Increased natural killer resistance to cyclosporine A by continuous doses of dexamethasone in rats

There is a controversy on the effects of physiological levels of glucocorticoids on natural killer (NK) cytotoxity. Therefore, the effects of exogenously administered dexamethasone on NK cytotoxity in 8-week-old male, Fischer 344 rats were studied. We suppose that the reason for the controversy is insufficient sensitivity of the ordinal radioactive chromium-release assay for normal healthy subjects or animals. Therefore, we developed a new index, a resistance to artificial immunosuppressor, cyclosporine A (CsA) using rat NK activity as an indicator, and named this index, increased resistance to immunosuppressor (IRIS). After some basic, characterizing studies, authors confirmed the fact that continuous doses of dexamethasone (DEX) attenuated NK suppression of CsA. In protocol 4, 18 rats were randomly divided into three groups: the first (DEX + CsA) was injected for 5 days with 0.1 mg DEX/kg/day and a single dose of CsA on the final day, intraperitoneally; the second (SAL + CsA) was treated with an equal volume of saline and CsA; the third (DEX + SAL) was treated with DEX but not CsA. The IRIS in NK activity was increased significantly (P < 0.01) with 5 days injection of DEX. These results demonstrated that physiological, and continuous dosage of glucocorticoids stimulated IRIS in NK activity in rats, and this suggests that appropriate stimuli through the hypothalamic-adrenal axis might be acting, at least, as a defence against immune collapses or dysfunctions.

Surgical treatment for pulmonary metastases of squamous cell carcinoma of the head and neck

PURPOSE

As locoregional control of head and neck cancer has improved, distant metastases have become increasingly common problems.

PATIENTS AND METHODS

To determine the role of surgical treatment, we reviewed 32 patients with squamous cell carcinoma (SCC) of the head and neck who underwent thoracotomy for pulmonary metastases.

RESULTS

The overall 5-year survival rate was 32%. The 5-year survival rate of the patients with SCC of the oral cavity was significantly poorer than that of the patients with other primary site (15.4% v 45.2%; P = .01). In the patients with single nodule, extent of the tumor was a significant prognostic factor (P = .007). Mediastinal lymph node involvement (P = .004) and pleural invasion (P = .04) also correlated with survival.

CONCLUSION

TNM classification of the primary tumor did not have an impact on survival in this study. Further studies of a large series should be performed to determine the indications and modalities of the surgical treatment for pulmonary metastases of the SCC of head and neck.

Avoidance of oocyte retrieval on the weekend through the use of scheduled ovarian hyperstimulation for in vitro fertilization and embryo transfer

OBJECTIVE

To avoid oocyte retrieval for IVF-ET during the weekend, the scheduled method of ovarian hyperstimulation, in which oocyte retrieval is planned in advance for Monday through Wednesday, was evaluated.

DESIGN

A retrospective study.

SETTING

The IVF-ET unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital.

PATIENT(S)

One hundred seventy-eight cycles in patients undergoing ovarian hyperstimulation for IVF-ET were stimulated according to the scheduled method of ovarian hyperstimulation (scheduled group). One hundred seventy-one cycles in patients of similar age and with comparable causes of infertility were stimulated according to the conventional method of ovarian hyperstimulation for IVF-ET (conventional group).

INTERVENTION(S)

In the scheduled method, under GnRH-a, the day of oocyte retrieval was determined in advance for IVF-ET. Ovarian stimulation with FSH and hMG was started 12 days before oocyte retrieval.

MAIN OUTCOME MEASURE(S)

The cancellation and clinical pregnancy rates (PRs), the days of oocyte retrieval, and other clinical parameters were evaluated in the two groups.

RESULT(S)

The cancellation rates in the scheduled and conventional groups were 9.6% and 4.7%, respectively. In about 75% of cycles in the scheduled group, oocyte retrieval was conducted on the scheduled day. When oocyte retrieval was scheduled for Monday through Wednesday, overtime work on the weekend could be avoided in 91% of the cycles without cancellation. The clinical PR was comparable between the two groups.

CONCLUSION(S)

The scheduled method of ovarian hyperstimulation for IVF-ET was useful for avoiding oocyte retrieval on the weekend.

Antiperistaltic transverse colostomy for massive bowel necrosis following surgery for an abdominal aortic aneurysm: report of a case

We herein report the findings of a 72-year-old man with gangrenous multivisceral necrosis following an operation for abdominal aortic aneurysm. The region of necrosis, which accompanied infarction of the left kidney, included the entire ileum and the ascending, descending, and sigmoid colon. An end ileostomy and transverse colostomy were performed subsequent to massive bowel resection in a second operation. After the second operation, he was managed with total parenteral nutrition and recovered uneventfully except for end-jejunostomy syndrome. A third operation was performed to reconstruct the interrupted bowel. To minimize abandoned bowel, antiperistaltic transverse colostomy was used for jejunocolonal reconstruction. The antiperistaltic colostomy improved the symptoms of end-jejunostomy syndrome and normalized the patient's vitamin B12 and bile acid levels. An antiperistaltic colostomy is thus considered to be useful for preventing short bowel syndrome after a massive bowel resection.

p21 expression as a predictor for favorable prognosis in squamous cell carcinoma of the lung

Although p21 WAF1/Cip1 expression has been detected immunohistochemically in non-small cell lung cancer (NSCLC), the associations between p21 expression and clinical characteristics are unknown. To determine the association between p21 expression and clinical features, p21 expression was immunohistochemically analyzed in paraffin-embedded tumor samples from 137 patients with curatively resected NSCLC. p21 expression, indicating normal p21 function, was detected in 48 (35.0%) of the 137 patients with curatively resected NSCLC and was detected more frequently in patients with stage I or II disease (40.2%) than in those with stage IIIA disease (22.5%; P = 0.0483). There was no difference in the positive rate between squamous cell carcinoma [SCC; 15 of 48 (31.3%)] and adenocarcinoma [30 of 77 (39.0%)]. For SCC, patients with tumors expressing p21 survived longer than did those with tumors negative for p21 expression; however, the corresponding survival time was not significant for adenocarcinoma. On the other hand, p53 expression, detected in 58 (42.3%) of these patients, did not act as any predictor for prognosis in either SCC or adenocarcinoma. Our findings suggest that the presence of p21 expression is associated with favorable prognosis in SCC and may be useful in obtaining candidates for adjuvant therapies from among patients with SCC.

Cyclosporine A inhibits interleukin-8 production in a human colon epithelial cell line (HT-29)

Intestinal epithelial cells produce various inflammatory mediators. However, the way in which immunosuppressive agents influence the production of these mediators by intestinal epithelial cells is not understood. The effects of cyclosporine A (CsA), tacrolimus (FK506), and dexamethasone (DEX) on cytokine-induced production of interleukin (IL)-8 in a human colonic cancer cell line (HT-29) were examined. HT-29 cells were stimulated with either IL-1 beta or tumor necrosis factor alpha (TNF alpha) together with CsA, FK506, or DEX. The presence of IL-8 protein was detected by enzyme-linked immunosorbent assay, and the expression of IL-8 messenger RNA (mRNA) by reversetranscription polymerase chain reaction. CsA (1, 5, and 10ng/ml) significantly reduced IL-1 beta-induced IL-8 production (by 32%, 41%, and 48%, respectively), and reduced TNF alpha-induced IL-8 production (by 21%, 42%, and 50%, respectively). FK506 or DEX had no effect on IL-1 beta- or TNF alpha-induced IL-8 production. The expression of IL-8 mRNA was also inhibited by CsA. These findings suggest that CsA may influence the production of inflammatory mediators in colonic cells in a different manner from FK506 and DEX.

[Interdural dermoid cyst of the cavernous sinus presenting with oculomotor palsy: case report]

A 19-year-old female was admitted to our hospital because of diplopia. Neurological examination showed slight anisocoria (right > left), disturbance of ocular movement in upward, downward and medial directions on the right side, and diplopia on upward gaze. Computed tomography (CT) scan demonstrated a well-demarcated cystic lesion in the right parasellar region. The lesion showed non-homogeneous low intensity with a high intensity margin on T1-weighted imaging and high intensity with a low intensity margin on T2-weighted imaging in magnetic resonance image (MRI). The lesion showed enhancement by contrast media on neither CT nor MRI. Cerebral angiography revealed no tumor stains. The lesion was approached via right fronto-temporal craniotomy. The right optic nerve, oculomotor nerve and internal carotid artery were compressed medially by the tumor. The tumor contents appeared to be flaky and greasy containing motor-oil-like fluid, mineralized body, and a few hairs. The tumor was attached to the lateral wall of the right cavernous sinus (inner membranous layer), but was totally resected with careful microscopic dissection. The histopathological examination confirmed the diagnosis of dermoid cyst. The patient's complaint of diplopia showed gradual improvement postoperatively. Supratentorial intracranial dermoid cyst is a rare congenital tumor and, to our knowledge, only one case arising within the lateral wall of the cavernous sinus and presenting oculomotor palsy has been reported. Total removal is ideal and may be possible even when the tumor arises from the lateral wall of the cavernous sinus.

Prognostic significance of serum p53 antibodies in squamous cell carcinoma of the lung

BACKGROUND

The prognostic significance of serum p53-Abs positivity for non-small cell lung cancer (NSCLC) is still unknown.

PATIENTS AND METHODS

To determine the prognostic value of serum p53-Abs status, we determined serum p53-Abs and immunohistochemistry in 140 patients with stage I-IIIA NSCLC.

RESULTS

p53-Abs were detected in 12.1% of all patients and in 17.6% of those with squamous cell carcinoma (SCC). Neither p53-Abs nor p53 overexpression alone was correlated with survival for all patients. When these factors were combined for SCC, seronegative patients with tumors overexpressing p53 survived significantly longer than did those with p53-Abs or p53-nonexpressing tumors. In multivariate analysis, p53-Abs status and p53 overexpression were independent prognostic factors for SCC (p = 0.0337).

CONCLUSIONS

These findings suggest that the combination of p53Abs seropositivity and p53 overexpression may be a prognostic factor for SCC.

Transcutaneous needle biopsy of the lung

PURPOSE

To evaluate the usefulness of transcutaneous needle biopsy (TCNB).

MATERIAL AND METHODS

From May 1988 to December 1994, we performed TCNB under fluoroscopic control in 408 patients with mass lesions of the peripheral lung. The Surecut needle (1.5 mm) was selected mainly because of its ability to obtain specimens large enough for histological examination. Of the 408 patients, 286 had had previous bronchofiberscopic examinations but no definite diagnosis had been reached.

RESULTS

A definite diagnosis was obtained by TCNB in 305 (74.7%) of 408 cases (251 malignant neoplasms, 54 benign lesions). In malignant neoplasms, the pathological diagnosis based on cytology and histology together was more reliable than that based on cytology alone. Although the complications of this procedure (such as pneumothorax) were within the range of acceptability, care should be taken to avoid air embolism and the seeding of cancer cells along the needle tract.

CONCLUSION

TCNB with the Surecut needle is a useful procedure with relatively low risk.

Mechanisms accounting for granulomatous responses in hypersensitivity pneumonitis

Hypersensitivity granuloma formation is an immunopathological feature of HP. It is induced by the T cell-mediated delayed-type hypersensitivity reaction to organic dusts or active chemicals invading the lung. Circulating, antigen-reactive, memory CD4+ T cells, generated by previous sensitization, migrate into lung parenchyma in response to chemokines such as RANTES. The T cells develop into either Th0, Th1, or Th2 effector depending upon the conditions in which they first encounter the antigens. The Th1 cells produce IL-2 and IFN-gamma. IFN-gamma can prime macrophages to transcribe and to secrete greater amounts of TNF and IL-1. The macrophages activated by TNF and IL-1 produce a wide range of biologically active mediators such as MAF, MCF, and MIF. These monokines attract young macrophages into the lesions, activate them, and young macrophages develop into mature macrophages, resulting in the hypersensitivity granuloma consisting of epithelioid cells and multinucleated giant cells. CD8+ T cells, the most predominant cell in the lesions of HP, may modulate the granuloma formation via the production of Th1-like or Th2-like cytokines.

Wideband and high frequency stabilization of an injection-locked Nd:YAG laser to a high-finesse Fabry Perot cavity

High frequency stabilization of a 2.2-W injection-locked laser-diode-pumped Nd:YAG laser to a high-finesse optical cavity has been realized by frequency control of the master laser. With the help of an external electro-optical modulator, the feedback bandwidth was extended to 1 MHz and the frequency noise relative to the reference cavity was suppressed to 3 x 10(-4) Hz/Hz(1/2) below 1 kHz. This feedback laser system is an ideal laser source for gravitational wave detectors, which require both ultralow frequency noise and high output power.

Effects of granulocyte and granulocyte-macrophage colony-stimulating factors in a neutropenic murine model of trichosporonosis

We produced disseminated trichosporonosis in a neutropenic murine model with Trichosporon asahii, which was identified by DNA relatedness analysis. We then assessed the efficacy of granulocyte colony-stimulating factor (G-CSF) (30 to 100 microg/kg of body weight per day) and granulocyte-macrophage colony-stimulating factor (GM-CSF) (0.8 to 2 microg/kg x day). The administration of G-CSF either before or after infection improved the survival rate from less than 25% up to 100% (P < 0.05). The effects of G-CSF on organ clearance and histological examinations were most remarkable in the lungs. The levels of tumor necrosis factor alpha (TNF-alpha) in bronchoalveolar lavage fluid (BALF) of neutropenic and G-CSF-pretreated mice were 60 +/- 6 ng/ml and 18 +/- 6 pg/ml, respectively, at 24 h after infection. Immunohistologically, alveolar macrophages proved to be the main source of TNF-alpha in BALF. GM-CSF increased neutrophil counts less significantly than did G-CSF and increased the lethality (P < 0.05) with a high level of TNF-alpha in BALF. Expecting to inhibit TNF-alpha, we administered anti-TNF-alpha intraperitoneally at the dose completely inhibiting TNF-alpha in plasma (2 x 10(4) U), but the TNF-alpha level in BALF and the lethality increased. Though the number of neutrophils at the early stage of infection appeared to be the most critical, the results suggest that other host defense mechanisms, such as TNF-alpha overproduction in the lungs, have an important role in the prognosis of trichosporonosis.

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

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

Coordinated change between complement C1s production and chondrocyte differentiation in vitro

In vitro synthesis of the first component of complement C1s was examined by using hamster epiphyseal chondrocytes (HAC) and human chondrosarcoma cell line HCS-2/8. Hamster and human C1s produced by the cells were quantified by immunoblotting and sandwich enzyme-linked immunosorbent assay (ELISA), respectively. It was possible to measure active and inactive C1s by sandwich ELISA, when we used anti-human C1s monoclonal antibodies, M241 recognizing only active C1s, and M365 and M81 recognizing both active and inactive C1s. Approximately 40% of C1s secreted from HCS-2/8 was found to be activated in the culture medium, whereas C1s from HAC was not. C1s production increased in accordance with chondrocyte differentiation induced by ascorbic acid. In contrast, transforming growth factor-beta1 and basic fibroblast growth factor, which inhibited differentiation, suppressed C1s production. These results confirmed our previous observation showing that C1s synthesis increased with differentiation into hypertrophic chondrocytes in vivo.

A prospective study of prognostic value of type IV collagenase activity in colorectal cancer tissue

The purpose of this prospective study was to evaluate the prognostic value of the type IV collagenase (IVase) activity in colorectal cancer tissue on disease-free and overall survival in 31 colorectal cancer patients. The clinicopathologic factors studied for prognostic value were age, tumor location, tumor differentiation, preoperative serum levels of carcinoembryonic antigen, Dukes' stage, and IVase activity in colorectal cancer tissue. IVase activities in colorectal cancer tissue were significantly higher in the group of patients with recurrences than in the group without recurrences (P = 0.019). Patients with high IVase activity in colorectal cancer tissue had a significantly shorter disease-free survival (P = 0.0016) and overall survival (P = 0.022) time than those with low IVase activity. Univariate and multivariate analysis showed that significant prognostic factors for disease-free survival were Dukes' stage (P = 0.029, P = 0.046, respectively) and IVase activity status (P = 0.0016, P = 0.0026, respectively). With respect to overall survival, only IVase activity status provided significant predictive value in multivariate analysis (P = 0.041). This prospective study suggests that IVase activity is a valuable prognostic factor in colorectal cancer patients.

c-fos expression in the trigeminal sensory complex and pontine parabrachial areas following experimental tooth movement

Ortodontic tooth movement causes continuous pain. However, it does not appear immediately, usually appearing after the application of orthodontic force to the teeth. Mechanically induced inflammatory responses in the periodontal membrane are assumed to be related to the mechanism of the later pain sensation. In the present study, we investigated Fos-like immunoreactivity in the trigeminal sensory complex and pontine parabrachial areas 24 h after the commencement of experimental tooth movement. An orthodontic elastic module was unilaterally inserted between upper molars. Following experimental tooth movement, Fos-like immunoreactive neurons appeared ipsilaterally in the trigeminal subnucleus caudalis and bilaterally in the lateral parabrachial nucleus. These results indicate that experimental tooth movement evokes delayed and continuous nociception after application of orthodontic force to the teeth and that the nociceptive information would be conveyed to the ipsilateral trigeminal subnucleus caudalis and further processed, at least in part, to the lateral parabrachial nucleus.

[A prospective controlled study of sairei-to in childhood IgA nephropathy with focal/minimal mesangial proliferation. Japanese Pediatric IgA Nephropathy Treatment Study Group]

To determine the effect of the Chinese herbal medicine, Sairei-to (TJ-114) in children with newly diagnosed IgA nephropathy showing focal/minimal mesangial proliferation, we undertook a prospective controlled study. One hundred and one patients were randomly assigned to receive Sairei-to for 2 years (group 1) or no drug for 2 years (group 2). Forty-six of the 50 patients in group 1 and 48 of the 51 patients in group 2 completed their trial. At entry, the two groups of patients did not differ in the clinical, laboratory and pathologic findings. At the end of the trial, urinary protein excretion and hematuria were significantly reduced in group 1, but were unchanged in group 2. Twenty-one group 1 patients (46%) had normal urine, but only 5 group 2 patients (10%) had normal urine at the end of the trial (p < 0.001). Blood pressure and creatinine clearance were normal at the end of the trial in all but one group 2 patient, who developed chronic renal failure. The present study demonstrates that 2-year Sairei-to treatment early in the course of disease is effective in children with IgA nephropathy showing focal/minimal mesangial proliferation.

En bloc pancreaticoduodenectomy and colectomy for duodenal neoplasms

Duodenal malignancy is rare and generally considered to have both a low resectability rate and a poor prognosis. Historically, the involvement of the colon or its mesentery has been considered a criterion for unresectability by many surgeons because of the overall magnitude of surgery involved with an en bloc colectomy and pancreaticoduodenectomy. In the past few years, several reports have noted a decrease in morbidity and mortality rates for pancreaticoduodenectomy. The current safety of the procedure suggests that the classical criteria for resectability can now be reevaluated for certain neoplasms. We report two cases of pancreaticoduodenectomy with en bloc colectomy done as attempted curative resections for primary duodenal malignancies. The procedure was well tolerated by both patients; there were no major complications, and it provided both prolonged survival and effective palliation.

Radiotherapy during pregnancy: effects on fetuses and neonates

To optimize the efficacy of radiotherapy for cancer patients who are pregnant, the following factors must be considered: the potential effects of the therapy on fetuses and neonates, the stage and prognosis of the mother's disease, and the possible risks to the patient of restricting cancer treatment. Malformations and mental retardation are the most serious consequences of fetal exposure to radiation that are observed after birth. The sensitivity to radiation is high from 2 to 8 weeks after conception for malformations and from 8 to 25 weeks (particularly up to week 15) for mental retardation; the risk of mental retardation declines rapidly after the 25th week of gestation. When a pregnant patient requires radiation therapy, the physician should consider fetal sensitivity to radiation in light of gestational age and the expected dose of radiation and should then calculate the risk to the fetus versus the benefits to the mother. The risk is negligible if fetal exposure does not exceed 0.1 Gy, preferably remaining below 0.05 Gy, during gestation. Furthermore, it is safest to administer radiotherapy during or after the 25th week of gestation.