[Current status and prospects for targeted therapy for thyroid cancer]

New strategies are currently being developed with regard to targeted (missile) therapy for cancer using anticancer agent-labeled specific antibodies. A range of problems prevent their clinical application, however, because each specific cancer may not yet have a known unique antigen. In turn, this serves to impede the development of specific antibodies. Regarding thyroid cancer, no reports of targeted therapy have appeared since specific antigens remain to be identified. Monoclonal antibodies A2B5, HISL-19 and 4F2 bind to neuroendocrine tumors (A2B5, HISL-19) and severe malignant tumors (4F2) indicating rapid growth, enabling these tumors to express common anti-genetic determinants to our monoclonal antibodies. The immunohistochemical study for thyroid cancers revealed that A2B5 and HISL-19 only react with medullary carcinoma and that 4F2 only reacts with anaplastic carcinoma. When 131I-labeled A2B5 was injected into the rat bearing insulinoma, the antigen of which is common to medullary carcinoma of the thyroid, clear accumulation of radiolabeled antibody corresponding to the transplanted tumor was observed by scintiscanning. Furthermore, the biochemical study undertaken to identify anti-genetic protein using the Western blotting procedure demonstrated new HISL-19 antigen in medullary carcinoma of the thyroid, which is not recognized in benign endocrine tumor, and 4F2 antigen in anaplastic carcinoma. Since these antigens do not circulate in the blood stream, the administered antibody reaches the targeted lesion without decreasing antibody titer. Although many problems remain, such as the effect on normal cells and affinity to the targeted lesion, our current aim is to establish an efficient and effective chemotherapy using monoclonal antibodies in medullary carcinoma and anaplastic carcinoma arising in the thyroid.

Acute low-tone sensorineural hearing loss without vertigo

OBJECTIVE

To study the pathophysiological features of acute low-tone sensorineural hearing loss without vertigo (ALHL) and its correlation with Meniere's disease.

DESIGN

Retrospective review of medical charts of patients with ALHL.

SETTING

University hospital clinic.

PARTICIPANTS

Eighty consecutive patients with ALHL, including 45 patients whose conditions were followed up for more than 3 years (average, 5 years 2 months; range, 3 years 3 months to 8 years).

OUTCOME MEASURES

Age and sex distributions and results of audiological and neuro-otological tests, initial outcome, recurrence rates, and differences between patients with and without recurrence.

RESULTS

About 75% (62/80) of the patients were between the ages of 30 and 60 years and the female-male ratio was 2:6. Positive glycerol test results were found in 74% (26/35) of patients and abnormally increased negative summating potential/action potential ratio in 63% (50/80). No abnormalities were found on neuro-otological tests. Hearing loss improved within 3 months in 84% (67/80) of the patients. Of 45 patients followed up for more than 3 years, 28 (62%) showed no evidence of recurrence, 12 (27%) developed cochlear Meniere's disease, and five (11%) developed classic Meniere's disease. No significant differences were found at the first examination between patients with and without recurrence.

CONCLUSIONS

These results suggest that ALHL may be caused by endolymphatic hydrops confined to the cochlea and that ALHL does not always lead to cochlear or classic Meniere's disease.

The synergistic antitumor effect of recombinant interleukin-1 and low-dose of cyclophosphamide in tumor-bearing mice

Intraperitoneal (i.p.) treatment of MOPC104E ascitic tumor-bearing BALB/c mice with interleukin-1 (IL-1) followed by a low dose of cyclophosphamide (CPA) resulted in synergistic prolongation of their survival time. This antitumor effect was abolished when administration of CPA preceded that of IL-1. The combined i.p. therapy also eradicated subcutaneous (s.c.) tumors, indicating a systemically operating antitumor mechanism. In Winn assay, splenocytes from MOPC104E-bearing mice treated with the combined therapy completely suppressed the growth of MOPC104E cells, but not that of another syngeneic tumor cell line, RL female-8 cells. This tumor-neutralizing activity was completely abrogated by treatment with anti-asialo-GM1 or anti-Thy1.2 and complement, and reduced by treatment with anti-Lyt2.2 and complement. Treatment of splenocytes with 1-leucine methyl ester (Leu0Me), which depletes natural killer (NK) cells and macrophages in vitro, did not affect the neutralizing activity.

Protection of cultured rat gastric cells against oxidant-induced damage by exogenous glutathione

BACKGROUND/AIMS

Reduced glutathione (GSH) is an intracellular protectant against oxidants. The present study determined whether extracellular GSH protects against oxidant damage or whether an uptake system of GSH is present in cultured gastric cells.

METHODS

Hydrogen peroxide was generated by glucose oxidase and glucose. Cytotoxicity was assessed by 51Cr release. Intracellular GSH was assayed by the method of Tietze.

RESULTS

Pretreatment with extracellular GSH decreased H2O2-induced 51Cr release. Treatment with GSH enhanced cellular GSH content. Protection by pretreatment with GSH was prevented by buthionine sulfoximine (an inhibitor of gamma-glutamylcysteine synthetase). Enhancement of intracellular GSH was also prevented by buthionine sulfoximine. Acivicin (an inhibitor of gamma-glutamyl transpeptidase) prevented intracellular accumulation of GSH from extracellular GSH. Cysteine was effective in preventing damage and enhancing intracellular GSH content, whereas both glutamine and glycine were not.

CONCLUSIONS

Extracellular GSH protects cultured gastric cells from H2O2 damage by accelerating intracellular GSH synthesis; this is mediated by membrane-bound gamma-glutamyl transpeptidase acting on extracellular GSH (which supplies these cells with cysteine) and then by intracellular gamma-glutamylcysteine synthetase.

Penile verrucous carcinoma with anaplastic transformation following radiotherapy. A case report with human papillomavirus typing and flow cytometric DNA studies

We report a case of penile verrucous carcinoma with anaplastic transformation after radiotherapy. A 49-year-old man with penile verrucous carcinoma initially underwent excision and chemotherapy followed by radiotherapy when the carcinoma recurred locally. Twenty-four months after the completion of radiotherapy, the verrucous cancer transformed to an anaplastic spindle-cell carcinoma, which resulted in his death 10 months after diagnosis. Autopsy confirmed a huge hemorrhagic recurrent lesion and lung metastases. In situ hybridization with biotinylated DNA probes did not detect any type of human papillomavirus (HPV) (types 6/11, 16/18, and 31/33/51) in either the primary or the anaplastic tumor. Immunohistochemical HPV capsid antigens were also negative in both lesions. A flow cytometric analysis, using paraffin-embedded materials, showed a diploid DNA content in the excised verrucous carcinoma and an aneuploid content in the anaplastic tumor. This patient most likely had radiation-induced transformation of an anaplastic carcinoma. Wide excision and, if necessary, amputation, are preferred to radiotherapy.

Biliary excretion of cholephilic organic dyes in glutathione-depleted rats

Sprague-Dawley rats were treated with a combination of buthionine sulfoximine (2.5 mmol/kg body wt) and diethyl maleate (6.2 mmol/kg). After 4 h, the hepatic glutathione was depleted to 0.02 +/- 0.01 mumol/g liver (mean +/- SD, n = 6) (4.73 +/- 0.29 mumol/g in controls (n = 6), p < 0.005). The bile flow rate was lower in treated animals than in controls (39.0 +/- 11.2 vs. 73.7 +/- 13.7 microliters.kg-1.min-1, p < 0.005). Bile concentrations of bile acids, phospholipids, and cholesterol were not changed compared to controls, while glutathione was virtually absent from the bile. A bolus of indocyanine green (6.5 mumol/kg), rose bengal (6.5 mumol/kg), or sulfobromophthalein-glutathione conjugate (20 mumol/kg) was injected i.v. and the biliary excretion was monitored. In glutathione-depleted rats, the excretion of indocyanine green was delayed, and the cumulative excretion in 90 min was 36 +/- 8% (n = 6) of the injected dose (79 +/- 18% in controls (n = 7), p < 0.005). The bile concentration of indocyanine green was lower in the glutathione-depleted rats than in controls, while the other dyes increased. The plasma disappearance curve of indocyanine green was not significantly altered by the treatment, whereas the hepatic retention of indocyanine green 90 min after the injection was significantly increased (58 +/- 12% of the injected dose vs. 8 +/- 2% in controls, p < 0.005). The results indicate that depletion of hepatic glutathione inhibits biliary excretion of indocyanine green.

Diagnosis of thyroid carcinoma by ultrasonic examination: comparison with diagnosis by fine needle aspiration cytology

Ultrasonic examination was performed on 120 patients who later underwent surgery. Ultrasonically, among the 64 cases of benign nodules and the 56 of carcinomas, 50 and 46 cases respectively were diagnosed correctly. In making the ultrasonic diagnosis, the following findings were considered; shape, margin, boundary, internal echoes, hyperechoic spots, the echo level of the nodule and the cystic pattern. The sensitivity for carcinoma diagnosis was 0.82, specificity was 0.78 and accuracy was 0.80. The diagnostic accuracy for the same patients using a newly devised diagnostic system that utilized a fuzzy inference was almost as high as that of the conventional method. Furthermore, the diagnostic accuracy of both of these methods did not differ significantly from that obtained by fine needle aspiration cytology. Therefore, non invasive ultrasonic examination is considered to be very useful for the detection and diagnosis of thyroid carcinoma.

An immunohistochemical study of the extracellular matrix in oral squamous cell carcinoma and its association with invasive and metastatic potential

The expression of extracellular matrices (ECMs) laminin (LN), type IV collagen (IV C), heparan-sulphate proteoglycan (HS-PG), fibronectin (FN), tenascin (TN), decorin and vitronectin (VN) was examined immunohistochemically in 112 primary tumours and 29 metastatic cervical lymph nodes in oral squamous cell carcinoma (OSCC). In highly invasive primary tumours, the expression of LN, IV C and HS-PG in the basement membrane along the tumour-stroma borderline and the expression of decorin and VN in the tumour stroma at the invasive site were all significantly decreased. The expression of FN and TN in the tumour stroma at the same site was markedly increased. In peritumour stroma in metastatic lymph nodes, LN, IV C, HS-PG, decorin and VN were weakly expressed, while FN and TN were strongly expressed. Thus, the staining pattern of the ECMs in the metastatic lymph nodes was similar to that in highly invasive primary tumours. Furthermore, in primary tumours of metastatic cases, the expression of LN, IV C, HS-PG, decorin and VN obviously decreased, while the expression of FN and TN increased when compared with those of the non-metastatic cases. The investigation of ECMs in OSCC was valuable in predicting tumour behaviour.

Purification and properties of a new exo-(1-->3)-beta-D-glucanase from Bacillus circulans YK9 capable of hydrolysing resistant curdlan with formation of only laminari-biose

A (1-->3)-beta-D-glucan glucanohydrolase (EC 3.2.1.6), capable of hydrolysing resistant curdlan, was purified chromatographically from the culture supernatant of Bacillus circulans complex YK9 on Toyopearl HW-55F and butyl-Toyopearl 650M columns. The purified enzyme had a specific activity of 190 units mg-1 on regenerated curdlan. The molecular mass was estimated to be about 70 kDa as judged by SDS-PAGE. The enzyme had a pH optimum of approximately pH 6.0. It hydrolysed regenerated and resistant curdlans yielding predominantly laminari-biose, although the rate of hydrolysis of the former was much higher than the latter. This enzyme rapidly hydrolysed laminaran, curdlan and carboxymethyl-curdlan, but did not cleave schizophyllan and screloglucan, which have glucosyl side chains. The enzyme hydrolysed low molecular mass (1-->3)-beta-D-glucans-(mean degree of polymerization, DPn = 131, 49 and 14) and laminari-heptaose more efficiently than curdlan. It also hydrolysed laminari-hexaose and -pentaose effectively, but laminari-tetraose only slightly and it did not hydrolyse laminari-triose or -biose. The enzyme is an exo-hydrolase of curdlan and various oligomers composed of (1-->3)-beta-D-glucosidic linkages, liberating laminari-biose from their non-reducing terminals. The laminari-biose generated was in the alpha-form.

Experimental study of microwave coagulation of a VX-2 carcinoma implanted in rabbit kidney

This paper describes the results of an experimental study of the microwave coagulation of VX-2 renal tumors implanted in rabbits. The rabbits undergoing microwave treatment exhibited a satisfactory survival rate and a complete response to treatment, as verified by histological examination. All the rabbits receiving no treatment died within 6 weeks of implantation of the VX-2 carcinoma. These results indicate that microwave coagulation may be a curative method of treatment for a relatively small renal tumor. Intraoperative real-time ultrasonic scanning permits the percutaneous microwave coagulation of renal cancer in a clinical situation.

Microarterial anastomosis with a distal tapering technique

In microsurgical arterial anastomoses, there are some occasions in which the diameter of the distal artery is much larger than that of the proximal one. A fish-mouth incision technique is useful when there is considerable size discrepancy. However, this method cannot be used when the distal artery is much larger than the proximal artery because turbulent flow and thrombus formation occur, due to the sudden increase of luminal diameter. The distal tapering technique is recommended to prevent turbulent flow. A wedge resection is performed in the distal surplus vessel wall, and there is no sudden change in luminal diameter. Two clinical cases are presented in which this technique was used effectively.

Mapping of a transcription element critical for expression of the fibroblast growth factor receptor 1 gene

The fibroblast growth factor receptor 1 (FGFR1) gene has no TATA or CCAAT-elements. To examine its mechanism of expression, we characterized the transcription element of this gene. The basal promoter element was mapped to the 5'-flanking region from -89 to -43. The DNase I protection assay and gel shift analysis revealed that a nuclear protein extracted from FGFR1-expressing cells (NIH3T3 and SC-3), but not from FGFR1-nonexpressing cells (P3U1), could bind to the nucleotide sequence from -62 to -42. The molecular weight of this protein was approximately 100 kDa by Southwestern analysis. In addition, both the promoter activity and the nuclear protein binding activity were markedly impaired by the substitution of two bases within this footprint site. Interestingly, this footprint site appeared to lack the consensus sequence of the currently reported transcription factors. These results indicate that the 5'-flanking region from -62 to -42 plays a pivotal role in FGFR1 gene expression.

[Recent intractable bacterial infections in otolaryngology]

Antibiotic treatment has resulted in a significant change in the etiology and character of bacterial infections in otolaryngology as well as in another fields. Classic signs and symptoms may be masked. Administration of penicillin can be still effective in the treatment of usual bacterial infections, as it is effective against group A beta-hemolytic streptococci and most anaerobes except those that produce beta-lactamase. Administration of antibiotics, such as penicillin with clindamycin or chloramphenicol to combat both aerobic and anaerobic bacteria, coupled with surgical drainage is essential in management of deep neck infections. In this communication, several important bacterial diseases are described. Care should be taken to prevent airway obstruction, especially in deep neck infections and acute epiglottitis.

[A case of bow hunter's stroke]

A case of vertebrobasilar insufficiency with vertigo and horizontal nystagmus induced by neck rotation is reported. This patient's angiography demonstrated obstruction of left vertebral artery at the Cl-2 level on right rotation of the head. Surgical decompression of the vertebral artery by partial transversectomy of the atlas vertebra in this case relieved the symptoms, and postoperative angiography demonstrated the disappearance of the vertebral artery occlusion at the neck rotation. The pathogenesis and treatment of vertebral artery occlusion at Cl-2 level are discussed.

Effects of capsaicin analogs on adrenal catecholamine secretion in rats

To assess the relationship among the structure, pungency and thermogenic action, a series of capsaicin analogs with saturated acyl moieties (heptanoyl to eicosanoyl vanillylamide) were synthesized. Pungency of the compounds and the thermogenic action, which was examined by the potential of the compounds (655 nmol/kg, i.v.) to enhance adrenal catecholamine secretion for 15 min in anesthetized rats, were compared. On the chain length of the acyl moieties of the analogs, nonanoyl to octadecanoyl vanillylamide caused strong adrenal catecholamine secretion, but heptanoyl vanillylamide and eicosanoyl vanillylamide caused weak or no response. Pungent analogs except heptanoyl vanillylamide and non-pungent analogs except eicosanoyl vanillylamide had strong potency to secrete adrenal catecholamine.

Molecular basis of beta-thalassemia in Japan: heterogeneity and origins of mutations

Characterization of beta-thalassemia mutations was attempted for 13 unrelated Japanese patients heterozygous for beta-thalassemia. We have systematically analyzed beta-thalassemia genes using polymerase-chain-reaction-related techniques; dot blot hybridization with oligonucleotide probes complementary to known mutations, restriction endonuclease assay and direct sequencing of amplified genomic DNA. Seven different mutations were detected. Six of them are an amber mutation in codon 90 (GAG to TAG), a four-base-pair deletion in codons 41 and 42 causing premature termination due to frameshift, a C-T substitution at position 654 of IVS-2, a G-A substitution at position 1 of IVS-2 and a C-G substitution at position 848 of IVS-2, leading to splicing defects, and an ocher mutation (GAA-TAA) in codon 121 causing a thalassemia intermedia phenotype with inclusion body formation in erythrocytes. A silent mutation (CTG-TTG) was also detected in codon 91 of the allele with the IVS-2 position 1 mutation. These mutations have been reported previously in the Japanese population. The other mutation is a novel one in the Japanese, an amber mutation (TGG-TAG) in codon 15, causing a beta zero-thalassemia phenotype by premature termination of the beta-globin chain synthesis. We analyzed haplotypes of chromosomes bearing each beta-thalassemia mutation. Origins and a spectrum of mutations in comparison with those detected in malaria-endemic regions are discussed.

Application of neutral red staining for evaluation of the viability of dermatophytes and Candida in human skin scales

The fungal elements observed by direct microscopic examination sometimes fail to grow on subsequent culture. To elucidate the cause of this discrepancy, the viability of dermatophytes and Candida in skin scales was evaluated by neutral red staining. Autoradiographic study using 3H-thymidine confirmed that grain-positive cells (viable cells) were stained with neutral red, whereas negative cells (non-viable cells) were not stained. Taking this as a baseline, the correlation between neutral red-positive fungal elements in scales taken from 211 patients with tinea and 27 patients with cutaneous candidosis and cultures on Sabouraud glucose agar was studied. Strong positive correlations were found in both mycoses. These findings suggest that neutral red staining provides a useful method for evaluating the viability of dermatophytes and Candida in human skin scales.

Clinical features of idiopathic bilateral sensorineural hearing loss

The Research Committee of the Ministry of Health and Welfare in Japan has defined hearing loss of unknown etiology with fairly high-speed progression as idiopathic bilateral sensorineural hearing loss (IBSH). Its diagnostic criteria consist of the following: that it is (1) progressive, (2) with bilateral involvement, and (3) of unknown etiology. In this study, we evaluated the clinical course in 20 cases of IBSH. Many cases of IBSH finally showed symmetrical profound sensorineural hearing loss. The clinical course of IBSH consisted of various combinations of the following four states: (1) fixed hearing, (2) rapid progression, (3) pathological slow progression and (4) physiological slow progression.

Acute tubular necrosis with loin pain and persistent multiple wedge-shaped contrast enhancement on CT

A 38-year-old man had severe loin pain and computed tomography performed 48 hours later, after drip infusion pyelography (DIP), revealed wedge-shaped contrast enhancement. He showed mild impairment of renal function with no evidence of rhabdomyolysis. The loin pain lasted for 5 days and the wedge-shaped contrast enhancement on CT persisted for 14 days and improved. The case was compatible with the new syndrome, loin pain and persistent wedge-shaped contrast enhancement on CT, proposed by Ishikawa et al (Nephron 27: 31, 1981).

Preferential adsorption of cationic anti-DNA antibodies with immobilized polyanionic compounds, dextran sulfate

It has been shown that cationic anti-DNA antibodies have nephritogenic potential in murine models of lupus nephritis. More recently, we have reported that there is a close relationship between the presence of circulating cationic anti-DNA antibodies and the development of lupus nephritis in humans, and that the cationic anti-DNA antibodies bind to heparan sulfate, a major glycosaminoglycan in glomerular basement membrane, much better than neutral anti-DNA antibodies. This suggests that cationic anti-DNA antibodies of the IgG class may be responsible for development of nephritis in vivo in patients with systemic lupus erythematosus. In this study, we first studied reactivity of anti-DNA antibodies with a panel of glycosaminoglycans in vitro using ELISA methods, and found that anti-DNA antibodies cross-react with dextran sulfate, hyaluronic acid and chrondroitin sulfate. The reactivity and selectivity of dextran sulfate with anti-DNA antibodies was confirmed by in vitro immunoadsorption of the patient's sera with dextran sulfate-fixed column; incubation of auto-antibody-positive sera with dextran sulfate cellulose column removed anti-DNA, but not anti-RNP, anti-Sm, anti-SSA and anti-SSB antibodies from the sera in vitro. Of note is that dextran sulfate cellulose column absorbed exclusively, if not all, cationic anti-DNA antibodies in their sera. Nonspecific binding of total immunoglobulins as well as total proteins to the column was marginal. It has been suggested that cationic anti-DNA antibodies in sera of patients with refractory lupus nephritis could be efficiently removed by apheresis using dextran sulfate column.

Synthesis of the metabolites of clentiazem

The metabolites of clentiazem in the urine or bile of rats and dogs were investigated. Fifteen basic, 6 acidic, 2 neutral and 4 conjugated metabolites were isolated. In the present paper, fourteen reference compounds as shown in Charts 1, 2 and 3 were synthesized to identify the structures of the metabolites in procedures fundamentally similar to those employed in the synthesis of the corresponding metabolites of diltiazem.