Primary chemotherapy for children with rhabdomyosarcoma of the 'special pelvic' sites: is preservation of the bladder possible?

Twenty-one children with rhabdomyosarcoma involving the "special pelvic" sites, defined as such occurring in the bladder, prostate, vagina and uterus, were treated with primary surgery between 1969 and 1977, and with primary chemotherapy beginning in 1978. Among 11 patients in the latter group who were placed in Clinical Group III (according to the classification of the US Intergroup Rhabdomyosarcoma Study (IRS), six showed partial response (PR) and underwent tumorectomy by radical surgery an average of 6 months after the start of treatment, and three showed complete response (CR) and were treated with further chemotherapy in the hope that cystectomy could be avoided. However, in the latter group, the tumor recurred (39 months, 35 months, and 27 months later), and all eventually underwent total cystectomy. Seven of the nine long-term survivors underwent total cystectomy and have premanent urinary-cutaneous stomas. Two had tumor-free bladders, but function was impaired in one because of the effect of irradiation. Normal function was preserved in only one patient in the series, whose tumor was located at the dome of the bladder. To preserve bladder function in children with rhabdomyosarcoma in these sites, more effective forms of chemotherapy will be required.

Dirofilaria immitis: a large-scale purification method and partial characteristics of a superoxide dismutase from adult worms

A superoxide dismutase (SOD) from adult worms of Dirofilaria immitis was purified using ethanol-chloroform and acetone treatment, DE 52 cellulose, and Sephadex G-75 gel chromatography to obtain a 677-fold purification and a specific activity of 5483 units/mg of protein. The purified SOD was essentially homogeneous as judged by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate and composed of two identical 18.5 kDa subunits. The purified SOD was inactivated completely by 3 mM potassium cyanide, and reduced to about 18% of the initial activity by incubation at 100 degrees C for 10 min and to 28% by treatment with 2% SDS. This means that D. immitis SOD differs markedly from the mammalian Cu/Zn SOD, although it is indeed a Cu/Zn SOD. Atomic absorption spectrometry revealed the presence of 0.80 mole of Cu and 0.78 mole of Zn per mole of subunit. The enzyme consisted of 22.6% acidic and 11.9% basic amino acids. No free amino acid was detected in the SOD by N-terminal amino acid sequencing.

Isolation of intact transition protein 1 and 3 from boar late spermatid nuclei

Boar transition protein 1 and 3 were extracted with acid from the late spermatid nuclei, separated from the TP-degrading proteases by ion-exchange chromatography on Fractogel EMD SO3- 650 (M), and further purified by HPLCs on Diol-120 and on Hitachi #3057, respectively. The circular dichroic spectra of the transition proteins with and without dithiothreitol showed that they have beta-form predominantly. Although sodium dodecyl sulfate partially induced helical structure, the beta-form was considerably retained. These indicate that the transition proteins have a structure-forming potential for the beta-structure.

[Role of postoperative irradiation for carcinoma of the uterine cervix: multivariate analysis of prognostic factors and patterns of failure]

We retrospectively analyzed the patterns of recurrence in 48 patients who underwent postoperative irradiation following surgery for carcinoma of the uterine cervix. The end points of pelvic control, distant metastases and disease-free survival were analyzed for parameters including FIGO stage, nodal status, degree of stromal invasion, histology and tumor size. Univariate and multivariate analyses showed that some prognostic parameters had little influence on pelvic control rate, but had a marked impact on the incidence of distant metastases and disease-free survival rate. These results suggest that postoperative irradiation improves pelvic control rate, but has little therapeutic benefit in preventing distant metastases or improving survival rate. In conclusion, we should give more consideration to adjuvant systemic therapy in addition to postoperative irradiation for high-risk patients.

[Successful patch angioplasty for the right coronary artery dissection following selective coronary perfusion]

A case of successful patch angioplasty for the right coronary artery (RCA) orifice dissection following selective coronary perfusion is reported. A 56-year-old woman who had mitral restenosis, aortic stenosis, and atrial fibrillation with bradycardia-tachycardia syndrome was referred to our hospital for operation. The operation, which contained aortic valve replacement and mitral commissurotomy, was performed with hypothermic cardiopulmonary bypass and crystalloid cardioplegic arrest. The ascending aorta was opened, and selective coronary perfusion was performed. The right coronary cannula was difficult to insert and dislodged several times. At the second infusion of the cardioplegic solution, the right coronary orifice and ascending aortic wall was dissected. The dissection extended to the proximal RCA. The aortotomy was extended into the RCA beyond its orifice. The Xenomedica pericardial patch was used to enlarge the diameter of the RCA with closing the dissected cavity. Then the patch was brought onto the side of the aorta and the aortotomy was closed in the usual manner. Post operative coronary angiography revealed widely patent RCA orifice and good runoff. Two years after operation the patient is free of angina with unlimited physical activity.

The amino acid sequence and phosphorylation sites of a boar transition protein 1

Boar transition protein 1 was extracted with acid from the testes, purified by chromatographies on CM-Sephadex C-25 and Sephadex G-50, and reduced and carboxymethylated. The modified protein was purified by HPLC on Nucleosil 300 7C18. The primary structure of the protein was determined by automated Edman degradation of the C-terminal peptide of the BrCN-cleaved protein and of the whole protein, and by carboxypeptidase digestion of it. The study of phosphorylation sites showed that Ser36 and Ser39 in the very conserved sequence 29-42 were partly phosphorylated, suggesting the involvement of this region in the interaction with DNA.

Protection against lethal bacterial infection in mice by monocyte-chemotactic and -activating factor

Chemotactic factors regulate the recruitment of neutrophils, lymphocytes, or monocytes-macrophages to infectious and inflammatory sites. The purpose of this study was to determine whether monocyte-chemotactic and -activating factor (MCAF [MCP-1], a JE gene product) also influences the host defense mechanism against microbial infection. We evaluated the effect of recombinant human MCAF on the survival rate of mice systemically infected with Pseudomonas aeruginosa or Salmonella typhimurium. The administration of 2.5 micrograms of MCAF 6 h before infection completely protected the mice from lethal infection. Mice with cyclophosphamide-induced leukopenia exhibiting increased susceptibility to P. aeruginosa were also endowed with resistance by the same dose of MCAF. Administration of MCAF at -6 h was critical, since MCAF given either earlier or later than -6 h failed to rescue mice from lethal infection. The in vivo effect on the survival of mice paralleled the reduced recovery of viable P. aeruginosa or S. typhimurium from the peritoneal cavity, i.e., the number of recovered bacteria from the MCAF (2.5 micrograms per mouse)-treated mice was reduced to less than 2% of control mice for P. aeruginosa and 4% of control mice for S. typhimurium at 24 h. Since MCAF exhibited chemotaxis on murine macrophages as well as enhanced phagocytosis and killing of bacteria in vitro, the activation of macrophages, followed by the recruitment into the peritoneal cavity, is responsible for eliminating bacteria and thus enhancing the survival rate.

Altered production of nerve growth factor in aganglionic intestines

Nerve growth factor (NGF), a target-derived neurotrophic molecule, is required specifically by sympathetic and dorsal root ganglion cells for their survival and maturation during embryonic and early postnatal development. In the present study, the NGF expression was studied both at the protein and mRNA level in normal and aganglionic intestines of Piebald-strain mice and also in 10 human specimens using immunohistochemical and reverse transcriptase polymerase chain reaction (RT-PCR) techniques. In the aganglionic intestines of the mice, immunoreactive NGF was found on the giant nerve fibers in the submucosal layer, but not found in the mucosal layer. In the mRNA study, the signal for NGFmRNA was less intense in the aganglionic rectum of the congenitally megacolonic mice than in the rectum of the normal mice. In contrast, the distal dilated colon of the congenitally megacolonic mice had a more intense signal for NGFmRNA than did the colon of normal mice. The results obtained from human specimens were compatible with the findings in the Piebald mice; the distal colons harvested from the patients with Hirschsprung's disease (or its allied disease) had a uniformly more intense signal for NGFmRNA than did the normal colons. The results of this study may indicate that NGF production is altered in the aganglionic intestines and also in the "transitional zone" in Hirschsprung's disease. The altered production of NGF may be useful in increasing the accuracy of diagnosis of Hirschsprung's disease.

[Ifosfamide in combined hormonochemotherapy on prostate cancer]

In 1987, we altered the protocol of hormonochemotherapy on prostate cancer from the combination of oral UFT (futraful with uracil) and cyclophosphamide to oral UFT and intravenous ifosfamide, 3 g once a week for 3 weeks. Sixty-three patients with poorly differentiated and/or advanced prostate cancer were treated with the protocol. Although this study had no control group and the result was preliminary, prognosis of 21 patients without bone metastasis were satisfactory and none died. The 3-year survival rate of 28 patients with bone metastases less than 5 foci (EOD) was 81.3%, and that of 14 patients with multiple bone metastases was 48.8% (p < 0.001). This subclassification is useful to analyze and determine the prognosis.

Aneuploidy in somatic cells of in utero exposed A-bomb survivors in Hiroshima

Cytogenetic data on cultured lymphocytes of the in utero exposed A-bomb survivors in the RERF Adult Health Study cohort have been analyzed using the G-banding technique to determine the frequency of aneuploid cells. The data consist of blood samples collected between 1985 and 1987 from 264 Hiroshima individuals for whom DS86 maternal uterine dose estimates are available: 124 proximally exposed (74 males and 50 females) with an estimated dose of 0.005 Sv or more, and 140 distally exposed (76 males and 64 females) with a dose estimate of 0 Sv, assuming the neutron relative biological effectiveness (RBE) of 10. A main feature of aneuploidy was that aneuploid frequency in autosomes depended generally on chromosome length; aneuploidies were significantly more frequent in shorter chromosomes than in longer chromosomes. The frequency of aneuploidies also depended on type, with chromosome loss approximately five times more frequent than chromosome gain. However, chromosome 21, as well as the sex chromosomes, were notable in that aneuploidy was much more frequent for these chromosomes than would be predicted from a simple relationship with length. X chromosome aneuploidies were significantly more frequent in females than in males. There was no dependence of aneuploid frequencies on dose when measured 40 years after the exposure.

[Prognosis of interstitial pneumonitis (IP) in polymyositis (PM)/dermatomyositis (DM)]

IP, the major complication of PM/DM, is closely related to the life of these patients. In this study the course and prognosis of IP associated with PM/DM were investigated. Thirty IP patients with PM/DM were divided into 4 groups according to the course of IP. Clinical manifestations, laboratory data, chest radiographs and treatment were examined retrospectively. Eleven cases improved (Group I), 11 cases were exacerbated (Group E), 3 cases were unchanged (Group U), 2 cases died due to rapid progression of IP (Group D) and 3 cases dropped out. Both Group D patients were middle aged female DM patients without CPK elevation. All cases were treated with corticosteroids. The clinical manifestations, laboratory data, chest radiographs and initial dose of corticosteroid were not markedly different between Group I and E. The total dose of corticosteroids during the first 3 months tended to be higher in Group I than in Group E. Unlike idiopathic interstitial pneumonitis, the decrease in lung volume on chest radiographs improved after the treatment in 5 cases. We conclude that IP associated with PM/DM should be treated initially with high doses of corticosteroids.

Renin inhibitors. III. Synthesis and structure-activity relationships of transition-state inhibitors containing dihydroxyethylene isostere at the P1-P1 site

The design, synthesis and structure-activity relationships of transition-state inhibitors containing the dihydroxyethylene isostere at the scissile site are described. The compounds with (2S,3R,4S)-4-amino-5-cyclohexyl-1-morpholino-2,3-pentanediol at the P1-P1 site are potent renin inhibitors. (2S,3R,4S)-4-[N-[(2S)-3-Ethylsulfonyl-2-(1-naphthylmethyl)propiony l]-L- norleucyl]amino-5-cyclohexyl-1-morpholino-2,3-pentanediol (2) (BW-175), which is the most potent inhibitor (IC50: 3.3 nM against human renin) in this series, poorly inhibits cathepsin D (IC50: 26000 nM) and pepsin (IC50: > 100000 nM), and thus it is specific for renin. Compound 2 contains only one amino acid and showed an oral bioavailability of 2.8% at 10 mg/kg and 9.7% at 30 mg/kg in rats. The interaction between renin and inhibitor 2 is discussed on the basis of molecular modeling studies.

Native zona pellucida structure is required for completion of sperm acrosome reaction in porcine fertilization

In fertilization in vitro, the penetration rate of zona-intact porcine oocytes by cryopreserved epididymal spermatozoa was about 100% while that of zona-free oocytes was only 30%. Spermatozoa treated with calcium ionophore A23187 penetrated both zona-intact and zona-free oocytes at the rate of more than 90%. Treatment of spermatozoa with solubilized procine zonae pellucidae hardly induced acrosome reaction and did not increase the penetration rate. These results suggest that the structure of the zona is necessary for completion of acrosome reaction.

[A pharmacokinetic study on high-dose methotrexate administration--the effects of volume changes of parenteral solutions on the elimination rate]

Methotrexate (MTX) serum concentrations were measured in 7 cases (2 patients) in which a high-dose administration of MTX with citrovorum factor rescue for osteogenic sarcoma were performed for repressing activity in the original lesion and satellite micrometastasis. In the pharmacokinetic analysis, the changes of MTX serum concentrations were explained by a 2-compartment open model under the assumption that the elimination rate was proportional to both of volume of parenteral solution and the amount of water intake. It was suggested that MTX serum concentration could be controlled by adjusting the volumes of parenteral solutions. MTX amount in the peripheral compartment was found about ten times larger than that in the central compartment after about 40 h of administration. It is considered that an early increase in the volumes of parenteral solutions is effective to keep the safety level of MTX serum concentration, and continuous infusion is important for avoiding the severe side effects caused by delayed elimination of MTX.

Biochemical and histological changes after more than four years of treatment of ursodeoxycholic acid in primary biliary cirrhosis

We report on three patients with symptomatic, anicteric, and noncirrhotic primary biliary cirrhosis (Ludwig histological stage III at first liver biopsy) who were treated orally with 600 mg/day of ursodeoxycholic acid (UDCA) for more than 4 years. Follow-up liver biopsy was performed twice (at 1-3 and 4-6 years) during treatment. In all cases, during the whole period of up to 4-6 years of UDCA treatment, transaminase, alkaline phosphatase, and gamma-glutamyltranspeptidase levels improved, remaining at subnormal levels compared with pretreatment levels. Moreover, histological stage did not change throughout the UDCA treatment of up to 6 years. The second liver biopsy (at 1-3 years) revealed decreased lymphocytic infiltration in all cases, and bridging fibrosis was decreased in two cases. However, in the third biopsy at 4-6 years, portal inflammation was increased in one case without fibrotic progression; in the other two cases, bridging fibrosis was slightly worsened without portal inflammatory progression. In summary, these three cases show that liver histology was found to be improved, as were blood chemistry and pruritus, during short-term UDCA treatment, but histology results were slightly worse after long-term treatment despite the sustained improvement in biochemistry and pruritus.

Hemodynamics and hepatic energy metabolism in canine model of acute hepatic venous occlusion with mesocaval shunt

The relationship between portal hemodynamics and the energy metabolism of the liver with acute hepatic venous occlusion (HVO) was investigated by assessing the changes in the hepatic blood flow, arterial blood ketone body ratio (AKBR) and adenylate energy charge potential (ECP) of the liver tissue in canine model. Acute HVO was induced by the ligation of both the supra- and infrahepatic inferior vena cava (IVC) over the protruding ends of a heparin-coated polyethylene cannula inserted into the IVC. All dogs with only HVO (n = 5) died within 30 min. HVO dogs with additional mesocaval (MC) shunt (n = 10) survived longer than 7 days, during which time their AKBR were maintained in the normal range (over 1.0). ECP was also maintained above the normal level (over 0.850) during the 28-day period. Along with increasing portal pressure caused by the narrowing of the shunt anastomosis, the hepatic blood flow decrease gradually, resulting in a sudden decrease in AKBR and ECP when the portal pressure increased over 11 mm Hg. It is suggested that the normalization of portal pressure is one of the most important factors for maintaining the hepatic energy metabolism and that MC shunt is an effective therapy for maintaining the function of the liver with HVO, as long as portal pressure can be kept within normal range.

The first application of a chemiluminescence probe, 2-methyl-6-[p-methoxyphenyl]-3,7-dihydroimidazo[1,2-a]pyrazin-3-one (MCLA), for detecting O2- production, in vitro, from Kupffer cells stimulated by phorbol myristate acetate

The purpose of this study was to investigate the generation of superoxide anion radical, O2-, by Kupffer cells in vivo in rat liver. Phorbol myristate acetate (PMA) was infused into perfused rat liver which had been continuously infused with 2-methyl-6-[p-methoxyphenyl]-3,7-dihydroimidazo- [1,2-a]pyrazin-3-one (MCLA, a highly sensitive luminescence reagent for O2-) and the MCLA luminescence from the liver surface was detected with a sensitive photon counter. Under identical conditions, but without MCLA infusion, PMA and nitro blue tetrazolium were infused to verify generation of O2- by formation of formazan deposition. Based on MCLA luminescence and formazan deposition, both dependent on the O2- reaction, we have concluded that liver Kupffer cells generate O2- in vivo in response to stimuli such as PMA. Further, the generation of O2- by Kupffer cells may be by the same mechanism as displayed by macrophages.

Pharmacological intervention for renal protection during cardiopulmonary bypass

The possibility of minimizing organ damage following cardiopulmonary bypass (CPB) was examined. In the control group, n = 21, upon completion of CPB, elevation of the lysosomal enzyme beta-glucuronidase, which is a sensitive indicator of cellular damage, was affected by the concentration of granulocyte elastase (r = 0.59) or the endothelial-derived constricting factor, endothelin, (r = 0.8). Renal damage, which was detected by an increase in renal tubular enzymes (N-acetyl-beta-D-glucosaminidase and gamma-glutamyltranspeptidase) in urine, was also affected by endothelin (r = 0.79, r = 0.56), elastase (r = 0.6, r = 0.71), and by free hemoglobin levels (r = 0.76, r = 0.82). Next, the efficacy of pharmacological intervention for the prevention of renal damage was evaluated. During CPB, the administration of an elastase inhibitor (ulinastatin, 3 x 10(5) IU), n = 8, or a calcium antagonist (nicaldipine HCl, elastase release inhibitor; 5 gamma/kg per min), n = 8, significantly reduced the elevation of beta-glucuronidase and renal tubular enzymes (p < 0.05). Although the ulinastatin and nicardipine groups demonstrated low values of elastase in the Intensive Care Unit (ICU), only the values of the nicardipine group reached statistical significance (p < 0.05). A reduction in endothelin levels compared to the control group was observed in the nicardipine group. However, preventive and counteractive effects of nicardipine against vasoconstriction caused by endothelin were also considered to play an important role in the prevention of renal damage. The addition of haptoglobin (4,000 IU) to the priming solution of the CPB also reduced levels of renal tubular enzymes (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Differential effects of acyclothymidine, a potent pyrimidine nucleoside phosphorylase inhibitor, on the pharmacokinetics of doxifluridine in rabbits via oral administration

Acyclothymidine (AcyT, 5-methyl-1-(2'-hydroxyethoxymethyl)uracil), a potent inhibitor of pyrimidine nucleoside phosphorylase (PyNPase), was co-administered with 5'-deoxy-5-fluorouridine (5'-DFUR), a PyNPase activating prodrug of 5-fluorouracil (5-FU), to rabbits. The absorption and pharmacokinetic parameters of 5'-DFUR and its active metabolite 5-FU, after administration of 5'-DFUR in combination with AcyT, were evaluated in the animals. Animals were given an oral or intravenous administration of 5'-DFUR (50 mg/kg) in combination with an equimolar dose of AcyT (40 mg/kg). The half-lives (t1/2) of 5'-DFUR and 5-FU in plasma were 16.8 and 11.5 min, respectively. AUC (area under the plasma concentration-time curve) of 5'-DFUR and 5-FU following the oral administration of 5'-DFUR (50 mg/kg) was 1710 and 24.3 micrograms.min/ml, respectively. After the oral co-administration of 5'-DFUR and AcyT (at a molar ratio of 1:1), the AUC values for 5'-DFUR and 5-FU increased to 2680 and to 121.1 micrograms.min/ml, respectively. However, this combination had little effect on the t1/2 of 5'-DFUR.

Effect of milk on absorption of norfloxacin in healthy volunteers

The authors studied the effect of milk on the bioavailability of norfloxacin in six healthy male volunteers in a randomized crossover trial. After an overnight fast, 200 mg of norfloxacin was given with 200 mL of water or milk. Area under the curve (AUC) of norfloxacin with milk was significantly (P < 0.01) smaller than that with water. The mean peak serum concentration was decreased to 60% after oral administration of norfloxacin with milk (P < 0.01). The apparent volume of distribution at central compartment (Vc/f) value of norfloxacin was significantly (P < 0.05) increased with milk. Milk exhibits a clinically significant effect on norfloxacin absorption.

Evaluation of three occlusal examination methods used to record tooth contacts in lateral excursive movements

Accurate and repeatable methods for recording tooth contacts are required for the clinical management of problems related to occlusion. A thorough understanding of the materials and procedures used in these methods is important to achieve desirable results in the treatment of such problems. This study compared three occlusal examination methods to determine the influence of materials and procedures on the number of tooth contacts recorded. Tooth contacts were analyzed at two lateral mandibular positions with each method. It was found that the method that uses black silicone recorded the highest number of tooth contacts. Thus the most frequent type of occlusal pattern observed was full-balanced occlusion. This study suggested that the disparities of results reported in literature on occlusal contact patterns could be the result of the different materials and methods used for occlusal registration.