[An unusual case of pyogenic hepatic abscess rupturing into the pericardial cavity]

A rare case of pyogenic hepatic abscess that ruptured into the pericardial cavity is reported. A 50-year-old female who had been admitted for cholangitis associated with bi-lateral stricture of bile duct and intrahepatic stones, presented a pyogenic hepatic abscess in the left lobe on an abdominal computed tomography (CT). Percutaneous transhepatic abscess drainage (PTAD) was performed. But during PTAD-graphy five days later, cardiac tamponade developed secondarily to rapid accumulation of contrast medium in the pericardial cavity flowing from liver abscess. An emergency subxiphoid pericardectomy was performed and she made a good recovery. Unfortunately seven months later, she died of septicemia caused by a newly developed abscess in the right lobe of the liver.

[Clinical evaluation of hepatic arterial infusion chemotherapy in patients with liver metastases from colorectal cancer]

Seventy-four cases of hepatic metastasis of colorectal cancer experienced in our hospital from January 1988 to February 1996 were examined for hepatic arterial infusion chemotherapy induced macrobiotic effect. A group (21 cases of hepatectomy and hepatic arterial infusion chemotherapy), B group (31 cases of hepatic arterial infusion chemotherapy only) and C group (22 cases of iv and po systemic chemotherapy) were comparatively examined for survival rate using Kaplan-Meier method. Single administration of adriamycin, epirubicin, cisplatin (CDDP) and 5-FU, along with CDDP-5-FU combined therapy and 5-FU 1,000 mg/5 hr intermittent continuous infusion therapy, were used. Mean survival period was 719 +/- 369, 426 +/- 417, 158 +/- 125 days for groups A, B and C, respectively. One-year survival rate by degrees of H factor was comparatively examined because of different H factor rates for these 3 groups. As a result, it proved to be 83 and 40% for groups A and B, respectively, in H1,2 cases and 32 and 11% for groups B and C, respectively, in H3 cases, with their respective significant differences (p < 0.05). Positive treatment, including hepatectomy, hepatic arterial infusion chemotherapy and the like, was suggested to contribute to patient macrobiosis.

Hepatocellular carcinoma associated with anabolic steroid therapy: report of a case and review of the Japanese literature

We report herein the case of a 35-year-old woman with aplastic anemia who developed hepatocellular carcinoma after long-term therapy with oxymetholone. She was treated with 60 mg/day of oxymetholone for 3 years (total dose 64.8 g). Alpha-fetoprotein, hepatitis B surface antigen, and hepatitis C antibody were all negative, but serum titers of carcinoembryonic antigen and carbohydrate antigen were elevated. Lateral segmentectomy of the liver was performed. The histopathological findings were compatible with those of multiple hepatocellular carcinoma without liver cirrhosis. Three years since the operation, the patient is doing well and no signs of tumor recurrence have been detected. According to our review of Japanese cases of hepatocellular carcinoma associated with anabolic steroid therapy, in all instances the tumors developed after long-term administration of anabolic steroids for hematologic diseases. In patients under long-term anabolic steroid therapy, routine screening of the liver by ultrasonography and computed tomography should be performed to detect liver tumors in the early stages.

Comparison of axonemal proteins from two kinds of Tetrahymena. I. Different characteristics of dyneins in heat stability

Tetrahymena thermophila could still swim after incubation of the cell body at 40 degrees C for 30 min, whereas Tetrahymena pyriformis did not show any motility after the treatment. Turbidity measurements revealed that axonemes of T. pyriformis lost ATP-dependent sliding activity by the heat treatment, whereas those of T. thermophilia still had the activity under the same conditions. In connection with this difference in susceptibility to high temperature, the biochemical characteristics of dyneins were compared between the two species of Tetrahymena. Axonemal dyneins from the two species had significant vanadate-sensitive ATPase activity even after the heat treatment. Native gel electrophoresis and the following two-dimensional electrophoresis showed that the outer arm dynein of T. thermophilia is more stable in maintaining native configuration than that of T. pyriformis against the heat treatment, although both treated dyneins keep three (alpha, beta and gamma) subunits. Analysis by peptide mapping demonstrated that beta- and gamma-subunits of the outer arm dynein are considerably different in amino acid sequences between the two species. These results imply that dynein of T. thermophilia changed their amino acid sequences and biochemical characteristics to adapt to high temperature.

[Outcomes of effective treatment of cases of metastatic liver tumors by intra-arterial infusion chemotherapy]

We studied the prognoses of unresectable liver tumors, including 31 colorectal cancers and 10 gastric cancers treated by intra-arterial infusion chemotherapy using an implantable reservoir. Adriamycin, epirubicin, or cisplatin were administered intermittently early on. Cisplatin and 5-FU combined therapy were given later. In nine with colorectal metastases and six with gastric metastases, metastatic lesions decreased, and in 4 patients with metastatic lesions could be resected. But in many patients, hepatic and other organ recurrences were observed. We need to try many other treatments.

Galactose-containing amphiphiles prepared with a lipophilic radical initiator: association processes between liposomes triggered by enzymatic reaction

A galactose-containing monomer (2-(methacryloyloxy)ethyl beta-D-galactopyranoside, MEGal) was polymerized by using a lipophilic radical initiator. The amphiphile obtained formed a liposome by mixing with bis(trans,trans-2,4-dioctadecadienoyl)phosphatidylcholine (DDPC), and the liposome obtained was physically stabilized by the polymerization of DDPC by UV irradiation. The enzymatic treatment of the galactose-containing liposomes with galactose oxidase resulted in the formation of aldehyde groups on the liposome surface. By the subsequent mixing of the liposome suspension with the amino group-containing liposome suspension, a rapid increase in turbidity was observed due to the formation of Schiff bases between the aldehyde groups and the amino groups at the interface of the liposomes. The rate of turbidity change strongly depended on the degree of polymerization of MEGal, the surface densities of galactose and amino groups on the liposome, the distance from the liposome surface to amino end groups, and the flexibility and deformability of the liposomes.

Galactose-containing amphiphiles prepared with a lipophilic radical initiator

Novel amphiphiles which contain galactose residues (degree of polymerization (DP) = 6.2, 10, and 15) were prepared by telomerization of 2-[(methacryloyloxy)ethyl]-beta-D-galactopyranoside using a lipophilic radical initiator. The galactose-carrying amphiphile incorporated in a liposome was recognized by a lectin from Ricinus communis (RCA120), which was proven by the increase in turbidity of the liposome suspension after mixing with the lectin. The recognition was largely affected by the degree of polymerization and the surface density of the amphiphile. The amphiphile would be useful as a component of the drug delivery system to hepatocytes.

[Evaluation of cases of metastatic liver tumors resected following intra-arterial infusion chemotherapy]

We encountered four cases whose unresectable metastatic liver tumors could be resected by operation after intra-arterial infusion chemotherapy using an implantable reservoir. Metastatic lesions were thus markedly reduced and localized. Three cases were metastases of colorectal cancer and one of gastric cancer. All cases of liver metastases were synchronous and more than H2 stage. In these cases, metastatic lesions were reduced at an early stage of this chemotherapy after resection of the primary lesions. Resection of metastases was carried out from 4 to 14 months after the first operation. Effects of this chemotherapy were also observed histologically; necrosis and fibrosis were found in the cancer nest, which paralleled the reduction in tumor size. Our results indicate that this chemotherapy could be a neoadjuvant chemotherapy for unresectable metastatic liver tumors which may become resectable after this chemotherapy as seen in our cases. However, lung metastases and peritoneal dissemination influenced the prognosis of our cases. Treatment of extra-hepatic recurrence seemed important to improve the prognosis of these patients.

Cloning and expression of a 5-hydroxytryptamine7 receptor positively coupled to adenylyl cyclase

A cDNA clone (designated as GP2-7) encoding a novel 5-hydroxytryptamine (5-HT) receptor was isolated from a guinea pig hippocampal library. The receptor shares amino acid homology within the hydrophobic domains with other cloned 5-HT receptor subtypes (34-48%). The sequence of GP2-7 is homologous to that described for a novel receptor previously cloned from a rat brain cDNA library and provisionally designated as 5-HT7. mRNA for GP2-7 was detected in cortical and limbic brain regions. Transiently expressed GP2-7 showed high-affinity binding to [3H]5-HT (pKi = 9.0) with the following rank order of affinities: 5-carboxyamidotryptamine (5-CT) > 5-HT = 5-methoxytryptamine (5-MeOT) > methiothepin > 8-hydroxy-2-(dipropylamino)tetralin (8-OH-DPAT) > spiperone >> sumatriptan. Adenylyl cyclase activity in CHO-K1 cells transiently transfected with GP2-7 was stimulated by several analogues of 5-HT with the following order of potency: 5-CT > 5-HT = 5-MeOT > dipropyl-5-CT > 8-OH-DPAT. Methiothepin and spiperone were potent antagonists. Preliminary analysis suggests that GP2-7 closely resembles a receptor in the guinea pig hippocampus that exhibits a high affinity toward 5-CT.

[Reservoir system implantation technique via the inferior epigastric artery for local recurrence of rectal cancer]

A reservoir system was implanted via the inferior epigastric artery into the internal iliac artery for local recurrence of rectal cancer under lumbar anesthesia. At the same time, the internal iliac artery on the opposite side of the tumor and the superior and inferior gluteal artery on the tumor side were embolized by gelform and coil. Five-hour continuous intraarterial infusion of 1,000 mg/m2 of 5-FU with intravenous drip infusion of 20 mg/m2 of leucovorin and one shot intraarterial infusion of 50 mg/m2 of cisplatin were performed as the treatment. This technique allows easier insertion of the catheter than by the conventional method, elevates the anticancer drug levels in the pelvic cavity and prevents ulcer of the buttocks and perineum. The technique is considered an effective form of treatment for local recurrence of rectal cancer.

[Study of intra-arterial infusion chemotherapy for hepatocellular carcinoma using an implantable reservoir]

Twenty-two patients with unresectable hepatocellular carcinoma were treated by intra-arterial infusion chemotherapy using an implantable reservoir. The catheter was placed in the hepatic artery via the left subclavian artery. Adriamycin or epirubicin were administered intermittently. From the result, the response rate in all cases was 22.7%, and no difference in the response rate by Stage was observed. However, the less the hepatic disturbance, the greater the effect was: 75% in clinical stage I, 18.2% in II and 0% in III. Significant differences of ICG R15, doses and frequency of intra-arterial infusion were observed between PR, NC and PD cases. The usefulness of this chemotherapy was suggested in highly advanced hepatocellular carcinoma, especially in Vp3.

[A case of breast cancer with thrombosis during treatment of lung metastasis]

A 74-year-old female with lung metastasis of breast cancer was treated with chemo-endocrine therapy (intravenous administration of epirubicin at 30 mg/2w, oral administration of UFT at 400 mg/day, alternate oral administration of medroxyprogesterone acetate at 800 mg/day and tamoxifen at 40 mg/day) and immuno-therapy (intravenous administration of lentinan at 2 mg/w). Lung tumors decreased in size and number. At the same time, deep vein thrombosis of the lower extremities occurred, which caused multiple pulmonary embolization. In this case, several factors were suggested to cause thrombosis in the advanced or recurrent breast cancer patient.

[A case of liver metastasis from retroperitoneal leiomyosarcoma successfully treated by intra-arterial infusion chemotherapy of adriamycin or epirubicin using an implantable reservoir]

A 59-year-old woman was diagnosed as having liver metastasis (H3) 38 months after undergoing resection for retroperitoneal leiomyosarcoma. A catheter was placed in the hepatic artery and intra-arterial infusion chemotherapy using an implantable reservoir was performed with 30 mg of adriamycin or epirubicin at each treatment every 2-4 weeks. Imaging revealed that the tumor had been markedly reduced, and a partial response was obtained for 18 months. The patient has survived for 33 months since liver metastasis was detected. Although effective chemotherapy for metastatic leiomyosarcoma in the liver has been poorly documented, intra-arterial infusion chemotherapy proved highly effective in this case, suggesting that it effectively improved the prognosis.

[Therapeutic results of intra-arterial infusion chemotherapy using an implantable reservoir on metastatic liver tumors]

Forty-four patients with unresectable liver tumors including 25 colorectal cancers, 7 gastric cancers, 6 breast cancer, and 6 other diseases, were treated by intra-arterial infusion chemotherapy using an implantable reservoir. The catheter was placed in hepatic artery via left subclavian artery or by direct insertion at laparotomy. Adriamycin, epirubicin or cisplatin were administered intermittently. Response rate was 31.8% for colorectal cancer, 42.9% for gastric cancer, and 60.0% for breast cancer, averaging 37.5% for all cases. Response in colorectal cancer tended to be higher for cases of H2, well-differentiated adenocarcinoma, and v(-). Response was also validated by survival time and changes in CEA. In a few patients, metastatic lesions could be resected after this treatment. Our results indicate that in combination with an aggressive surgical procedure, this treatment may improve the prognosis of patients with metastatic liver tumors.

Extension incision for renal carcinoma including invaded vena cava and right lobe of liver

We report on a thirty-five-year-old woman with renal cell carcinoma who successfully underwent right radical nephrectomy and extended right hepatic lobectomy with resection and reconstruction of inferior vena cava (IVC). A temporary bypass was placed between the infrarenal IVC and right atrium using a heparin-coated synthetic tube. The tumor was resected en bloc including right kidney, adrenal gland, hepatic lobe, and IVC. The IVC was reconstructed using an expanded polytetrafluoroethylene (EPTFE) graft. Her postoperative course was uneventful with no signs of recurrence four years after surgery.

[Experimental study of combination medical endocrine therapy on DMBA-induced mammary tumor, with special reference to the effect of drug-dose on various factors]

Changes of various factors associated with the antitumor effect of medroxyprogesterone acetate (MPA) and tamoxifen (TAM) against the DMBA-induced mammary tumor in rats were studied. Tumor bearing SD rats were divided into control group and experimental groups, consisting of single therapy group and combination therapy groups; TAM----MPA (T----M) group and MPA----TAM (M----T) group. A much higher degree of suppression of tumor growth was observed in the combination groups than in the single group. A significant reduction of spleen weight was observed in all of the experimental groups. The reduction of ER-expression in mammary tumor was observed in MPA groups (M, T----M) and in TAM groups (T, M----T), whereas the reduction of PgR was seen in two kinds of combination groups. The serum level of luteinizing hormone was decreased in M, but not in the combination groups. No change was observed in the percentage of pan T, CD4+ and CD8+, T cell subsets, except Thy 1+T cell was decreased depending on the MPA dose. In the combination group, using high dose MPA, the reduction of the degree of inflammatory cell infiltration into the adenocarcinomatous foci was observed immunohistochemically. These findings indicate that the combination medical endocrine therapy for mammary tumor might be much more effective for the tumor regression than single use, without inducing any detectable side effects on either hormonal or immune systems, when a low dose of MPA less than 1.5 mg/100g B.W. was combined with TAM.