[Surveillance following orchiectomy for stage I testicular tumor]

Thirty-one cases with clinical Stage I testicular tumor were treated by surveillance policy after orchiectomy alone at Cancer Institute Hospital from April in 1985 to October in 1991. Histological types were seminoma in 22 cases and nonseminomatous germ cell tumors (NSGCT) in 9. Relapses were observed in 7 (22.5%) patients between 2.5 and 9.3 months after orchiectomy. Five (22.7%) of 22 seminoma and 2 (22.4%) of 9 NSGCT recurred and received further cis-platin based chemotherapy. In all of 5 seminoma and one of NSGCT cases recurrences developed in the retroperitoneal lymph nodes and in another NSGCT case lung metastasis was observed. All patients have been treated with success and are alive without evidence of disease between 5 and 48 months after salvage therapy. One of the recurrent cases with seminoma had an evident retroperitoneal metastasis misdiagnosed as the small intestine at staging retrospectively. And 2 of 3 seminoma cases and one of 2 NSGCT cases with minimally abnormal findings in the retroperitoneal lymph nodes had recurred. Surveillance policy may not be adequate for patients with these changes. But overall survival rate of stage I testicular tumors were estimated 100%. And relapse were observed in a small number of stage I without "minimally changes". So we regarded that surveillance policy was valid in patients with clinical stage I testicular tumor under careful staging and intensive follow up.

Giant benign mesenchymoma of the mediastinum causing superior vena cava syndrome: report of a case

The surgical resection of a giant primary mediastinal mesenchymoma causing superior vena cava syndrome is herein described. A 53-year-old man was admitted to the hospital complaining of severe dyspnea. A chest roentgenogram showed a large mediastinal mass shadow compressing the superior vena cava. At surgery, a yellow tumor measuring 27 x 25 x 12 cm and weighing 3,620 g was resected. The histological diagnosis was benign mesenchymoma. The patient's postoperative course was uneventful with a successful resolution of his superior vena cava syndrome.

[A case of successfully operated hypertrophic obstructive cardiomyopathy in a child]

A case of surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM) in a 5-year-old boy is reported. This is the youngest case in Japan. He had been diagnosed as HOCM and treated conservatively with beta-blocker and Ca-antagonist, but his complaints of dyspnea and chest oppression during efforts had increased. Cardiac catheterization showed a peak systolic pressure gradient of 110 mmHg between the left ventricle and systemic artery, and echocardiogram disclosed a systolic anterior motion (SAM) of the mitral valve and mitral regurgitation (MR). At operation transaortic septal myectomy and myotomy were performed according to preoperative findings by echocardiogram and MRI, and a marked reduction in pressure gradient and a decrease in SAM and MR were obtained. Thus, a satisfactory result can be obtained by myectomy and myotomy without mitral valve replacement in a pediatric patient with HOCM, based on the preoperative image analysis.

Expression of carbohydrate antigens in human pulmonary adenocarcinoma

BACKGROUND

The altered and anomalous expression of carbohydrate antigens (CA) occur in patients with lung carcinomas.

METHODS

To investigate the relationship between prognosis and immunohistochemical findings of CA in serum and pulmonary adenocarcinomas (PA), PA specimens surgically resected from 102 patients were studied with the use of A, B, H, Lewis(Le)a, Le(b), Le(x), Le(y), sialyl Le(a) (FH-7), sialyl Le(x-i) (SLX) (FH-6), sialosyl Tn (TKH-2), and CA 19-9. The Lewis blood group types were determined by the dot blotting method on patients' serum using monoclonal anti-Le(a), Le(b), Le(x), and Le(y). Formalin-fixed paraffin-embedded PA sections were stained using the avidin-biotin-peroxidase complex methods.

RESULTS

There was no correlation between the patients' postoperative survival and tissue expression of CA, although survival correlated with the clinical stages, histologic differentiation of PA, and serum SLX in Stage 4. The higher the positive rate of both Le(b) and Le(y), the better their differentiation in PA specimens. Regardless of blood group type, PA showed high positive reactions for FH-6 (88%) and Le(y) (87%). The serum concentration of CA 19-9 correlated with immunohistochemical reactions of tumors (Spearman correlation coefficient = 0.33, P = 0.02). The expression of Le(a) in Lewis (a-b+) phenotype patients and Type 2 CA, such as Le(y) and FH-6, is characteristic in PA.

CONCLUSIONS

The findings suggest that CA tissue expression may not reflect postoperative survival length of patients with PA, but biological aberrant fucosylation or sialylation as well as morphologic alteration may occur in neoplastic cells.

[Palliative radiotherapy for local progression of hormone refractory stage D2 prostate cancer]

From 1970 to 1992, 10 patients with hormone refractory stage D2 adenocarcinoma of the prostate presenting themselves with urinary retention and/or gross hematuria were treated by palliative irradiation for local progression at Cancer Institute Hospital. External beam irradiation was delivered to the primary lesion at dose of 38 Gy to one patient and 30 approximately 27 Gy to seven patients. Five of these patients in whom an urethral catheter had been indwelling were able to void without difficulty following the treatment. Of four patients with severe hematuria resulting vesical tamponade, none had hematuria after the treatment. These effect lasted until patients' death or more than 11 months follow-up. In other 2 patients, irradiation had to be discontinued at dose less than 20 Gy because of deteriorated general conditions and no significant effect. Complications of the treatment were minimal. These results indicate that the optimal dose of local palliative irradiation is around 30 Gy. Irradiation is a good choice for palliation of locally progressive hormone refractory prostate cancer in view of its certain and long-lasting effect, low invasiveness and minimal complications. When to institute palliative irradiation is one of the most important question in order to secure a good quality of life for patients. From our experiences, it is our belief that if local progression is symptomatic, palliative irradiation should be initiated as soon as possible.

Lectin binding and expression of blood group-related antigens in carcinoma-in-situ and invasive carcinoma of urinary bladder

To determine whether histochemical reactivities of carcinoma-in-situ of the urinary bladder differ from those of invasive transitional cell carcinoma, we tested a profile of eight different lectins and three antibodies directed against blood group-related antigens for 15 cases of carcinoma-in-situ and 26 cases of non-papillary (6 superficially and 20 deeply) invasive transitional cell carcinoma that had been diagnosed according to the histopathological criteria of the International Union against Cancer. For biotin-labelled lectins and monoclonal antibodies to mouse blood group-related antigens, the avidin-biotin peroxidase complex method was applied. Positive histochemical reactions of peanut agglutinin without neuraminidase treatment--PNA N(-)--in the 20 deeply invasive tumour cases were significantly higher than those in the 15 carcinoma-in-situ cases (P < 0.05). In contrast, the reactions of blood group-related antigens in the 20 deeply invasive tumour cases were significantly lower than those in the 15 carcinoma-in-situ cases or the 11 normal controls (P < 0.05). The results confirm previously reported studies of the staining of PNA N(-) and blood group-related antigens on carcinoma-in-situ and invasive tumours of urothelial organs. The application of lectins and blood group-related antigens to the histopathology of urinary bladder cancer may be helpful in the differential diagnosis of carcinoma-in-situ from invasive cancer, but neither PNA N(-) nor blood group-related antigens can be solely reliable in this.

Exposure-excretion relationship of styrene and acetone in factory workers: a comparison of a lipophilic solvent and a hydrophilic solvent

A factory survey was conducted in the second half of a working week on 41 exposed male workers, who were engaged in fiber-reinforced plastics work and exposed to the mixed vapors of styrene and acetone. Nonexposed workers, 20 men, were recruited from the same factory. Styrene and acetone in respiratory zone air were monitored for a 8-h shift with carbon cloth- and water-equipped personal diffusive samplers, respectively. Blood and urine samples were collected at the shift-end. Acetone and styrene concentrations in whole blood, serum and urine were measured by head-space gas chromatography, and phenylglyoxylic acid in urine by high-performance liquid chromatography. All biological exposure indicators analyzed correlated significantly with the intensity of exposure to the corresponding solvent during the shift. The slopes of the regression lines indicate that a very small fraction of styrene absorbed will be excreted into urine as styrene per se, and that styrene is quite effectively excreted into urine after metabolic conversion. In contrast, the slopes of regression lines for acetone suggest that acetone distributes both in the blood and urine quite evenly. When the distribution of the solvent in serum was compared with that in the whole blood, it was found that almost all of styrene in blood is present in the serum, whereas acetone distributed very evenly in the cellular and noncellular fractions of the blood.

Effect of ebrotidine on gastric mucosal calcium channel activity

Ebrotidine is a new H2-receptor antagonist also known for its gastroprotective effect against ethanol-induced mucosal injury. In this study, we investigated the effect of ebrotidine on the activity of the gastric mucosal calcium channels. The channel complex was isolated from the solubilized gastric epithelial cell membranes by affinity chromatography on wheat germ agglutinin. After being labeled with [3H]PN200-110, the complex was reconstituted into phosphatidylcholine vesicles which exhibited active 45Ca2+ uptake into intravesicular space and responded in a concentration-dependent manner to calcium channel activator, BAY K8644, as well as to calcium channel antagonist, PN200-110. The 45Ca2+ uptake was inhibited by ebrotidine. Maximum inhibitory effect was attained at 50 micrograms/ml ebrotidine, at which point a 54.9% decrease in uptake occurred. The gastric mucosal calcium channels, on epidermal growth factor binding (EGF) in the presence of ATP, responded by an increase in tyrosine phosphorylation of 55 and 170 kDa proteins, and the vesicles containing the phosphorylated channels displayed a 48% greater 45Ca2+ uptake. This phosphorylation process was inhibited by ebrotidine. Furthermore, ebrotidine also interfered with the binding of EGF to calcium channel protein. The results point toward the importance of EGF in the maintenance of gastric mucosal calcium homeostasis, and suggest that ebrotidine has the ability to protect the cellular integrity from calcium imbalance by modulating the EGF-stimulated gastric mucosal calcium channel phosphorylation.

[Problems of survey materials in external quality control survey]

In the past over twenty years the Japan Medical Association Quality Control Survey Committee has experienced various types of problems in preparing a large amount of different control survey materials with some matrix effects. This may have caused inappropriate evaluation for some of the participated laboratory. Not only the participated laboratories but also some industrial companies should participate to identify the exact matrix effects, so that the Committee may be able to avoid some inappropriate decisions on evaluation of the reported results. However, at the present time, no standard is available for the identification of matrix effects. The Japanese Committee for Clinical Laboratory Standards, in 1991, organized the research group on external quality control, and suggested a proposal to identify some matrix effects of survey materials for a particular assay system.

Diffuse alveolar damage and acute interstitial pneumonitis: histochemical evaluation with lectins and monoclonal antibodies against surfactant apoprotein and collagen type IV

Diffuse alveolar damage (DAD) and acute interstitial pneumonitis (AIP) often present clinically as the adult respiratory distress syndrome. To evaluate the usefulness of histochemical techniques and to better understand the histopathologic changes of these diffuse lung injuries, postmortem lung sections of 14 and 33 patients who had been diagnosed as having DAD in organizing stage and AIP, respectively, were studied with the use of lectins and monoclonal antibodies against surfactant apoprotein (PE-10) and collagen type IV. On hematoxylin-eosin stained sections, type II pneumocyte hyperplasia and hyaline membrane formation were the major histopathologic findings in both DAD and AIP. The binding rates of type II pneumocytes to Ulex europaeus agglutinin I (UEA-I) in both DAD (64%) and AIP (45%) cases were significantly higher than those of type I pneumocytes or alveolar macrophages (both P < 0.001). Reactions of type II pneumocytes to PE-10 varied from 40 to 44% in DAD and 0 to 100% in AIP cases depending on the use of respirator and steroid medication. Therefore, it may be said that UEA-I and PE-10 are useful methods for outlining hyperplastic type II pneumocytes in both DAD and AIP. Hyaline membrane coating alveolar septal surfaces and exudate in alveolar air spaces were also stainable with PE-10. Surfactant apoprotein remained demonstrable histochemically within type II pneumocytes and hyaline membrane despite severe inflammatory injuries of the lungs. The immunohistochemical stain using anti-collagen type IV antibody revealed discontinuous alveolar basement membrane in 50% of DAD patients with respirator use and 80% of AIP patients with steroid medication.

Osteoinductive activity of composites of bone morphogenetic protein and pure titanium

Titanium sponges were infused with bone morphogenetic protein (BMP-Ti), and the osteoinductivity of the resultant composite was measured. New bone formation occurred three weeks after implantation and was identified by soft x-ray analysis. Quantitative analysis showed no significant difference between BMP-Ti composites and control samples (BMP only). Consequently, pure titanium neither inhibited nor promoted BMP activity. Chondrocytes and new bone formation occurred in direct contact with the surfaces of the titanium. X-ray microanalysis demonstrated new bone formation inside the pores of the titanium sponges. The BMP-Ti composite has interesting properties as an osteoinductive implant and has potential practical clinical applications.

[Standardization in clinical laboratory--its national and international activities]

In order to obtain comparability among laboratory results obtained by different laboratories, standardization is necessary in all steps related to clinical laboratory practice. Standardization in clinical laboratory is a consensus process among professional, industrial and governmental organizations. Everyone concerned in clinical laboratory practice should try to follow those consensus proposed. The International Organization for Standardization (ISO) is a key international body which is represented by many different national organizations. World Health Organization (WHO) plays an important role in medical field, but many non-governmental organizations (NGO) such as the World Association of Societies of Pathology (WASP), the International Federation for Clinical Chemistry (IFCC) and others also contribute significantly. In 1975, the National Committee for Clinical Laboratory Standards (NCCLS) was established in USA and has been the most active. In 1985, The Japanese Committee for Clinical Laboratory Standards (JCCLS) was established as some other CCLS in different European countries. National activity for establishing many reference materials in Japan is briefly reviewed.

Nonhuman primate responses to murine and humanized OKT4A

A nonhuman primate antimurine response (MAMA) has been observed in 17 cynomolgus renal allograft recipients of murine OKT 4A. Neither cyclosporine, nor total-lymphoid irradiation, nor donor bone marrow preparation inhibited this antixenogeneic response. In an attempt to alter the antimurine basis of the response, a humanized chimeric OKT4A (IgG4) containing the entire variable portion of the murine OKT4A and a humanized CDR grafted OKT4A mAb sharing only the Complementarity Determining Region from the murine OKT4A, were administered to 8 cynomolgus allograft recipients. MAMA was detected in each recipient. In contrast to sera from recipients of murine OKT4A, sera from recipients of humanized OKT4A displayed no reactivity to other murine mAbs. MAMA specificity did not assay constant (C) region differences between the murine and humanized mAb; however, C region homology in humans should preclude a human antimouse antibody (HAMA) to the Fc portion of a humanized mAb. Furthermore, cynomolgus recipient serum levels of the humanized OKT4A mAb were maintained (> 1 microgram/ml) for a longer period than following treatment with murine OKT4A (murine < 12 days versus between 12 and 24 days for the humanized). If the HAMA response to humanized mAb in future clinical trials, were to be predictably anti-idiotypic, then the opportunity for treatment with sequential mAbs of differing idiotypes would be retained. Moreover, these current studies also suggest that humanized construction may influence the duration of therapeutic mAb levels. Thus, anti-idiotypic reactivity may not be as consequential to the clinical administration of humanized mAb to allograft recipients.

[Phase I study of flutamide, a nonsteroidal antiandrogen, in patients with prostatic cancer]

A phase I study of orally administered flutamide (a pure anti-androgen) was performed in 26 patients with prostatic cancer. No side effects were observed in 11 patients receiving single doses of either 125, 250, 375 or 500 mg. However, in the daily dosing schedule of 375, 750, 1125 and 1,500 mg/day doses, where medication was taken in three divided doses, discomfort in the stomach, nausea, vomiting and anorexia were experienced in one of the four patients receiving the highest dose of 1,500 mg. Nine patients receiving the other doses did not complain of toxic symptoms. Laboratory values did not change in the three patients receiving the lowest 375 mg/day dose, but elevation of transaminase was observed in five of the nine patients given higher doses. This elevation was observed in all the three patients receiving 1,500 mg/day dose. Among the serum hormone levels, significant increases of luteinizing hormone were observed. As for efficacy, objective responses were observed in two of the three patients in each of the four daily dosing groups. Improvement of pain, voiding obstruction symptoms, and performance status were also observed. Flutamide was found to be absorbed rapidly and to exist as a hydroxylated form (hydroxy-flutamide) in the plasma. The half-life of hydroxy-flutamide was similar in the single and daily administration, but the peak concentration and area under the concentration versus time curve in the daily administration became greater than those in the single administration. In conclusion, flutamide should be examined for efficacy and safety using doses of 375 to 1,125 mg/day in the phase II study.

[Clinical evaluation of flutamide, a pure antiandrogen, in prostatic cancer phase II dose-finding study]

The phase II study of flutamide, a pure anti-androgen, was performed to estimate the clinical doses on 165 hormone untreated or treated patients with prostatic cancer. The hormone-untreated patients were given orally flutamide of 90, 375, 750 or 1,125 mg/day in three divided doses daily for 12 weeks. Responses were not observed at the 90 mg/day dose except for improvement of clinical symptoms. However, an objective response rate of 48.8-46.7% was obtained at 375-1,125 mg/day doses. In hormone-treated patients including cases refractory to the previous hormonal treatment, the objective response rates were 13.3 and 8.3% in 375 and 750 mg/day flutamide groups, respectively. Side effects such as gynecomastia, nausea, vomiting, diarrhea, and abnormal laboratory findings such as the elevation of hepatic transaminases were observed. The incidence increased dose-dependently. Determinations of serum hormone levels revealed an increase in testosterone levels by the use of flutamide. In conclusion 375 mg/day of flutamide is the optimal dose in monotherapy for hormone-untreated patients with prostatic cancer, where the quality of life can be maintained compared with therapies involving testosterone suppression. This dose is also expected to show some efficacy in cases refractory to hormone treatment.

Excretion of methylhippuric acids in urine of workers exposed to a xylene mixture: comparison among three xylene isomers and toluene

The correlation between exposure to three xylene isomers and resulting urinary excretion of corresponding methylhippuric acid (MHA) isomers was studied among 175 Chinese workers of both sexes who had been predominantly exposed to xylenes (exposure to xylenes accounting for 70% or more of the total exposure on a ppm basis). Nonexposed controls (281 men and women) were also studied to define the background level of MHAs in urine. The solvent exposure of xylene-exposed workers during their workshift was monitored by diffusive sampling of breathing zone air, and MHAs in shift-end urine were determined by high-performance liquid chromatography. Regression analysis showed that the concentration of each MHA isomer correlated significantly with the time-weighted average intensity of exposure to the corresponding xylene isomer, and therefore the correlation between the sum of three xylene isomers in air and that of three MHA isomers in urine was also significant; the slope of the regression line was essentially the same among the three isomers. The calculated regression line suggested that the urinary MHA level after hypothetical exposure to xylenes at 100 ppm will be somewhat less than the proposed biological exposure index and biological tolerance value. Two social habits of smoking and drinking in combination suppressed the conversion of xylenes to MHAs in male workers.

[Renal cell carcinoma in a horseshoe kidney: report of two cases]

We report 2 patients with renal cell carcinoma in a horseshoe kidney. A renal tumor was diagnosed during evaluation of right humeral metastatic cancer of unknown origin in case 1 (64-year-old male) and gross hematuria in case 2 (54-year-old male). Both patients underwent radical nephrectomy with division of isthmus and retroperitoneal lymph node dissection. The tumors were staged pathologically as pT2bpN0pV0pM1(oss) and pT3pN0pV1bM0, respectively. Only 27 cases of renal cell carcinoma developed in a horseshoe kidney, including the present two cases, have been reported in the Japanese literature. The blood supply to the horseshoe kidney and its evaluation by preoperative angiography were discussed.

Elevated interleukin-8 levels in the urine of patients with urinary tract infections

Pyuria is one of the main features of urinary tract infections (UTI). Nevertheless, the mechanism of polymorphonuclear leukocyte (PMN) recruitment into the urine remains to be investigated. We examined whether interleukin-8 (IL-8), a potent neutrophil chemoattractant and activator, was involved in pyuria seen in UTI. Of 113 patients, 112 had elevated levels of IL-8 in their urine (1,078.0 +/- 181.5 pg/ml), regardless of whether they had an upper or lower UTI; this was in contrast to undetectable levels (less than 16 pg/ml) in the urine of all of the 20 normal individuals and 74 control patients without UTI. A concomitant study revealed increases in urine IL-6, but not IL-1 beta, and tumor necrosis factor alpha levels in patients with UTI. In addition to gram-negative bacteria, a wide spectrum of microorganisms was capable of inducing IL-8 production in urine. Local production of IL-8 in the urinary tract was suggested by a urine IL-8 level that was higher than the paired serum IL-8 level. The urine IL-8 level correlated with the number of PMN in the urine, and an average of half of the chemotactic activity in urine from patients with UTI could be abrogated by anti-IL-8 antibody treatment in vitro. Furthermore, urine IL-8 purified from patients was bioactive and showed multiple forms on immunoblotting analysis. This is the first documentation of IL-8 in the urine of patients with UTI, and these results imply that IL-8 is involved in inducing PMN migration into the urinary tract.

EBER-1 expression in thymic carcinoma

The Epstein-Barr virus-encoded small nuclear RNA, EBER-1, has been shown to be a suitable target for the in situ hybridization detection of EBV in routinely processed tissue specimens. We evaluated the presence of EBV in thymic carcinoma and invasive thymoma using EBER-1 in situ hybridization on formalin-fixed paraffin-embedded tissue sections. EBER-1 expression was demonstrated in a case of lymphoepithelioma-like thymic carcinoma, but was not detectable in other thymic carcinomas including six squamous cell carcinomas, a clear cell carcinoma and seven invasive thymomas. As reported in three previous cases of EBV-associated thymic carcinoma, lymphoepithelioma-like thymic carcinoma was shown to be closely associated with EBV in our series.

[Sequential hormone and radiation therapy for stage D1 prostate cancer]

From 1980 to 1991, 18 patients with pathologically proven stage D1 prostate cancer were treated with sequential hormone and radiation therapy at Cancer Institute Hospital. The patient mean age was 65.5 year old and mean follow-up period was 3.7 years. Diethylstilbestrol diphosphate or chlormadinone acetate was given prior to radiation therapy and 70 Gy of external radiotherapy using linear accelerator was sequentially delivered to the primary lesion in 35 fractions. Hormone therapy was continued following radiation therapy. Complete flattening of the primary lesion on digital examination was achieved in all cases. Complications of the treatment were minimal and transient. Tumor progression was observed in 4 cases and 2 of them died of cancer. Five-year non-progression rate, 5-year overall survival rate, 5-year disease specific survival rate and cancer death rate were 65%, 68%, 82% and 50% respectively. Prognoses of the patients with poorly differentiated cancer were worse than those with more differentiated cancer. Sequential hormone and radiation therapy for patients with stage D1 prostate cancer improved the patients' survival almost comparable to those of patients with stage C disease.

[Sequential estrogen and radiation therapy for stage C prostate cancer]

Sequential estrogen and radiation therapy was introduced to improve treatment result for stage C of the prostate cancer. Staging operation was performed in order to exclude stage D1 cases at the beginning of the treatment. Twenty of 34 stage C cases have been treated by sequential estrogen and radiation in our hospital between 1980 and 1989 and half of them had actually been done staging operation. An average age was 69.3. Tumor differentiations were distributed to well in 5 cases, moderately in 5 and poorly in 9. The other unknown differentiation case was diagnosed by fine needle aspiration cytology. Previously administered estrogens were DES-DP in 15 cases and others in 5. Total doses of 70 Gy in 35 fractions were sequentially delivered to the prostate, involving if necessary the seminal vesicles over a seven-week period by bilateral 120 degrees pendel using linear accelerator. Radiation field was sized from 6 x 6 to 8 x 8 cm. Estrogens have been continuously administered following radiation in 11 cases. Therapeutic effects upon the prostate were evaluated by digital rectal palpation. Improvement rate and atrophy rate of the primary lesion were 94.4% and 50% respectively. Recurrences were observed in 4 cases and 3 of them recurred within 3 years after initiation of the treatment. Recurred sites were in primary lesion in 2 cases and in bone in two. Five year non-recurrence rate was 81% by Kaplan Meier's method. One of 3 who discontinued hormone administration during or immediately after radiotherapy had local recurrence after 65 months and the other 2 cases died of gastric cancer and unknown cause, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)