[Usefulness of palliative care for the patients with recurrent gastric cancer by home-IVH]

Depending upon the type of cancer involved, the period of the end stage varies greatly, and with it decreases the quality of life (QOL). In gastric cancer, for example, the terminal stage is usually short and the QOL diminishes abruptly. Thus, it takes time keeping this decrease in QOL to minimum, despite the complications, so that the patient's last days will be even somewhat more acceptable. Improvement in QOL for the patient who cannot eat due to recurrent gastric cancer can be effectively achieved by alleviation through IVH. With this in mind, the conditions consonant with the application of home IVH are as follows: 1) The patient's pain can be kept under control at home. 2) The patient wishes to remain. 3)There is sufficient human support at home. The caretakers in the family, and especially the key person(s) must exert much effort and labor and they need rest as well. Home medical care in the terminal stage presupposes a social environment involving day care, short stay, and hospice nursing facilities of all kinds. At present, public services of this kind differ with the community, much remains uninformed to public, and clinic-hospital networking will be needed more than ever. In this difficult situation, the home-care medical services provided by the private sector are effective. These services are only for the short term, of course, and there will be a financial problem. Various measures (tax deduction, public assistance) must be considered to support the patients and caretakers.

Serum anti-Helicobacter pylori antibody and gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Helicobacter pylori is recognized as one of the possible causes of gastric carcinoma. There have been few studies on the relationship between H. pylori and gastric carcinoma in patients younger than 40 years.

METHODS

Data and sera were collected from the cases (105 hospitalized patients younger than 40 years with gastric carcinoma from 9 hospitals in the Kanto-Shin-Etsu Area in Japan) and controls (102 hospitalized control subjects and 101 screening control subjects) whose sex and age (within 4 years) were matched. The serum anti-H. pylori immunoglobulin G antibody was measured, and the odds ratio (OR) for the association between seropositivity and gastric carcinoma was calculated.

RESULTS

The OR (95% confidence interval) was 13.3 (5.3-35.6). For women, the OR was 32.8, whereas for men it was 6.8. The OR for patients with early gastric carcinoma was 20.8, and for patients with advanced disease, it was 10.8. The OR for intestinal-type carcinoma was 18.0, and for diffuse-type carcinoma, it was 12.8. The OR for proximal carcinoma was 11.3, and for distal carcinoma it was 14.8.

CONCLUSION

The OR for these young subjects was considerably larger than that for the older subjects in previously published studies. Among those younger than 40 years of age, early stage carcinoma has a stronger association with H. pylori than advanced carcinoma, and intestinal- and diffuse-type carcinomas have an association with H. pylori.

Serum anti-Helicobacter pylori antibody and gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Helicobacter pylori is recognized as one of the possible causes of gastric carcinoma. There have been few studies on the relationship between H. pylori and gastric carcinoma in patients younger than 40 years.

METHODS

Data and sera were collected from the cases (105 hospitalized patients younger than 40 years with gastric carcinoma from 9 hospitals in the Kanto-Shin-Etsu Area in Japan) and controls (102 hospitalized control subjects and 101 screening control subjects) whose sex and age (within 4 years) were matched. The serum anti-H. pylori immunoglobulin G antibody was measured, and the odds ratio (OR) for the association between seropositivity and gastric carcinoma was calculated.

RESULTS

The OR (95% confidence interval) was 13.3 (5.3-35.6). For women, the OR was 32.8, whereas for men it was 6.8. The OR for patients with early gastric carcinoma was 20.8, and for patients with advanced disease, it was 10.8. The OR for intestinal-type carcinoma was 18.0, and for diffuse-type carcinoma, it was 12.8. The OR for proximal carcinoma was 11.3, and for distal carcinoma it was 14.8.

CONCLUSION

The OR for these young subjects was considerably larger than that for the older subjects in previously published studies. Among those younger than 40 years of age, early stage carcinoma has a stronger association with H. pylori than advanced carcinoma, and intestinal- and diffuse-type carcinomas have an association with H. pylori.

Serum anti-Helicobacter pylori antibody and gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Helicobacter pylori is recognized as one of the possible causes of gastric carcinoma. There have been few studies on the relationship between H. pylori and gastric carcinoma in patients younger than 40 years.

METHODS

Data and sera were collected from the cases (105 hospitalized patients younger than 40 years with gastric carcinoma from 9 hospitals in the Kanto-Shin-Etsu Area in Japan) and controls (102 hospitalized control subjects and 101 screening control subjects) whose sex and age (within 4 years) were matched. The serum anti-H. pylori immunoglobulin G antibody was measured, and the odds ratio (OR) for the association between seropositivity and gastric carcinoma was calculated.

RESULTS

The OR (95% confidence interval) was 13.3 (5.3-35.6). For women, the OR was 32.8, whereas for men it was 6.8. The OR for patients with early gastric carcinoma was 20.8, and for patients with advanced disease, it was 10.8. The OR for intestinal-type carcinoma was 18.0, and for diffuse-type carcinoma, it was 12.8. The OR for proximal carcinoma was 11.3, and for distal carcinoma it was 14.8.

CONCLUSION

The OR for these young subjects was considerably larger than that for the older subjects in previously published studies. Among those younger than 40 years of age, early stage carcinoma has a stronger association with H. pylori than advanced carcinoma, and intestinal- and diffuse-type carcinomas have an association with H. pylori.

[Portal blood immunoreactive insulin concentration after glucose infusion in elderly patients during gastrectomy compared with younger patients]

We evaluated the effect of aging on portal blood immunoreactive insulin concentration, AKBR, and keton body concentration (acetoacetate + beta-hydroxybutyrate) after glucose infusion (25 g glucose in an hour) in patients undergoing gastrectomy. Twenty-seven patients studied were elderly (above 65 years) and twenty-eight were younger (below 60 years). There was no significant difference in portal blood immunoreactive insulin concentration after glucose infusion between the two groups of patients. In elderly patients, however, AKBR was significantly lower and keton body concentration was significantly higher than those in younger patients, and these imply that suppression of ketogenesis and activation of hepatic mitochondrial function due to insulin may be reduced in elderly patients. These findings suggest that, during gastrectomy, pancreatic insulin secretion may not be impaired in elderly patients, but insulin action may be attenuated with aging.

[Non-Fukuyama type merosin-positive congenital muscular dystrophy with delayed muscle fiber type differentiation: a case report]

A patient with non-Fukuyama type merosin-positive congenital muscular dystrophy (nonFCMD) who had severe muscle weakness leading to early death was reported. He was the first product of epileptic mother who had been placed on phenobarbital and phenytoin. The patient had severe respiratory failure and muscle weakness at the neonatal period, and died at 4 months of age. Multiple joint contractures were also noted at birth. Serum creatine kinase was within normal limits (123 IU/l). Electromyography showed a myogenic pattern. Brain computed tomographic (CT) scan and magnetic resonance imaging (MRI) were normal without white matter lucency or pachygyria. Muscle biopsy revealed dystrophic changes and type 2C fiber predominance. Dystrophin, dystrophin-associated glycoproteins and merosin were all positively demonstrated. Although patients with merosin-positive nonFCMD have relatively mild clinical course, our patient had severe muscle weakness with fatal outcome. Defect in muscle fiber maturation and differentiation, such as an increase of undifferentiated type 2C fibers, may be a major factor to influence muscle symptoms in non FCMD.

Serum anti-Helicobacter pylori antibody and gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Helicobacter pylori is recognized as one of the possible causes of gastric carcinoma. There have been few studies on the relationship between H. pylori and gastric carcinoma in patients younger than 40 years.

METHODS

Data and sera were collected from the cases (105 hospitalized patients younger than 40 years with gastric carcinoma from 9 hospitals in the Kanto-Shin-Etsu Area in Japan) and controls (102 hospitalized control subjects and 101 screening control subjects) whose sex and age (within 4 years) were matched. The serum anti-H. pylori immunoglobulin G antibody was measured, and the odds ratio (OR) for the association between seropositivity and gastric carcinoma was calculated.

RESULTS

The OR (95% confidence interval) was 13.3 (5.3-35.6). For women, the OR was 32.8, whereas for men it was 6.8. The OR for patients with early gastric carcinoma was 20.8, and for patients with advanced disease, it was 10.8. The OR for intestinal-type carcinoma was 18.0, and for diffuse-type carcinoma, it was 12.8. The OR for proximal carcinoma was 11.3, and for distal carcinoma it was 14.8.

CONCLUSION

The OR for these young subjects was considerably larger than that for the older subjects in previously published studies. Among those younger than 40 years of age, early stage carcinoma has a stronger association with H. pylori than advanced carcinoma, and intestinal- and diffuse-type carcinomas have an association with H. pylori.

[Portal and peripheral blood immunoreactive insulin concentrations after glucose infusion during gastrectomy]

We evaluated portal and peripheral blood immunoreactive insulin concentrations (IRI) after glucose infusion in patients undergoing gastrectomy. Seventy-four patients were divided into following two groups: 68 received 25g glucose infusion in an hour (glucose group), and the remainder received no glucose (control group). Portal blood IRI level in glucose group was about thirty-fold higher than that in control group. However, peripheral blood IRI did not correlate with portal blood IRI in glucose group. In addition, significant negative correlation between portal blood IRI and blood glucose was observed in glucose group. Our results reveal that adequate pancreatic insulin secretion occurs after glucose infusion during gastrectomy, but peripheral blood IRI does not reflect this pancreatic insulin secretion. The results also suggest that blood glucose may be regulated by the liver under these conditions.

[Evaluation of preoperative blood preparation and blood consumption for implementation of type and screen and maximum surgical blood order schedule]

We analyzed preoperative blood preparation and intraoperative blood transfusion in Kagawa Prefectural Central Hospital and evaluated the effectiveness of maximum surgical blood order schedule (MSBOS) and Type and Screen (T&S). Forty seven kinds of surgery were performed on 1,283 cases from May, 1991 to April, 1992. Transfusion was performed in 179 cases of them. All of 1,884 units of blood that had been prepared, were crossmatched and 1,078 of them were actually transfused. The Crossmatched to Transfused ratio (C/T ratio) was 1.71. If we adopted MSBOS and T&S in 13 elective surgery, 766 units of blood and labour work for preoperative blood preparation could have been saved. MSBOS and T&S are beneficial for efficient usage of blood transfusion in surgery.

Management of chylothorax after pulmonary resection

BACKGROUND

Conservative management with intrapleural drainage and total parenteral nutrition (TPN) has been the first choice of treatment for postoperative chylothorax. With this approach, however, it usually takes several weeks for the chylothorax to resolve and it is sometimes unsuccessful. In this study, we reviewed seven patients who had chylothorax develop after pulmonary resection for primary carcinoma of the lung.

STUDY DESIGN

The patients were treated according to a "one-week trial" that consisted of one week of observation with intrapleural drainage and maximum parenteral nutritional support followed by operative intervention if the effect of the conservative therapy was not adequate. When the chylous leak was decreased to less than 100 mL/day or less than 15 percent of the maximum daily drainage volume after the "one-week trial," the conservative management was continued for two more weeks. After observation for three weeks, oral intake was begun and a final evaluation of the treatment was made.

RESULTS

One patient did not consent to the "one-week trial" and underwent operative treatment on the third postoperative day. Two patients had chylous leaks less than 100 mL/day or less than 15 percent of the maximum daily chylous leak after one week observation. Conservative management with TPN was continued in these patients for two more weeks and operation was performed in one on the 20th day and in the other on the 22nd postoperative day. The remaining four patients underwent operative treatment on the seventh or eighth postoperative day. All of the operations for chylothorax were successful, and chest tubes were removed promptly. These results show that operative management of chylothorax was reliable and safe. The "one-week trial," however, offered few advantages in determining the therapeutic strategy for postoperative chylothorax.

[Prolonging home residence and treatment of cancer in patients with recurrent stomach cancer]

A study was conducted on 27 patients with cancer of the stomach who died from a postoperative recurrence of the cancer, 26 of whom died in the hospital and one of whom died at home. The period from the manifestation of initial symptoms of the recurrence to confirmed diagnosis was less than two months in 20 of the 26 cases (77%). The period from confirmed diagnosis to terminal hospitalization was in excess of three months in 11 of the 26 cases (42%). Of these cases, there were some in which it appeared that the time spent at home could have been extended through means such as another operation, insertion of an intraperitoneal access apparatus, or insertion of a subselective movable catheter. Forty-six percent (46%) of the patients were notified of their diagnosis, but none of them were notified of the recurrence of the cancer, suggesting the difficulty of notifying a patient of a diagnosis of cancer recurrence. A private home-care medical system was used in the case of the patient who had died at home of terminal stomach cancer. There were no major problems with this system other than the complaint that it placed a great financial burden on the family.

[Evaluation of medicinal lymph node dissection in advanced gastric cancer]

In order to improve the results of surgical treatment in advanced gastric cancer, we performed preoperative targeted chemotherapy for metastatic lymph nodes. The solution which contained aclarubicin adsorbed on activated carbon was submucously injected around gastric tumor under endoscopic observation 2-7 days prior to the operation. We termed this method medicinal lymph node dissection (MLD). Our standard surgical treatment (SST) for gastric cancer consists of gastrectomy and extended lymph node dissection (N1 and N2 lymph nodes). Patients of curative resection with histologically positive lymph node metastasis were enrolled, as the subjects. We compared the cumulative survival rate in 47 patients treated with SST+MLD (MLD group) with that in 125 patients treated with SST only (control group). Five year survival rates in the MLD and control groups were 60% and 48%, respectively. The MLD group showed significantly higher survival rate in patients with N3, N4 and infrapyloric lymph node metastasis. A significant difference of the survival rate suggests the efficacy of SST+MLD against micrometastasis in N3 and para-aortic lymph nodes. The SST+MLD therapy is recommended to the advanced gastric cancer, especially in the lower third of the stomach.

Thalamic hyperdensity on CT in infantile GM1-gangliosidosis

Thalamic hyperdensity on computer-associated tomography (CT) has been reported as a disease-specific finding for GM2-gangliosidosis. However, a boy with the typical clinical symptoms and enzyme defect of infantile GM1-gangliosidosis had hyperdense thalamic lesions at 12 months of age. At the age of 34 months, the thalamus showed atrophy and the hyperdensity was restricted to the medial part of the thalamus, which exhibited increased intensity on T1-weighted and decreased intensity on T2-weighted images. Thalamic hyperdensity may be specific not only to GM2-gangliosidosis but also to GM1-gangliosidosis.

[Effects of combination chemotherapy using 5-FU, leucovorin, and CDDP (FLP therapy) for noncurative resected or recurrent stomach cancer in outpatients]

We performed combination chemotherapy consisting of 5-FU, leucovorin, and CDDP (FLP therapy) against noncurative resected or recurrent stomach cancer in outpatients as of August 1991. Seventeen outpatients patients underwent FLP therapy until February 1993. Therapeutic responses, survival time after the operation or recurrence, rate at home, and the improvement of performance status (PS) were studied. The response rate was 54.5%, median survival time was 410 days, the rate at home was 75.5 +/- 14.7%, and the rate of improvement of PS was 82.4%. Toxicities were observed in 70.6%. Thrombocytopenia must be followed carefully, but it was encountered in only a few patients. FLP therapy for advanced or recurrent stomach cancer in outpatients was expected to improve the QOL.

[A case of refractory status epilepticus associated with aberrant intracranial shunt tube: efficacy of lidocaine in the determination of the epileptic focus]

We report our experience using lidocaine to determine the epileptic focus in a case of refractory status epilepticus associated with an aberrant intracranial shunt tube. Pentobarbital anesthesia rapidly suppressed convulsions. However, whenever the pentobarbital was decreased, the status epilepticus was resumed. The seizure looked primarily generalized both clinically and electroencephalographically, but EEG monitoring with intravenous administration of lidocaine demonstrated that the ictal waves began from the right anterotemporal area, where the shunt valve and tube were placed. Removal of the shunt tube and the surrounding scar tissue eliminated status epilepticus. Our result suggests the excellent efficacy of lidocaine to distinguish secondarily generalized status epilepticus from primarily generalized one.

Serum pepsinogen as a new marker for gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.

METHODS

Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.

RESULTS

The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.

CONCLUSIONS

These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.

Serum pepsinogen as a new marker for gastric carcinoma among young adults. Research Group on Prevention of Gastric Carcinoma among Young Adults

BACKGROUND

Gastric carcinoma is relatively uncommon in Japan among persons younger than 40 years of age, but its prognosis is not favorable and it affects young adults in their most productive years. This study was performed to evaluate the validity of serum pepsinogen as a new marker for gastric carcinoma among Japanese younger than 40 years of age.

METHODS

Data and sera were collected from the patients (108 patients younger than 40 years of age with gastric carcinoma from nine hospitals in the Kanto-Shin'etsu area in Japan) and from the control subjects (108 hospital control subjects and 108 screening control subjects) whose sex and age (within 4 years) were matched. Pepsinogen I and pepsinogen II values were measured and compared between patients and control subjects by paired t test. Sensitivities and specificities when criteria were defined by pepsinogen I, pepsinogen II, and pepsinogen I/II ratio were calculated.

RESULTS

The pepsinogen I and pepsinogen II levels among patients were higher and the pepsinogen I/II ratio among patients was lower than among control subjects. When a pepsinogen II level higher than 14.8 ng/ml was considered positive, the test showed high sensitivity (83.3% for total gastric carcinoma and 85.0% for early gastric carcinoma) and high specificity (76.9% for hospital control subjects and 75.0% for screening control subjects). Similar degrees of sensitivity and specificity were obtained with the pepsinogen I/II ratio.

CONCLUSIONS

These results suggest that a high pepsinogen II level combined with a low pepsinogen I/II ratio may be a useful screening test for gastric carcinoma in a young population at high risk for gastric carcinoma. This impression should be confirmed by a more extensive field trial to determine whether performance of these assays promotes early diagnosis of gastric carcinoma.

[Clinicopathological study of 4 patients with idiopathic BOOP, interstitial type on chest X-ray]

We studied four patients with idiopathic Bronchiolitis Obliterans Organizing Pneumonia (BOOP) diagnosed by open lung biopsy. All of four presented with acute onset and a rapid course with progressive dyspnea. Their chest X-ray films showed ground-glass opacities with reduced volumes in the bilateral lower lobes. Their chest CT revealed marked increases in lung density with air bronchograms. Radiologically, it was difficult to distinguish these cases from patients with acute interstitial pneumonia. Histologically, in the uninflated specimens, the collapse of alveoli and alveolar spaces filled with foamy macrophages and proteinous exudates were observed. The organizing tissues were present predominantly in the alveolar ducts, but varied in extent among cases. We considered the reduced lung volumes on chest X-ray films and the marked increases in lung density on chest CT to reflect alveolar collapse. Proliferation of type II pneumocytes was remarkable in all cases, but reactivity to antisurfactant protein-A antibody staining was decreased in the collapsed alveoli. It was suggested that the alveolar collapse was caused, in part, by decreased pulmonary surfactant in addition to obstruction of the alveolar ducts. The rapid responses to of these patients corticosteroid therapy may be due to improvement of the alveolar collapse.

[Concentrations of haptoglobin and free hemoglobin in preserved whole blood]

In bank blood, red blood cells are destroyed and free hemoglobin increases during preservation. Concentrations of haptoglobin and free hemoglobin were measured in 73 packages of preserved whole blood which had been kept for various periods, 1 to 21 days. Those blood samples were divided into 7 groups depending on preserved period, 1 to 3, 4 to 6, 7 to 9 days, and so on. Total haptoglobin decreased to less than 100 mg.dl-1 in the blood preserved over 7 days. Total hemoglobin increased with the passage of preserved period. Free hemoglobin appeared in 40% or more of the blood preserved over 7 days and its concentration increased depending on preserved time. Free hemoglobin of 10 mg.dl-1 or more was detected in the blood preserved over 7 days. It is recommended that for massive blood transfusion the whole bank blood under 7 days of preservation should be used.

Hepatocyte growth factor accelerates the wound repair of cultured gastric mucosal cells

Effects of hepatocyte growth factor (HGF) on gastric wound repair were assessed. Artificial wounds of uniform size were made by mechanical cell denudation in confluent rabbit gastric mucosal cell sheets. The changes in wound size were analyzed quantitatively. The wound repair process contained an initial migration stage and a later proliferation stage. The wound was completely repaired in 36 h in controls; this repair was accelerated by HGF with the induction of cell migration followed by proliferation and was retarded by tyrosine protein kinase inhibitor genistein. HGF might play some roles in gastric ulcer healing.

Effect of nicotine in migration and proliferation of rabbit gastric mucosal cells in a culture cell model

The aim of this study was to assess the effects of nicotine on the gastric epithelial restoration using primary cultured rabbit gastric mucosal cell model. Confluent monolayer mucosal cell sheets consisting of mainly mucous cells were wounded using a rotating silicon tip. The process of restoration was monitored, and the size of wound was measured and analysed quantitatively. Artificial wounds recovered in 36 h in controls. The nicotine treatment (10(-5), 10(-4) and 10(-3) mol/L) did not cause any effects on the process of wound repair. Bromodeoxyuridine (BrdU) positive cells appeared around the wound 24-36 h after injury and then disappeared after the complete repair in controls and also in nicotine-treated groups. However, in the morphological observation, numerous vacuoles were detected in parietal cells of nicotine-treated groups. This effect of nicotine was reversible by removing nicotine from the medium. Present data suggest that nicotine has no direct effects on the mucosal restoration but might have an effect on the structure and function of parietal cells.

Activation of anthocyanin synthesis genes by white light in eggplant hypocotyl tissues, and identification of an inducible P-450 cDNA

Eggplant seedlings (Solanum melongena) grown under red light irradiation showed a normal morphology with green, fully expanded cotyledons. When the seedlings grown under red light were irradiated with ultraviolet-containing white light, anthocyanin synthesis was induced in the hypocotyl tissues, especially when a UV light supplement was added. The accumulation of pigments was closely associated with the expression of genes involved in flavonoid synthesis. These genes include chalcone synthase (CHS) and dihydroflavonol 4-reductase (DFR). Using subtracted probes, which had been enriched for the accumulated mRNA, one white light-responsive cDNA was identified as being a P450 gene by comparison with database sequences. The maximal amino acid homology this cDNA had with other P450s was 36%. This was with CYP71 from avocado (Persea americana). Thus it represents a new P-450 family, which has been named CYP75. The mRNA of this gene was localized in the hypocotyl tissues of eggplant seedlings, which had been white light-irradiated. The transcript was accumulated by changing the light source, as in the case of other flavonoid biosynthesis genes. In delphinidin producing petunia plants, the mRNAs corresponding to the eggplant P-450 and flavonoid biosynthesis genes such as CHS and DFR were most abundant during the mid stage of flower bud development, but could not be detected in leaf tissues. These results suggest that this P-450 gene encodes a hydroxylating enzyme involved in flavonoid biosynthesis.

Induction of cytolytic activity of lymphocytes from carcinomatous pleural effusion by IL-2 and autologous tumor cells

We established a cell line (STKM-1) from tumor cells obtained from carcinomatous pleural effusion of a gastric cancer patient. The lymphocytes separated from her peripheral blood or pleural effusion were cryopreserved and immunological experiments were performed after the establishment of the cell line. They were treated with IL-2 or with both IL-2 and mitomycin C (MMC)-treated autologous STKM-1 cells. The cytolytic activity against STKM-1 cells was elevated in lymphocytes cultured with IL-2, and was more prominently augmented in lymphocytes cultured with both IL-2 and MMC-treated STKM-1 cells. The elevation in cytolytic activity was more marked with pleural effusion lymphocytes than with the peripheral blood lymphocytes. The results suggest that the lymphocytes obtained from the pleural effusion would be an excellent source for adoptive immunotherapy.

[Neuroimaging in movement disorders--CT, MRI, and PET study]

The recent advance in non-invasive methods of neuroradiology such as magnetic resonance imaging (MRI) and positron emission tomography (PET) has been lead to give us much informations about the structural changes with high resolution, the iron distribution in the brain, the regional metabolism, and the receptor mapping etc. These new methods have been also applied to the movement disorders. For example, in Parkinson's disease, MRI revealed the narrowed T2 image of pars compacta of nigra without striate lesion. Also PET in this disease demonstrated normal regional cerebral blood flow, normal regional glucose metabolism, decreased uptake of DOPA, reduced re-uptake of dopamine, and normal D1 and D2 receptors in the striatum. These anatomical, metabolic, and molecular physiologic information has not only elucidated the pathophysiology but has also helped us to understand normal brain function.

The cloning of eggplant seedling cDNAs encoding proteins from a novel cytochrome P-450 family (CYP76)

Using a CYP75 cDNA as a probe, we have cloned and sequenced two closely related cDNAs from eggplant seedlings, which encode typical cytochrome P-450 (P450) proteins. A database search revealed that the predicted proteins share less than 40% amino acid homology with other P450 proteins, which suggests that they form a novel P450 gene family (CYP76).

cDNAs sequences encoding cytochrome P450 (CYP71 family) from eggplant seedlings

Three cytochrome P450 (P450) cDNAs were isolated from an eggplant hypocotyl cDNA library using eggplant CYP75 cDNA as a probe. These cDNAs have greater than 65% identity in their amino acid sequences, indicating that they belong to the same family. Comparison of these with P450 proteins from other sources showed that the protein with the greatest degree of homology is CYP71, isolated from avocado fruits (approximately 48%). We concluded that they are novel members of the CYP71 gene family (CYP71A2, 3 and 4). We have examined the level of mRNA transcripts from the CYP71 family in eggplant hypocotyl tissues and petunia flower buds, and found that the level of transcripts is developmentally regulated in the flower bud.

[A case of rheumatoid arthritis with obstructive bronchiolitis appearing after D-penicillamine therapy]

A 56-year-old woman was diagnosed as having rheumatoid arthritis in 1983. She was treated with D-penicillamine in addition to non-steroid anti-inflammatory drugs from April 1990. In August she noticed shortness of breath on exertion. Chest X-ray films showed bilateral interstitial shadows, and chest CT revealed bilateral multiple wedge-shaped shadows extending distally. Blood gas analysis showed severe hypoxemia and pulmonary function tests demonstrated decreased %VC, FEV1.0% and diffusion capacity. Open lung biopsy specimens revealed infiltration of inflammatory cells and fibrotic change in the walls of bronchioles. She was diagnosed as having obstructive bronchiolitis. Corticosteroid therapy and discontinuation of D-penicillamine therapy stopped the progression of her symptoms, and she was discharged on corticosteroid maintenance treatment and home oxygen therapy.

[Translumbar local injection of OK-432 on para-aortic lymph nodes for recurrence of gastric carcinoma]

CDDP, 5-FU and LCV are administrated for recurrent gastric carcinoma in our hospital. We have been attempting translumbar local injection of a suspension of OK-432 and Lipiodol into the para-aortic lymph nodes or their surrounding areas for patients with para-aortic lymph node metastases when it was confirmed that the patient had a recurrence. This emulsion gradually degraded successively in the body. In this paper, we report the translumbar local injection method and its effective use in a case with para-aortic lymph node recurrence of gastric carcinoma.

[Intra-arterial infusion chemotherapy for advanced uterine cancer before surgical treatment]

Three cases of advanced uterine cancer were treated by CDDP intra-arterial infusion chemotherapy before curative operation. In Case I (stage IVb, G2), chemotherapy was done by BOAI method before radical hysterectomy and by implantable reservoir system after operation. In Case II (IIIa, G1), modified radical hysterectomy could be performed after chemotherapy using an implantable reservoir system, though inoperable at first. In Case III (IVa, G1), the patient was given intra-uterine arterial infusion chemotherapy twice with BOAI method before radical hysterectomy. The results suggested that this treatment is effective for advanced uterine cancer, and further study of prognosis was considered necessary.

[The efficacy of semiselective intraarterial infusion therapy in advanced or recurrent gastric cancer]

We use CDDP and have compared the semiselective intraarterial infusion (ia group) with intravenous infusion (i.v. group) by measuring levels of the administered drug in blood and the abdominal organ tissues. In portal blood, the ia group showed a significant increase compared with the i.v. group. The patient tissue level was compared between the two groups. Higher levels were obtained in the peritoneum in the ia group. These results suggest that semiselective intraarterial infusion therapy is effective in peritoneal dissemination.

[A patient with stage IV gastric cancer responding to combination chemotherapy with 5-FU, leucovorin and CDDP]

The patient was a 44-year-old male with gastric cancer accompanied by pancreatic invasion and metastasis to the periaortic lymph nodes. Combination chemotherapy with 5-FU, leucovorin (LCV) and CDDP (FLP therapy) was preoperatively given. Pancreaticoduodenectomy was carried out as absolutely noncurative resection. FLP therapy was continued postoperatively, and resulted in disappearance of the metastases in the periaortic lymph nodes on CT. As there were no findings of recurrence, the patient was regarded as being in complete response. In addition, the performance status improved from Grade 2 to Grade 0. Since the three-drug combination therapy induced only slight adverse reactions (Grades 1-2), it could be safely carried out at the outpatient department. Thus, combination therapy with 5-FU, LCV and CDDP is thought to be effective against gastric cancer.

Aberrant retrotracheal goiter: report of a case

A case of intrathoracic retrotracheal goiter in a 40-year-old woman is herein described. A computed tomographic scan, magnetic resonance imaging and endoscopical ultrasonography all confirmed the existence of a retrotracheal encapsulated lesion, which was suspected to be aberrant mediastinal goiter. Radioiodine scintigraphy, however, demonstrated little uptake in the mass. A large (7 x 6 x 4 cm), encapsulated adenomatous goiter was then easily removed via a right thoracic approach.

[A case of stage IVb ovarian carcinoma successfully treated with intra-arterial infusion chemotherapy using implantable reservoir system]

A patient with liver metastasis from ovarian cancer was treated by intra-arterial infusion chemotherapy (well differentiated adenocarcinoma--CDDP 50 mg/body, ADR 30 mg/body, CPA 500 mg/body (iv)). After the chemotherapy, the metastatic tumor appeared remarkably smaller and could be resected successfully at the second reduction surgery. This patient is active 30 months after the first appearance and enjoying a favorable quality of life.

Adjuvant radiotherapy after complete resection of thymoma

Seventy patients were studied after undergoing complete resection of thymoma to determine the effect of postoperative adjuvant mediastinal radiotherapy on prognosis, with regard to clinical stage, histological type, and pleural factor. Pleural factor was defined as follows: p0, no adhesion to the mediastinal pleura; p1, fibrous adhesion to the mediastinal pleura without microscopic invasion; and p2, microscopic invasion of the mediastinal pleura. Recurrence of thymoma after complete resection was observed in 13 patients, 12 (92%) with pleural dissemination, 6 (46%) with local recurrence, and 2 (15%) with distant metastasis (types of recurrence are overlapping). In stage I and stage II p0 patients, no recurrence was observed, regardless of mediastinal radiotherapy. Whereas mediastinal irradiation completely prevented recurrence in stage II p1 patients, 4 (36.4%) nonirradiated stage II p1 patients experienced recurrence. In stage II p2 patients, 75% had pleural dissemination even after radiotherapy. A high incidence of recurrence was also observed in stage III, nonirradiated (25%) and irradiated (30%) patients. The results suggest that mediastinal irradiation for stage I and II p0 patients is not always necessary, and that therapy for stage II p1 is essential and also expected to decrease the recurrence rate. On the other hand, in stage II p2 and stage III thymomas, mediastinal irradiation is not sufficient to prevent pleural recurrence even after complete resection. Our classification based on pleural factor is useful for better selection of appropriate postoperative treatment for thymoma patients.

[Results of patients in stage I and II primary lung cancer with curative resection]

We analyzed 91 patients who had curative resection from 1982 to 1989 for stage I and II primary lung cancer. The 5-year survival rates were 71.4% for stage I and 44.7% for stage II. The 5-year survival rates were 86.6% for T 1 N 0 M 0, 47.3% for T 2 N 0 M 0, 56.3% for T 1 N 1 M 0, and 37.9% for T 2 N 1 M 0. There was no cancer death in patients with squamous cell carcinoma of T 1 N 0 M 0. For stage I, tumor diameter was significant factor to influence survival. Although there was a statistically significant difference between stage I and II in patients with adenocarcinoma, there was no significant difference in those with squamous cell carcinoma. Chemotherapy had no significant improvement in survival for stage I and II lung cancer.

[Epidural midazolam with bupivacaine--optimal dose for postoperative pain relief]

Optimal dose of epidural midazolam with bupivacaine for postoperative pain relief was investigated. Forty seven patients for upper abdominal surgery were divided into 5 groups. Each group had either 0.25% bupivacaine 6 ml (control group), 0.25% bupivacaine 6 ml + midazolam 0.025 mg.kg-1 (0.025 group), 0.05 mg.kg-1 (0.05 group), 0.075 mg.kg-1 (0.075 group), or 0.1 mg.kg-1 (0.1 group) administered epidurally for complaint of first postoperative pain. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and sedation score (SS) were monitored for 120 minutes, and the time interval for next analgesics (TNA) was checked. In each group, BP fell down 10 minutes after injection, HR was unchanged, and RR (except for 0.1 group) decreased, compared with the preinjection level. There was no difference between control group and others in BP, HR and RR. But 3 cases in 0.075 group and 4 cases in 0.1 group needed chin lift with a pillow under the shoulder for slight airway obstruction. The most optimal SS was obtained in 0.05 group. TNA was significantly longer in 0.025 and 0.05 groups than in the control group. It was concluded that the optimal dose of epidural midazolam with 0.25% bupivacaine 6 ml was 0.05 mg.kg-1 for postoperative pain relief after an upper abdominal surgery.

[A case of invasive broncho-pulmonary aspergillosis associated with influenza A (H3N2) infection]

A 49-year-old man with high alcohol consumption was admitted with fever, cough and progressive dyspnea after a one week history of influenza-like symptoms. Chest X-ray film on admission showed diffuse peribronchial shadows and patchy infiltration in the right lower lung field. Chest X-ray film the following day and chest CT film on the 4th day of admission showed multiple nodular shadows and cavity formation. At bronchoscopy the bronchial surface was covered by white plaque, and Asp. fumigatus was subsequently cultured from BAL fluid. On the basis of suspected invasive pulmonary aspergillosis, anti-fungal agents were commenced. However, the shadows on chest X-ray increased, and the patient died on the 10th day of admission of respiratory failure and septic shock. Histological examination revealed bronchial wall invasion by hyphae of aspergillus and abscess formation in the pulmonary parenchyma. The precipitin antibody against aspergillus antigen was positive in reserved serum. Anti-Influenza A virus antibody (CF) was positive (X 256), and hemagglutination inhibition test of Influenza A (H3N2) was positive (X 2048) in serum on admission. The suppression of cellular immunity and destruction of the mucociliary system of airways induced by Influenza A infection was suspected to have predisposed to aspergillus superinfection.

[An electron microscopic study of the pulmonary alveolar capillaries in idiopathic interstitial pneumonia and lungs of collagen vascular diseases]

The ultrastructure of pulmonary alveolar capillaries in idiopathic interstitial pneumonia (IIP) and collagen vascular diseases (CVD) were investigated. In IIP, the endothelial cells were only slightly swollen. The basement membrane (BM) was moderately thickened. In CVD, swelling of the endothelial cells and thickening of the BM were more severe than those of IIP. The injury of the endothelial cells seemed to be more severe than IIP. The patients with PSS and MCTD revealed degeneration of endothelial cells as well as lamellation of BM. The endothelial cell damage was most severe among CVD cases, and these changes were assumed to induce pulmonary hypertension. Microtubular structures were observed in the endothelium of SLE, dermatomyositis, polymyositis, PSS and MCTD patients. Weibel-Palade bodies and increase of pericytes were noticed in PSS and MCTD patients which seemed to be related to endothelial injuries. No electron-dense deposits were observed in any case.

[A case of pulmonary arteriovenous fistula accompanied with marked polycythaemia]

A 67-year-old male was admitted with cyanosis, digital clubbing and exertional dyspnea. Laboratory data revealed severe polycythaemia with 26 mg/dl hemoglobin, red blood cell; 866 x 10(-4)/mm3, hematocrit 72.8% and PaO2 44.6 mmHg. Selective pulmonary angiography demonstrated a large arteriovenous fistula involving the right middle lobe. After venesection of 1,200 ml of blood, the middle lobectomy was performed safely. In a case of pulmonary arteriovenous fistula with such severe polycythaemia, preoperative venesection is useful to decrease perioperative complications.

Differential intracardiac sympathetic and parasympathetic innervation to the SA and AV nodes in anesthetized dog hearts

Stimulation of discrete intracardiac sympathetic nerves to the SA (SAS stimulation) or AV nodal region (AVS stimulation) increased the heart rate or decreased AV conduction time and caused an AV junctional rhythm, respectively, in anesthetized dogs treated with atropine. Topical application of tetrodotoxin (TTX) at the SAS or AVS stimulation locus totally inhibited the response to each stimulation, whereas each TTX treatment slightly attenuated the chronotropic response to the right ansa stimulation by 23 +/- 7.7% and the dromotropic response to the left ansa stimulation by 7 +/- 7.5%. TTX abolished AVS stimulation-induced one. Before atropine, topical application of hexamethonium at the locus for stimulation of intracardiac parasympathetic nerves to the SA (SAP stimulation) or AV nodal region (AVP stimulation) abolished almost totally negative chronotropic responses to SAP and cervical vagus stimulation or negative dromotropic responses to AVP and cervical vagus stimulation, respectively. These results demonstrate that activation of a very small population of intracardiac sympathetic nerves to target cells is enough to induced positive chronotropic and dromotropic responses in the heart in situ, and that SA and AV nodal pacemaker activity and AV conductivity are controlled multi-directionally by intracardiac sympathetic nerves in contrast with parasympathetic ones.

[Analysis of prognostic factors in high risk gestational trophoblastic disease with respect to remission and recurrence]

Sixty-nine patients with high risk gestational trophoblastic disease (excluding invasive mole) were treated at Chiba University from 1973 to 1988. The clinical features and results of treatment which influenced remission and recurrence in these high risk patients were analyzed statistically. The factors analyzed were (1) the height of pretreatment urinary hCG titer, (2) the type of antecedent pregnancy, (3) the time interval from pregnancy to treatment, (4) the metastatic site, (5) age, (6) the type of chemotherapy, (7) the time of operation and (8) the number of additional chemotherapy courses. With respect to the remission rate and the metastatic site, the type of chemotherapy was statistically significant. In addition, the factors related to the time of operation were significant in relation to recurrence.

[A case of alveolar hemorrhage associated with mixed connective tissue disease]

A 52-year-old woman was admitted to our hospital because of anemia and abnormal lung shadow. She had Raynaud's symptom for 6 months, and recently developed cough and easy fatigability. She had thrombocytopenia, restrictive pulmonary dysfunction, and swollen fingers. ANF was positive (X1280), and anti-RNP antibody was also positive. Mixed connective tissue disease was diagnosed. Chest X-ray showed a diffuse alveolar pattern, and BAL revealed many hemosiderin-laden macrophages. Alveolar hemorrhage was suspected. The pulmonary shadow resolved spontaneously, and no recurrence occurred after steroid and immunosuppressant therapy.

[A case of chondrosarcoma arising from the left first rib]

A 46-year-old female was admitted to our hospital because of a left supraclavicular tumor. The chest CT scan and MR imaging revealed that the tumor arose from the left first rib and developed into the supraclavicular region. In this case, we tried to resect the tumor using the so-called "trap-door" thoracotomy. Although removal of subclavian vessels and brachial plexus from the tumor was easily performed, we could not enough treat the vertebral side of the first rib through this thoracotomy without the T1 nerves injury. In cases of superior sulcus tumors developing into the posterior chest wall, a posterior incision combined with an anterior one will be useful to remove these tumors safely.

[A clinicopathological study on gestational trophoblastic disease comparing with high risk criteria and diagnostic score of choriocarcinoma]

In the past 15 years, 274 patients with the gestational trophoblastic disease have been treated at Chiba University and the diagnosis of 125 patients was confirmed pathologically. There were 55 cases (44%) in the high risk and 70 cases (56%) in the low risk group with the following criteria: (1) the urinary hCG titer was more than 100,000 IU/L; (2) the duration between antecedent pregnancy and the start of treatment was more than 1 year; (3) antecedent pregnancies were full-term or abnormal pregnancies except hydatidiform mole. These pathologically confirmed patients were evaluated with the choriocarcinoma diagnostic score. From this study, the following results were obtained: (1) The overall remission rates in high risk and low risk patients were 79.1%, 100%, respectively. (2) Out of 55 patients with high risk diagnosed pathologically, 49 (89.1%) patients had choriocarcinomas. On the other hand, 65 (92.9%) patients with low risk had invasive moles. (3) The discrepancies between the pathological and the clinical diagnosis chiefly depended on the inadequate evaluation of recurrent cases and the pretreatment urinary hCG. (4) Compared with our criteria, the choriocarcinoma diagnostic scoring system more closely corresponds to the pathological diagnosis but this system is more complex and inadequate than our criteria for older up patients that have not been adequately followed up.