[Preoperative and postoperative variations of human hepatocyte growth factor (hHGF) in hepatectomized patients]

We clinically analyzed significance of serum human hepatocyte growth factor (hHGF) concentrations (ng/ml) before and after hepatectomies. We examined 39 hepatectomized patients (Group H) and 8 non-hepatectomized patients as control (Group C). In group H, hHGF levels elevated significantly on postoperative 1st, 3rd, 5th, and 7th days (0.59 +/- 0.24, 0.47 +/- 0.23, 0.38 +/- 0.16, 0.38-0.14, respectively) compared with the preoperative value (0.27 +/- 0.11). On the 3rd day hHGF levels in Group H (0.45 +/- 0.22) were significantly higher than those in Group C (0.30 +/- 0.06). Nineteen cases of 2-segmentectomy and 8 cases of partial resection showed significantly higher hHGF levels on the 3rd day than those in Group C. In 12 patients with liver cirrhosis, hHGF levels were significantly higher on the 5th and 21st days than those in 27 patients without cirrhosis. Three patients with hepatic failure showed significantly higher hHGF levels correlated conversely with preoperative serum albumin and hHGF levels on the 1st day after operation significantly correlated with operative time, blood loss during the operation. It was suggested that serum hHGF level correlated with hepatic functional reserve. We concluded that serial measurement of hHGF was useful for evaluation of postoperative damage of hepatic functions, and prolonged high hHGF levels might suggest hepatic failure.

Occupational exposure to solvent mixtures: effects on health and metabolism

Exposure monitoring by personal diffusive samplers, biological monitoring of toluene exposure by urinary hippuric acid determination, haematology, serum biochemistry for liver function, and a subjective symptom survey by questionnaire were conducted on 303 male solvent workers. They were exposed to a mixture of solvents including toluene (geometric mean 18 ppm), methyl ethyl ketone (MEK; 16 ppm), isopropyl alcohol (IPA; 7 ppm), and ethyl acetate (9 ppm). The intensity was mostly below unity using the additiveness formula based on current Japanese occupational exposure limits, but more than eight times unity at the maximum. The results were compared with the findings in 135 non-exposed male workers of similar ages. Haematology and liver function tests did not show any exposure related abnormality, and subjective symptoms were mostly related to central nervous system depression and local irritation. Further analysis suggested that the irritation effects were not related to exposure to MEK. Analysis of the relation between toluene exposure and hippuric acid excretion in urine showed that there was no metabolic interaction between MEK and toluene, or between IPA and toluene. Overall, therefore, it is concluded that there was no sign or symptom detected to suggest anything other than toluene toxicity, that there was no evidence to indicate any modification of toluene toxicity or metabolism due to coexposure, and that the additiveness assumption is reasonable for risk assessment for the combination of solvents under these exposure conditions.

[Renal tubular dysfunction in open pediatric heart surgery--preventive effect of haptoglobin]

Preventive effect of haptoglobin (Hb) for renal tubular dysfunction was studied in 16 pediatric patients undergoing open heart surgery under extracorporeal circulation (ECC). The patients were divided into two groups; Hp(+) group consisting of 7 patients administered haptoglobin (100 U/kg) in priming of ECC, and Hp(-) group of 9 patients not administered haptoglobin. As parameters of renal tubular function, urinary alpha 1-microglobulin-index (U-alpha 1m.I), urinary beta 2-microglobulin-index (U-beta 2m.I), urinary N-acetyl-beta-D-glucosaminidase-index (U-NAG.I), fractional clearance of alpha 1m (Fc-alpha 1m) and beta 2m (Fc-beta 2m), as well as Free-Hb, were measured just before start of ECC and then at periodical time after ECC to the 7th day. The results obtained are as follows. (1) Maximum Free-Hb in Hp(+) group was significantly less (p < 0.05) than that in Hp(-) group. (2) Every parameter of renal tubular function were shown a peak at the end of ECC. Maximum values of U-alpha 1m.I, U-NAG.I and Fc-alpha 1m in Hp(+) group were significantly less (p < 0.05) than those in Hp(-) group. Maximum U-beta 2m.I and Fc-beta 2m in Hp(+) group were less than those in Hp(-) group, although there was no significant difference. These results indicate that administration of haptoglobin suppresses the increase of Free-Hb and is useful for prevention of renal tubular dysfunction during ECC.

[Clinical study of serum ErbB-2 protein using sandwich radioimmunometric assay (ErbB-2 IRMA 'Eiken')]

Sandwich radioimmunometric assay (ErbB-2 IRMA 'Eiken') was developed to determine the levels of c-erbB-2 oncogene product (ErbB-2 protein) in human sera, and a clinical investigation was carried out to evaluate this novel oncogene product. The mean serum concentration of the ErbB-2 protein determined from 364 donors was 4.0 +/- 0.69 ng/ml (mean +/- SD) for females and 4.5 +/- 0.96 ng/ml for males. Cut-off values were set at 5.4 ng/ml for females and 6.5 ng/ml for males. The positivities of serum ErbB-2 protein in patients with breast carcinoma were 13.0% for primary cases and 47.9% for recurrent cases. Patients with hepatic disorders also had positive serum ErbB-2 protein levels, ie, 43.8% (7/16) for hepatocellular carcinoma and 28.9% (11/38) for hepatitis and liver cirrhosis, although the increase was slight and barely exceeded 10 ng/ml. In comparison with the levels of other tumor markers, such as CEA, CA 15-3 and NCC-ST 439, the serum ErbB-2 level was shown to have poor correlations, and was thus assumed to be useful for combination with those tumor markers. In serial determinations of serum ErbB-2 protein in two patients with recurrent breast carcinoma, the antigen increased preceding the increases in the other tumor markers, thereby also showing usefulness as a monitoring marker for breast carcinoma. In conclusion, these results indicated that ErbB-2 measurement improves the assessment of breast cancer in combination with other tumor markers and is useful as a tool for monitoring the clinical condition and the response for treatment in breast cancer.

[Clinical evaluation of serum ErbB-2 protein using enzyme immuno assay (ErbB-2 EIA [Nichirei])]

The levels of ErbB-2 protein in serum samples from patients with breast cancer, other various malignant tumors, and benign diseases were determined using the sandwich EIA for clinical evaluation. In 364 healthy blood donors, cut-off values were set at 5.4 ng/ml for females and 6.5 ng/ml for males. The positive rate of primary breast cancer was 13.0% (24/185) and that of recurrent breast cancer was 51.2% (62/121). No significant correlation was found between serum levels of ErbB-2 protein and other tumor markers, such as CEA, CA 15-3, and ST 439. Measurement of ErbB-2 protein in combination with these tumor markers showed increased sensitivities. The positive rates and levels of ErbB-2 protein in sera of patients with metastasis to multiple organs were significantly higher than those in patients with metastasis to only a single organ. In postoperative follow-up of two patients with recurrent breast cancer, the levels of ErbB-2 exceeded its cut-off value a few months earlier than did the other tumor markers. These results indicate that the measurement of the ErbB-2 protein in serum is useful for the diagnosis and a monitoring the relapse of breast carcinoma.

Electronic endoscopy in perspective

Electronic endoscopy, developed in 1983, enables the endoscopic image to be transmitted through electric signals that can be easily processed by computer. An electronic endoscope is composed of three vital parts, i.e., a charge-coupled device (CCD) that converts the image to electric signals, a video processor that converts analog electric signals to the digital and processes them to become video signals, and a television monitor. The introduction of electronic endoscopy has enabled computer management of endoscopic images, on one hand, and provided an opportunity for image processing and analysis, on the other. A digital image management system will further develop into a database of endoscopic images. Combined with the technologies of remote control and remote sensing, the introduction of CCD to endoscopy has made it possible to transform the endoscope, so that it could become a capsule. Future advances in the research of image processing and analysis will lead to the development of a system of automated endoscopic diagnosis.

HLA antigens in Japanese patients with high titre anti-ribonucleoprotein antibodies

Images

Radiologic appraisal of healing after iliac crest bone grafts

Radiographic changes were observed in 45 patients who had undergone iliac bone grafting with either metal or wire fixation after resection of the mandible. Changes were generally not observed during the first month after surgery. Bony resorption was seen during the second or third month. Osteogenesis commenced at any stage, but was usually radiographically evident by 3 to 6 months. Union was not radiographically evident in most cases until more than 6 months had elapsed after surgery. For follow up, plain film radiographs 4 to 6 months after surgery are recommended in patients who receive bone grafts.

[Primary malignant lymphoma of the urinary bladder achieving complete response by COMPA intraarterial chemotherapy: a case report]

A case of primary malignant lymphoma of the bladder is reported. A 70-year-old woman was admitted to our clinic with the chief complaint of intermittent gross hematuria on March 31, 1992. Examination of cystoscopy, IVP, ultrasonography and CT scan suggested a non-papillary invasive bladder tumor. Pathological examination of transurethral biopsy revealed malignant lymphoma, B cell type. After 5 courses of intraarterial COMPA (CDDP, VCR, MTX, PEP, ADR) chemotherapy, she have been in complete remission. Intraarterial COMPA chemotherapy might be effective and useful for primary malignant lymphoma of the urinary bladder.

Synchronous inverted papilloma and submucosal leiomyoma of the urinary bladder

We report a case of synchronous inverted papilloma and submucosal leiomyoma of the bladder in a 43-year-old man and review the relevant literature.

[Postgraduate training in Laboratory Administration and Management]

The new edition of the postgraduate training requirement in clinical pathology includes "Laboratory Administration and Management". There are many different ways to receive its training, such as supervised experience in one's institution and continuing educational programs offered by professional organizations. The Japanese Association of Clinical Laboratory Physicians (JACLaP) now offers two kinds of its continuing educational programs for "Good Laboratory Management"; a workshop for a small group of its members and an educational conference.

[Past and present of JSCP international exchange]

The Japan Society of Clinical Pathology was established in 1951 among laboratory physicians working in central clinical laboratories who discussed at the first several years on what clinical pathology and clinical pathologists mean. Many foreign guest lecturers were invited for its annual congresses. In 1962 returned from USA the three Japanese physicians who were certified in both anatomic and clinical pathology by the American Board of Pathology. Then, they also reported on various aspects in relation to clinical pathology, mainly in USA. The First International Symposium on Quality Control-Tokyo was held in 1974, inviting several laboratory scientists in Asia. In 1975, the Japanese-Korean Joint Conference in Clinical Pathology started, and in 1990 it was reorganized to the Asian Conference of Clinical Pathology, currently consisting of 4 national clinical pathology societies; Japan, Korea, China-Taipei and Indonesia. The official exchange program between the China-Beijing and JSCP started in 1992. JSCP joined to WASP (World Association of Societies of Pathology, Anatomic and Clinical) in 1957, and since then many members have been participating to various activities of the WASP. Dr. Tadashi Kawai, the Past President of JSCP, served the WASP President from 1991-1993. The permanent WASP Administrative Office was opened in Tokyo since 1992. The JSCP is expected to participate and contribute further for various WASP activities in future.

[Perioperative management of pediatric patient with vena cava superior thrombosis complicated with nephrotic syndrome]

Nephrotic syndrome is a disease which accompanies hypoproteinemia, edema, hyperlipidemia and coagulopathy. This syndrome has also been recognized in pediatric patient. We experienced recently a case of 11-year-old girl, who had insertion of a plasma exchange catheter because of secondary hyperlipidemia due to nephrotic syndrome. She suffered soon from a severe SVC obstruction by thrombosis grown up around the catheter and an emergency thrombectomy was planned under the cardiopulmonary bypass. Renal function was maintained preoperatively, in comparison with nephrotic syndrome in adult where some problems in perioperative management, such as difficulties in tracheal intubation, choice of anesthetic drugs, blood and fluid management, monitoring without CVP and weaning from ventilator are observed. Induction was carried out carefully under spontaneous breathing and the anesthetic method we used consisted of balanced technique using N2O, O2, fentanyl and pancuronium bromide with moderate hyperventilation. Intraoperative course was uneventful and the patient was extubated on the second day after the operation without any neurological defects.

[Clinical study of the advanced testicular tumor non-achieved complete response by primary chemotherapy and relapse cases. The East Japan Testicular Tumor Study Group]

The East Japan Testicular Tumor Study group has studied advanced testicular tumors. Treatment and prognosis of the patients who did not achieved complete response on the primary chemotherapy were discussed in this paper. Also 8 patients who had once reached complete response by primary treatments and relapsed later have been clinically analyzed. 1. Concerning the patients non-achieving complete response on the primary chemotherapy: Two cases who had resection of the residual tumors and 4 cases who had radiation therapy had reached NED in 7 cases of seminoma stage II. Nine of 10 cases in non-seminoma stage II reached NED on resection of the residuals. Moreover, 10 out of 17 cases in stage III showed NED on excision of the residuals. On the other hand, recuperating was very difficult in the cases who could not have excision of residual tumor. The histological findings of the residual tumors after chemotherapy were necrosis and fibrosis in 13 cases, viable cells in 4 cases, teratoma in 6 cases and other 2 cases were not clear. Five out of 15 who had teratoma in the primary lesion had teratoma in the resected residuals on metastatic lesion. On the other hand 5 patients who did not have teratoma originally had no any teratoma elements in the residuals. 2. Concerning the relapse cases by primary treatments: Although relapses were possible in any stages, they were more common with stage IIIB and IIIC cases. Those who achieved complete response after chemotherapy alone fewer relapse than those who had partial response after chemotherapy and there after had excision of residual tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Myelodysplastic syndrome associated with immunoblastic lymphadenopathy-like T-cell lymphoma: simultaneous clinical improvement with chemotherapy

A 75-year-old woman presented with anemia, lymphadenopathy, hepatomegaly and lingual tumor, but no constitutional symptoms. The laboratory data showed pancytopenia and polyclonal hypergammaglobulinemia. A bone marrow aspirate represented an apparent myelodysplastic syndrome (MDS) feature, specifically, refractory anemia with excess of blasts. A lymph-node biopsy revealed the disappearance of normal architecture, small arborizing blood vessels, large lymphoid cells with prominent cytoplasm (so-called pale cells) and a clonal proliferation of T-lymphocytes. The patient was diagnosed as having MDS associated with immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma. She was subsequently treated with cyclophosphamide, adriamycin, vincristine and prednisolone for lymphoma which successfully induced a remission of not only the T-cell lymphoma but also the MDS. The case suggested that MDS might be a paraneoplastic complication of IBL-like T-cell lymphoma.

[Low dose COMPE. Cisplatin, vincristine, methotrexate, peplomycin, etoposide chemotherapy for advanced testicular cancer]

We presented 15 patients with advanced testicular cancer treated with to 7 courses (mean: 3.2 courses) of COMPE chemotherapy. The low dose COMPE, given 14 patients, consisted of the chemotherapeutic agents as follows: cisplatin, 5 mg/m2 by intravenous push infusion and thereafter 25 mg/m2 by continuous 24-hour-infusion on day 3 and 30 mg/m2 by continuous 24-hour-infusion on day 4; vincristine, 0.6 mg/m2 by drip intravenous infusion (div) on days 1 and 2; methotrexate, 10 mg/m2 by div on day 1; peplomycin, 10 mg/m2/day, divided to three times by intramuscular injection on days 1 to 3; etoposide, 100 mg/m2, by div on days 3 to 5. The regular dose COMPE (given one patient) had CDDP dosage up to 50 mg/m2/day on days 3 and 4. the regimens were given every 3 or 4 weeks in admission. Patients were adequately hydrated but no diuretics were used. The patients were diagnosed as 5 seminomas with 4IIA and one IIB and as 10 non-seminomas with 2IIA, one IIB, one IIIB 1,4 IIIB2, and 2 IIIC stagings, respectively. Of the 15 patients, 12 patients are alive with no evidence of disease at 13-86 months (mean: 39.5 months) of follow-up duration. Six patients achieved complete remission. Of 8 patients achieved partial remission with chemotherapy alone, 6 patients achieved complete remission by following resection of residual masses or irradiation but another 2 patients (IIB2:1, IIIC:1) failed to achieve complete remission had relapse and died after 19 and 25 months, respectively. One patient (IIIC) showed no change had progression and died after 5 months.(ABSTRACT TRUNCATED AT 250 WORDS)

CDR-grafted OKT4A monoclonal antibody in cynomolgus renal allograft recipients

In an attempt to improve therapeutic efficacy and limit antimurine responses to the IgG2a monoclonal antibody OKT4A, humanized complementarity determining region (CDR)-grafted OKT4A mAbs (IgG1 and IgG4 isotypes) were developed from the murine molecule. Preclinical evaluation was undertaken in 12 cynomolgus renal allograft recipients (IgG1, n = 7; IgG4, n = 5). Control animals received either no therapy (n = 2) or OKT3 (n = 2). The mAbs were given as a single 10-mg/kg bolus on the day of transplantation or as multiple 1-mg/kg doses. Mean allograft survival (+/- SEM) was 9 +/- 0.7 days in control animals; 45.2 +/- 6.0 days, P = 0.002 (single dose, n = 5), and 39 +/- 5.0 days, P = 0.053, (multiple doses, n = 2) in IgG1-treated animals; and 35.3 +/- 7.2 days, P = 0.034, (single dose, n = 3) and 15.5 +/- 6.5 days, P = .251 (multiple doses, n = 2) in IgG4-treated animals. Whereas IgG4-treated animals showed coating of peripheral blood CD4+ T cells, significant CD4+ T cell depletion was observed in IgG1-treated animals. These results confirm the retained immunosuppressive efficacy of humanized OKT4A antibodies. In contrast to murine mAbs, the use of these agents would not preclude sequential treatment with mAbs directed against different epitopes. The fact that rejection can occur despite peripheral blood CD4+ cell depletion suggests that indefinite control of allograft rejection in primates may require more intensive therapy than has proved effective in rodent models.

Gastric epithelial damage induced by local ischemia-reperfusion with or without exogenous acid

We evaluated the damage to the gastric epithelium produced by local ischemia-reperfusion (IR) with or without luminal perfusion with 0.1 N HCl. Local gastric ischemia was induced by clamping the left gastric artery. Use of radioactive microsphere technique revealed a significant reduction in blood flow induced only in the corpus (67% reduction). Because no measurable gross lesion was observed in this model, the blood-to-lumen clearance of 51Cr-labeled EDTA (51Cr-EDTA) served as an index of epithelial damage. In the absence of exogenous acid, the histological damage was minimum and could not be quantified. However, a significant increase in 51Cr-EDTA clearance was observed shortly after reperfusion in a manner that depended on the duration of ischemia. This increase in clearance reached a maximum approximately 10 min after reperfusion and returned rapidly toward control levels within 40-50 min after reperfusion. In the presence of exogenous acid, EDTA clearance increased significantly during ischemia, increased further during reperfusion, and did not recover for at least 60 min after reperfusion. The acid infused after reperfusion (no acid before reperfusion) did not significantly aggravate the mucosal damage that followed reperfusion. However, the acid infused before reperfusion (no acid after reperfusion) showed an effect on EDTA clearance similar to that induced by continuous acid perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-emetic principles of Magnolia obovata bark and Zingiber officinale rhizome

Magnolol and honokiol, biphenyl compounds, were isolated as anti-emetic principles from the methanolic extract of Magnolia obovata bark. [6]-, [8]-, and [10]-shogaols and [6]-, [8]-, and [10]-gingerols were isolated from the methanolic extract of Zingiber officinale rhizome as anti-emetic principles. Some phenyl-propanoids with allyl side-chains were found to show the same activity. They inhibited the emetic action induced by the oral administration of copper sulfate pentahydrate to leopard and ranid frogs.