Discriminant validity of the Inventory to Diagnose Depression between patients with major depression and pure anxiety disorders

We examined the discriminant validity of the Inventory to Diagnose Depression (IDD), a self-report instrument designed to diagnose major depressive disorder as defined in DSM-III-R. Forty patients with major depression (MD), 20 patients with anxiety disorders, who had not had a lifetime history of depression (ADs), and 40 control subjects completed the IDD. The IDD results were compared in the three contrasting groups (MD vs. AD+control subjects, MD vs. AD, and MD vs. control subjects). The concordance between the IDD and clinical diagnoses, using a structured interview, was significantly high in the three groups (k = 0.81, 0.66, 0.90, respectively). The IDD total score in the MD group was the highest among the three groups and was distinguished from the AD group or control group (P < 0.001, F = 139.9, d.f. = 2,97). However, the IDD occasionally diagnosed subjects with AD as having MD.

[Clinical statistics of living and cadaveric renal transplantation at the Department of Urology, Mie University School of Medicine]

A statistic survey was made on the clinical results of living and cadaveric renal transplantations performed at our department between October 1980 and June 1996. A total of 38 patients received 6 living and 32 cadaveric renal transplants. The graft and patient survival rates of a living renal transplantation were 83.3% and 100% at 3 years, respectively. The graft survival rate of cadaveric renal transplantation was 66.3% at 3 years and 56.0% at 5 years. In a cadaveric renal transplantation, patients with episodes of acute rejection within 12 months showed a significantly worse graft survival rate. This clinical parameter seems to be a prognostic factor for a long-term graft survival.

A safe technique for laparoscopic cholecystectomy for incarcerated gallbladder stone

BACKGROUND/AIMS

We present our new laparoscopic technique for treating incarcerated stones in either the cystic duct or the neck of the gallbladder.

PATIENTS AND METHODS

One hundred sixteen patients who underwent laparoscopic cholecystectomy were studied.

RESULTS

In all, 18 patients (16%) were found to have incarcerated stones in gallbladder or cystic duct. Eleven patients were drip infusion cholangiography (DIC) negative. The length of the operative time for these patients was significantly longer than that in non-incarcerated stone cases. We present our new laparoscopic technique for treating incarcerated stones in either the cystic duct or neck of the gallbladder and this procedure includes a needle aspiration of the bile juice, the transsection and removal of the incarcerated stone and an extracorporeal ligation.

CONCLUSIONS

This above procedure was successfully performed on a series of 4 patients. Our procedure is therefore considered to allow us to complete a laparoscopic cholecystectomy even in extremely hypertrophic cases with incarcerated stones either in the cystic duct or Hartmann's pouch.

Generation of cell transfectants expressing cardiac calcium ion channel and calcium indicator protein aequorin

Chinese hamster ovary (CHO) cells stably coexpressing cardiac calcium ion channel [L-type calcium channel or ryanodine receptor (RyR)] and the calcium-sensitive bioluminescent protein aequorin were generated by transfecting aequorin cDNA. In a selected clone, C1-17, carrying the L-type calcium channel, depolarization induced by high concentration of K+ produces aequorin luminescence. In another clone, R3-7, carrying RyR, caffeine produces aequorin luminescence. In the presence of selective calcium ion channel blockers, the aequorin luminescence was inhibited in a dose-dependent manner. These results indicate that functionally expressed calcium ion channels in these transformants can be monitored through the activation of endogenous aequorin luminescence following a physiological signal similar to that of native calcium channel. Moreover, the aequorin system compared very well with Fura-2 measurements. Thus, the recombinant cell models, which expressed cloned calcium channel and aequorin, will contribute to the elucidation of Ca2+ movement through the cell surface and intracellular calcium ion channels.

Association study between schizophrenia and dopamine D3 receptor gene polymorphism

Crocq et al. [1992: J Med Genet 29:858-860] reported the existence of an association between schizophrenia and homozygosity of a BalI polymorphism in the first exon of the dopamine D3 receptor (DRD3) gene. In response to this report, further studies were conducted; however, these studies yielded conflicting results. In the present study, we examined 100 unrelated Japanese schizophrenics and 100 normal controls to determine any association between this polymorphism and schizophrenia. Results suggest that neither allele nor genotype frequencies of the DRD3 gene in the schizophrenics as a whole are significantly different from those of the controls. Further, we found no association between any allele or genotype and any clinical subtype based on family history of schizophrenia and age-at-onset. A significantly high frequency of homozygosity of a dopamine D3 receptor gene allele was not observed in the schizophrenics as a whole, or in clinical subtypes. Our results suggest that an association between the dopamine D3 receptor gene and schizophrenia is unlikely to exist.

Expression of cutaneous fatty acid-binding protein and its mRNA in rat skin

Cutaneous fatty acid-binding protein (C-FABP) has been purified from rat skin. Since there was little information about the role of C-FABP in the skin, we investigated the expression of C-FABP and its mRNA in normal rat skin using an immunohistochemical technique and in situ hybridization. In the epidermis, C-FABP mRNA was found to be expressed in basal cells and highly in prickle cells, while C-FABP itself was strongly expressed in the upper prickle and the granular cell layers. In sebaceous glands, both C-FABP and its mRNA were expressed in both peripheral and differentiating cells, although the expression of C-FABP mRNA gradually reduced during differentiation of sebocytes. Since epidermis and sebaceous glands are active sites of fatty acid synthesis, these results suggest that C-FABP may have important roles in the transport and synthesis of fatty acids.

Lack of association between dopamine D2 receptor gene Cys311 variant and schizophrenia

Itokawa et al. [1993] reported identifying one missense nucleotide mutation from C to G resulting in a substitution of serine with cysteine at codon 311 in the third intracellular loop of the dopamine D2 receptor in schizophrenics. Arinami et al. [1994] reported finding a positive association between the Cys311 variant and schizophrenia. In response to the report by Arinami et al. [1994] we examined 106 unrelated Japanese schizophrenics and 106 normal controls to determine if there is any association of the Cys311 variant with schizophrenia. However, we found no statistically significant differences in allelic frequencies of Cys311 between schizophrenia and normal controls. The present results as well as those of all previous studies except for that of Arinami et al. [1994] indicated that an association between the dopamine D2 receptor gene and schizophrenia is unlikely to exist.

Discriminant validity of the inventory to diagnose depression, lifetime version

We examined the discriminant validity of the Inventory to Diagnose Depression, lifetime version (IDDL), that is, a self-report instrument designed to diagnose a lifetime history of major depressive disorder. Remitted patients with major depression (MD), remitted patients with anxiety disorders (ADs) and controls completed the IDDL. The IDDL results were then compared in the three contrasts: MD vs. ADs + controls, MD vs. ADs, and MD vs. controls. The agreement between the IDDL and clinical diagnoses was high in each of the three contrasts, and the IDDL total score in the MD group was the highest among the three groups and distinguished from the ADs group or controls. However, the IDDL occasionally diagnosed subjects with a lifetime history of ADs as having a lifetime history of MD.

Lack of association between dopamine D4 receptor gene and schizophrenia

An intriguing property of the dopamine D4 receptor gene is a hypervariable segment in the coding region characterized by a varying number of direct imperfect 48 bp repeats (2-8 or 10 repeats) in the third exon of the gene [Lichter et al., 1993: Hum Mol Genet 2:767-773]. The authors analyzed 70 unrelated schizophrenics and 70 normal controls to determine the allele and genotype frequencies created by length polymorphism of dopamine D4 receptor gene. All patients and controls were unrelated and from the Japanese population. Patients were divided into three groups with regard to age at onset, familial loading, and severity of symptoms assessed strictly with Manchester scale. There were no statistically significant differences if the distributions of alleles and genotypes were analyzed for schizophrenia as a whole or analyzed in consideration of those clinical subtypes. Lichter and colleagues [1993] have reported that at least 25 haplotypes exist for this polymorphic region of the dopamine receptor D4 gene. In this study only the alleles created by length polymorphism were analyzed, and further investigation to determine the haplotypes of patients and controls on using a much larger sample size will be required.

Dimensional changes of relined denture bases with heat-cured, microwave-activated, autopolymerizing, and visible light-cured resins. A laboratory study

The dimensional changes of relined denture bases were evaluated in a laboratory study. Heat-cured resin, two autopolymerizing resins, microwave-activated resin and a new visible light-cured resin were used as relining materials in this study. The gaps between the metal die and the relined denture bases were measured immediately after the relining procedure and subsequently on the first day, first week, fourth week, and eight week. The relined denture bases were stored in distilled water at 37 degrees C between measurements. It was shown that dimensional changes in relined denture bases were influenced by the relining materials and procedures, and that heat-cured resin proved to have the smallest dimensional change as well as the greatest dimensional stability in comparison with the other relining materials and procedures.

[Status quo of pyrazinamide as an antituberculosis drug]

Pyrazinamide (PZA), an antituberculosis agent, was first synthesized in 1940 by Hall and Spoerri and a clinical trial was carried out since 1949 by Yeager and others. Its usefulness as a potent antituberculosis drug was first reported by them in 1952. PZA was once believed to be a secondary choice drug for cases with refractory tuberculosis and/or relapsed cases which are resistant to all other antituberculosis drugs. There was some hesitation among doctors to use PZA for the initial treatment of tuberculosis because of rather high incidence of liver impairment after the use of regimens with PZA. It was, however, revealed later that this was not always true as PZA was ordinarily employed for clinical use in combination with ethionamide and/or cycloserin, and the latter drugs are both known to be hepatotoxic, too. PZA has a unique biological activity observed in murine experimental tuberculosis. The study showed that PZA when administered to animals, enters into the bacilli-ingested macrophages and exerts its killing effect on the bacilli under the environment of acidic pH inside the phagosome of the cells and in areas of acute inflammation both of which favors the acid-fast bacilli to stay in a dormant state and proliferate very slowly. This unique killing ability of PZA which is deficient in other drugs has recently spotlighted PZA once again as a pivotal and first line agent for the 6 months short course chemotherapy of tuberculosis. Sterile eradication of microbe is indispensable for the chemotherapy of tuberculosis, and the potency of a certain antituberculosis agent could be assessed by the availability of negative conversion of bacilli in sputum by culture within two months of administration of the drug. Another important aspect to assess the potency of a drug is to observe the relapse rate after the termination of therapy with the drug. The addition of PZA to the ordinary regimen consisting of INH, RFP and SM/EB has been reported to raise the negative conversion rate of bacilli from 60-70% by the regimen without PZA to as high as 80-90% by the regimen with PZA. In addition, there is no difference in the relapse rate of about 0-2% within 2 years after the termination of chemotherapy between the two regimens; 6 months with PZA and 9 months without PZA. Thus, the addition of PZA to the ordinary regimen enabled us to shorten the duration of antituberculosis chemotherapy than before.(ABSTRACT TRUNCATED AT 400 WORDS)

Frontal intermittent rhythmic delta activity (FIRDA) in pituitary adenoma

We report a case of FIRDA in the EEG of a patient diagnosed as major depression with pituitary adenoma and hyponatremic encephalopathy. The pituitary adenoma appeared to be a major factor responsible for FIRDA in this case. Although other factors associated with this case, i.e., diffuse encephalopathy and administration of antipsychotic drugs, have been reported to be causative, FIRDA remained in the EEG after these other factors diminished. Although size of the pituitary adenoma that might be associated with FIRDA in the EEG recording was not identified in this study, FIRDA may be associated with a small pituitary adenoma less than 10 mm in diameter. We think a diligent search for additional pathology is recommended if FIRDA is seen in the EEG of an otherwise normal patient.

Thyroid hormone inhibits fatty acid synthase gene transcription in chicken liver

The effect of triiodothyronine (T3) on regulation of fatty acid synthase in chicken liver was investigated. In hypothyroid animals, enzyme activity was about one half of that in euthyroid animals. T3 treatment increased the enzyme activity in hypothyroid animals. There is little difference in both the mRNA concentration and the transcription rate between euthyroid and hypothyroid animals. T3 treatment markedly decreased both the mRNA concentration and the transcription rate in euthyroid and hypothyroid animals. These results suggested that T3 maintained the normal level of enzyme expression primarily by stimulating the post-transcriptional step, while the transcription of the gene was inhibited by hyperthyroidism.

The effects of patients' sera with sperm-immobilizing antibodies on sperm of the Japanese monkey

In order to study the interspecies cross-reactivity of sperm-immobilizing antibodies found in sera of women who were infertile for unknown reasons, we used the sperm-immobilization test to examine the effects of patients' sera with or without sperm-immobilizing antibodies on the sperm of the Japanese monkey (Macaca fuscata). Fourteen of 17 antibody-positive sera and 7 of 14 antibody-negative sera showed sperm-immobilizing activity with regard to monkey sperm. The sperm-immobilizing antibody that was active against both human and monkey sperm could be absorbed only by sperm from each corresponding species. The periodate treatment of human or monkey sperm markedly diminished their antibody-absorbing capabilities. Human and mouse monoclonal antibodies having sperm-immobilizing activity with regard to human sperm showed no sperm-immobilizing activity with regard to monkey sperm. These results indicate that the sperm-immobilizing activity of the sera of infertile women against human and monkey sperm might be due to antibodies with different specificities, which recognize a unique carbohydrate antigen epitope expressed in the sperm of each species.

[Efficacy of PCR-microwell plate hybridization method (Amplicor Mycobacterium) for detection of M. tuberculosis, M. avium and/or M. intracellulare in clinical specimens]

Recently, a new kit to detect and identify mycobacteria in clinical specimens was developed by Japan Roche Co. Limited. The new method is based on amplification of DNA of mycobacteria in clinical specimens by PCR and hybridization of amplified DNA by microwell plate hybridization method, which is the "Amplicor Mycobacteria, Roche, (AMP-M)". Cooperative study was organized with 15 tuberculosis hospitals and institutions throughout Japan, and 349 clinical specimens from newly admitted tuberculosis patients and/or suspects were collected during July and August, 1993. All the specimens were examined by smear microscopy (Ziehl-Neelsen's staining), culture on Ogawa egg media, culture on variant 7H9 liquid media and by AMP-M. Excluding 25 specimens which had failed to identify the species of mycobacteria because of contamination, disability to multiply on the transplanted solid media and so on, the results of the examinations in 324 specimens consisting of 167 specimens from previously untreated cases and those of 157 specimens from previously treated cases were analysed. Main results obtained were as follows; 1. Of 70 smear positive specimens from previously untreated cases, culture positive on Ogawa media and 7H9 media, and by AMP-M positive were 59 (84.3%), 61 (87.1%) and 66 (94.3%), respectively. Of 97 smear negative specimens, culture positive were 20 (20.6%), 22 (22.7%) and 27 (27.8%), respectively. The AMP-M showed the highest positive rate in both groups. 2. The sensitivity and the specificity of AMP-M in previously untreated cases were calculated by assuming that positive on Ogawa and/or variant 7H9 media is "positive". The sensitivity was 95.8% (68/71) and the specificity was 94.8% (91/96) for M. tuberculosis in previously untreated cases. The sensitivity and the specificity for M. avium and M. intracellulare were all 100%, although the numbers observed were small. 3. So-called false positive of the AMP-M were observed in 5 cases out of 96 culture negatives on both Ogawa and variant 7H9 media. However, all 5 cases were positive by repeated AMP-M, 3 become culture positive later, and another 2 showed clinical findings consistent with tuberculosis. Hence, the authors considered that the false positive rate of the AMP-M method is to be very low in previously untreated cases. 4. Of 86 smear positive cases with history of previous chemotherapy, the positive culture on Ogawa media, variant 7H9 media and that by AMP-M method were 64 (74.4%), 77 (89.5%) and 85 (98.8%), respectively. In the smear negative cases, culture positive was 10 out of 71 (14.1%), 13 (18.3%) and 24 (33.8%), respectively.

[A case of Larsen syndrome with severe cervical cord compression]

We reported a case of Larsen syndrome with cervical cord compression. She had a flattened face, bilateral joint dislocations of the elbows, hips and knees, and equinovalgus deformity on the feet. At first she had flaccidity of the upper and lower limbs, she gradually developed spastic. On laboratory examination, CSF protein was elevated. EMG showed fibrillation. In short latency somatosensory evoked potential (SSEP), N 20 was not detected. MRI showed a severe cervical cord compression. Cervical spine deformity has been often described in the previous reports on Larsen syndrome, but cervical cord compression demonstrated by MRI was reported in only one case. We should take into consideration this risk associated with Larsen syndrome.

Identification and characterization of a 27 kDa acrosome protein of human sperm defined by a monoclonal antibody with fertilization-blocking effect

A monoclonal antibody, MAb 1G1, possessing a strong fertilization-blocking activity was prepared by immunizing a BALB/c mouse with capacitated human sperm in order to study the molecular nature of sperm antigens relevant to fertilization. MAb 1G1 inhibited human sperm penetration into zona-free hamster eggs. It reacted to the apical portion of acrosome-reacted human sperm, but did not react to live sperm before the acrosome reaction as demonstrated by immunofluorescence staining. In paraffin-embedded testis sections, the round spermatids, spermatocytes and spermatozoa were stained with MAb 1G1, but the spermatogonia were not stained. Neither Sertoli cells, Leydig cells nor other somatic tissues were stained. The sperm of Japanese monkey, bull, boar, hamster and mouse were not stained. Therefore, the staining of sperm was species specific. The antigen corresponding to MAb 1G1 showed a band at 27 kDa by immunoblotting. The reactivity of the antigenic component was not destroyed by periodic acid treatment. From the results obtained, it was postulated that the antigenic molecule might be a polypeptide. These results indicated that this MAb might be a useful tool for studying the mechanism of human sperm-egg fertilization and the development of a contraceptive vaccine.

Regulation of IL-1 alpha expression in human keratinocytes: transcriptional activation of the IL-1 alpha gene by TNF-alpha, LPS, and IL-1 alpha

Epidermal epithelial cells (keratinocytes) produce IL-1 alpha potentially relevant for mechanisms of microbial invasion, inflammation, immunological reactions, and tissue injury in the skin. We investigated the regulation of IL-1 alpha expression by human keratinocytes. RIA showed that TNF-alpha, LPS, and PMA caused a marked accumulation of IL-1 alpha Ag in keratinocyte lysates and supernatants after 2 h of exposure. Northern blot analyses demonstrated that TNF-alpha, IL-1 alpha, and LPS transiently increased the steady-state levels of IL-1 alpha mRNA by 8-fold, 10-fold, and 6-fold, respectively, at 2 h. Nuclear run-on transcription studies with isolated nuclei from cells treated with TNF-alpha, IL-1 alpha, and LPS showed that the transcription rate of the IL-1 alpha gene increased 6-fold, 6.5-fold, and 4-fold, respectively, after 2 h of treatment. PMA led to a more sustained accumulation of IL-1 alpha mRNA and had no effect on the transcription rate of the IL-1 alpha gene. The 5' region of the IL-1 alpha gene between base pairs -105 and +724 was linked to the luciferase reporter gene and used in transient expression studies. LPS stimulated luciferase activity from the chimeric gene, suggesting that the 5' region of the IL-1 alpha gene tested may, in part, include a responsive sequence to LPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of immunoglobulin classes and subclasses of sperm immobilizing antibodies in infertile women and the inhibitory effect of IgG4 subclass on the sperm immobilizing antibody activity

Immunoglobulin classes and subclasses of sperm immobilizing antibodies (SI-Abs) in the sera of sterile women were determined by the absorption of patients' sera with Staphylococcus aureus and immunoadsorbents bound with class or subclass-specific anti-human immunoglobulin antibodies. Among 18 patients' sera tested, 16 had the IgG-dominant SI-Abs and the remaining 2 sera contained IgM-dominant SI-Abs. From the former patients' sera, 9 were further studied to determine the IgG subclasses; 6 of them had IgG1-dominant SI-Abs, one IgG2-dominant, and in the other two IgG1 and IgG2 were equally dominant. Interestingly, SI-Ab activities in 6 of the 9 patients' sera increased after absorption of IgG4 subclass and the addition of IgG4 purified from an SI-positive patient to the same patient's serum diminished the SI-Ab activities.

Diglucuronoflavones from purple leaves of Perilla ocimoides

Three flavones from purple leaves of Perilla ocimoides var. crispa were characterized as the 7-O-diglucuronides of apigenin, luteolin, and scutellarein. The latter is a new natural compound.

[Multilocular cystic renal cell carcinoma: a report of two cases]

Two cases of multilocular cystic renal cell carcinomas in a 48-year-old man and in a 41-year-old woman are reported. Radical nephrectomy was performed in both cases. Both histologic diagnoses were multilocular cystic renal cell carcinoma, clear cell subtype, grade 1. We had some difficulty in diagnosing the latter case with multilocular cystic mass which had smooth, glistening lining and contained clear-yellow fluid. Microscopical examination of the permanent sections revealed that the cysts were lined by a cuboidal or flattened epithelium, but no tumor cells. However, laminar growth of renal cell carcinoma of the clear cell type was present in several areas in the septa, and a few residual tumor cells were found in the hyalinized septa. When renal cell carcinoma is present in only a part of the multilocular cystic renal mass, it should be diagnosed as multilocular cystic renal cell carcinoma. The literature was surveyed.

[Short course chemotherapy and relapse in pulmonary tuberculosis in Japan]

As far as short course chemotherapy of pulmonary tuberculosis is concerned, Japan is considered to have been a little behind the trend of the world in the past. However, since 1978 the concept of the chemotherapy has begun to be adopted in some hospitals and research councils (Cooperative Study Unit of Chemotherapy of Tuberculosis of National Sanatoria, Tuberculosis Research Committees, Ryoken), and then seems to be prevailing in other hospitals as the results of their gradual understanding. This movement has likely been accelerated since Dr. W. Fox came to Japan in 1978 at the invitation of Japanese Society of Tuberculosis and gave us much information and suggestion through his special lecture on short course chemotherapy of tuberculosis. Fifteen years have past since short course chemotherapy started in Japan. At this opportunity, I would like to review the results of short course chemotherapy studies reported by Japanese investigators. Bacteriological relapse rates in cases followed-up for three years and for from five to nine years after the end of short course chemotherapy were 1.9% (20 out of 1067) and 3.3% (26 out of 783), respectively. According to the analysis of the time of relapse after completion chemotherapy, bacteriological relapses could be divided into two types. One was early relapse which occurred within one year after completing treatment, and the other was late relapse which occurred two or three years after completing treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Repair of skin defect after extensive resection for penile cancer: report of two cases, and clinical observation of patients with penile cancer at Mie University hospital]

Case 1: A 48-year-old male with stage 4 penile cancer is reported. We used peplomycin (PEP) and cisplatinum (CDDP) for preoperative chemotherapy. Chemotherapy was effective. Radical surgery with bilateral inguinal lymphadenectomy was done and skin defect was covered with a skin flap. Case 2: A 61-year-old male with stage 4 penile cancer underwent radical surgery after modified MBD therapy with methotrexate (MTX), PEP and CDDP. Emasculation with skin resection and inguinal and pelvic lymphadenectomy were performed. The skin defect was deep and wide. It was covered with a glacilis myocutaneous skin flap. Distal end of the flap became necrotic. It was covered with tensor fascia lata myocutaneous flap. Seventeen patients with penile cancer were treated between 1972 and 1990 at Mie University Hospital. Nine patients were in stage 1, 4 stage 2, 1 stage 3, 3 stage 4. Treatment consisted of surgery (3), surgery+chemotherapy (10), surgery+chemotherapy+irradiation (2), chemotherapy+irradiation (1), and surgery+irradiation(1). Cancer death was observed in 2 cases (stage 2), 2 patients died of other diseases, 10 are alive, and 3 patients were lost to follow up.

Comparative studies of the antigens recognized by sperm-immobilizing monoclonal antibodies

Characteristic properties of the antigens recognized by sperm-immobilizing monoclonal antibodies (SI-mAbs) from different sources were compared by ELISA competitive inhibition assay, Western blot analysis, chromatographic analysis, and enzymatic digestion studies. Among 9 SI-mAbs, human mAb H6-3C4 and three mouse mAbs--2C6, 2B6, and 2E5--also possessed strong sperm-agglutinating activity. Binding of human mAb H6-3C4 to sperm was strongly inhibited by the three mouse mAbs (2C6, 2B6, and 2E5), but not by the rat or the other four mouse mAbs. SDS-PAGE revealed that mAb H6-3C4 and three mouse mAbs recognized the same antigen molecules of 15-25 kDa present in both sperm extracts and seminal plasma. Chemical treatments with trifluoromethanesulfonic acid and sodium metaperiodate destroyed the antigen determinants recognized by the above four mAbs, as detected by both ELISA and antibody absorption tests. Western blot analysis revealed that the antigens were susceptible to treatments with papain, proteinase K, and N-glycanase, but resistant to trypsin, V8 protease, and thermolysin. These results indicate that one of the major antigens recognized by mAbs with sperm-immobilizing action may be a sperm membrane-associated glycoprotein of 15-25 kDa and the epitope may involve N-linked oligosaccharides.

Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced urothelial cancer

A series of 31 patients with advanced urothelial cancer were treated with combination chemotherapy consisting of 1-4 cycles of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC). Of the 31 patients, 29 had measurable and evaluable lesions. A complete remission was achieved by 4 of these 29 patients (14%) for 1-46 months. A partial remission was observed in 14 of the 29 patients (48%) for 1-9 months. Whereas bony and hepatic metastatic lesions did not respond, some nodal (7/12), pulmonary (4/8), and pelvic lesions (2/3) as well as primary bladder tumors (4/6) and a tumor marker (1/2) responded. Complete tumor remission was observed in nodal (2/12) and pulmonary (1/8) metastatic lesions, in invasive lesions to the prostate and seminal vesicle (1/1), and in primary lesions in the bladder (2/6), ureter (1/1), and urethra (1/1). Two of three patients with non-transitional cell tumors attained a partial remission for 1-7 months. Complete remission of the pulmonary lesions was obtained in a case of squamous cell cancer of the bladder with pulmonary metastases. The toxicity of this regimen was generally tolerable and included moderate to severe myelosuppression, mild to moderate nausea and vomiting, renal toxicity, and mucositis. These results suggest that the M-VAC regimen holds promise for the treatment of advanced metastatic transitional cell cancer as well as non-transitional cell cancer of the urothelium.