Abdominal surgery for patients on maintenance hemodialysis

Despite the growing number of major surgical procedures being performed for patients on maintenance hemodialysis, few reports focus on the management and outcome of such patients, especially those undergoing major abdominal surgery. We conducted a retrospective review of 30 patients on maintenance hemodialysis who underwent abdominal surgery, 20 of whom underwent an elective operation and 10, an emergency operation. The indications of elective surgery included gastrointestinal cancer, biliary tract disease, and abdominal aortic aneurysm, while those for emergency surgery mainly involved gastrointestinal perforation or bleeding. There were no statistically significant differences between the elective group and the emergency group regarding either the mean time on hemodialysis or the preoperative clinical data. The morbidity and mortality rates were 15% and 10%, respectively, for the patients who underwent elective surgery and 50% and 70%, respectively, for those who underwent emergency surgery (P < 0.01 and P < 0.05, respectively). Those patients with more than a 2-year history of hemodialysis had a significantly higher mortality rate following abdominal surgery than those with less than a 2-year history (P < 0.01). Thus, the morbidity and mortality rates of patients on maintenance hemodialysis who require major abdominal surgery are significantly high, which reinforces the need to further improve the intensive perioperative management of such patients.

A gene encoding antigenic peptides of human squamous cell carcinoma recognized by cytotoxic T lymphocytes

Except for melanomas, tumor antigens recognized by cytotoxic T lymphocytes (CTLs) are yet unidentified. We have identified a gene encoding antigenic peptides of human squamous cell carcinomas (SCCs) recognized by human histocompatibility leukocyte antigens (HLA)- A2601-restricted CTLs. This gene showed no similarity to known sequences, and encoded two (125- and 43-kilodalton [kD]) proteins. The 125-kD protein with the leucine zipper motif was expressed in the nucleus of the majority of proliferating cells tested, including normal and malignant cells. The 43-kD protein was expressed in the cytosol of most SCCs from various organs and half of lung adenocarcinomas, but was not expressed in other cancers nor in a panel of normal tissues. The three nonapeptides shared by the two proteins were recognized by the KE4 CTLs, and one of the peptides induced in vitro from peripheral blood mononuclear cells (PBMCs) the CTLs restricted to the autologous tumor cells. The 43-kD protein and this nonapeptide (KGSGKMKTE) may be useful for the specific immunotherapy of HLA-A2601(+) epithelial cancer patients.

The effect of radioimmunotherapy using murine monoclonal antibody KIS1 on esophageal squamous cell carcinoma-bearing nude mice

The monoclonal antibody (MoAb) KIS1 has been shown to react specifically with an antigen of human squamous cell carcinoma (SCC); however, a major problem in its clinical application is that the intact murine antibody induces a human anti-mouse antibody (HAMA). To overcome this problem, we produced the KIS1 F(ab')2 fragment, then radioiodinated the intact KIS1 antibody and its F(ab')2 fragment. Nude mice bearing human esophageal SCC implants were injected with 100 microCi of 131I-intact KIS1 or 131I-KIS1 F(ab')2, and images were obtained using a gamma camera. Radioimmunotherapy (RIT) was performed by injecting the tumor-bearing nude mice with 131I-intact KIS1 or 131I-KIS1 F(ab')2 at a dosage of 300 microCi, following which 7 or 3 days were required to produce high quality tumor images by scintigraphy. The tumor-bearing mice treated with 131I-KIS1 F(ab')2 showed significant tumor growth inhibition, about 5.4 times greater than that of the control group and 1.8 times greater than that of the 131I-intact KIS1 group 21 days after the injection. These results indicate that the KIS1 F(ab')2 fragment is superior to intact KIS1, and that it may be clinically useful for radioimmunodetection followed by tumor targeting therapy for patients with SCC of the esophagus.

Overexpression of the MTA1 gene in gastrointestinal carcinomas: correlation with invasion and metastasis

The mta1 gene is a recently identified novel candidate metastasis-associated gene. The deduced amino acid sequence contains an src homology-3 domain binding motif, a zinc finger motif and possible phosphorylation sites, suggesting that this gene is involved in signal transduction or regulation of gene expression. The purpose of our study was to examine the mRNA expression levels of the MTA1, the human homologue of the rat mta1 gene in colorectal and gastric carcinomas and thus to evaluate the relevance of the expression of this gene to human carcinoma progression. The expression of MTA1 mRNA in 36 colorectal and 34 gastric carcinoma samples was compared with that in corresponding normal mucosa tissues by semi-quantitative reverse-transcription polymerase chain reaction (RT-PCR) and the results were compared with clinico-pathologic data. A relative overexpression of MTA1 mRNA (tumor/normal ratio > or = 2) was observed in 14 of 36 (38.9%) colorectal carcinomas and 13 of 34 (38.2%) gastric carcinomas. Clinico-pathologic correlations demonstrated that in colorectal carcinomas, tumors overexpressing MTA1 mRNA exhibited a significantly deeper wall invasion and a higher rate of metastasis to lymph nodes, and tended to be at an advanced Dukes' stage with frequent lymphatic involvement. In gastric carcinomas, the tumors overexpressing MTA1 mRNA showed significantly higher rates of serosal invasion and lymph node metastasis and tended to have a higher rate of vascular involvement. Our data suggest that overexpression of the MTA1 gene correlates with tumor invasion and the presence of metastases and that a high expression of MTA1 mRNA may be a potential indicator for assessing the malignant potential of colorectal and gastric carcinomas.

[Long-term results of preoperative hyperthermo-chemo-radiotherapy (HCR) for patients with esophageal carcinoma invading neighboring structures (T4)]

PATIENTS

A total of 180 patients with esophageal carcinoma invading the neighboring structures (T4) were surgically treated by esophagectomy and reconstruction in the Department of Surgery II, Kyushu University from January 1965 to April 1997. Any of these cases with distant node metastasis and demonstrating organ metastasis or a combined resection of adjacent structures were excluded from this study. As a result, twenty-six patients treated with preoperative hyperthermo-chemo-radiotherapy (HCR Group), 39 treated either with preoperative radiotherapy or preoperative chemo-radiotherapy (R or CR Group) and 23 non-treated patients (Non-tx Group) were thus entered in this study.

RESULTS

The 3-year survival rates after esophagectomy in HCR Group, R or CR Group and Non-tx Group were 26.5%, 0% and 9%, respectively, while the 5-year survival rate of the HCR group was 15.9%. The group with preoperative HCR thus showed a significantly more favorable outcome than R or CR Group and Non-tx Group. (p < 0.05).

DISCUSSION

The significant difference observed in the prognosis was thought to be due to the reinforced effect of local regulation due to hyperthermia. Our data thus suggest that preoperative HCR contributes to the prolonged post-operative survival for carcinoma of the esophagus invading the neighboring structures.

Overexpression of the MTA1 gene in gastrointestinal carcinomas: correlation with invasion and metastasis

The mta1 gene is a recently identified novel candidate metastasis-associated gene. The deduced amino acid sequence contains an src homology-3 domain binding motif, a zinc finger motif and possible phosphorylation sites, suggesting that this gene is involved in signal transduction or regulation of gene expression. The purpose of our study was to examine the mRNA expression levels of the MTA1, the human homologue of the rat mta1 gene in colorectal and gastric carcinomas and thus to evaluate the relevance of the expression of this gene to human carcinoma progression. The expression of MTA1 mRNA in 36 colorectal and 34 gastric carcinoma samples was compared with that in corresponding normal mucosa tissues by semi-quantitative reverse-transcription polymerase chain reaction (RT-PCR) and the results were compared with clinico-pathologic data. A relative overexpression of MTA1 mRNA (tumor/normal ratio > or = 2) was observed in 14 of 36 (38.9%) colorectal carcinomas and 13 of 34 (38.2%) gastric carcinomas. Clinico-pathologic correlations demonstrated that in colorectal carcinomas, tumors overexpressing MTA1 mRNA exhibited a significantly deeper wall invasion and a higher rate of metastasis to lymph nodes, and tended to be at an advanced Dukes' stage with frequent lymphatic involvement. In gastric carcinomas, the tumors overexpressing MTA1 mRNA showed significantly higher rates of serosal invasion and lymph node metastasis and tended to have a higher rate of vascular involvement. Our data suggest that overexpression of the MTA1 gene correlates with tumor invasion and the presence of metastases and that a high expression of MTA1 mRNA may be a potential indicator for assessing the malignant potential of colorectal and gastric carcinomas.

Assessing the permeability of the gastrointestinal mucosa after oral administration of phenolsulfonphthalein

BACKGROUND/AIMS

In this study, the oral phenolsufonphthalein (PSP) absorption test as a simple and non-invasive method for the assessment of either the extent of the permeability of or damage to the gastrointestinal mucosa was evaluated.

METHODOLOGY

The permeability of the gastrointestinal mucosa of patients with liver cirrhosis and those who underwent gastrointestinal surgery was assessed by the oral administration of 30 mg of PSP and the measurement of its urinary recovery rate.

RESULTS

The urinary PSP excretion in patients with liver cirrhosis (n = 8; 28.8 +/- 6.0%) was significantly higher than that of patients who underwent vascular surgery (n = 8; 10.0 +/- 1.7%) (p < 0.01), which thus suggested an increased permeability of the gastrointestinal mucosa in patients with liver cirrhosis. The urinary PSP excretion rate in patients who underwent a total gastrectomy with Roux-en-Y reconstruction (n = 5) was 17.3 +/- 1.7% which was significantly higher than that observed in the control (p < 0.05), while the same rates in patients who underwent a partial gastrectomy (n = 10) or colectomy (n = 10) were 10.2 +/- 1.8% or 10.6 +/- 0.7%, respectively, which suggested that the intestinal mucosa is damaged by a total resection of the stomach.

CONCLUSIONS

The oral PSP absorption test, which is non-invasive, simple and inexpensive, is thus considered to be useful for assessing the degree of damage to or the permeability of the gastrointestinal mucosa under various conditions.

[Allergic bronchopulmonary aspergillosis in a patient without bronchial asthma who had chronic airway infection with Pseudomonas aeruginosa]

A 25-year-old man was admitted to the hospital because of uncontrollable coughing and sputum production. He had been suffering from coughing and sputum production since he was 7 years old. He was given a diagnosis of bronchiectasis and persistent airway infection with Pseudomonas aeruginosa when he was 16 years old. One year of treatment with erythromycin and another year of treatment with roxithromycin were not effective. After he was referred to our hospital in 1993, he was given clarithromycin together with tosufloxacin for two years as an outpatient. The treatment was not very effective, but some prophylactic effect was seen with regard to prevention of acute exacerbations of Pseudomonas aeruginosa airway infection. Examination after admission revealed a high level of serum IgE (3703 U/ml), a strong skin reaction to aspergillus allergen, and marked central bronchiectasis in both upper lobes. He had no history of eosinophilia or of attacks of dyspnea. Our diagnosis was acute exacerbation of long-standing allergic bronchopulmonary aspergillosis and chronic airway infection. Treatment with oral prednisolone (30 mg per day) together with intravenous cefsulodin for three weeks resulted in marked relief symptoms and improvement in pulmonary function. The delay in correct diagnosis seems to have been caused by the lack of an obvious episode of asthma, and by the fact that the chronic productive coughing was thought to have been due to bronchiectasis, and to chronic bacterial infection. The characteristic bronchiectasis of this patient prompted us to examine the allergic reaction to aspergillus and let us to the correct diagnosis.

cDNA cloning, tissue distribution, and subcellular localization of horseshoe crab big defensin

A full-length cDNA for horseshoe crab big defensin with a strong antimicrobial activity was obtained from a hemocyte cDNA library. The open reading frame of the cDNA coded for an NH2-terminal signal sequence followed by a propeptide and the mature big defensin. The propeptide is linked to the mature protein through an -Arg-X-Lys/Arg-Arg- motif, the processing site for Kex2-like proteases. Northern blot analysis revealed that big defensin is expressed in all the tissues tested, suggesting that big defensin plays an important role not only in hemocytes but also in other tissues for host defense. The subcellular localization, determined by immunocytochemistry at ultrastructural level, confirmed the previous findings obtained by biochemical analysis that big defensin locates in both small and large granules in hemocytes. Big defensin is the first example to demonstrate the existence of broad tissue distribution in horseshoe crab.

Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus

Factors responsible for recurrence of esophageal cancer were investigated in 90 patients who underwent extended radical esophagectomy with three-field dissection for a squamous cell carcinoma in the thoracic esophagus. The initial tumor recurrence was grouped as either locoregional (site of the primary tumor, anastomotic site, or lymph nodes) or as distant (distant organs, pleura, or peritoneum). Nineteen patients (21%) developed a locoregional recurrence, and 19 (21%) developed a distant recurrence. One (1%) developed both recurrences simultaneously and was classified as a distant recurrence. The locoregional recurrence was correlated with the stage factors, particularly the number of metastasis-positive nodes. For the distant recurrence, vascular invasion was found to have been the most important prognostic factor. Our findings suggested that locoregional recurrence was due to tumor progress related to the extent of lymph node metastasis, whereas distant recurrence was due to the oncologic behavior of the tumor. Locoregional recurrence in patients with limited disease may be reduced by extended radical esophagectomy with three-field dissection. Distant recurrence cannot be controlled by surgery. Adopted postoperative adjuvant therapies showed no effect on recurrence.

Expression of p53 protein in glandular differentiation admixed with squamous cell carcinoma of the esophagus

BACKGROUND

Glandular differentiation in squamous cell carcinoma of the esophagus is occasionally recognized by serial histologic investigations. We previously performed histopathologic investigations of such tumors and suggested the possibility of field carcinogenesis in esophageal cancer.

MATERIALS AND METHODS

In the current study, we performed an immunohistochemistry analysis for p53 protein in such cases to investigate the mode of carcinogenesis from the view point of genetic changes. p53 protein expression in both ordinary squamous cell carcinoma and glandular differentiation of nine cases to demonstrate the coexistence of these components.

RESULTS

The expression of p53 in the areas of squamous cell carcinoma was diffusely detected in three and focally in two (five in all, 55.6%) and, in these five cases, p53 was also positive in the areas of glandular differentiation in four cases. On the other hand, the expression of p53 in the glandular components was negative in all four tumors with p53 negative squamous cell carcinoma.

CONCLUSIONS

The process of carcinogenesis within the tumor was thought to be similar in almost all cases even in the different histopathologic components.

Pathogenicity of glycoprotein C-deficient herpes simplex virus 1 strain TN-1 which encodes truncated glycoprotein C

A clinical isolate of herpes simplex virus 1 (TN-1) from a stromal keratitis patient was found to be defective in the glycoprotein C (gC) gene (UL44), thus resulting in the production of truncated gC upon infection. To study the pathogenetic role of truncated gC, we prepared a recombinant LTN-8 derived from TN-1 with deletions of the 1.5 kilobase pairs of the gC gene including the initiation codon. A penetration assay revealed LTN-8 to be less efficient in its penetration ability than TN-1, the laboratory strain KOS and RTN-1-20-3, a recombinant derived from TN-1 with the KOS gC gene. The penetration of LTN-8 was facilitated by the addition of TN-1-infected culture medium. TN-1 virus preparations had no hemagglutinating activity. However, the animals infected with TN-1 did develop hemagglutination inhibition (HI) antibodies. The LTN-8-infected animals did not develop HI antibodies. The pathogenicity in BALB/c mice following either corneal, intraperitoneal or intracerebral inoculation did not significantly differ among TN-1, RTN-1-20-3 or LTN-8. Our results indicate that truncated gC was sufficient for the induction of HI antibodies and was also able to facilitate penetration in vitro. Although truncated gC might be a virulence factor acting as a decoy, both truncated gC and intact gC had little effect on the outcome following intracerebral, intraperitoneal or corneal inoculation.

Development of cancer vaccine by tumor rejection antigens

Identification of the MAGE genes allowed us the molecular approach to identify genes encoding tumor rejection antigens expressed on human cancer cells. MAGE-1 proteins are normal tissue antigens compartmentalized in the particular testicular cells playing an important role in the early phase of the spermatogenesis. The MAGE-1, -2, -3, -4 and -6 genes are preferentially expressed in many different cancers at both the mRNA and protein levels. The MAGE genes, particularly MAGE-1, became positive in relatively advanced stages of cancers and recurrent cancers. Approximately one-third to half of human cancers except for myelo-monocytic leukemia expressed at least one of these MAGE genes. The MAGE gene products shall be appropriate target molecules for development of new cancer vaccine.

The clinical and histopathological contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy for the patients with esophageal cancer

BACKGROUND/AIMS

The effectiveness of hyperthermic treatment combined with irradiation and chemotherapy for patients with esophageal cancer on local response as well as on long-time survival has been reported. In order to investigate the contributing factors influencing the effectiveness of preoperative hyperthermo-chemo-radiotherapy (HCR therapy), this study was performed.

MATERIALS AND METHODS

One hundred nineteen patients with esophageal cancer who underwent preoperative HCR therapy followed by esophagectomy were reviewed in this retrospective study. The rate of effectiveness of preoperative HCR therapy was then compared in resected tissue specimens with regard to such factors as age, sex, the location of the tumor, the longitudinal diameter of the esophagogram, the radiographic type of tumor, the histological type and the histological depth of invasion using univariate and multivariate analyses.

RESULTS

Both univariate and multivariate analyses showed that the clinical and histopathological factors which had the greatest effect on preoperative HCR therapy were well differentiated squamous cell carcinoma regarding the histological type and tumorous type regarding the radiographic types.

CONCLUSION

We thus conclude that preoperative HCR therapy shows great promise for the treatment of patients with esophageal cancer, especially in instances of well differentiated and radiographic tumorous type squamous cell carcinoma.

Simultaneous combination therapy of carboplatin and radiation for patients with carcinoma of the esophagus

BACKGROUND/AIMS

Carboplatin is a less nephrotoxic analog of cisplatin with a significant effect against a variety of malignancies including carcinoma of the esophagus. Furthermore, the supra-additive effect between carboplatin and radiation has been reported in both clinical and experimental studies.

METHODS AND MATERIALS

Seven patients with carcinoma of the esophagus underwent a combined therapy of carboplatin (30 mg/m2, total 1500-2000 mg) and radiation (1.6 Gy/day, five days/week, total 50-70 Gy).

RESULTS

Six patients had a complete tumor remission while in the remaining patient a partial response was observed. In five of these six cases, no evidence of recurrence has been recognized at 9-13 months after the treatment. Two patients survived without any evidence of recurrent disease 43 and 57 months after the initiation of the treatment. The major side effects were leukopenia and thrombocytopenia, which were grade II to IV but not fatal. However, no significant renal toxicity, gastrointestinal disorders nor liver toxicity were recognized.

CONCLUSIONS

These data thus indicate the clinical utility of the combined therapy of radiation and carboplatin for patients with carcinoma of the esophagus.

Electron microscopic study of chronic eosinophilic pneumonia

Two cases of chronic eosinophilic pneumonia were examined electron microscopically to study the role of eosinophil granulocytes. Eosinophils, together with macrophages and lymphocytes, were observed to have infiltrated prominently in the lung tissues of the two cases. Degeneration and necrosis of pneumocytes were observed, and denuded basement membranes and destroyed alveolar structures were occasionally found. In the alveolar septa, swelling of the endothelial cells of the blood capillaries, edema of the stroma and fibrin deposition were observed. Eosinophils, released eosinophil granules and macrophages phagocytosing eosinophil granules were found frequently near the degenerated and necrotic alveolar tissues. These findings suggest that the tissue injuries were induced by the cytotoxic effects of the eosinophil granules.

Transcolonic approach for a stapled end-to-end colorectal anastomosis in low anterior resection

We designed the transcolonic approach for a stapled end-to-end colorectal anastomosis using a premium curved EEA in low anterior resection. The advantage of this repair is the elimination of transanal introduction of the stapler by a second assistant from below, which make the stapled anastomosis technically easier and safer. The fact that the anvil can be removed from the center shaft by pressing on the anvil release button allows the anvil to be released from anus, which theoretically prevents suture break down. This procedure can be considered for selected patients who have anal structure and where it is impossible to insert the instrument.

Endosonography for preoperative staging of specific nodal groups associated with esophageal cancer

The results of endoscopic ultrasonography (EUS), used preoperatively in 74 endoscopically evaluable patients, were compared with the histopathology after subsequent total esophagectomy with radical lymphadenectomy involving a three-field dissection of the lower cervical, mediastinal, and abdominal nodes. Patients with obstruction to endoscopy were excluded from this study. Overall accuracy, specificity, and sensitivity were 87%, 90%, and 37%, respectively. EUS has an accuracy of more than 80% for detecting metastatic nodes in the cervical paraesophageal, supraclavicular, right recurrent laryngeal, left paratracheal, upper and lower paraesophageal, infraaortic, infracarinal, and lower posterior mediastinal regions. Its sensitivity is highest for cervical and upper thoracic paraesophageal, infracarinal, left paratracheal, and recurrent laryngeal nodes. Accuracy is maximum for periesophageal nodes and varies inversely with the axial distance of the nodes from the esophageal axis. We recommend that EUS be used routinely for preoperative assessment of the cervical and mediastinal nodal status.

An integrated microsatellite length analysis using an automated fluorescent DNA sequencer

Analyzing microsatellite instability (MI) in malignant tumors is thought to be useful for screening cancer patients to identify those patients with a higher risk of developing second malignant tumors. In this paper, we report a new, accurate, and efficient method of detecting MI using an automated fluorescent DNA sequencer and a computer that automatically calculates the size, height, and area of each fluorescent product, making it possible to assess MI more accurately and more rapidly. The primers for amplification of each microsatellite locus are labeled by two different fluorescent dyes, rox (red) and fam (blue). The rox-labeled primer was used for the tumor, whereas the fam-labeled primer was used for the corresponding normal tissue. Two amplified products from both the tumor and the normal tissue were co-loaded into a single lane of the sequencing gel and were analyzed. MI could be detected based on the presence of different waving patterns. Furthermore, several loci could also be analyzed simultaneously for MI in a single lane. Using this method, we examined the frequency of MI in gastric cancer. The results showed that 5 of 22 (22.7 %) gastric cancers were MI-positive, which corresponds to the findings of previous reports that used the radioisotopic method. The improved method may open up the possibility of performing routine examination of MI in many cancer patients and offers hope for the potential clinical application of Ml analysis as a follow-up evaluation of cancer patients.

[Tracheal carcinoma causing severe tracheal stenosis]

A 47-year-old woman was admitted to our hospital because of shortness of breath. She had wheezed for a long time before admission. A flow-volume curve showed a pattern consistent with a fixed obstruction of the trachea. CT findings also revealed severe stenosis of the trachea caused by a tumor mass. Tracheal carcinoma was diagnosed after transbronchoscopic biopsy. The patient received chemotherapy and radiation therapy concurrently for about six weeks. Her symptoms resolved, and a second flow-volume curve had a normal pattern. Tracheal carcinoma should be included in the differential diagnosis of airway obstruction. In such cases, the flow-volume curve can be useful as a screening test.

A monoclonal antibody KIS-1 recognizing a new membrane antigen on human squamous-cell carcinoma

A KIS-1 monoclonal antibody (MAb) (IgG1, kappa) recognizing a membrane antigen on human squamous-cell carcinomas (SCC) was developed to understand their antigenicity using an esophageal SCC as an immunogen. The KIS-1 MAb recognized a membrane antigen on a majority of esophageal, lung, and oral- cavity SCC by immunofluorescent and by immunohistochemical analyses. In contrast, it showed little reactivity to adenocarcinomas from different organs, and none to keratinocyte cell lines. This MAb showed reactivity to the cells in the basal layer of normal esophageal epithelium adjacent to the esophageal SCC, but none of the other normal tissues, including esophageal epithelium far from the SCC and that from patients with non-malignant disease. The KIS-1 MAb immunoprecipitated a 46-kDa membrane protein of the esophageal SCC in non-reducing and in reducing conditions. It recognized the 46- and the 40-kDa proteins of the esophageal SCC by immunoblot analysis. These results suggest that the KIS-1 MAb recognizes a new membrane antigen preferentially expressed on SCC, and that this antigenicity is shared only by the cells in the basal layer of the esophageal epithelium adjacent to SCC. The KIS-1 MAb may be a new tool for understanding the antigenicity of SCC.

Prognostic significance of immunological parameters in patients with esophageal cancer

BACKGROUND

The role of immunosurveillance in the fight against cancer is well known. In addition, cancer patients have been reported to have an impaired immune function. In patients with esophageal cancer, however, the relationship between the immunological parameters of the host and their survival has not yet been evaluated fully.

MATERIALS AND METHODS

Of 103 patients with esophageal cancer who underwent esophagectomy, lymphocyte subsets (CD4+ and CD8+), the PHA response, and natural killer cell (NK) activity were all assessed in relation to clinicopathological features and the prognostic significance was evaluated using both a univariate and multivariate analysis.

RESULTS

The CD4+/CD8+ ratio in 58 (56%) patients was higher than the mean of the control, while the PHA response and NK activity in 74 (72%) and 70 (68%) patients, respectively, were lower than 1 SD below the mean of the control. None of these three parameters demonstrated a low value in 5 patients, while 1, 2 and 3 parameters showed a low value in 28, 49 and 21 patients, respectively. The survival rate of the patients with low values in all of three of these parameters was significantly worse than that for the patients in whom the number of low parameters was less than two. A multivariate analysis revealed that tumor invasion and the number of low values in these parameters were independently significant prognostic factors.

CONCLUSIONS

This survival analysis revealed that low values in the CD4+/CD8+ ratio, the PHA response, and the NK activity will help predict a poor prognosis in patients with esophageal cancer.

[Rigid spine syndrome associated with marked hypoxemia and hypercapnia]

A 48-year-old man was referred to our hospital because of hypoxemia (PaO2 = 43 mmHg), hypercapnia (PaCO2 = 70 mmHg), complete atrio-ventricular block, and heart failure. He also had limitation of spine flexion, scoliosis, deformity of the rib cage, and constriction of the ankle joints, complicated by cor pulmonale. These findings were compatible with rigid spine syndrome. To avoid progressive pulmonary hypertension and hypoxemia, nasal BiPAP and home oxygen therapy (0.5 liters/minute) were begun. Rigid spine syndrome is clinically characterized by limitation of spine flexion, and the limitation of thoracic movement often causes severe constrictive respiratory dysfunction. This syndrome should be considered when evaluating patients who have both thoracic deformity, especially scoliosis, and respiratory failure.

[Tumor-rejection antigens expressed on human squamous cell carcinoma]

Squamous cell carcinoma (SCC) is one of the most common cancers in human. SCC, particularly, esophageal and lung SCC are relatively resistant to currently available regimens of chemotherapy or radiation therapy. Therefore, development of a specific immunotherapy using tumor specific cytotoxic T lymphocytes (CTL) would be important to offer other treatment modalities. However, generation of HLA class I-restricted CTL recognizing SCC has been rarely reported. We established the HLA A2601-restricted CTL cell line recognizing a peptide antigen expressed on SCC. This CD4- CD8+ cytotoxic T lymphocyte (KE-4 CTL) cell line was established in a patient with esophageal cancer. The KE-4 CTL recognized a peptide antigen on esohageal and lung SCC in an HLA A2601-restricted manner as evaluated by cytotoxity against a panel of tumor cells, transfection experiments with HLA A2601 cDNA, and reconstitution with eleted peptides. None of normal cells tested was lysed by this CTL. These results suggest the exstence of HLA A2601-restricted CTL precursors recognizing a peptide antigen on SCC in a patient with esophageal cancer.