[Antitumor effect and indication of chemoembolization using degradable starch microspheres and regional hyperthermia in patients with hepatocellular carcinoma]

Antitumor effects and indications of chemoembolization using degradable starch microspheres (DSM) and regional hyperthermia were investigated in patients with unresectable hepatocellular carcinoma. Chemoembolization using DSM was performed in 40 cases and fourteen cases were treated with the combination of hyperthermia. Tumor regression rate over 50% was 48% (chemoembolization alone: 42%, combined hyperthermia: 57%). Though one and two year survival rates were 62% and 54% respectively in the treatment with chemoembolization alone, one year survival rate was 91% in the treatment with combined hyperthermia. From the viewpoint of antitumor effect, it was thought that effectual indications of chemoembolization using DSM alone were the cases whose tumor size were below 7 cm and portal invasion were negative. These indications however were spread by the combination of hyperthermia. The DSM, temporary embolus, is suitable for combination of hyperthermia because chemoembolization using DSM can be performed many times. The cases with clinical stage III and obstruction of the first branch of portal veins did not become severe hepatic failure because DSM was temporary embolus. Therefore, from the viewpoint of safety, chemoembolization using DSM has almost the same indications as intra-arterial infusion therapy. These results suggested that chemoembolization using DSM will be a beneficial methods as combination therapy for unresectable hepatocellular carcinoma.

[Role of lipid peroxidation and polymorphonuclear leukocytes-derived oxygen radicals in acute gastric lesions induced by hyperthermic treatment]

Acute gastric lesions were experimentally induced by local hyperthermic treatment (42 degrees C, 40 min). Thiobarbituric acid (TBA) reactants in the gastric mucosa were significantly increased 40 min after the hyperthermia. There were no changes in gastric mucosal blood flow and gastric acid secretion. The total area of gastric erosions and TBA reactant in gastric mucosa of rats deficient in vitamin E were significantly increased compared with those of rats supplemented with vitamin E. The increase in the total area of gastric erosions and TBA reactants in gastric mucosa were significantly inhibited by the treatment of bovine Cu, Zn-SOD and bovine catalase, and by the depletion of polymorphonuclear leukocytes (PMN). Allopurinol did not show any influence on these pathological changes induced by hyperthermia. These results suggest that lipid peroxidation and PMN-derived oxygen radicals may play an important role in the pathogenesis of gastric lesions induced by hyperthermic treatment.

Role of lipid peroxidation and oxygen radicals in compound 48/80-induced gastric mucosal injury in rats

Repeated administration of a small dose of compound 48/80 induced acute gastric mucosal injury in rats. Thiobarbituric acid (TBA) reactants in the gastric mucosa were significantly increased and serum alpha-tocopherol was significantly decreased after the treatment. The total area of gastric lesions and the increase in TBA reactants in the gastric mucosa were significantly reduced by pretreatment with superoxide dismutase (SOD) and/or catalase, allopurinol and anti-rat polymorphonuclear leukocytes (PMN) antibody. Lipid peroxidation and oxygen radicals derived from both the xanthine-xanthine oxidase system and PMN may be involved in the pathogenesis of compound 48/80-induced gastric mucosal injury.

Treatment of malignant ascites and pleurisy by a streptococcal preparation OK-432 with fresh frozen plasma--a mechanism of polymorphonuclear leukocyte (PMN) accumulation

A single injection of a streptococcal preparation, OK-432, with fresh frozen plasma (FFP) (or fresh human serum) into the peritoneal or pleural cavity for the treatment of malignant ascites or pleurisy resulted in a complete reduction of ascitic fluid or pleural effusion in 5 out of 11 patients. FFP was used a further source of complement for the effective accumulation of antitumor polymorphonuclear leukocytes (PMNs) by complement-derived chemotactic factors in the cavity. C5a increased in the fluids 3-9 h after the injection and preceded a massive increase in PMNs. C1 inhibitor (C1INH) and C3b inactivator (C3bINA) decreased in several cases 6 h after the treatment. Chemotactic arachidonic acid metabolites, thromboxane B2(TXB2) as a characteristics of TXA2, and leukotriene B4(LTB4) also increased at the same time even in cases where C5a changed only minimally, and may play a role in accumulating antitumor PMNs in the cavity.

Pathogenesis of platelet-activating factor-induced gastric mucosal damage in rats

Platelet-activating factor (PAF), given intravenously, induced erosions and hyperemia to the rats stomachs. Gastric mucosal blood flow was decreased and thiobarbituric acid (TBA) reactants (an index of lipid peroxidation) in the gastric mucosa were increased 10 min after PAF injection. Superoxide dismutase plus catalase reduced the gastric mucosal lesions and TBA reactants, but had no influence on gastric mucosal blood flow. A reduction in the number of circulating polymorphonuclear leukocytes (PMN) reduced the gastric mucosal damage and TBA reactants, and inhibited the decrease in gastric mucosal blood flow, as observed 30 and 60 min after PAF injection. PAF induced superoxide production by rat PMN and enhanced that stimulated by opsonized zymosan or phorbol myristate acetate. These results suggest that microcirculatory disturbance and oxygen-derived free radicals generated by PMN play important roles in gastric mucosal lesions induced by PAF.

Role of free radicals and lipid peroxidation in gastric mucosal injury induced by ischemia-reperfusion in rats

Ischemia and reperfusion are of the greatest importance in the pathology of many diseases. We investigated the roles of oxygen-derived free radicals and lipid peroxidation in gastric mucosal injury, such as spotty and linear hemorrhagic erosions, induced in rats by ischemia-reperfusion. The gastric mucosal injury and the increase in thiobarbituric acid (TBA) reactants in the gastric mucosa induced by ischemia-reperfusion were significantly inhibited by treatment with SOD and catalase. These results suggest that oxygen-derived free radicals and lipid peroxidation play important roles in the pathogenesis of acute gastric mucosal lesions induced by ischemia-reperfusion.

[Chemoembolization and regional hyperthermia with degradable starch microspheres in the treatment of malignant hepatic tumors]

Antitumor effects of chemoembolization with degradable starch microspheres (DSM) combined with regional hyperthermia (HT) were investigated in patients with hepatocellular carcinoma and metastatic liver cancer. Chemoembolization with DSM was performed in 39 cases of hepatocellular carcinoma (HCC) and in 25 cases of metastatic liver cancer. Thirteen cases of HCC and 3 cases of metastatic liver cancer were treated with the combination of HT. A catheter was placed in the proper hepatic artery via the trans-femoral approach. Adriamycin or Mitomycin C mixed with DSM was injected every 2 or 3 weeks through the catheter. Thermotron RF-8, the heating device used in this study, is operated at 8 MHz radiofrequency. Hyperthermia treatment was applied twice a week. The therapeutic effect of this treatment was evaluated by the change in tumor size measured by angiography or computed tomography. Tumor regression over 50% was observed in 42% of the patients with HCC treated with chemoembolization alone and in 54% of those with chemoembolization and HT. In the patients with metastatic liver cancer, tumor regression over 50% was observed in 65% of the patients treated with chemoembolization alone and in 33% of those with chemoembolization and HT. One-year survival rate after the initial treatment in patients with HCC was 66% and 89% in the patients treated with chemoembolization alone and with chemoembolization and HT, respectively. One and two-year survival rates in the patients with metastatic liver cancer was 55% and 41% in the treatment with chemoembolization alone. These results suggest that chemoembolization using DSM was markedly effective in the patients with malignant hepatic tumors, particularly in metastatic liver cancer.

[Chemoembolization with degradable starch microspheres in metastatic liver cancer]

Transcatheter chemoembolization using Degradable Starch Microspheres (DSM) was performed in 22 patients with metastatic liver cancer. DSM, 45 micron in diameter, which are degraded by serum amylase, temporarily obstruct arterial blood flow at the arteriolar capillary bed. Mitomycin C mixed with DSM was injected into the proper hepatic artery. The therapeutic effect of this chemoembolization was evaluated by the change in tumor size measured by angiography or computed tomography. Tumor regression of over 50% was observed in 15 of 22 cases (68%). Elevated serum CEA levels (greater than 10 ng/ml) decreased in 13 of 18 cases (72%). The overall one-year survival rate was 55%. The one-year survival rate was 83% in 8 patients with H2 type liver metastasis. Although half of the patients had transient pain within 2 hours, no major side effects such as bone marrow suppression or hepatotoxicity were observed. Our results suggest that chemoembolization using DSM is effective in the treatment of metastatic liver cancer.

Esophageal candidiasis

Among 3,501 individuals receiving endoscopic examination for the upper digestive tract, 41 were found to have esophageal candidiasis including 17 malignancies, 14 immunological disorders, 4 diabetes mellitus, 7 other underlying diseases and 7 apparently healthy subjects. The diagnosis was made either by brushing of the esophagus or by histological examination of the biopsied specimen. Systemic invasion of fungi was observed mainly in patients with malignancy involving the hematopoietic system, and most of them had been treated by corticosteroids, antibiotics or anticancer agents. Although complications associated with esophageal candidiasis are rare, it is emphasized that those patients with malignancy as well as impared immunity should be carefully examined for esophageal candidiasis, in order to prevent the fungi from developing invasive candidiasis. It should be noted that a few cases of gastric ulcer treated by H2 blocker revealed esophageal candidiasis, suggesting that decrease of gastric acidity might be one of the factors involved in this pathological condition.

[Effects of hyperthermia combined with chemoembolization using degradable starch microspheres in the treatment of hepatocellular carcinoma]

Twenty-eight cases with non-resectable hepatocellular carcinoma were examined. Chemoembolization using degradable starch microspheres (DSM) was performed in 19 cases. DSM, 40-45 micron in diameter, which are degraded by serum amylase, temporarily obstruct arterial blood flow at capillary bed. Adriamycin mixed with DSM was injected into patients through the proper hepatic artery. Hyperthermia (8 MHz radiofrequency) combined with chemoembolization was performed in 9 cases. In all cases treated by hyperthermia combined with chemoembolization, the intratumoral temperature was measured by a thermocouple thermometer during heating alone and heating after injection of DSM. The therapeutic effect was evaluated by the change in tumor size measured by angiography or computed tomography. The efficacy of hyperthermia combined with chemoembolization was compared with that of chemoembolization alone. Intratumoral temperature was 1.0 degree C higher by heating after injection of DSM than by heating alone. Partial response (tumor regression of over 50%) was observed in 8 of 19 cases (42%) with chemoembolization alone. Partial response was observed in 6 of 9 cases (67%) with hyperthermia combined with chemoembolization. One-year survival rate was 58% in chemoembolization alone, against 83% in hyperthermia combined with chemoembolization. Our results suggest that hyperthermia combined with chemoembolization using DSM is effective in the treatment of hepatocellular carcinoma.

Vascular endothelial cell injury and platelet embolism in Duchenne muscular dystrophy at the preclinical stage

Blood vessels in muscle biopsy specimens from 4 Duchenne muscular dystrophy (DMD) patients (including 3 at the preclinical stage) were examined by electron microscopy and compared with those in non-diagnostic biopsy specimens from age-matched controls and cases of other childhood neuromuscular disorders. The most striking feature was the blister-like swelling of vascular endothelial cells in the biopsied muscle specimens from the 3 preclinical stage DMD patients, which was observed in 23-39% of the small blood vessels examined. Other noticeable features in the preclinical DMD patients were: (1) replication of the basement membrane, there being more than 3 layers in 30% of the capillaries; (2) many degenerating and regenerating capillaries; and (3) platelet adhesion and aggregation in small blood vessels including small arteries and veins. Morphometric analysis showed that the capillary and endothelial cell areas were much greater in the preclinical DMD patients than in the controls or the cases of the other neuromuscular disorders. These phenomena strongly suggest an as yet undetermined process in blood vessels in preclinical DMD.

[Chemoembolization with degradable starch microspheres in malignant hepatic tumors]

A new method of chemoembolization with degradable starch microspheres (DSM) was used for patients with malignant hepatic tumors. DSM, 40-45 micron in diameter, which are degraded by serum amylase, temporarily obstruct arterial blood flow at the arteriolar capillary bed. Experimental studies have demonstrated that such occlusion enhances the regional uptake and reduces systemic exposure to simultaneously administered arterial anticancer drugs. Transcatheter chemoembolization with DSM was performed in 14 cases of hepatocellular carcinoma and 8 cases of metastatic liver cancer. Adriamycin or Mitomycin C mixed with DSM was injected into the patients with hepatocellular carcinoma or metastatic liver cancer, respectively, through the proper hepatic artery. The therapeutic effect of this chemoembolization was evaluated by the change in tumor size measured by angiography or computed tomography. In hepatocellular carcinoma, tumor regression of over 50% was observed in 5 of 14 patients. Elevated serum AFP level of more than 200 ng/ml was decreased in all 6 cases. In metastatic liver cancer, tumor regression of over 50% was observed in 4 of 8 cases. Although half of the patients had transient pain within 2 hours, no major side effects such as bone marrow suppression and hepatotoxicity were observed. Our results suggest that chemoembolization with DSM can be effectively used in the treatment of malignant hepatic tumors.

Creatine kinase brain isoenzyme in infantile osteopetrosis

A 14-month-old girl with infantile osteopetrosis had hematologic and neurologic complications with severe brain atrophy. Although serum contained high creatine kinase brain isoenzyme activity (CK-BB), CK-BB activity was not detected on repeated cerebrospinal fluid examinations. After frequent blood transfusions and steroid therapy, hematologic involvement improved gradually and disappeared finally at age 11 months; serum CK-BB tended to show a concomitant proportional increase in activity. A 111Indium chloride scan was performed at age 4 weeks when the patient had relatively low serum CK-BB activity. It indicated active extramedullary hematopoiesis in the liver and spleen. The second scan was performed at age 12 months when she had high serum CK-BB activity and indicated active medullary hematopoiesis in the cranium. The tests disclosed that the elevated serum CK-BB activity was the result of bone marrow serum leakage, and not leakage from brain tissue. This finding may be a good marker of medullary hematopoietic activity in patients with osteopetrosis. Meanwhile, biopsied sural nerve revealed storage of cellular debris, including myelin figures in the Schwann cells, which suggested increased degradation process in the cells or lysosomal enzyme deficiency.

[Intraperitoneal cavity injection of OK-432 with fresh human serum in a case of carcinomatous peritonitis--determination on the complement-derived chemotactic factor]

Large numbers of neutrophils appear in the peritoneal cavity within a few hours after administration of OK-432 into the peritoneal cavity, and play an important role in the destruction of cancer cells. As OK-432 can activate complement in vitro, it is possible that a chemotactic factor such as C5a is generated and attracts neutrophils into the cavity. We injected OK-432 with fresh human serum preincubated at 37 degrees C for 60 min in order to generate large amounts of complement-derived chemotactic factor. Neutrophils increased in number within a few hours after the injection of OK-432 with preincubated human serum into the peritoneal cavity of a recurrent gastric cancer patient with carcinomatous ascites, and persisted much longer compared with treatment using OK-432 alone. Cancer cells rapidly decreased in number and ascites disappeared two weeks after the treatment with OK-432 and preincubated human serum. It was found that C5a levels measured by RIA initially increased a few hours before neutrophils appeared, and then decreased gradually, after injection of either OK-432 with preincubated human serum or with OK-432 alone. Although complement-derived chemotactic factor might be responsible for attracting neutrophils into the peritoneal cavity, the role of other chemotactic factors should also be investigated.