[A case of recurrent advanced colon cancer treated with CPT-11 for second-line chemotherapy]

A 59-year old male patient had been operated on for sigmoid colon cancer in July, 1990. Operative findings were, P0, H0, S1, N (-), Stage I, and histological findings were ss, ly 2, v0, n (-). In July 1994, the CEA level elevated, and be was diagnoted as having para-aortic LN swelling and stenosis of anastomosis of colon. He was admitted for treatment of recurrent colon cancer. Initially, he was treated with continuous injection of 5-FU, low-dose CDDP and Leucovorin. His CEA level decreased and para-aortic LN diminished in size. But, in December 1995, the CEA level and para-aortic LN relapsed. 5-FU, CDDP and Leucovorin were administered, but the CEA level became more and more elevated. This regimen was not considered responsible for drug resistance. CPT-11 was administered at 60 mg/week 6 times, and 80 mg/week 3 times. The side effects disappeared, LN sightly diminished in size, and the CEA level decreased. Judging by the anticancer effect without severe side effect, we found CPT-11 a useful drug for second-line chemotherapy.

Change of tryptophan-niacin metabolism in D-galactosamine-induced liver injury in rat

The change of tryptophan-niacin metabolism in D-galactosamine (D-galN) injected rats was investigated. Rats fed with niacin-free diets containing 40% casein for 11 days were injected with D-galN (0.8 g/kg body weight). The urinary excretions of nicotinamide and its metabolites, and the activity of liver alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD) (EC 4.1.1.45), a key enzyme of tryptophan-niacin metabolism, were assayed. As the result, the urinary excretions of N1-methylnicotinamide (MNA), N1-methyl-2-pyridone-5-carboxamide (2-Py), N1-methyl-4-pyridone-3-carboxamide (4-Py) and their sum (nicotinamide+MNA+2-Py+4-Py) were higher in the D-galN-injected group than in the control group. Hepatic ACMSD activity in the D-galN-injected group was lower than that of the control group. These results suggest that the increase in urinary excretion of nicotinamide and its metabolites after the injection of D-galN is considered to be attributable to a decrease in liver ACMSD activity.

Effect of dietary L-glutamine on the hepatotoxic action of D-galactosamine in rats

The protective effect of dietary L-glutamine against the hepatotoxic action of D-galactosamine (GaIN) was investigated by model experiments with rats. Rats fed with 20% casein diets containing 10% free amino acids were injected with GaIN, and the serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase activities and the hepatic glycogen content were assayed 20 hours after the injection. These enzyme activities in the group fed with 10% L-glutamine diet for 8 days were lower than those in the groups fed with the control, 10% L-glutamic acid and 10% L-alanine diets for 8 days. The more prolonged the feeding period with the 10% L-glutamine diet was, the more the serum activity levels of such enzymes were decreased. Although neomycin also lowered these enzyme activities, its simultaneous ingestion with neomycin did not show any additive or synergistic effect. The hepatic glycogen content in the 10% glutamine group still remained high after the GaIN treatment. It is therefore assumed that the effectiveness of glutamine intake would have been mediated by glycogen metabolism rather than by uridine metabolism.

Purification and properties of alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), key enzyme of niacin synthesis from tryptophan, from hog kidney

alpha-Amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD) (EC 4.1.1.45) was purified to a homogeneous state from hog kidney cytosol by ammonium sulfate fractionation, Butyl-Toyopearl 650, hydroxyapatite, DEAE-Sephadex, Toyopearl HW55, Superdex 200 and TSK-gel G3000SW chromatographies. The molecular weight of the enzyme was estimated to be 58,000 by TSK-gel G3000SW gel filtration. The optimum pH (constant concentration) was 7.5. The Km for alpha-amino-beta-carboxymuconate-epsilon-semialdehyde was 1.61 x 10(-5) M. The activity of purified enzyme was inhibited by some chemical modifying reagents such as monoiodoacetic acid and p-(chloromercuri) benzoic acid. A sulfhydryl group was deduced to exist in the active site of the enzyme.

Dietary wheat gluten alleviates the elevation of serum transaminase activities in D-galactosamine-injected rats

The effects of dietary protein on the elevation of activities of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in D-galactosamine-injected rats were investigated. The rats fed with experimental diets containing test protein sources for 2 weeks were injected with D-galactosamine (0.8 g.kg-1 body weight). The activities of AST and ALT in serum were assayed after 20 h. According to the results, these enzyme activities in the rats fed 40% casein diet were higher than those of 5, 10, or 20% casein groups. In the 40% gluten group, these enzyme activities were lower than in the 40% casein group. This difference was not considered to be caused by the deficit of L-lysine and L-threonine in gluten. The extent of the reduction of UTP and UDP-glucose in liver by D-galactosamine was almost the same in the 40% gluten and 40% casein groups. These results suggest that levels and quality of dietary protein affect the susceptibility of animals to the hepatotoxin D-galactosamine and dietary gluten was found to alleviate the elevation of serum transaminases in rats by the drug.

Effects of dietary gluten on the hepatotoxic action of galactosamine and/or endotoxin in rats

This study was done to clarify the effects of dietary wheat gluten on the hepatotoxic action of D-galactosamine (GalN) and endotoxin (Etx). Male Wistar rats fed a high casein or high gluten (supplemented with L-Lys and L-Thr) diet were injected with GalN or Etx, and the plasma glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, and lactase dehydrogenase activities were examined 20 h later. In rats fed the high gluten diet, these enzyme activities were lower than in the high casein group after injection of 800 mg/kg of GalN. But such a difference between the casein and gluten groups was not clear when they were treated with 400 mg/kg of GalN nor observed even after injection of Etx or Etx+GalN (400 mg/kg). Similarly these was no difference in the plasma concentrations of Etx, tumor necrosis factor-alpha, or interferon-gamma in the rats receiving an injection of 800 mg/kg of GalN between both dietary groups. These results suggest that dietary gluten affords protection against hepatic injury by a high dose of GalN but not by a low dose of GalN and/or Etx.

Effect of dietary linoleic acid on the tryptophan-niacin metabolism in streptozotocin diabetic rats

To make clear the mechanism of change of tryptophan-niacin metabolism in diabetic rats, we investigated the effect of dietary linoleic acid on the tryptophan-niacin metabolites and the activity of liver, alpha-amino-beta-carboxymuconate-epsilon-semialdehyde decarboxylase (ACMSD), a key enzyme of tryptophan-niacin metabolism, in streptozotocin diabetic rats. Moreover, we investigated the involvement of linoleic acid in the induction of hepatic ACMSD activity by streptozotocin diabetes. In diabetic rats, the sum of urinary excretion of nicotinamide, N1-methylnicotinamide (MNA), N1-methyl-2-pyridone-5-carboxamide (2-Py) and N1-methyl-4-pyridone-3-carboxamide (4-Py) was higher in the fat free diet group than in the linoleic acid group, that was accompanied by the increase of tryptophan intake and reduction of body weight in the fat free diet group. In diabetic rats, hepatic ACMSD activity was higher in the fat free diet group than in the linoleic acid group. The results indicated that the induction of hepatic ACMSD activity by diabetes was not due to removal of the suppressive effect of the linoleic acid on the enzyme. In the diabetic+insulin group, hepatic ACMSD activity was significantly lower than in the diabetic group.

Clinical study on the pathophysiology and treatment of PPI-resistant ulcers

We studied the gastric acidity, gastric emptying, and proton pump inhibitor (PPI) plasma levels in 10 patients with PPI-resistant ulcers. The pH3 holding-time ratio was low in nine of these patients, with an average ratio of only 39%. PPI plasma levels in those patients were also much lower than in those with nonresistant ulcers. Gastric emptying, determined by the acetaminophen method, was reduced in all 10 patients. Therefore, PPI-resistant ulcers appear to result from insufficient inhibition of gastric acidity, with reduced gastric emptying interfering with the absorption of PPIs. In patients with mild reductions in gastric emptying, PPI plasma levels increased after a change from single-unit enteric-coated tablets (omeprazole) to multiunit enteric-coated granules in capsules (lansoprazole). This change in formulation markedly inhibited gastric acidity and led to rapid healing. In patients with moderate reductions in gastric emptying, doubling the dose of lansoprazole was effective. In patients with severely reduced gastric emptying, there appeared to be a limit to the effectiveness of oral administration of PPIs. Changing the formulation and doubling the dose to compensate for reduced gastric emptying are effective approaches in the treatment of patients with PPI-resistant ulcers.

[Mucin histochemical study of differentiated adenocarcinoma of stomach]

The mucin phenotypic expression of gastric differentiated adenocarcinoma was investigated by mucin histochemical method. Seventy-nine advanced gastric carcinomas, which showed histologically differentiated type (well and moderately differentiated type) in the mucosa, were classified into four types; gastric type (30.4%), intestinal type (19.0%), combined type with both gastric and intestinal phenotype (45.6%) and lack of mucin type (5.1%). Moreover, differentiated adenocarcinoma of gastric type were subclassified into foveolar (F) type (37.5%), pyloric gland (P) type (37.5%) and mixed (M) type with foveolar and pyloric type (25.0%). Both gastric type and intestinal type differentiated adenocarcinoma were apt to change to undifferentiated type in the invasive lesion below the submucosa. On the contrary, carcinoma of combined type changed to undifferentiated type with significantly lower incidence than the former two type. F-type differentiated adenocarcinoma tended to develop scirrhous or non-solid type infiltration and carcinoma of P-type showed medullary or solid growth with significantly higher incidence than the other type. Mucin phenotypic expressions of differentiated adenocarcinoma had much to do with the mode of growth and infiltration of cancer in the gastric wall below the submucosal layer.

[Psychosocial features of the patients with home oxygen therapy]

Home oxygen therapy (HOT) has released patients with chronic respiratory failure (CRF) from hospitalization for the rest of their lives, and has brought some relief from their physical restriction due to CRF. However, some new psychosocial problems have arisen from this home care treatment. Research has been performed on 85 patients in our hospital by: (1) comprehensive psychosomatic questionnaire for patients with long-term oxygen therapy, (2) CMI, (3) SRQ-D (depression), (4) MAS and Questionnaire C of JMHW-CRF research group. The results of (1) indicated some problems in the majority of patients. Also in SRQ-D, about half of the patients showed a depressive state. In MAS, more than a few patients revealed a high anxiety level concretely, recognized psychosocial problems with loss of desire for treatment pessimism recording their prognosis, in addition to loss of QOL. All the above and an understanding by the staff of the psychosocial situation of patients and a grasp of their mental state are extremely important in the long-term care of HOT patients.

[Psychological approach to chronic respiratory failure]

Patients with chronic respiratory diseases, particularly chronic respiratory failure, are seriously handicapped mentally and physically as compared with those with diseases of other medical fields. This is because their disorders relate to breathing, which is the basic physical function directly associated with sustaining life. The authors have attempted a psychosomatic approach for patients with chronic respiratory disorders. Clinical science in this field of medicine in Japan is far behind that of other advanced nations. In the Comprehensive Emphysema Inventory, it was clearly reported that in many cases, psychological stress is involved in the onset of dyspnea. In SRQ-D or MAS, moreover, decreased motivation for treatment, anxiety regarding prognosis, and conflict were notable in psychosomatic tests. Patients on home oxygen therapy (HOT) appear to have problems in family relations and in the daily-living environment, even though HOT provides both mental and physical benefits. It was also noted that holistic or comprehensive care designed for improvement of not only physical condition, but also psychosocial aspects and quality of life, is essential to achieve good results in the respiratory rehabilitation of patients affected by chronic respiratory failure.

[Food poisoning caused by enteroinvasive Escherichia coli (O164:H-)--a case in which the causative agent was identified]

Food poisoning due to "Godofu (Sasayuki tofu)" as a main causative foodstuff which broke out on July 14, 1988. There were 670 out of 918 persons who ingested this food who became ill (incidence 73.0%). The main symptoms were diarrhea (93.4%), fever (77.5%), abdominal pain (64.5%), and vomiting (19.9%). A high degree of fever and watery diarrhea were characteristic of this poisoning. The average latent period was 35 hours with a range of one to 156. The O164:H- strains of enteroinvasive Escherichia coli (EIEC) were detected from 22 of the 32 fecal samples collected from the patients, five of ten samples collected from workers engaged in tofu making, and one sample of left-over Godofu. The virulence of EIEC strains isolated from the patients, workers, and left-over food was confirmed by invasion into HeLa and HEp-2 cells, Sereny test, and ELISA test to detect invasive plasmid-derived protein of the organism (conducted at Tokyo Metropolitan Research Laboratory of Public Health). These EIEC strains were sensitive (less than or equal to 0.19 to 6.25 micrograms/ml) to GM, ABPC, CBPC, CER, CET, NA, PB, MINO, TC and CP as well as KM and OFLX which were used for treatment. However, their susceptibility to FOM varied to some extent (6.25 to 25.0 micrograms/ml) and one strain isolated from a tofu worker was resistant to MINO, TC, FOM and CP (25 to greater than or equal to 100 micrograms/ml). Since investigation revealed that Godofu was left at room temperature about 29 degrees C until ingested, we did a experiment to check the bacterial growth in Godofu under similar conditions at the time of outbreak.(ABSTRACT TRUNCATED AT 250 WORDS)

[Usefulness of ceftazidime in intractable respiratory tract infections]

Usefulness of ceftazidime (CAZ) was studied in 56 cases of intractable respiratory tract infections. CAZ was administered at a daily dose of 2-4 g in 2 divided doses by intravenous drip infusion for 3-15 days. 1. Analysis was carried out in 38 cases and the following result was obtained. Efficacy rate was: 68% (17/25) in pneumonia, 60% (3/5) in chronic bronchitis and 67% (4/6) in secondary infections in chronic respiratory disease cases, and the overall efficacy rate was 63.2% (24/38). 2. In bacteriological study, 68.2% (15/22) of eradication rate was obtained. Against Staphylococcus aureus, eradication was obtained in all strains (4 strains). Against Pseudomonas aeruginosa, eradication occurred in 4 strains out of 10, and decrease in number in 2 strains. 3. As for adverse effects, mild hepatic disorder was observed in 2 cases (3.6%) out of 56. 4. From the above result, CAZ is considered to be very useful when used as monotherapy for aged patients and in the treatment of severe and intractable infections accompanied by underlying diseases.

[Radiograph stress measurement of metallic denture base formed by wire explosion energy. 1. Stress changes during various stages of manufacturing metallic denture base]

The radiograph stress measurement method is the only known means of a non-destructive measurement, and this method is used to assess the residual stresses of various metals. This study was made to evaluate the possibility of radiograph stress measurement of the metallic denture base formed by the wire explosion energy. Radiograph stress measurements of stress changes during various stages of manufacturing metallic denture base were successfully obtained.

[Case of primary double lung cancer in the same lobe]

In a 70-year-old male complaining chiefly of cough and expectoration, an abnormal shadow was detected in the left upper lobe by chest X-ray. Therefore, he was admitted for further examination. A tumorous shadow, 5 X 4.5 X 2.5 cm was noted; it corresponded to S1 + 2b on the left side. Left upper lobectomy was performed. Histologic findings of the excised lung were giant cell cancer in the tumorous part, and squamous epithelial cancer at the cut end of the bronchus, i.e. the cut end of the left upper bronchi. This is a rare case with primary double cancer in the same lobe.

Regulatory mechanism of delayed-type hypersensitivity in mice. V. Augmentor cells for DTH responses

Mice primed with 1 microgram of reduced and alkylated ovalbumin (RA-OA) developed not only long-lived memory cells for delayed-type hypersensitivity (DTH), capable of differentiating into DTH-effector T cells (DTH-Te) against ovalbumin (OA) when restimulated in vitro with OA, but also spleen cells capable of augmenting recipients' DTH responses to OA when transferred into cyclophosphamide (CY)-pretreated mice. The augmenting activity in spleen cells, upon transfer, was found 7 days, but not 21 or 91 days, after priming with RA-OA, although memory DTH-Te were present throughout the period of observation. The loss of augmenting activity after day 7 of priming was not due to the presence of suppressor cells; spleen cells taken 21 days after priming failed to suppress, upon transfer, the augmenting activity in 7-day-primed spleen cells as well as induction and expression of DTH responses to OA. When 7-day-primed spleen cells were fractionated on a discontinuous bovine serum albumin density gradient, the augmenting activity was found only in the medium-density-cell layer, although memory DTH-Te were separated in the high-density layer. Augmentation of DTH-Te generation could also be demonstrated in vitro when 7-day-primed spleen cells, but not 21-day-primed spleen cells, were added to cultures of spleen cells from CY-pretreated mice. These results indicate that, in the 7-day-primed spleen, there is an augmentor cell population which is different from memory DTH-Te and interacts with CY-resistant unprimed cells to facilitate DTH-Te generation.

Allorestriction and xenorestriction phenomena in the induction of delayed-type hypersensitivity (DTH) responses in the guinea pig against azobenzenearsonate- (ABA) modified peritoneal exudate cells

The role of MHC products in the induction of DTH responses Ia antigens play a crucial role in these cells in the recognition of ABA determinants by lymphocytes. Second, JY-1 guinea pigs were employed as responder animals. A clear allorestriction phenomenon was observed again when weakly modified ABA-PEC were used. On the other hand, the allorestriction phenomenon was apparently abrogated when heavily modified ABA-PEC were employed: allogeneic as well as syngeneic ABA-PEC induced strong and comparable DTH responses. Even in this condition, xenogeneic (mouse) ABA-PEC were barely immunogeneic, On the basis of these observations, the cross-reactivity of Ia antigens in the conjunctive recognition of haptenic determinants by T cells is discussed.

Correlation between production of inflammatory substances and generation of effector T cells mediating delayed-type hypersensitivity in mice

In vitro exposure to human serum albumin (HSA) of splenic lymphocytes from mice sensitized for delayed-type hypersensitivity (DTH) against HSA resulted in the release of substances that could induce a footpad inflammatory reaction with a maximum of 6 hr after injection into normal mice. The substances were fractionated mainly in a molecular weight range of 30,000 to 70,000 daltons on Sephadex G-200. The ability of sensitized lymphocytes to produce the substances was dependent on T cells, was antigen specific, and correlated well with the ability of the lymphocytes to mediate DTH reactions. Moreover, the substances were produced efficiently by the DTH effector cell population generated in the in vitro culture system and also by the effector cell-enriched fractions on discontinuous bovine serum albumin gradients. These results suggest that the substances are produced by DTH-effector cells.

Allorestriction and xenorestriction phenomena in the induction of delayed-type hypersensitivity (DTH) responses in the guinea pig against azobenzenearsonate- (ABA) modified peritoneal exudate cells

The role of MHC products in the induction of DTH responses Ia antigens play a crucial role in these cells in the recognition of ABA determinants by lymphocytes. Second, JY-1 guinea pigs were employed as responder animals. A clear allorestriction phenomenon was observed again when weakly modified ABA-PEC were used. On the other hand, the allorestriction phenomenon was apparently abrogated when heavily modified ABA-PEC were employed: allogeneic as well as syngeneic ABA-PEC induced strong and comparable DTH responses. Even in this condition, xenogeneic (mouse) ABA-PEC were barely immunogeneic, On the basis of these observations, the cross-reactivity of Ia antigens in the conjunctive recognition of haptenic determinants by T cells is discussed.

Regulatory mechanism of delayed-type hypersensitivity in mice. III. In vitro analysis of memory T cells involved in augmentation of DTH responses

The memory of delayed-type hypersensitivity (DTH), manifested by the augmented responsiveness upon challenge with alum-absorbed ovalbumin (OA), was induced in mice primed 7 days, 21 days, or 90 days previously with 1 microgram of reduced and alkylated OA. The memory cells involved in the augmentation of DTH responses were analyzed in the in vitro induction system of T cells which mediate DTH against OA. Spleen cells from the primed mice generated DTH-effector T cells (DTH-Te) in a significantly accelerated fashion, compared with unprimed spleen cells, when cultured with OA. The accelerated generation of DTH-Te in vitro was induced antigen specifically and was dependent on a certain T cell population in the primed spleen. The T cell population was found in the spleen of primed mice for at least 3 months after priming, corresponding to the persistence of DTH-memory in vivo. Moreover, it was fractionated in the high-density layer by discontinuous bovine serum albumin gradient centrifugation. The high-density cell population decreased in density with increase in the time of culture and developed into DTH-Te, which were separated in the low-density layer on day 4 of culture. These results indicate that the T cells involved in the accelerated generation of DTH-Te in vitro are long-lived DTH-memory T cells, which are probably precursor cells, capable of differentiating into DTH-Te upon challenge with the antigen.