Clinical results of radiofrequency hyperthermia for malignant liver tumors

PURPOSE

To evaluate thermometry and the clinical results of radiofrequency (RF) hyperthermia for advanced malignant liver tumors.

METHODS AND MATERIALS

One hundred seventy-three patients with malignant liver tumors treated between 1983 and 1995 underwent hyperthermia. The 173 tumors consisted of 114 hepatocellular carcinomas (HCCs) and 59 non-HCCs (47 metastatic liver tumors and 12 cholangiocarcinomas). Eight-megahertz RF capacitive heating equipment was used for the hyperthermia. Two opposing 25-cm electrodes were generally used for heating the liver tumors. Our standard protocol was to administer hyperthermia 40-50 min twice a week for a total of eight sessions. The liver tumor temperature was measured by microthermocouples when possible. Transcatheter arterial embolization, radiotherapy, immunotherapy, and chemotherapy were combined with hyperthermia treatment in accordance with each patient's liver function.

RESULTS

One hundred forty (81%) of the 173 patients who underwent more than four sessions of hyperthermia were evaluated in this study. Thermometry was performed in 77 (55%) of these 140 patients. The maximum tumor temperature, average tumor temperature, and minimum tumor temperature in the HCC were (mean +/- standard error) 41.2 +/- 0.2 degrees C, 40.3 +/- 1.3 degrees C, and 40.1 +/- 0.2 degrees C, respectively. The same thermometry results for non-HCC were 42.3 +/- 0.2 degrees C, 41.2 +/- 0.2 degrees C, and 40.9 +/- 0.2 degrees C, respectively. The maximum and minimum temperatures (41.8 +/- 0.2 degrees C and 40.3 +/- 0.4 degrees C) in the patients with a complete or partial response (CR or PR) were higher than those in the patients with no response or progressive disease (NR or PD) (41.3 +/- 0.5 degrees C and 39.8 +/- 0.4 degrees C), but the difference was not significant. Of the 73 cases with HCC who were evaluated by computed tomography (CT), CR was achieved in 7 (10%), PR in 15 (21%), NR in 37 (51%), and PD in 14 (19%). Of the 45 cases involving liver metastases evaluated by CT, CR was achieved in 3 (7%), PR in 17 (38%), NR in 12 (27%), and PD in 13 (29%). The 1-year cumulative survival rate for HCC patients was 30.0%, and the 5-year survival rate was 17.5%. The 1-year survival of non-HCC patients was 32.5%, and the longest survival was 30 months. The sequelae of hyperthermia included focal fat necrosis in 20 patients (12%), gastric ulceration in 4 (2%), and liver necrosis in 1 (1%). The sequelae of thermometry were severe peritoneal pain in seven patients (11%), intraperitoneal hematoma in one (1%), and pneumothorax in one (1%).

CONCLUSION

Even though the thermometry results for liver tumors were not satisfactory, the treatment results are promising. Further clinical trials of RF capacitive hyperthermia for the treatment of advanced liver tumors should be encouraged.

Effects of dietary fiber on prostanoid concentrations in cecal mucosa of rats

Changes were investigated in prostanoid contents in cecal mucosa of rats fed with guar gum, a fiber diet. The rats were divided into 3 groups, the control group fed non-fiber diet and 2 groups fed respectively diets containing 7.5% and 15% of guar gum. Twelve rats in each group were sacrificed 10, 20, and 30 days respectively after initiation of diets, and length and weight of cecum and prostanoid contents in cecal mucosa were determined. The length and weight of cecum increased significantly 10 days after commencement of the fiber diets, and more remarkable changes were observed in the 15% fiber diet group. The ratio of prostaglandin (PG) E2 to PGD2 (PGE2/PGD2) was also increased by the content of guar gum dependently. These results suggest that alteration in prostanoid profiles is implicated in the fiber diet-induced enlargement of large bowels.

Effects of dietary fibre on dimethylhydrazine-induced changes in prostanoid concentrations in rat colonic mucosa

1. This study was designed to elucidate the effects of guar gum, a dietary fibre, on changes in prostanoid contents induced by 1,2-dimethylhydrazine, a carcinogenic agent, in rat colonic mucosa. 2. Prostanoid contents were determined using high performance liquid chromatography; five prostanoids, namely 6-keto-prostaglandin F1 alpha, prostaglandin F2 alpha, prostaglandin E2, prostaglandin D2 and thromboxane B2, were detected. 3. Four subcutaneous injections of dimethylhydrazine, 60 mg/kg every 6 days, increased the mucosal concentrations of prostaglandin E2 and thromboxane B2 by approximately 50%. Other prostanoids did not change significantly throughout the experiments. 4. In rats treated with dimethylhydrazine and a fibre diet a significant increase in thromboxane B2 content was not observed, although a significant increase in prostaglandin E2 content was observed. These effects were observed in rats fed with fibre diet over 20 days but not observed in rats fed with fibre diet over 10 days. 5. From these results and the report that aspirin use at low doses is effective in the reduction of the risk of fatal colonic cancer, inhibiting thromboxane B2 synthesis by fibre diet might be involved in the protective effect against the occurrence of colonic cancer.

Potential parameters of male reproductive toxicity: reproductive performance, histopathology and sperm evaluation in SD rats given nitrazepam

The present study was designed to elucidate the correlation between findings from reproductive performance testing and those from histopathological examination of the testis and sperm analysis in rats given a benzodiazepine derivative, nitrazepam, for 2 and 4 weeks. The mechanisms of toxicological action of nitrazepam on the male reproductive organs were also investigated. Nitrazepam was given orally to Sprague-Dawley male rats (6-week-old) at a daily dose of 80 mg/kg for 2 weeks or at daily doses of 20, 40 or 80 mg/kg for 4 weeks. Treated males were mated to examine reproductive performance with untreated females after each dosing period, and after 4 and 9 week of recovery periods. Necropsy was performed for histopathological examination of the testis and epididymis and for sperm analysis after each dosing period and the final mating trial (total of 11 weeks recovery). In the findings from reproductive performance testing, significant decrease in the fertility index was observed in the 80 mg/kg group even after 2 weeks dosing and thereafter until 4 weeks recovery, though the mating index did not significantly differ from that of controls through the experiment. In the histopathological examination and sperm analysis, testicular signs of toxicity, decrease in number of sperm heads in the testis and increase in number of sperm with abnormal heads in the seminiferous tubules were noted in the 80 mg/kg group after 2 weeks dosing and in the 40 and 80 mg/kg groups after 4 weeks dosing. Concentrations of plasma testosterone and content of testis testosterone in nitrazepam-treated groups were not significantly different from those of controls. Plasma FSH concentration was significantly elevated in the 80 mg/kg group through the experiment, although significant elevation of plasma LH was observed only after 2 weeks dosing. These results indicate that histopathological examination is the most reliable approach to detect male reproductive adverse effects induced by nitrazepam rather than using parameters from mating trials. The four-week-dosing period is appropriate for their detection. Hypospermatogenesis induced by nitrazepam is suggested to be caused by direct action of nitrazepam on germ cells and/or Sertoli cells rather than by indirect action through inhibition of testosterone secretion.

[Diagnosis of the pancreatic diseases by intraductal ultrasound of the pancreas--with special reference to clinical cases difficult to diagnose differentially pancreatic diseases by the endoscopic retrograde pancreatography]

We examined the usefulness of the intraductal ultrasound (IDUS) examinations by comparing the IDUS images with the endoscopic retrograde (ER) pancreatograms. We inserted an IDUS probe with 30 MHz at frequency transpapillary into the main pancreatic duct (MPD) in 105 cases with pancreatic diseases (30 cancers, 30 mucin-producing tumor, 3 islet cell tumor, 1 pancreatic serous cyst adenoma, 1 pancreatic teratoma, 1 pancreatic solid and cystic tumor and 39 chronic pancreatitis). All 105 cases were performed ER pancreatography. Sixty-four of 105 cases (22 cancers, 20 mucin-producing tumor, 3 islet cell tumor, 1 pancreatic serous cyst adenoma, 1 pancreatic teratoma, 1 pancreatic solid and cystic tumor and 16 chronic pancreatitis) were operated and the IDUS images were compared with the corresponding histopathological sections. The usefulness of the IDUS examinations of the pancreatic diseases were the following cases; differential diagnosis between benign and malignant cases with localized stenosis of the MPD, differential diagnosis of the cases with displacement of the MPD, and the diagnosis of the intraductal extent and of invasion of the tumor in the mucin-producing tumor of the pancreas with the dilation of the MPD. IDUS examinations are performed by the IDUS probe with high frequency, so the indications of the IDUS examinations are to detect the small lesions in the pancreas.

Study on the acceleration in healing of ethanol-induced gastric lesions in rats by methylprednisolone

This study was designed to determine the influences of methylprednisolone (MP, CAS 2375-03-3) on the genesis and healing of gastric lesions induced by 50% ethanol in relation to the changes in gastric mucosal prostaglandin (PG) and leukotriene (LT) contents and vascular permeability. Intragastric administration of 1 ml of 50% ethanol induced hemorrhagic lesions in the fundic portion, and these lesions were not affected by 20 mg/kg of MP injected subcutaneously 30 min before ethanol administration. In untreated rats, 4 kinds of PGs, i.e., 6-keto-PGF1a, PGF2a, PGE2, and PGD2, were determined in gastric mucosa by high performance liquid chromatography (HPLC), but no LTs were detected. Administration of ethanol significantly reduced all PG contents and increased production of peptide-LTs in gastric mucosa. Pretreatment with MP did not influence ethanol-induced changes in PG and peptide-LT contents. Ethanol-induced lesions required 96 h for total healing. Ulcer healing was not affected by MP, which was injected subcutaneously twice daily from 1 h after ethanol administration until the end of the experiment, and complete ulcer healing was observed after 72 h. MP did not affect ethanol-induced decrease in PG contents, their recoveries, or peptide-LT contents. Ethanol increased vascular permeability and MP reduced this increase. These results suggest that MP does not have a hazardous effect, but is rather beneficial with regard to healing of ethanol-induced gastric lesions through prevention of the increase in vascular permeability caused by ethanol, and that it affected neither gastric mucosal PG nor peptide-LT contents.

Stimulation of rat placental lactogen-II (rPL-II) secretion by cultured trophoblasts by insulin: development of a rat placental cell culture system and effects of peptide hormones on rPL-II secretion in vitro

The purpose of this study was to develop a primary culture system using serum-free medium for rat placental trophoblast cells and to investigate the factors that control rat placental lactogen-II (rPL-II) secretion in vitro. The placentae of day 13 pregnant rats were dissociated in Medium 199 containing 0.1% collagenase and 0.002% DNAase. Dissociated cells were fractionated into five segments by centrifugation through a 40% Percoll density gradient and incubated on rat tail collagen bed in medium SFM-101 for up to 7 days. Fraction B at the Percoll gradient density of 1.05 g ml-1 was enriched with rPL-II-producing cells and the time course of rPL-II secretion was characterized by a rapid increase in the first 2 days, remaining at high values (mean: 14-16 ng micrograms-1 DNA) for the following 2-3 days and decreasing thereafter. The rPL-II-producing cells from faction B identified by immunocytochemical examination accounted for approximately 69% of total cultured cells and consisted of a few giant cells and polygonal cells. Growth factors (bovine insulin, 0.1-20 micrograms ml-1; recombinant human insulin-like growth factor (IGF)-I, IGF-II, 0.1-1.0 micrograms ml-1; murine epidermal growth factor (EGF), 0.001-10 micrograms ml-1), rat pituitary hormones (rat growth hormone, rat prolactin, 0.1-10 micrograms ml-1) and hypothalamic hormones (human growth hormone-releasing hormone (GHRH), corticotrophin-releasing hormone (CRH), LHRH, 0.1-10 micrograms ml-1) were individually added to the culture medium to investigate the putative factors that directly control rPL-II secretion by the trophoblast cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-associated decreases in prostaglandin contents in human gastric mucosa

This study was designed to clarify effects of ageing on human gastric mucosal prostaglandin (PG) contents. Forty examinees were divided into 5 age groups of 8 persons each, as follows: age under 40, age 40-49, age 50-59, age 60-69, and age over 70. PG contents in human gastric mucosa were measured by microcolumn high performance liquid chromatography (HPLC) with helium/cadmium laser induced fluorescence detection using biopsy samples obtained by endoscopy. The contents of 6-keto-PGF1 alpha, PGF2 alpha, PGE2, and PGD2 in the under 40 group were 638 +/- 39, 97 +/- 16, 468 +/- 68, 497 +/- 86 (pg/mg tissue), respectively. No significant differences in PG contents among groups aged under 70 were observed. In contrast, significantly low PG contents in the over 70 group were observed, i.e., the contents of 6-keto-PGF1 alpha, PGF2 alpha, PGE2, and PGD2 were 311 +/- 58, 36 +/- 8, 196 +/- 48, 171 +/- 40, respectively, and their contents were significantly lower than those in other age groups. In conclusion, gastric mucosal PG contents decrease significantly in over 70 years-old and this might be a contributing factor in the pathogenesis of gastric ulcers in elderly people.

Natural history of colorectal polyps and the effect of polypectomy on occurrence of subsequent cancer

To elucidate the natural history of colorectal polyps and to observe the influence of endoscopic polypectomy on the incidence of colorectal cancer, we conducted a retrospective cohort study of all patients who had undergone colonoscopic examination at the Center for Adult Diseases, Osaka, between April 1974 and December 1985. The study subjects consisted of a control group (760 non-polyp patients) and a polyp group (648 polyp patients, including 136 treated by polypectomy at the initial examination). These subjects were followed up until the end of 1987 by record linkage with the Osaka Cancer Registry's file to observe the occurrence of colorectal cancer. The O/E (observed/expected numbers derived from the general population) was 5.1 (95% confidence interval = 2.5-9.4) and 1.0 (0.1-3.6) for the polyp and control group, respectively. When subjects in the polyp group were categorized into polypectomy and non-polypectomy sub-groups, the O/E was 2.3 (0.1-12.6) and 8.0 (3.4-15.8) respectively. The relative risk of undergoing polypectomy to developing subsequent cancer was estimated at 0.3 (0.1-2.1). These results suggest an increased risk of developing cancer among polyp patients and the possibility of prophylactic effect of polypectomy against subsequent cancer. A large-scale and long-term follow-up study is required to confirm these findings.

Papilloma of renal pelvis in childhood

A papilloma in the renal pelvis of a five-year-old girl is reported. The transitional cell tumors of the renal pelvis in the pediatric age group are reviewed, and this is found to be the first case of a benign papilloma in childhood. We believe this pathologic entity should be included in the differential diagnosis of hematuria in a child.

[Histamine release from human leukocytes by human recombinant interleukin-3]

Human recombinant interleukin-3 (hrIL-3) released histamine from human leukocytes in vitro. The histamine release by hrIL-3 significantly correlated with those by anti-IgE, thrombin, and f-met. peptide, but not by A23187. Histamine release by hrIL-3 was a Ca2(+)-dependent reaction, as was that by anti-IgE, although the time course of histamine release by hrIL-3 was slower than that by anti-IgE. Pre-treatment of leukocytes with hrIL-3 decreased the histamine release by hrIL-3 itself, but enhanced the histamine releases by anti-IgE, f-met. peptide, thrombin and A23187. These results suggested that the mechanism of hrIL-3-induced histamine release was different from those of anti-IgE, f-met. peptide, thrombin, and A23187. There was no significant difference between hrIL-3-induced histamine release of leukocytes from asthmatics and healthy controls.

Verruciform xanthoma on the scrotum

A case of 80-year-old man with a verruciform xanthoma on the right side of the scrotum was reported. The tumor was examined histologically by light and electron microscope. We surveyed the literature and found 25 Japanese cases and 11 foreign cases in the skin. We also reviewed the pathogenesis and the location of this disease.

[Production of monoclonal antibody to renal cell carcinoma]

We report a novel way of obtaining a monoclonal antibody to renal cell carcinoma (RCC). BALB/c mice were immunized with RCC cells (ACHN, ATCC CRL1611) and hyperimmunized spleen cells were fused with Sp/2 murine myeloma cell line by PEG 2000. Many hybridoma supernatants were screened by enzyme linked immunosorbent assay (ELISA). After the cloning by limiting dilution, we established a hybridoma reactive to RCCs and named it A25. It belonged to the IgG1 subclass of immunoglobulins. According to our results using ELISA, 4 of 5 RCC cell lines were reactive to A25, while the remaining 23 non RCC cell lines did not react. The supernatant from A25 was used as a primary antibody preparation for avidin-biotin complex immuno peroxidase staining of multiple cases of RCC, normal tissue, and other tumors. This antibody reacted with 3 of 3 grade 1 RCC, 10 of 11 grade 2 RCC and 0 of 3 grade 3 RCC. Proximal tubules of the kidney shared this antigen. However, cross reactivity of this antibody was observed to pyloric glands of the stomach and adenocarcinoma of the colon. The epitope of A25 seemed to originate from normal kidney tubules. Low grade tumors preserved this epitope well, but this character of the original tissue seemed to disappear as tumor grade increased.

Penis tuberculid (papulonecrotic tuberculid of the glans penis): treatment with a combination of rifampicin and an extract from tubercle bacilli (T.B. vaccine)

A case of penis tuberculid (papulonecrotic tuberculid of the glans penis) and its treatment with combination of oral rifampicin (RFP) and injection of an extract from tubercle bacilli (T.B. vaccine) were reported. We also examined the literature and discovered 37 cases of this disease in Japan in the last 10 years (between 1978 and 1987).

Primary malignant melanoma of the penis--a case report and a review of the literature

A 50-year-old man had a primary malignant melanoma of the penis associated with granuloma telangiectaticum in the pigmented lesion. The patient had an operation for phimosis at the age of 20 and after the operation, he noticed a pigmented lesion at the operation site. We examined the literature and found 16 cases of primary malignant melanoma of the penis in Japan.

[Treatment of advanced cancer of the urinary tract with interleukin-2 (IL-2)]

Eight patients with advanced cancer of the urinary tract were treated with recombinant interleukin-2(IL-2) at our department between December, 1985 and September, 1987. Patients were given 5 x 10(5)-4 x 10(6) units of IL-2 by intravenous drip infusion daily. One of five patients who received IL-2 for over 28 days showed 62% regression in size of hepatic metastasis of bladder cancer on computed tomography and another showed marked improvement of Performance Status. The upward tendency of natural killer and lymphokine-activated killer activity of peripheral blood was observed during treatment. Fever, mental disturbance, hypotension and eosinophilia and others were recognized during administration of IL-2, and cardiac failure and disturbance of renal function were also recognized as severe side effect.

Renal cell carcinoma with solitary contralateral adrenal metastasis

We report on 2 cases of renal cell carcinoma with solitary contralateral adrenal metastasis which was demonstrated six months and one year, respectively, after radical nephrectomy. Pulmonary metastases developed six months after adrenalectomy in 1 patient; the other patient is alive without any evidence of disease twenty-two months after adrenalectomy.

Hyperphalangeal bones induced in rat pups by maternal treatment with nifedipine

Hyperphalangeal bones were found in postnatal rat pups of mothers treated with nifedipine during pregnancy. The anomaly occurred only at the region between the middle and distal phalanges of the 3rd and 4th fingers and toes. The critical periods of the anomaly were days 13 and 14 of pregnancy for the fingers, and days 14 and 15 of pregnancy for the toes. The incidences were dose-related, being more than 90% in both fingers and toes at a single dose of 150 mg/kg, and even more marked at the 4th digits than at the 3rd digits. Neither right/left difference nor sex difference was manifested in the incidence of the anomaly.