin, norepinephrine and dopamine increased when the winning streak finished (i.e. at "Fever-end") compared to baseline (p < 0.05-0.01). (4) Norepinephrine increased past 30 minutes after "Fever-end" compared to baseline (p < 0.05). (5) Heart rate increased before "Fever-start" compared to baseline, peaked at "Fever-start" and rapidly decreased to match rates measured at rest. But the increase was observed from 200 seconds after "Fever-start" (p < 0.05-0.001). (6) There was a positive correlation between the number of hours subjects played Pachinko in a week and the differences between beta-endorphin levels at "Fever-start" and those at rest (p < 0.05). (7) The number of T-cells decreased while the number of NK cells increased at "Fever-start" compared to baseline (p < .05). These results suggest that intracerebral substances such as beta-endorphin and dopamine are involved in the habit-forming behavior associated with Pachinko.

Early detection of anthracycline-induced cardiotoxicity by radionuclide angiocardiography

For the early detection of myocardial damage associated with anthracycline therapy, electrocardiography, echocardiography, and radionuclide angiocardiography were used to assess cardiac function in 37 patients receiving anthracyclines (ie, adriamycin and daunorubicin at a total dose of 100-2,030 mg/m2). None of the patients developed clinical congestive heart failure. There were no significant changes of electrocardiographic and echocardiographic parameters after anthracycline administration. The left ventricular ejection fraction did not change significantly on radionuclide angiocardiography. However, the 1/3 peak filling rate (PFR) corrected by the end-diastolic count (EDC) (1/3 PFR/EDC) and the 1/3 filling fraction (1/3 FF), the indices of early diastolic function, showed a significant decrease. These findings suggest that the 1/3 PFR/EDC and 1/3 FF determined by radionuclide imaging are useful for detecting silent myocardial damage induced by anthracyclines.

Pathological characteristics of gastric carcinomas in the very old

A total of 69 gastric carcinomas of very old people (aged > or = 85) were collected and pathologically analyzed in comparison with those of young to middle-aged (30-39) and elderly (65-69) people, with special attention to their phase. In the very old, almost all (34/35) carcinomas in the early phase belonged to well-differentiated categories. In the advanced phase, half of them (17/34) were classified into poorly differentiated categories when determined from the predominant pattern, but a well-differentiated pattern almost always coexisted in the superficial site. Thus, the gastric carcinomas in the very old may principally develop as well-differentiated carcinomas which then progress to poorly differentiated carcinomas with time, in contrast to those of the young to middle-aged, most of which emerged from the very early phase as poorly differentiated lesions. The gross features of the carcinomas were also in line with these histological observations. The carcinomas of the elderly showed distinct similarity to those of the very old. The results suggest that poorly differentiated carcinomas of the young to middle-aged and the old may be better classified and analyzed separately in view of the generally recognized etiological (e.g., specifically close causal relationship with environmental factors of the intestinal-type carcinoma of the old) and biological (e.g., practically no tendency for hematogenous metastasis of the diffuse-type carcinoma of the young to middle-aged) differences, although in the General Rules for Gastric Cancer Study of Japan, both are placed in the same category, por (por2).

Pancreatic metastasis from a lung cancer. Preoperative diagnosis and management

A case of a surgically resectable solitary metastasis to the pancreas from a lung cancer, confirmed by immunohistochemical staining (PE-10), is reported. ERCP revealed meniscoid interruption of the main pancreatic duct, which is uncommon in patients with primary pancreatic cancers of the pancreas in our hospital. This patient lived for 29 mo after the surgical resection of the pancreatic lesion. Therefore when metastasis limited to the pancreas is evident on clinical imaging, surgical management may be more optimal than other treatment approaches.

Histologic phenotypes of colonic carcinoma in Sweden and in Japan

The occurrence of predominant histologic phenotypes in overt colonic carcinomas from two disparate geographical regions were analyzed. A total of 424 overt colonic carcinomas (223 in Swedish and 201 in Japanese patients) were classified into predominant phenotypes (i.e. comprising > 50% of the tumor). Six predominant phenotypes were found: tubular, serrated-microcystic, villous, fenestrated, signet ring cell and undifferentiated. A predominant phenotype was present in 57.3% (n = 243) of the 424 tumors (in 55.2% of the 223 tumors from Swedish patients and in 61.7% of the 201 tumors from Japanese patients). The serrated-microglandular phenotype was significantly more frequent in Japanese than in Swedish patients. Environmental and/or ethnic factors may be the possible cause(s) for that difference. The frequency of regional lymph node tumor spread (Dukes C) was significantly lower in serrated-microglandular and in villous phenotypes than in undifferentiated-signet ring cell types, despite that patients harbouring either one of the two former phenotypes were among the oldest in the whole series. Serrated-microglandular and villous colonic cancer phenotypes may carry a better prognosis (independently of their degree of histologic differentiation or age) since they are less prone to metastasize to regional lymph nodes than undifferentiated-signet ring cell phenotypes.

Progress in the study of pancreatic cancer and its pathology

Recent advances in diagnostic techniques allow detection of relatively small ductal cancers and mucinous cystic neoplasms of the human pancreas. The histopathological characteristics of a series of such small pancreatic carcinomas encountered in our hospital were: 1) all were invasive ductal carcinomas accompanied by fibrosis, 2) four of seven carcinomas were thought to originate in the branch ducts, 3) no precancerous lesions were found, and 4) lymph node metastasis was detected in only one patient. Mucinous cystic neoplasms were of two types: megacystic and ductectatic. The megacystic type is the classical mucinous cystic neoplasm. The ductectatic type is characterized by the presence of multilocular cysts (reminiscent of bronchiectasia of the lung), and papillary proliferation of the lining epithelium-differing from typical ductal carcinomas as well as from megacystic lesions in terms of morphological features, intrapancreatic location, patient age, and sex. The ductectatic type occurs exclusively in the head and body of the pancreas, and is found predominantly in aging males.

Clinicopathologic and immunohistochemical studies of papillary thyroid microcarcinoma presenting with cervical lymphadenopathy

Although most papillary thyroid microcarcinomas (PMCs) are of little clinical significance, patients with PMCs occasionally have an unfavorable outcome, especially when they present with bulky nodal metastasis or distant metastasis. We have attempted to identify "high-risk" PMCs by evaluating clinical, pathologic, and immunohistochemical prognostic factors. Among 190 patients with a PMC, 156 without clinically apparent nodal metastasis had a benign course. The remaining 34 patients, who presented with cervical lymphadenopathy of at least 1 cm, were studied. Three of the four patients who developed distant metastasis died of the disease, and the other died of local recurrence. All patients who developed distant metastasis or died of the disease had both nodal metastasis of at least 3 cm and a nonencapsulated type of primary lesion. All patients who developed distant metastasis showed both extracapsular extension of the metastatic lesions in lymph nodes and positive staining for transforming growth factor-beta3 (TGFbeta3) (a potent growth inhibitor) in the primary lesion. The Ki-67 (an indicator of cell proliferation) labeling indices in the primary and metastatic nodal lesions of patients who died of cancer were significantly higher than those of the others with nonfatal disease. None of the patients showed P53 (nuclear tumor-suppressor phosphoprotein) overexpression. In conclusion, patients with PMC who have both 3 cm or larger lymphadenopathy and a nonencapsulated type of primary lesion may be regarded as high-risk patients. Immunohistologic positivity for Ki-67 and TGFbeta3 in cancer cells is a potential indicator of aggressively malignant PMC.

Clinical role of p53 and p21WAF1/CIP1 in squamous cell carcinoma of the pyriform sinus

To investigate the clinical significance of p53 and p21WAF1/CIP1 in the advanced squamous cell carcinoma (SCC) of the pyriform sinus, we performed immunohistochemical staining of p53 and p21WAF1/CIP1 on the biopsy specimens from patients with stage III or stage IV SCC of the pyriform sinus. The results were compared with clinico-pathological features, including age, histological grade, TNM classification, number of neck lymph node metastases on histopathological examination (pLN) and prognosis. Specific staining for p53 and p21WAF1/CIP1 was detected in 36% and 32% of the specimens, respectively. Positive staining of p21WAF1/CIP1 was observed not only in the p53-negative specimens but also in the p53-positive specimens. Age (p < 0.05) and pLN (p < 0.001) were regarded as the significant prognostic factors. The 5-year survival rate of the p53-positive patients (55%) was significantly higher than that of the p53-negative patients (26.5%: p < 0.03). However, there is no significant difference between the p53 groups after controlling pLN. Although it was not statistically significant, the 5-year survival rate of the p21WAF1/CIP1-positive patients (58.8%) was higher than that of the p21WAF1/CIP1-negative patients (26.9%). These results suggest that expressions of p53 and p21WAF1/CIP1 are independent genetic alterations that may play different roles in the SCC of the pyriform sinus. Expression of p53 could not be regarded as an independent prognostic factor at this point. Further studies including the molecular biological analysis should be performed in order to determine the clinical role of p21WAF1/CIP1.

Suppressive effect of a chloride bicarbonate exchanger inhibitor on staurosporine-induced apoptosis of endothelial cells

We examined staurosporine-induced apoptosis of vascular endothelial cells with respect to ion movement. Cultured vascular endothelial cells from bovine carotid arteries were used. Apoptosis was determined by propidium iodide assay. Treatment of the endothelial cells (EC) with staurosporine (1 mumol/l) for 6 h induced nuclear fragmentation in 70.5 +/- 1.5% of cells. Concomitant treatment of ECs with 1 mmol/l of 4,4-diisothiocyanatostilbene-2,2-disulfonic acid (DIDS), a chloride bicarbonate exchange blocker, completely inhibited staurosporine-induced apoptosis. Next, we determined whether chloride ion or bicarbonate is involved in apoptosis. Incubation with a chloride ion removal buffer did not inhibit staurosporine-induced apoptosis of ECs; in fact, the buffer itself induced apoptosis in 30.6 +/- 3.3% of cells. Apoptosis due to chloride ion removal was completely inhibited by DIDS (1 mmol/l). Moreover, EC apoptosis due to staurosporine and due to chloride ion (Cl-) removal was completely suppressed by an inhibitor of Ced-3/interleukin 1 beta-converting enzyme (ICE) proteases, benzyloxycarbonyl -Asp- CH2- O(C)O-dichlorobenzene (zD-dcb; 50 mumol/l). Staurosporine (1 mumol/l) increased the intracellular pH of ECs, and DIDS (1 mmol/l) inhibited the increase in pH caused by staurosporine. Our findings suggest that EC apoptosis induced by staurosporine is associated with Cl- and bicarbonate ion (HCO3-). Thus, Cl- efflux from cells or HCO3- influx to cells (which increases pH) may play an important role in signal transduction, such as activation of Ced-3/ICE proteases in staurosporine-induced apoptosis.

Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction

The clinical significance of the time of onset of atrial fibrillation (AF) was investigated in patients with acute myocardial infarction (AMI). Among 1,039 patients with AMI, 100 (9.6%) had AF. These patients were divided into 3 groups: AF group 1 (n = 45), who developed AF within 24 hours of the onset of AMI; AF group 2 (n = 41), who developed AF >24 hours after the onset of AMI; and AF group 3 (n = 14), who developed AF before the onset of AMI. The infarct-related lesion was most frequent (67%) in the proximal right coronary artery in AF group 1 (p <0.01). Right atrial pressure was most significantly increased in AF group 1. The left atrial dimension and pulmonary arterial wedge pressure were most significantly increased, and left ventricular ejection fraction was most significantly decreased in AF group 2. In the acute phase, the frequencies of heart failure, cardiogenic shock, and in-hospital mortality were higher for all 3 AF groups than the sinus group (p <0.01). The long-term survival rate was significantly lower in AF group 1 and AF group 2 than in the sinus group. AF was an independent predictor of cardiac death in both AF group 1 (odds ratio 2.5; 95% confidence interval 1.2 to 5.0; p = 0.0012) and AF group 2 (odds ratio 3.7; 95% confidence interval 1.8 to 7.5; p = 0.0005), but not in AF group 3. The onset time of AF appears to be a useful parameter for evaluating the cardiac status and prognosis of patients with AMI.