Analysis of regional lymph node metastases from rectal carcinoma by the clearing method. Justification of the use of sigmoid in J-pouch construction after low anterior resection

PURPOSE

It has been reported that functional outcome following low anterior resection of resection of rectal cancer is improved by construction of a colonic J-pouch compared with straight anastomosis. Hence, we tried to justify use of the sigmoid colon in the construction of a J-pouch by the analysis of regional lymph node metastases.

METHODS

A total of 182 patients underwent resection for rectal cancer. Node metastases were examined by the clearing method. According to Japanese General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus (JGR), nodes were classified into the perirectal nodes (PR-N), pericolic nodes (PC-N), central intermediate nodes (C-IM-N), central main nodes (C-M-N), lateral intermediate nodes (L-IM-N), and lateral main nodes (L-M-N).

RESULTS

Metastatic rate (number of patients with node metastases/total number of patients) of PR-N was 57.1 percent. Metastatic rate of C-IM-N was 18.7 percent and that of C-M-N was 7.1 percent. Metastatic rates of L-IM-N and L-M-N were 8.8 and 3.3 percent, respectively, and both were highest in the case of lower rectal cancer. Metastatic rate of PC-N was only 1.1 percent. The number of cases without node metastases (n(-) cases) was 78, that with only PR-N metastases (PR-N cases) was 63, that with intermediate but not main node metastases (IM-N cases) was 29, and that with main node metastases (M-N cases) was 12. Five-year survival rate after curative resection was 88.5 percent for n(-) cases, 70.9 percent for PR-N cases, 65.9 percent for IM-N cases, and 41.7 percent for M-N cases.

CONCLUSIONS

In low anterior resection, high ligation of the inferior mesenteric artery and dissection of C-M-N, C-IM-N and PR-N are necessary, with the addition of the L-IM-N and L-M-N in the case of lower rectal cancer. Resection of sigmoid colon is not required, and therefore, a J-pouch can be constructed using the sigmoid colon. Nodal classification according to the JGR was predictive of case distribution and five-year survival rate.

Azelastine hydrochloride inhibits platelet activating factor-like activity in human eosinophils

We investigated the inhibitory effect of azelastine hydrochloride (azelastine), an anti-asthmatic drug, on platelet-activating factor (PAF)-like activity in eosinophils obtained from asthmatic and non-asthmatic patients. Eosinophils were preincubated with or without azelastine and stimulated with f-Met-Leu-Phe (fMLP, 10 mumol) for 15 min. PAF-like activity was detected by aggregation of washed guinea-pig platelets. PAF-like activity released from asthmatic eosinophils without preincubation of azelastine was 2.36 [1.02] (mean [SD], ng/10(7) cells) in supernatants and 13.87 [4.77] in cell pellets. After preincubation with 10(-8), 10(-6), and 10(-4) M azelastine, PAF-like activity reduced to 1.85 [0.46] (mean [SD], ng/10(7) cells), 1.11 [0.14], and 0.88 [0.09] (n = 15) in the supernatants, and 11.83 [2.93], 8.32 [1.41], and 6.27 [1.25] (n = 15) in the cell pellets, respectively. PAF-like activity in non-asthmatic eosinophils without preincubation of azelastine was 2.01 [0.86] (mean [SD], ng/10(7) cells) in supernatants and 7.44 [0.99] in cell pellets. After preincubation with 10(-8), 10(-6), and 10(-4) M azelastine, PAF-like activity reduced to 1.73 [0.64] (mean [SD], ng/10(7) cells), 1.12 [0.23], and 0.84 [0.17] (n = 20) in the supernatants, and 6.26 [2.08], 4.65 [0.88], and 3.02 [0.43] (n = 20) in the cell pellets, respectively. Our results showed that preincubation with azelastine caused a dose-dependent inhibition of intra and extracellular PAF-like activity from asthmatic and non-asthmatic eosinophils in the same manner.

Alteration of bile acid metabolism by cimetidine in healthy humans

BACKGROUND

To clarify an effect of cimetidine on bile acid metabolism, we evaluated whether an increased deconjugation of bile acids would occur in healthy humans who have received cimetidine. We examined: 1) whether healthy volunteers taking cimetidine would have positive bile acid breath tests because of bacterial overgrowth in the jejunum; 2) whether the isolated bacteria would exhibit deconjugation ability; and 3) whether a change in gastric pH was related to the bacterial overgrowth.

METHODS

We evaluated 73 healthy Japanese volunteers; 53 of them received cimetidine and 20 did not. Deconjugation of bile acids was detected as 14CO2 specific activity of expired air measured by a bile acid breath test giving 5 muCi of oral glycine-1-(14)C labeled glycocholate. Aspiration of jejunal fluids was performed by a double lumen tube with a rubber cover on the tip, and deconjugation ability of bacteria was evaluated using thin layer chromotography.

RESULTS

Samples of expired breath from the 53 healthy volunteers showed a significant increase in 14CO2 specific activity after the administration of cimetidine rather than before the administration of cimetidine. Bacterial over-growth was found in the jejunal fluid after the administration of cimetidine. The administration of tetracycline to 27 subjects significantly reduced the 14CO2 specific activity. The following species were identified in the jejunal fluid samples obtained from the subjects: enterococcus, Lactobacillus bifidus, Bacteroides vulgatus, B uniformis, Eubacterium lentum, E parvum, and Escherichia coli. Except for E coli, all of the bacterial species identified deconjugated bile acids. We observed a significant relationship between 14CO2's specific activity and gastric pH before and after administration of cimetidine, respectively.

CONCLUSIONS

Healthy volunteers who received cimetidine showed an increased deconjugation of bile acid caused by overgrowth of bacteria in the jejunum, which can deconjugate bile acids. The bacterial overgrowth is probably associated with a shift to neutral pH in the gastric juice caused by cimetidine.

Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size

PURPOSE

Functional outcome after low anterior resection with ultralow coloanal anastomosis for rectal cancer is improved by construction of a colonic J-pouch vs. straight anastomosis. Optimum size of this pouch has yet to be determined. Therefore, we initiated a prospective, randomized trial using 5-cm and 10-cm pouches to determine this size.

METHODS

Patients with tumors 5 to 10 cm from the anal verge were included in the study. Before a low anterior resection anastomosis was performed, patients were randomized to either a 5-cm J-pouch group (5-J group) or a 10-cm J-pouch group (10-J group). Functional assessments were performed one year postoperatively. Clinical functions were evaluated using a functional scoring system. Physiologic functions, such as sphincter and reservoir function, were evaluated by anorectal manometry and evacuation function by the balloon expulsion and saline evacuation tests.

RESULTS

Forty patients among 43 randomized patients were assessed for functional outcome one year postoperatively (5-J group, n = 20; 10-J group, n = 20). The functional score was similar for the two groups, although reservoir function in the 5-J group was significantly less than in the 10-J group. Sphincter function was similar between the two groups. Evacuation function in the 5-J group was significantly superior to that in the 10-J group.

CONCLUSIONS

The 5-cm J-pouch conferred adequate reservoir function without compromising evacuation.

[Diagnosis and therapy for metastatic liver cancer]

Hepatic metastases occur frequently in patients with colorectal cancer. Patients with advanced cancer should be followed carefully after curative resection of the primary lesions for the early detection of the recurrence. If hepatic metastasis is suspected on the basis of rising CEA levels, more sophisticated imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging and hepatic angiography should be employed for the diagnosis. However, these tests are not cost-effective and not warranted on a routine follow-up basis. To be more cost-effective, a relatively simple and sensitive test or group of tests should be used. The authors have proposed that the basement membrane producibility of the primary lesion yields the most important information predicting a liver metastasis; the basement membrane producing cancer highly metastasizes to the liver. In contrast, more than 90% of non-producing cancer does not metastasize to the liver. The basement membrane producibility is easily examined by laminin staining. In the treatment of hepatic metastases, hepatic resection is the preferred approach when the metastases are located in a resectable segment or can be encompassed by as many as five wedge resections, but these scenarios are relatively uncommon. For unresectable disease, chemotherapy and intravenous and/or intra-arterial embolization are viable alternatives. Loco-regional treatment may offer a pharmacological advantage since a liver metastasis is almost exclusively fed by the hepatic artery. A pilot study we conducted on hepatic infusion chemotherapy combined with interleukin-2 (IL-2.MF) revealed very encouraging results (response rate: 76%), and further study in a prospective randomized trial confirmed this high response rate. Adjuvant IL-2.MF infusion therapy after curative resection of liver metastases is also effective for the prevention of recurrence in the residual liver. Based on the data, we conclude that multimodal treatments of hepatic resection and loco-regional infusion of immuno-chemotherapy (IL-2.MF) make it possible to control both resectable and unresectable liver metastases.

Pain-related somatosensory evoked potentials can quantitatively evaluate hypalgesia in Wallenberg's syndrome

In 6 patients with Wallenberg's syndrome who showed a dissociated loss of pain sense, we recorded pain-related somatosensory evoked potentials following CO2 laser stimulation of the hand dorsum (pain SEPs). Two components, N2 and P2, were recorded by stimulation of the unaffected hand, whereas on the affected side they were absent or decreased in proportion to the severity of hypalgesia which was evaluated by both needle test and CO2 laser stimulation. Latency of either component, if appeared, was longer in the affected hand stimulation than that in the unaffected one. In contrast, N20 of the conventional electrically-stimulated SEPs (electric SEPs) showed no difference between the two sides. It is concluded that, unlike other electrophysiological methods, pain SEPs following CO2 laser stimulation can quantitatively evaluate functional impairment of the spinothalamic tract in Wallenberg's syndrome.

[Analysis of genetic changes in progression of colorectal cancer]

To investigate whether genetic changes of the p53 gene and genetic defects in DNA-mismatch repair systems are involved in progression of colorectal carcinomas (CRCs), we examined loss of heterozygosity (LOH) on 17p and mutations in exon 5 through 8 of the p53 gene as well as replication errors (RER) at four microsatellite loci in DNAs from 108 CRCs at all clinical stages (20 Dukes A, 40 Dukes b, 48 Dukes C). We observed that LOH on 17p and/or p53 mutation were detected in 93% of Dukes A carcinomas and in 84% of Dukes C carcinomas, suggesting that the p53 gene is mutated and/or deleted before carcinoma has been produced. RER-positive phenotype was observed in approximately 30% of CRCs, irrespective of clinical stage. These results suggest that genetic instability is likely to play an important role in development of a subpopulation of sporadic CRCs, but not in progression of CRCs. In addition, we found no significant association between genetic alterations and progression of CRCs. We consider that genetic defects in DNA-mismatch repair pathway do not necessarily promote genomic instability at the p53 sequences in CRCs.

In vivo effect of prednisolone on release of leukotriene B4 from neutrophils from asthmatic patients

We examined the release of leukotriene B4 from calcium ionophore A23187-stimulated neutrophils from asthmatic patients treated with or without intravenous prednisolone during an asthmatic attack. The mean level of LTB4 in the supernatant of stimulated neutrophils from patients treated with intravenous prednisolone was significantly lower than that in the supernatant of stimulated neutrophils from those without prednisolone treatment. Preincubation with prednisolone caused a dose-dependent inhibition of LTB4 release from calcium ionophore A23187-stimulated neutrophils. These findings suggest that intravenous prednisolone inhibits the release of LTB4 from neutrophils in vivo.

Autopsy findings in Down's syndrome with cerebrovascular disorder

We describe the vascular pathologic findings in a 20-year-old Japanese man with Down's syndrome (DS) who developed stroke-like symptoms and died of respiratory failure attributed to a cerebral infarction. The latter was verified at autopsy, which also revealed vascular abnormalities resembling those of moyamoya disease. There were occlusions or stenosis in the bilateral internal carotid arteries, middle cerebral arteries, left posterior communicating artery, and basilar artery due to fibrous hypertrophy of the arterial intimal walls. The tunica media was highly atrophic and the internal elastic lamina was tortuous and duplicate. However, unlike moyamoya disease, main trunks of the cerebral arteries were of normal size, and there was marked stenosis of the basilar artery. These cerebrovascular abnormalities may have been the result of an immune deficiency, thrombosis, maldevelopment of the skull and brain, or may have been linked to moyamoya disease. Further study of similar cases is necessary to clarify the association between DS and moyamoya disease, as well as the pathogenesis of that disease.

Unilateral tongue atrophy due to an enlarged emissary vein in the hypoglossal canal

A 16-year-old girl presented to our clinic with right-sided tongue atrophy and fasciculations of 1-year duration. Enlargement of the outer opening of the hypoglossal canal was reveal by conventional and computed tomography of the skull. Magnetic resonance imaging disclosed an enlarged venous system extending from the jugular vein to the internal jugular vein on the right, with low signal density suggestive of a flow void. A right-sided occipital craniotomy was performed. When the hypoglossal canal was opened, an enlarged emissary vein compressing the hypoglossal nerve was identified. This is the first reported case of unilateral tongue atrophy and an enlarged hypoglossal canal due to an enlarged emissary vein.

Studies on cochleamycins, novel antitumor antibiotics. II. Physico-chemical properties and structure determination

The structure of cochleamycins A, A2, B and B2 (Fig. 1), novel antitumor antibiotics, were elucidated by NMR spectral analysis. Cochleamycins were found to possess novel carbocyclic skeletons.

Pain-related and cognitive components of somatosensory evoked potentials following CO2 laser stimulation in man

We recorded cortical potentials evoked by painful CO2 laser stimulation (pain SEP) employing an oddball paradigm in an effort to demonstrate event-related potentials (ERP) associated with pain. In 12 healthy subjects, frequent (standard) pain stimuli (probability 0.8) were delivered to one side of the dorsum of the left hand while rare (target) pain stimuli (probability 0.2) were delivered to the other side of the same hand. Subjects were instructed to perform either a mental count or button press in response to the target stimuli. Two early components (N2 and P2) of the pain SEP demonstrated a Cz maximal distribution, and showed no difference in latency, amplitude or scalp topography between the oddball conditions or between response tasks. In addition, another positive component (P3) following the P2 was recorded maximally at Pz only in response to the target stimuli with a peak latency of 593 msec for the count task and 560 msec for the button press task. Its scalp topography was the same as that for electric and auditory P3. The longer latency of pain P3 can be explained not only by its slower impulse conduction but also by the effects of task difficulty in the oddball paradigm employing the pain stimulus compared with electric and auditory stimulus paradigms. It is concluded that the P3 for the pain modality is mainly related to a cognitive process and corresponds to the P3 of electric and auditory evoked responses, whereas both N2 and P2 are mainly pain-related components.

Studies on cochleamycins, novel antitumor antibiotics. III. Biosyntheses of cochleamycins: incorporation of 13C- and 2H-labeled compounds into cochleamycins

Biosynthetic studies using 13C- and 2H-labeled compounds revealed that the carbon skeletons of cochleamycins A and B were derived from eight acetic acid units and one propionic acid unit with the introduction of an acetoxy group at C-10, which was replaced by an isobutyryl residue derived from valine in cochleamycins A2 and B2.

Studies on cochleamycins, novel antitumor antibiotics. I. Taxonomy, production, isolation and biological activities

Novel antitumor antibiotics cochleamycins A, A2, B and B2 (Fig. 1) were isolated from the culture broth of Streptomyces sp. DT136. They were purified by column chromatography on silica gel, reversed phase HPLC and then isolated as colorless powder. Cochleamycins showed growth inhibition against tumor cells in vitro.

Purification and characterization of new trehalose-producing enzymes isolated from the hyperthermophilic archae, Sulfolobus solfataricus KM1

Amylolytic activity that converts soluble starch to alpha, alpha-trehalose (trehalose), was found in the cell homogenate of the hyperthermophilic acidophilic archae, Sulfolobus solfataricus KM1. DEAE chromatography of the homogenate as well as other new reliable assay methods showed two enzymes to be essential for this activity. These enzymes, a glycosyltransferase and an amylase, were purified to homogeneity and characterized. Their molecular masses were 76 kDa and 61 kDa and activities were maximal at 70-80 degrees C and 70-85 degrees C, respectively. High thermostability was noted for each. The reaction products by the two enzymes on maltooligosaccharides were identified by 1H- and 13C-NMR spectra and HPLC analysis. The cooperative mechanism of the two enzymes was used in a new enzymatic pathway for trehalose synthesis from starch.

Priming effect of platelet activating factor on leukotriene C4 from stimulated eosinophils of asthmatic patients

BACKGROUND

Eosinophils from asthmatic patients are known to release greater amounts of leukotrienes than normal eosinophils when stimulated by the calcium ionophore A23187. The effect of platelet activating factor (PAF) in priming eosinophils was investigated.

METHODS

Eosinophils were obtained from 18 asthmatic patients and 18 healthy donors. Cells separated by the Percoll gradients were incubated with PAF (C-18) for 30 minutes and then stimulated with the calcium ionophore A23187 (2.5 microM) for 15 minutes. The amount of leukotriene C4 (LTC4) in supernatants was measured using a combination of high pressure liquid chromatography and radioimmunoassay.

RESULTS

The mean (SD) amount of LTC4 released by eosinophils from asthmatic patients upon stimulation with the calcium ionophore A23187 alone was 27.9 (9.9) ng/10(6) cells (n = 6). The amount of LTC4 released following stimulation with the calcium ionophore A23187 after pretreatment with PAF (1, 5, and 10 microM) was 57.2 (8.9), 75.1 (14.3), and 52.6 (10.7) ng/10(6) cells (n = 6), respectively. Trace amounts of LTC4 (0.9 (0.02) ng/10(6) cells, n = 6) were detected in the supernatant of the cells after stimulation by PAF alone (5 microM). The amount of LTC4 released upon stimulation by calcium ionophore A23187 alone in eosinophils from healthy donors was 10.3 (3.7) ng/10(6) cells (n = 4). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with PAF at concentrations of 1, 5, and 10 microM were 11.9 (3.5), 17.8 (5.6), and 12.7 (5.1) ng/10(6) cells (n = 4), respectively. Trace amounts of LTC4 (0.6 (0.02) ng/10(6) cells, n = 4) were detected in the supernatant of the cells upon stimulation with PAF alone (5 microM). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with lyso-PAF at concentrations of 1, 5, and 10 microM (n = 4 or 6) were 30.8 (5.2), 22.9 (5.1), and 27.3 (4.3) ng/10(6) cells (n = 6) from the eosinophils of asthmatic patients and 13.7 (3.3), 15.2 (4.9), and 14.7 (3.8) ng/10(6) cells (n = 4) from the eosinophils of healthy donors.

CONCLUSIONS

The results indicated that PAF enhanced LTC4 formation by eosinophils obtained from asthmatic patients stimulated with the calcium ionophore A23187, but not those obtained from normal subjects.

Morphology of the lateral ligament in the human temporomandibular joint

The morphology of the lateral ligament of the human temporomandibular joint is of two types: ligamentous and without distinct structure. Under the scanning electron microscope, a sheath-like structure that contained bundles of collagen was mainly found in the posterior region of the lateral ligament. Analysis of macromolecular components revealed that type III collagen was mainly present on the collagenous framework of the sheath-like structure. Type I collagen, laminin, and tenascin were found in the framework of the sheath-like structure. Supported collagenous bundles and the distribution of macromolecular components might be related to the stability of the temporomandibular joint. The sheath-like structure and other components of the lateral ligaments store energy and protect the capsule from stress and tension during movements of the jaw.

Increased sympathetic outflow to muscles in patients with amyotrophic lateral sclerosis: a comparison with other neuromuscular patients

We investigated the effects of muscle loss and limitation of daily activities on sympathetic outflow to muscles by measuring muscle sympathetic nerve activity (MSNA) in 12 patients with amyotrophic lateral sclerosis (ALS) as compared with other 15 neuromuscular patients (controls). The burst incidence of MSNA at rest was significantly higher in patients with ALS, even in elderly patients, compared with controls (p < 0.01). There were no differences in the level of disability, heart rate or blood pressure at rest between two groups. Blood pressure and MSNA were less changed by head-up tilting in patients with ALS compared with controls. MSNA of ALS was not correlated with the disability score, PaO2, PaCO2, forced vital capacity, the disease duration or prognosis. MSNA at rest was increased in ALS patients, regardless of the severity of muscle loss or disability. It might be suggested that autonomic motor neurons seem to become affected by the same pathologic process that kills motor neurons.

Effect of cilazapril therapy on glucose and lipid metabolism in patients with hypertension

The effects of long-term monotherapy with cilazapril, an angiotensin-converting enzyme inhibitor, on blood pressure, glucose tolerance, and serum lipid profiles were prospectively investigated in 66 patients with hypertension: 23 with normal glucose tolerance and 43 with glucose intolerance (including 9 patients with non-insulin-dependent diabetes mellitus). The levels of plasma glucose, serum insulin, serum lipids, glycated hemoglobin A(lc) (Hb A(lc)), and fructosamine were determined before and during long-term (mean +/- SD, 26.2 +/- 1.2 weeks) therapy with cilazapril. A 75-g oral glucose tolerance test was performed before and during treatment. Significant reductions in both systolic and diastolic blood pressures in both patient groups were maintained during the study. Neither fasting nor post-glucose load venous plasma glucose levels were altered in either group of patients, and no patient with normal glucose tolerance developed diabetes mellitus during the study. There was no significant change in the insulinogenic index (delta serum insulin/delta venous plasma glucose at 30 minutes post-glucose load) in either group, and glucose intolerance was slightly improved with significant reductions (P < 0.01) in Hb A(lc) and fructosamine in the patient group with impaired glucose tolerance. Serum total cholesterol (TC), low-density lipoprotein cholesterol, and triglyceride levels were significantly (P < 0.01) decreased and high-density lipoprotein cholesterol levels increased in patients with hypercholesterolemia (TC levels > or = 5.69 mmol/L). These results suggest that long-term cilazapril therapy may improve glucose and lipid metabolism in hypertensive patients with impaired glucose tolerance. Cilazapril also appears to be useful as an antihypertensive agent for hypertensive patients with either impaired glucose tolerance or hypercholesterolemia.

[Muscle sympathetic nerve activity in patients with spinocerebellar degeneration without orthostatic hypotension]

Muscle sympathetic nerve activity (MSNA) was compared in 6 patients (age; 45-76 years old, 3 males and 3 females) with spinocerebellar degeneration (SCD) without orthostatic hypotension (OH) and in 10 (age; 38-78 years old, 3 males and 7 females) with other neurologic disorders (controls). MSNA was elicited from the peroneal nerve at the resting recumbent position by using a microneurographic method. MSNA, heart rate (HR) from the electrocardiogram and mean blood pressure (MBP) measured by Finapres were recorded simultaneously at rest and during the head-up tilting at 45 degrees. Although there were no significant differences in MBP and HR between both groups, burst rate (bursts per minute) and burst incidence (bursts per 100 heart beats) of MSNA in SCD patients were significantly decreased as compared with controls (p < 0.01). During the head-up tilting, responses in MBP and MSNA showed a tendency to decrease in SCD patients. We concluded that the sympathetic noradrenergic system might be potentially impaired in SCD patients without OH.

Inhibition of experimental metastasis of human adenocarcinoma by cilostazol, a platelet phosphodiesterase inhibitor

Cilostazol, an inhibitor of platelet phosphodiesterase, was used to inhibit the platelet aggregating potential and metastasis of human adenocarcinoma cell lines. In vitro platelet aggregation potential of HAL8 and HAL33 cell lines was inhibited by cilostazol in a concentration dependent manner. Fatal acute thromboembolism of nude mice induced injection of HAL8 and HAL33 cell was completely inhibited by cilostazol/10 mg/kg p.o. Retention of injected (125)IdUrd-labeled cells in the lungs was also inhibited by cilostazol pretreatment. Cilostazol given 2 h before cell injection inhibited by 87 and 100% respectively, experimental lung metastasis of HAL8 and HAL33. Cilostazol given 72 h after cell injection had no effect on HAL8 and HAL33 metastasis. These results show that platelet aggregation of HAL8 and HAL33 cells play an important role in metastatic systems and that cilostazol inhibits human cancer metastasis.

In vivo effect of prednisolone on release of leukotriene C4 in eosinophils obtained from asthmatic patients

We investigated the release of leukotriene C4 from eosinophils of asthmatic patients who were treated with or without intravenous prednisolone. The mean level of LTC4 in the supernatant of A23187-stimulated eosinophils obtained from asthmatic patients during an attack was significantly lower with intravenous prednisolone than without prednisolone treatment. Findings suggest that intravenous prednisolone inhibits the release of LTC4 from the eosinophils of asthmatic patients by acting on these cells in vivo.

[A case of chronic progressive radiation myelopathy with cavity formation in the thoracic spinal cord]

A 70-year-old man was admitted to our hospital in March 1994 because of subacute progressive paraparesis and sensory impairment below the level of the second thoracic (TH 2) spinal cord on the right side. He had received radiation therapy (48 Gy) on his neck and mediastinum eight years previously due to adenocarcinoma of the right upper lung. Blood chemistry, CT of the spine, bone and gallium scintigraphy were unremarkable. In magnetic resonance imaging (MRI) of the thoracic cord, the gadolinium (Gd)-enhanced T1-weighted image showed abnormal signal intensities from Th 3 to Th 4 of the spine. Myelography revealed no abnormalities. Three months later, the patient became a complete spinal man below the level of Th 4. Gd-enhanced MRI of the thoracic cord, performed eleven months later, showed formation of a spindle-shaped cavity from Th 2 to Th 5 of the spine surrounded by a ring-shaped enhanced cord. Chronic progressive radiation myelopathy (CPRM) was diagnosed based on these clinical and MRI findings. This was a rare case in which MRI-confirmed cavity formation in the spinal cord appeared in a patient with CPRM.

Spatial distribution of thalamic projections to the supplementary motor area and the primary motor cortex: a retrograde multiple labeling study in the macaque monkey

The exact knowledge on spatial organization of information sources from the thalamus to the supplementary motor area (SMA) and to the primary motor cortex (MI) has not been established. We investigated the distribution of thalamocortical neurons projecting to forelimb representations of the SMA and the MI using a multiple retrograde labeling technique in the monkey. The forelimb area of the SMA, and the distal and proximal forelimb areas of the MI were identified by electrophysiological techniques of intracortical microstimulation and single neuron recording. Injections were made into these three representations with three different dyes in the same animal (horseradish peroxidase conjugated to wheat germ agglutinin, diamidino yellow, and fast blue), and the thalamic neurons were retrogradely labeled. Injections into the SMA densely labeled thalamic neurons in nuclei ventralis lateralis pars oralis (VLo), ventralis lateralis pars medialis (VLm) and ventralis lateralis pars caudalis (VLc), but not in nucleus ventralis posterior lateralis pars oralis (VPLo). Injections into the MI labeled thalamic neurons primarily in VLo, VLc, and VPLo. We found that the distribution of projection neurons to the three areas was largely separate in the thalamus. However, in the middle part of VLo, and in a limited portion of VLc, thalamic neurons projecting to the SMA partially overlapped with those to the distal forelimb area of the MI. They overlapped little with those to the proximal forelimb area of the MI. We noted no overlap between the distributions of thalamic projection neurons to the distal and proximal forelimb areas of the MI. These findings suggest that the SMA and MI receive separate information from the thalamus, while sharing minor sources of common inputs.

Localization of oncofetal and normal fibronectin in colorectal cancer. Correlation with histologic grade, liver metastasis, and prognosis

BACKGROUND

Expression of oncofetal fibronectin (oncFN) and normal fibronectin (norFN) in colorectal cancer specimens was examined to investigate the correlation between fibronectin localization and histologic grade, liver metastasis, and prognosis.

METHODS

Immunohistochemical staining of oncFN and norFN was performed on 99 primary lesions and 12 liver metastases of colorectal cancer. The expression of norFN and oncFN was evaluated by grading the intensity of staining as negative, positive, or strongly positive.

RESULTS

Positive staining for oncFN correlated positively with increasing stage. The rate of strongly positive staining for oncFN was 53% for primary lesions with liver metastasis, significantly higher than the oncFN-positive rate of 13% for metastasis free cases (P < 0.05). Liver lesions had an oncFN-positive rate of 92%. The postoperative 5-year survival rate for 51 cases classified as Dukes Stage C was 77.8% for oncFN-negative cases, 36.5% for oncFN-positive cases, and 22.2% for oncFN-strongly positive cases; these rates were significantly different (P < 0.01). Conversely, there was no correlation between norFN and any clinical variable.

CONCLUSION

Expression of oncFN is correlated with a poor prognosis of Dukes C colorectal cancer and may serve as a useful postoperative prognostic sign.

[Analysis of malignant potential on colorectal carcinoma utilizing expression of epidermal growth factor and DNA ploidy patterns]

Human epidermal growth factor (EGF) and DNA ploidy patterns were investigated in order to elucidate malignant potential of 216 surgically resected colorectal carcinomas. EGF positive was detected in 140 out of 216 (64.8%) cases and DNA aneuploidy was found in 137 out of 216 (63.4%). No significant correlations were recognized between EGF expressions and DNA ploidy patterns. We subclassified the cases into four groups according to their histological EGF expressions and DNA ploidy patterns. In these groups, the relationship among EGF expressions, DNA ploidy patterns and clinicopathological findings was studied. Subgroups had a significant relation to depth of invasion, lymph node metastasis, lymphatic invasion and clinical stage. In patients with curative operation, the prognosis was significantly lower in EGF-positive-DNA aneuploidy group than in EGF-negative-DNA diploidy group. In DNA diploidy, the prognosis of EGF-positive group was poorer than in the EGF-negative group. In conclusion, the EGF expression as well as DNA ploidy patterns may be useful to assess malignant potential in colorectal carcinoma.

Effect of H2-receptor antagonists on bile acid metabolism

BACKGROUND

Several reports have been presented concerning pronounced overgrowth of bacteria in gastric juices of patients treated with H2-receptor antagonists. However, there has been no report concerning influence of H2-receptor antagonists on jejunal flora. Thus, to investigate the influence and its effect on bile acid metabolism, this study was performed: 1) to examine whether patients with gastric ulcers who have been treated with H2-receptor antagonists have positive bile acid breath tests due to bacterial overgrowth in their jejuna; 2) to verify that these bacteria, isolated and identified, have deconjugation ability; and 3) to determine whether the changes in the gastric pH are related to bacterial overgrowth.

METHODS

The methods used were detection of deconjugation of bile acids in early phase by a bile acid breath test using 5 muCi of oral glycine-1-14C labeled glycocholate, aspiration of jejunal fluids by a double lumen tube with a rubber cover on the tip, and examination of deconjugation ability by thin layer chromatography.

RESULTS

Expired breath samples from all 18 patients after administration of H2-receptor antagonists showed a significant increase in 14CO2 specific activity compared with those before administration of H2-receptor antagonist and the normal controls, and bacterial overgrowth was found in the jejunal fluid of the patients after administration of H2-receptor antagonist. The administration of tetracycline to the 18 patients reduced the 14CO2 specific activity significantly. The following species were identified in the jejunal fluid samples obtained from the patients: Escherichia coli, Candida albicans, Pseudomonas aeruginosa, enterococcus, Lactobacillus bifidus, Bacteroides vulgatus, Bacteroides thetaiotaomicron, Bacteroides uniformis, Eubacterium lentum, and Eubacterium parvum. All of the species identified except for Escherichia coli, Pseudomonas aeruginosa, and Candida albicans deconjugated bile acids. There were significant correlations between the 14CO2 activity and gastric pH before and after administration of H2-receptor antagonist, respectively.

CONCLUSIONS

Patients with gastric ulcers who were treated with H2-receptor antagonists have increased bile acid deconjugation due to bacterial overgrowth in their jejuna containing species that can deconjugate bile acids. The bacterial overgrowth is probably associated with a shift to neutral pH in the gastric juice caused by the H2-receptor antagonists.

Leukotriene B4 levels in the arterial blood of asthmatic patients and the effects of prednisolone

Prednisolone is very effective in controlling wheezing attacks of bronchial asthma, but its mechanism and the pathogenic role of leukotriene B4 remain unclear. We measured changes in plasma levels of leukotriene B4 in an open study during the clinical course of bronchial asthma, with or without water-soluble prednisolone treatment. Two millilitres of blood was drawn from the radial artery of patients on three occasions: 1) during remission; 2) on admission to hospital with an asthma attack; and 3) 2 days after admission and treatment with intravenous prednisolone (1,000 mg.day-1). Leukotriene B4 was detected by chromatographic fractionation and radioimmunoassay. In 11 asthmatic patients, leukotriene B4 levels on the three occasions were 26.8 (10.7), 106.0 (39.9) and 51.6 (20.2) pg.ml-1 (mean (SD)), respectively. In contrast, the mean leukotriene B4 level of 10 normal controls was 35.9 (10.5) pg.ml-1. Leukotriene B4 levels differed significantly between remission and attack treated without prednisolone, and between attacks treated with and without prednisolone. Mean arterial carbon dioxide (PaCO2) values were 4.8 (0.4) kPa (36.0 (3.0) mmHg), 6.1 (0.4) kPa (45.6 (2.9) mmHg), and 5.5 (0.3) kPa (41.6 (2.0) mmHg), respectively. There were significant differences between these mean PaCO2 values. The mean leukotriene B4 levels on the three occasions were correlated with the mean PaCO2 values. Thus, leukotriene B4 levels in arterial blood reflect the severity of asthmatic attacks and may be affected by intravenous prednisolone.

Leukotriene B4 levels in the arterial blood of asthmatic patients and the effects of prednisolone

Prednisolone is very effective in controlling wheezing attacks of bronchial asthma, but its mechanism and the pathogenic role of leukotriene B4 remain unclear. We measured changes in plasma levels of leukotriene B4 in an open study during the clinical course of bronchial asthma, with or without water-soluble prednisolone treatment. Two millilitres of blood was drawn from the radial artery of patients on three occasions: 1) during remission; 2) on admission to hospital with an asthma attack; and 3) 2 days after admission and treatment with intravenous prednisolone (1,000 mg.day-1). Leukotriene B4 was detected by chromatographic fractionation and radioimmunoassay. In 11 asthmatic patients, leukotriene B4 levels on the three occasions were 26.8 (10.7), 106.0 (39.9) and 51.6 (20.2) pg.ml-1 (mean (SD)), respectively. In contrast, the mean leukotriene B4 level of 10 normal controls was 35.9 (10.5) pg.ml-1. Leukotriene B4 levels differed significantly between remission and attack treated without prednisolone, and between attacks treated with and without prednisolone. Mean arterial carbon dioxide (PaCO2) values were 4.8 (0.4) kPa (36.0 (3.0) mmHg), 6.1 (0.4) kPa (45.6 (2.9) mmHg), and 5.5 (0.3) kPa (41.6 (2.0) mmHg), respectively. There were significant differences between these mean PaCO2 values. The mean leukotriene B4 levels on the three occasions were correlated with the mean PaCO2 values. Thus, leukotriene B4 levels in arterial blood reflect the severity of asthmatic attacks and may be affected by intravenous prednisolone.

Selective inhibition of myosin phosphorylation and tension of hyperplastic arteries by the kinase inhibitor HA1077

To examine possible alterations in myosin light chain phosphorylation in hyperplastic arteries, rabbit strips from right hyperplastic and left normal control carotid arteries were used for experiments 6 weeks after the ballooning procedure. When the hyperplastic artery was stimulated with various concentrations of K+ (10, 20, 30, 40 and 60 mM), the maximal tension in response to each concentration was significantly higher (P < 0.05) than that in the control artery. The maximal extent of myosin light chain phosphorylation induced by 60 mM K+ in the hyperplastic artery was also significantly higher than that in the control (55.1 +/- 4.1 vs. 45.1 +/- 3.2%, mean +/- S.D.). However, the [Ca2+]i response to elevated K+ in hyperplastic arteries was much the same as that in control arteries, when measured with fura-PE3. HA1077 (1-5-(isoquinolinesulfonyl)-homopiperazine), a protein kinase inhibitor, was about 3-5 times more effective in inhibiting the tension and myosin light chain phosphorylation induced by 60 mM K+ in the hyperplastic artery than in the control artery. Nifedipine inhibited the tension and myosin light chain phosphorylation to the same extent in control and hyperplastic arteries. Thus, an alteration of the myosin light chain phosphorylation system, but not an alteration of Ca2+ mobilization, may be involved in the enhanced contraction of the hyperplastic artery. The enhanced phosphorylation of myosin light chain may be sensitive to HA1077.

Effects of semotiadil fumarate (SD-3211) and its enantiomer, SD-3212, on the changes in cytosolic Ca2+ and tension caused by KCl and norepinephrine in isolated rat aortas

Semotiadil fumarate (SD-3211), a Ca2+ channel blocker of benzothiazine derivative and its (S)-(-)-enantiomer (SD-3212), inhibited K(+)- and norepinephrine (NE)-induced contractions in isolated rat aortas. Inhibition of NE contraction induced by both drugs was greater than that induced by diltiazem or bepridil, whereas inhibition of K(+)-contraction was similar to that induced by diltiazem or bepridil. Semotiadil and SD-3212 (10 microM) inhibited the increase in cytosolic Ca2+ ([Ca2+]i) induced by 65.4 mM K+ in fura-2-loaded preparations as well as diltiazem and bepridil (10 microM). On the other hand, semotiadil and SD-3212 (10 microM) inhibited only the early phase of increase in [Ca2+]i induced by 1 microM NE. After 5 min, no significant effect on [Ca2+]i was observed with these compounds despite the significant decrease in the contraction. In contrast to these compounds, diltiazem and bepridil 10 microM affected neither the increase in [Ca2+]i nor the contraction induced by NE. Semotiadil and SD-3212 inhibited the transient contraction induced by 1 microM NE in the absence of external Ca2+. Both compounds partially but significantly inhibited the NE-induced contraction in nifedipine-treated muscles. These results suggest that semotiadil and SD-3212 inhibit contractions of vascular smooth muscle (VSM) not only through blockade of voltage-dependent Ca2+ channels but also through other mechanisms, such as inhibition of Ca2+ release from Ca2+ stores or decrease in sensitivity of the contractile elements to Ca2+.

Pain-related somatosensory evoked potentials following CO2 laser stimulation of foot in man

Since our previous study of pain somatosensory evoked potentials (SEPs) following CO2 laser stimulation of the hand dorsum could not clarify whether the early cortical component N1 was generated from the primary somatosensory cortex (SI) or the secondary somatosensory cortex (SII) or both, the scalp topography of SEPs following CO2 laser stimulation of the foot dorsum was studied in 10 normal subjects and was compared with that of the hand pain SEPs and the conventional SEPs following electrical stimulation of the posterior tibial nerve recorded in 8 and 6 of the 10 subjects, respectively. Three components (N1, N2 and P2) were recorded for both foot and hand pain SEPs. N1 of the foot pain SEPs was maximal at the midline electrodes (Cz or CPz) in all data where that potential was recognized, but the potential field distribution was variable among subjects and even between two sides within the same subject. N1 of the hand pain SEPs was maximal at the contralateral central or midtemporal electrode. The scalp distribution of N2 and P2, however, was not different between the foot and hand pain SEPs. The mean peak latency of N1 following stimulation of foot and hand was found to be 191 msec and 150 msec, respectively, but there was no significant difference in the interpeak latency of N1-N2 between foot and hand stimulation. It is therefore concluded that N1 of the foot pain SEPs is generated mainly from the foot area of SI. The variable scalp distribution of the N1 component of the foot pain SEPs is likely due to an anatomical variability among subjects and even between sides.

Captopril inhibits neutrophil synthesis of leukotriene B4 in vitro and in vivo

The aim of this investigation was to determine the effects of metalloproteinase inhibitors on leukotriene (LT) A4 hydrolase in human neutrophil cytosol and to examine the effects of captopril on intact neutrophils in vitro and in vivo. Cytosolic fractions were assayed for LTA4 hydrolase and 5-lipoxygenase activity in the presence or absence of inhibitors. Only bestatin, 1,10-O-phenanthroline, captopril and fosinoprilat demonstrated significant effects. The IC50 of captopril and fosinoprilat for LTA4 hydrolase activity were 500 microM and 1 mM, respectively. No inhibition of 5-lipoxygenase activity in cytosolic fractions was detected. The effect of captopril was only minimally reversed by ZnSO4. The IC50 of captopril for inhibition of LTB4 synthesis in intact neutrophils was 63 microM. Furthermore, 5-HETE production in intact cells was diminished 25.3 +/- 8.5% in the presence of 1 mM captopril. Oral captopril inhibited stimulated LTB4 release by subsequently isolated neutrophils by 48.1 +/- 5.6% and 5-HETE release by 43.2 +/- 5.5%. Thus, captopril is an inhibitor of LTB4 synthesis in neutrophils in vitro and in vivo. However, there are differences between the potency of this drug as assessed in cytosol and intact cell studies. This study significantly extends previous reports in that it demonstrates that captopril is a more potent inhibitor of LTB4 synthesis in intact neutrophils than in cytosol and in that it demonstrates an inhibitory effect of captopril on synthesis of LTB4 by neutrophils exposed to captopril in vivo.

Captopril inhibits neutrophil synthesis of leukotriene B4 in vitro and in vivo

The aim of this investigation was to determine the effects of metalloproteinase inhibitors on leukotriene (LT) A4 hydrolase in human neutrophil cytosol and to examine the effects of captopril on intact neutrophils in vitro and in vivo. Cytosolic fractions were assayed for LTA4 hydrolase and 5-lipoxygenase activity in the presence or absence of inhibitors. Only bestatin, 1,10-O-phenanthroline, captopril and fosinoprilat demonstrated significant effects. The IC50 of captopril and fosinoprilat for LTA4 hydrolase activity were 500 microM and 1 mM, respectively. No inhibition of 5-lipoxygenase activity in cytosolic fractions was detected. The effect of captopril was only minimally reversed by ZnSO4. The IC50 of captopril for inhibition of LTB4 synthesis in intact neutrophils was 63 microM. Furthermore, 5-HETE production in intact cells was diminished 25.3 +/- 8.5% in the presence of 1 mM captopril. Oral captopril inhibited stimulated LTB4 release by subsequently isolated neutrophils by 48.1 +/- 5.6% and 5-HETE release by 43.2 +/- 5.5%. Thus, captopril is an inhibitor of LTB4 synthesis in neutrophils in vitro and in vivo. However, there are differences between the potency of this drug as assessed in cytosol and intact cell studies. This study significantly extends previous reports in that it demonstrates that captopril is a more potent inhibitor of LTB4 synthesis in intact neutrophils than in cytosol and in that it demonstrates an inhibitory effect of captopril on synthesis of LTB4 by neutrophils exposed to captopril in vivo.

Muscle spasm induced sympathetic reflex bursts on microneurography in a case with pontine demyelination

Microneurography was performed in a 39-year-old woman with demyelination of the pontine white matter associated with muscle spasms in the lower extremities. Single bursts on the microneurogram were observed immediately after cessation of the spasm with no systemic changes in the blood pressure or heart rate. Voluntary tonic flexion of the lower extremities induced similar bursts with small amplitudes. These reflex bursts possessed a characteristic of muscle sympathetic nerve activity, because the latency between the peak of each burst and the prior R-wave on the electrocardiograph was constant. The occurrence of these bursts suggests that a segmental compensatory mechanism in the spinal cord may stabilize the muscle blood flow influenced by muscle contraction.

[A case of central pontine myelinolysis and extrapontine myelinolysis during rapid correction of hypernatremia]

A 69-year-old woman was admitted because of severe dehydration due to anorexia. Consciousness disturbance was found to be due to severe abnormalities of serum electrolyte balance, but recovered quickly by correcting the hyperosmolality. While the initial serum sodium value of 186 mEq/L was corrected to 139 mEq/L in 5 days, locked-in syndrome, bilateral hand tremor and tetraparesis appeared. Brain magnetic resonance imaging (MRI) revealed symmetrically high signal intensity areas on T2-weighted images and low signal intensity areas on T1-weighted images in central part of pons and bilateral middle cerebellar peduncles. One and a half month later, these neurologic symptoms were improved and the MRI abnormalities also disappeared. Auditory brain stem responses which showed prolongations of III to V wave peak to peak latency at the onset returned to normal. It is noted in this case that central pontine myelinolysis (CPM) and extrapontine myelipolysis (EPM) appeared during the period of rapid correction of hypernatremia. Although it is known CPM and EPM are caused by hypernatremia or the rapid correction of hyponatremia, there has been reported only one case of CPM and EPM after rapid correction of hypernatremia. According to the hypothesis of Norenberg, rapid rise in serum sodium may cause CPM and EPM, but if CPM and EPM are caused by the rapid correction of hypernatremia in this case, CPM and EPM may be caused by another pathogenesis of the disorder.

[MultiCycle software for cell cycle analyses]

MultiCycle software (M-cycle), a computer cell cycle analysis program that has a background debris and aggregation compensating function, was utilized in this study to prove the usefulness of the M-cycle. The S phase fraction (SPF) calculated by the M-cycle was compared to that of bromodeoxyuridine labelling index (BLI) using colorectal carcinoma cell lines. The SPF value was slightly lower using the M-cycle than that of the BLI in Colo 201 and Colo 320 and lower significantly in Widr. This may indicate that the M-cycle effectively compensated for the background existing in the DNA histogram. The SPF value was computed both by the M-cycle and the sum of broadened rectangles model (SOBR). The SPF value of these cell lines showed a lower figure in the M-cycle than in the SOBR. The SPF value of paraffin-embedded material through the M-cycle and the SOBR was compared according to DNA ploidy patterns. The SPF value computed by the M-cycle was significantly lower in both ploidy patterns than that of the SOBR. In conclusion, the M-cycle is a useful tool for cell cycle analyses of simple DNA flow cytometric histograms obtained by paraffin-embedded material.

Plasma levels of leukotriene E4 during clinical course of bronchial asthma and the effect of oral prednisolone

To investigate the relationship between circulating leukotriene E4 and bronchial asthma, we tried to measure the concentration of leukotriene E4 during the clinical course of bronchial asthma with or without oral prednisolone treatment. Additionally, we investigated the relationship between the LTE4 levels and FEV1 (percent predicted) and PaCO2 (mm Hg) concomitantly. Two milliliters of blood were drawn from the femoral artery of eight patients on three occasions: (1) during remission; (2) during an attack treated without prednisolone; and (3) during an attack treated with prednisolone. Leukotriene E4 was detected by high-pressure liquid chromatography and radioimmunoassay. In eight asthmatic patients, mean (SD) leukotriene E4 levels on the three occasions were 11.8 (2.61), 48.4 (18.2), and 32.6 (8.28) pg/ml, respectively. In contrast, the mean leukotriene E4 level of ten normal control subjects was 11.8 (4.49) pg/ml. Leukotriene E4 levels differed significantly between remission and attack treated without prednisolone, and between attacks treated with and without prednisolone. Mean FEV1 values were 85.5 (3.07), 50.5 (9.58), and 65.9 (7.44) on the three occasions, respectively; corresponding mean PaCO2 values were 31.7 (2.74), 55.5 (5.81), 48.9 (2.56), respectively. Leukotriene E4 was significantly correlated with FEV1 and relatively with PaCO2 during an attack without prednisolone. We suggest that leukotriene E4 levels in arterial blood reflect the severity of asthmatic attacks and orally administered prednisolone may affect the leukotriene E4 levels.

Leukotriene A4 hydrolase in human bronchoalveolar lavage fluid

We examined cell-free human bronchoalveolar lavage fluid (BALF) for enzymes of the 5-lipoxygenase pathway. BALF was obtained from six patients who were active smokers and six nonsmokers. Enzymatic activity in cell-free BALF was assessed by specific assays for leukotriene (LT) A4 hydrolase, 5-lipoxygenase, and LTC4 synthase using HPLC. Only LTA4 hydrolase enzymatic activity was found. This activity ranged from 101 to 667 when expressed as picomoles of LTB4 produced per milliliter BALF. Enzymatic activity in smokers vs nonsmokers was 484 +/- 120 vs 129 +/- 32 pmol LTB4/ml BALF (mean +/- SD, P < 0.0001). There were no leukotrienes found in BALF before assay. Immunoblot analysis revealed an immunoreactive band at a relative molecular mass of 69,000 D in all samples, consistent with LTA4 hydrolase, but no evidence of 5-lipoxygenase. BALF had greater LTA4 hydrolase activity per milligram of protein than neutrophil cytosol, epithelial cell cytosol, plasma, or serum. The synthesis of LTB4 was significantly increased when neutrophils were stimulated in BALF. These data indicate the selective presence of LTA4 hydrolase in BALF which is significantly increased in smokers. This enzyme in BALF may contribute to the inflammatory response in tobacco-related lung disease.

Generator mechanism of pain-related evoked potentials following CO2 laser stimulation of the hand: scalp topography and effect of predictive warning signal

In order to clarify the generator mechanism of pain-related evoked potentials (pain EPs), we studied the scalp topography of the pain EPs following CO2 laser stimulation of hand dorsum by using balanced sternovertebral electrodes as the noncephalic reference in 11 normal volunteers. We also examined the effects of predictive warning signal (light-emitting diode) on the pain EPs. In both the warned and unwarned conditions, all of the 22 hand stimulations showed a large negative component (N2) at the peak latency of about 213 ms followed by a large positive component (P2) at the peak latency of about 329 ms. A preceding small negative component (N1) at the peak latency of about 148 ms was detected in 12 of the 22 hand stimulations in the warned condition and in 13 of the 22 hand stimulations in the unwarned condition. P2 was significantly larger and occurred earlier in the warned condition than in the unwarned condition, whereas other components did not differ between the two conditions, suggesting that an increased attention of the subject to the stimulus influenced the generator mechanism of the P2 component. With regards to the scalp topography, N2 was maximal at Cz and widespread transversely to both sides, whereas P2 was maximal at Cz or Pz and spread more posteriorly than N2. These findings suggest that P2 is generated by a different mechanism from N2 and is most likely associated with pain-related cognitive function. N1 was localized to the contralateral central and midtemporal areas, confirming that the nociceptive inputs are perceived in the sensory cortex in humans. The question as to whether the N1 component is generated in the hand area of the primary somatosensory cortex or in the secondary somatosensory cortex, or in both areas, remains to be solved.

Complete remission of liver metastases from colorectal cancer by treatment with a hepatic artery infusion (HAI) of interleukin-2-based immunochemotherapy: reports of three cases

In an attempt to improve the therapeutic efficacy against liver metastases, a hepatic arterial infusion (HAI) of interleukin-2 (IL-2)-based immunochemotherapy for anticipating the regional potentiation of hepatic lymphokine-activated killer (LAK)/tumor-infiltrating lymphocytes (TIL) was initiated. We present herein the cases of three patients with multiple liver metastases from colorectal cancer in whom complete remission was achieved by treatment with an HAI of IL-2 in combination with mitomycin C (MMC) and 5-fluorouracil (5-FU). These patients received an HAI of IL-2 at 8 x 10(5) JRU, 5-FU at 250 mg daily, and MMC at 4 mg once weekly for 3 weeks, being the induction regimen, after which they were discharged on maintenance therapy consisting of IL-2 at 2 x 10(6) JRU, 5-FU at 250 mg twice weekly, and MMC at 4 mg once weekly. It was evident from the liver CT scan taken after 2-3 months that the metastatic foci seen before therapy had clearly disappeared, while the serum carcinoembryonic antigen (CEA) had decreased to normal levels in all three patients. Pancytopenia was seen in one patient, but other laboratory studies of the hepatic and renal parameters were normal. The total lymphocyte count in the peripheral blood showed a mild decrease, while the lymphocyte phenotype study showed a notable increase in CD4+ cells and a decrease in CD8+ cells, with an elevation of a 4/8 ratio, in all cases during therapy. One patient relapsed with pelvic recurrence 14 months after the initiation of therapy, but the other two patients are still in remission 25 and 22 months after the initiation of therapy.