[Successful treatment with combined chemotherapy (carboplatin, etoposide, adriamycin, bleomycin) and radiotherapy for recurrent intracranial malignant germ cell tumor: case report]

We report a case of a patient with recurrent malignant germ cell tumor who was successfully treated with carboplatin combination followed by radiation therapy. A 13 year-old female presented with diabetes insipidus six years ago. From the homogeneous tumor intensity on CT scan and negative titer of AFP and HCG, we made a diagnosis of suprasellar germinoma, and treated her with radiation therapy (40Gy), which resulted in almost complete disappearance of the tumor. The tumor recurred six years later in the primary region and in the cervical spinal cord with elevated AFP titer (160ng/ml) and HCG titer (404mlU/ml). She was treated with multi-agents chemotherapy consisting of carboplatin (450mg/m2, day 1), etoposide (150mg/m2, days 1-3), adriamycin (30mg/m2, day 1), and bleomycin (20mg/m2, days 1 and 8), followed by radiation therapy to the whole brain (20Gy), the whole spine (30Gy) and the cervical spine (20Gy). The tumors completely disappeared. We discuss treatment failures of clinically diagnosed germinoma without histological verification, and effective aggressive chemotherapy for recurrent malignant germ cell tumors.

[Integrated diagnosis of small hepatocellular carcinoma with imaging diagnosis]

Herein, we present the diagnostic efficacy of various imaging diagnostic techniques for small liver cancer(HCC) and HCC occurrence predictability by ultrasonography during the follow-up period of chronic liver diseases. During the recent 4 years, 78 nodules of small liver cancer measuring 2 cm or less in diameter were found in 50 patients with liver cirrhosis. In this study, the tumor size was divided into 2 groups; 1.5 cm or less in maximal diameter (group A) and 1.6 to 2 cm (group B). The tumor detectability of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), angiography and lipiodol CT in group A vs group B was 96% vs 97%, 68% vs 88%, 65% vs 94%, 12% vs 78% and 38% vs 89%, respectively. Therefore, angiography and lipiodol CT were not effective for detection of small HCCs smaller than 1.5 cm. Recently, helical CT scanning has been induced in the diagnosis of HCCs and the tumor detectability was enhanced to 82% even in group A. Additionally, helical-dynamic CT has some advantages in evaluating vascularity, especially arterial feeding which is a specific finding to HCCs. In comparison with contrast-enhanced US using CO2-microbubbles, helical-dynamic CT had equivalent accuracy in diagnosing hypervascular tumors, while hypovascular masses were observed in about 30% of group A. With respect to prediction of HCC occurrence in cirrhotic liver, sonographic evaluation of liver parenchyma seemed to be an important parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of advanced breast cancer with multiple lung metastases responding well to postoperative combined administration of doxifluridine (5'-DFUR) and tamoxifen]

A 72-year-old female with right breast cancer having multiple lung metastases was treated by combined administration of 5'-DFUR at 800 mg/day, and tamoxifen, at 20 mg/day, after standard radical mastectomy. Plain chest X-ray and computed tomography examinations have shown complete disappearance of the multiple lung tumor since the therapy. No serious side effects have been observed during the treatment course, and there has been no definite evidence of tumor recurrence.

Further study of experimental gastritis in rats: endocrine and neurocrine profile

We conducted this study to identify the endocrine and neurocrine mechanisms of gastric mucosal protection in rats with experimental atrophic gastritis (erosive atrophic antritis) induced by prolonged exposure to taurocholate. This resulting gastritis was characterized by a significant reduction of parietal cell mass, a decrease in mucosal thickness, decreased numbers of pyloric glands, infiltration by inflammatory cells, and fibrotic proliferation in the gastric mucosa. Mucosal erosions were also prominent. These morphologic and morphometric findings indicate the presence of erosive atrophic gastritis, as previously described. Fasting levels of serum gastrin increased significantly in the rats with gastritis versus controls, whereas the mucosal gastrin levels did not differ significantly from those of controls. Mucosal levels of somatostatin decreased significantly, and vasoactive intestinal peptide (VIP) increased significantly in the pyloric sphincter region. These findings suggest that these peptides and neuropeptides are involved in the induction of this form of gastritis. The peptides may play an important role in the mechanisms of gastric mucosal protection (i.e., gastrin is an aggressive and somatostatin is a defensive factor, and VIP promotes the reflux of bile into the stomach by relaxing the pyloric sphincter).

[Comparison between ELISA and culture method for detection of Helicobacter pylori]

Detection of Helicobacter pylori (H. pylori) by ELISA was compared with that by the culture method in 115 patients with gastroduodenal diseases. Both the sensitivity and specificity were more than 85% for patients with histological gastritis with neutrophil infiltration. This indicated that the detection of H. pylori by ELISA is useful for the diagnosis of H. pylori-related gastritis. Although the sensitivity between the ELISA and culture method was 85%, the specificity was 58.8%. The false negative detection may have been caused by a sampling error during the endoscopic biopsy.

Malignant duodenocolic fistula: report of a case and considerations for operative management

Malignant duodenocolic fistula is a rare complication of gastrointestinal malignancy. We present herein the case of a 34-year-old female in whom a large duodenocolic fistula was caused by advanced transverse colonic carcinoma. Right hemicolectomy combined with pancreaticoduodenectomy enabled en bloc resection of the tumor, and the patient has been free of disease for 1 year and 8 months postoperatively. A review of the international literature, including 33 cases reported in Japan, indicates that if the disease is curable, the treatment of choice is right hemicolectomy with pancreaticoduodenectomy, whereas if it is not curable but locally resectable, the best palliation appears to be right hemicolectomy with partial duodenectomy to include the fistulous tract. Dehiscence of the duodenal wound closure associated with partial duodenectomy can be prevented by using the mucosal or serosal patch techniques with intestinal loops. These therapeutic principles are also applicable for colonic carcinoma which massively involves the duodenum without fistula formation.

Reduced phototoxicity of a fluoroquinolone antibacterial agent with a methoxy group at the 8 position in mice irradiated with long-wavelength UV light

A newly developed fluoroquinoline, Q-35 (8-OCH3), in which a methoxy group was substituted at the 8 position of the quinoline nucleus, was very stable under irradiation with long-wave UV light (UVA). Derivatives, a fluoroquinolone with no substitution (the 8-H analog) and one in which a fluorine was substituted (the 8-F analog), were degraded in their solutions by the UVA irradiation. The phototoxic inducibility by these derivatives was further studied in a murine model. When mice were dosed orally with 800 mg of Q-35 (8-OCH3) per kg of body weight, the maximum dose given, and exposed to the UVA light, no inflammatory lesions were observed in their ears. Ear redness was marked in mice given more than 12.5 mg of the 8-F analog or 200 mg of the 8-H analog per kg. Histopathological changes, edema, and infiltration of neutrophils were also observed microscopically in groups receiving the 8-H or 8-F analog but not in groups receiving Q-35 (8-OCH3). Similar inflammatory reactions were observed to occur in a dose-dependent manner with other available fluoroquinolone antibacterial agents such as lomefloxacin, enoxacin, norfloxacin, ciprofloxacin and ofloxacin. These results suggest that the introduction of a methoxy group at the 8 position of the quinolone nucleus is important for the reduction of phototoxicity.

Dyspepsia and dyspepsia subgroups in Japan: symptom profiles and experience with cisapride

In 240 patients with symptoms of dyspepsia, recruited consecutively and investigated in 12 hospitals in Japan, 24.2% were diagnosed having organic dyspepsia; 75.8% had functional dyspepsia, of whom 63.2% were diagnosed by the investigator having dysmotility-like, 13.7% ulcer-like, 11.5% reflux-like, and 11.5% non-specific dyspepsia. There was, however, considerable overlap of symptom profiles. Cisapride therapy initiated in functional dyspeptic patients resulted in moderate or marked improvement in 79.1% of the patients with the highest response rates for dysmotility-like (85.2%), reflux-like (81.0%), and non-specific dyspepsia (76.1%) (versus 52.0% for ulcer-like dyspepsia).

[An evaluation of temporary clipping during aneurysmal surgery: a retrospective study]

A temporary clipping of a parent artery has been found convenient in facilitating an aneurysmal dissection. This is because it controls the bleeding from an unexpected rupture and keeps the sac collapsed during the operation. Such a temporary arterial occlusion, however, involves the risk of a focal ischemia that may lead to permanent postoperative neurological deficits. Therefore, to evaluate the influence of a temporary clipping on the outcome of an operation, a retrospective study of 302 patients who underwent an operation for a ruptured supratentorial aneurysm between 1981 and 1990 has been conducted. This study has revealed the information that follows: 1) Overall outcomes In patients given no temporary clipping, their postoperative activity in daily living (ADL) grade was good in 70.7%, i.e. ADL 1 or 2, whereas only 46.4% of the patients given a temporary clipping achieved a similar ADL. 2) Influence of the preoperative Hunt and Kosnik neurological classification on the outcome Irrespective of whether a temporary clip had been used, patients with a Hunt and Kosnik grade of 1 or 2 made a good recovery, whereas patients with a grade of 4 or 5 did not. The application of a temporary clip in grade 3 patients led to a poor result, whereas in grade 3 patients given no temporary clipping the results were good. This would seem to indicate that Hunt and Kosnik grade 3 rating is a critical factor in consideration whether a temporary clip should be used or not. 3) Influence of the operative timing on the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes of colonic vasoactive intestinal peptide and cholinergic activity in rats with chemical colitis

The vasoactive intestinal peptide concentration was examined in the colonic wall and portal venous plasma of rats with chemical colitis by radioimmunoassay, and the colonic localization was determined with immunocytochemistry. Colonic acetylcholine esterase activity was also measured, and the response of vasoactive intestinal peptide to acetylcholine administration was determined. Colitis was induced by administration of dextran sulfate for three months. The chemical colitis was histologically similar to active human ulcerative colitis. We observed a significant increase of immunostained neurons and nerve fibers and a significant rise in the colonic wall vasoactive intestinal peptide content in chemical colitis rats, while plasma concentrations of the peptide did not change significantly. Colonic acetylcholine esterase activity was significantly elevated in colitis rats compared with control rats. Systemic administration of acetylcholine significantly increased the colonic and plasma vasoactive intestinal peptide concentrations in colitis rats. These findings demonstrated a positive association between colitis activity and an increase of vasoactive intestinal peptide and suggested that increased vagal tone promoted the peptide's release.

[Effects of stimulation of the vertebral nerve around the proximal vertebral artery on pupil and the autonomic nervous system--a contribution to pathophysiology of Powers' intermittent vertebral artery compression syndrome]

In order to elucidate the pathophysiology involved in Powers' intermittent vertebral artery compression syndrome, the author investigated sympathetic and parasympathetic changes produced by stimulation of nerves around the proximal vertebral artery (the vertebral nerve) in anesthetized and immobilized cats. These changes were observed mainly through pupillary changes, pulse and blood pressure, evoked potentials in the lateral horn of the upper thoracic cord (centrum ciliospinale), in the cervical sympathetic trunk, and in the short ciliary nerve. Electrical stimulation of vertebral nerve and local application of K ion around the vertebral artery produced stimulus-dependent ipsilateral mydriasis; when stimulation of higher strength was applied pronounced ipsilateral and mild contralateral mydriasis and hypertension occurred. Electrical stimulation of perivascular tissue around the subclavian artery proximal to origin of the vertebral artery showed ipsilateral mydriasis; while on stimulating the distal subclavian, the costcervical, the omocervical and the internal thoracic arteries did not show any pupillary response. Neuronal discharges in the lateral horn of upper thoracic cord and in the cervical sympathetic trunk showed stimulus-dependent increases on stimulating the vertebral nerve; while, inhibitory responses were observed in the short ciliary nerve formed by parasympathetic nerve fibers. From the data available, it seems likely that the stimulation of periarterial neural structure of the vertebral artery produced sympathetic excitatory as well as parasympathetic inhibitory neuronal discharges simultaneously may probably be derived from the integrating autonomic center in the hypothalamus.

Distribution of neurokinin A-like and neurokinin B-like immunoreactivity in human peripheral tissues

Using specific radioimmunoassay and immunocytochemistry for neurokinin A (NKA) and neurokinin B (NKB), distribution and localization of the two peptides in human peripheral tissues were studied. Both NKA-like immunoreactivity (NKA-LI) and NKB-like immunoreactivity (NKB-LI) were present in the walls of the gut and gall bladder and in the pancreas. In the gut, the values for NKA-LI were 0.56-35.73 pmol/g wet weight, while those in pancreas and gall bladder were 0.64-0.68 and 0.36 pmol/g wet weight, respectively. The values of NKB-LI were 0.45-2.66 pmol/g wet weight in the gut, 0.93-1.65 pmol/g wet weight in the pancreas, and 0.30 pmol/g wet weight in the gall bladder. The immunocytochemical reactivity to both peptides was localized to ganglia of the submucosal and myenteric nerve plexuses in the gut wall, and to neurons in the muscle layer and mucosa of the gut wall. Weak but positive NKA-LI appeared in nerve cells of the pancreas, while NKB-LI was not detectable in the pancreas. Conversely, in the gall bladder wall, NKA-LI was undetectable while a very faint NKB-LI was found in the muscle layer. The localization of NKA corresponded closely to that of NKB in the tissues although the relative concentrations of the peptides varied from organ to organ.

Treatment of established taurocholate-induced chronic erosive gastritis in rats with cimetidine

The study investigated whether cimetidine could heal chronic erosive gastritis induced experimentally in rats by the administration of taurocholate for 6 months. Taurocholate gastritis is associated with mucosal erosions, the infiltration of inflammatory cells, reduction of the parietal cell mass, reduction of mucosal thickness, and interstitial fibrosis, a histopathological picture similar to that of human erosive gastritis. Microscopic quantitative morphological studies were used to determine the effect of cimetidine administered freely to rats for two weeks in the form of food containing 0.4 or 0.8% of the agent after the withdrawal of taurocholate. Basal acid secretion was analysed in rats with pyloric ligation 12 hours after withdrawal of the cimetidine-containing food. Basal gastrin levels were determined after a 12-hour fast by radioimmunoassay. The total length of the mucosal erosions was significantly decreased in the cimetidine-treated rats of Group A (cimetidine: 400 mg/kg/day: median 294.6 mm) and Group B (800 mg/kg/day; 225.7 mm) when compared to Group C (control gastritis group; 626.4 mm). Both the grade of inflammatory cell infiltration and fibrosis were also significantly reduced in Groups A and B compared with Group C. The number of parietal cells per unit area (A: 101.0, B: 108.8) and the mucosal thickness of the fundic mucosa (A: 0.610, B: 0.710) and of the antral mucosa (A: 0.220, B: 0.240) were greater in Groups A and B than in Group C (85.1 and 0.52 of the fundic mucosa, 0.170 of the antral mucosa, respectively). Basal acid secretion was significantly inhibited in Groups A and B (31.8 and 26.3 mu Eq/hr/100 g body weight, respectively) when compared to Group C (69.6 mu Eq/hr/100 g body weight). Basal serum gastrin levels were significantly higher in Groups A and B (198.1 and 210.5 pg/ml, respectively) than in Group C (98.7 pg/ml). It was concluded from these results that cimetidine had a curative effect on chronic erosive gastritis induced experimentally by taurocholate. The inhibition of acid and gastrin secretion may play an important role in the mechanism of its action.

Preventive effect of cimetidine on chronic erosive gastritis induced by taurocholate in rats

We studied the preventive effect of cimetidine at the microscopic level on chronic erosive gastritis induced experimentally by 6-months of administration of drinking water containing 5 mmol/l of the sodium salt of taurocholic acid (TCA) in rats. The chronic erosive gastritis was characterized by mucosal erosions, reduction of mucosal thickness and reduction in the number of parietal cells per unit area, infiltration of inflammatory cells which were mainly lymphocytes and plasmocytes, and proliferation of collagenous fibers in the gastric mucosa. A standard meal including cimetidine 0.4 and 0.8%, which was administered ad libitum with TCA, reduced the total length of erosions, normalized the mucosal thickness and the number of parietal cells, and reduced inflammatory cell infiltration in the gastric mucosa. However, cimetidine did not show any effect on the proliferation of collagenous fibers in the interstitial space of the mucosa. The doses administered were 400 mg/kg/day and 800 mg/kg/day for 6 months. Cimetidine, thus, had a preventive effect on experimental chronic erosive gastritis in rats.

Positive indium-111 leukocyte imaging in post myocardial infarction syndrome

The diagnosis of post myocardial infarction syndrome (PMIS) is sometimes difficult because of the absence of a specific test. We report a 68-year-old man with PMIS who had a persistent accumulation of indium-111 oxine labeled leukocytes in the infarcted myocardium for 1 month. The uptake of leukocytes preceded the appearance of the main symptoms and disappeared with the clinical improvement after the therapy with steroids. Leukocyte imaging has a potential as a useful tool for early diagnosis, evaluation of therapy and assessing the mechanism of PMIS.

Further study of mucosal repair by sofalcone in experimental gastritis

The effect of sofalcone on the glandular structure and cell proliferation in the gastric mucosa of rats with gastritis induced by the administration of sodium taurocholate (TCA) for 6 months was examined by histoquantitative analysis and [3H]thymidine autoradiography. Morphometric observation revealed that, with TCA treatment, mucosal thickness, parietal cell mass, and the ratios of the length of the glandular portion/total length of the gastric gland were decreased in both the fundic and pyloric glands. Inflammatory cell infiltration and collagenous fiber proliferation were present in the gastric mucosa following TCA and indicated the presence of atrophic gastritis. These atrophic changes and inflammatory cell infiltration were reversed by a 3 week administration of sofalcone. Cellular proliferative activity assessed by the labeling indices of the gastric mucosa increased in TCA-induced gastritis in rats. The administration of sofalcone to rats with TCA-induced gastritis significantly increased labeling indices, particularly in the pyloric glands. From these results, it appears that sofalcone stimulates the compensatory increase in proliferative activity of generative cells, which then may become available to heal the gastritis.

Increased serum pepsinogen I and recurrence of duodenal ulcer

To determine whether the serum pepsinogen I (PG I) level would be a suitable marker for selecting patients at risk for duodenal ulcer recurrence and, thus, would benefit from maintenance therapy, we treated duodenal ulcer patients with H2-receptor antagonists. After healing 140 ulcer patients we assessed the recurrence rate at 1 year with and without maintenance therapy. The annual recurrence rates in duodenal ulcer patients with hyper-PGI (95 ng/ml or more), with 66 ng/ml less than or equal to PGI less than 95 ng/ml, and with PGI less than 66 ng/ml were 87.0%, 27.3%, and 17.9%, respectively, when they did not receive maintenance therapy. In patients with hyper-PGI the recurrence rate was significantly lower in patients receiving maintenance therapy than in patients not receiving maintenance therapy, whereas in patients with PGI less than 66 ng/ml the recurrence rate was as low as 20% regardless of maintenance therapy. These results indicate that maintenance therapy with half the dose of H2-receptor antagonist is not required by patients with PGI less than 66 ng/ml, whereas those with hyper-PGI may be good candidates for long-term maintenance therapy.

Inhibitory action of enprostil (4,5-dehydro-16-phenoxy-17,18,19,20-tetranor-PGE2) on tetra-gastrin stimulated acid secretion in human subjects

A double-blind study was conducted to examine the effect of enprostil on tetra-gastrin stimulated gastric acid secretion in twelve healthy male volunteers. Each subject underwent four tests in random order on separate days with oral doses of 15, 25, 35 micrograms enprostil and placebo. After measuring basal secretion and gastrin release, tetra-gastrin was injected intramuscularly. Gastric secretion and gastrin release were measured over the next two hours. Enprostil dose-dependently inhibited tetragastrin stimulated gastric secretion volume, acid and pepsin output. There were significant differences in gastric acid secretion inhibition between the 15 and 25 micrograms doses, and the 15 and 35 micrograms doses, but only a slight dose response was seen between the 25 and 35 micrograms doses with no significant difference. Serum gastrin level was not influenced by the administration of enprostil. No side effects attributed to enprostil were observed throughout the study.

Beta-endorphin-like immunoreactivity in normal mucosa, muscle layer, adenocarcinoma, and polyp of the colon

beta-Endorphin-like immunoreactivity was detected in the mucosa and muscle layer of normal colon, adenocarcinomas derived from the colon mucosa, and colon polyps which were histologically confirmed to be adenoma without a focus of carcinoma or with in situ carcinoma. The contents of beta-endorphin-like immunoreactivity in adenocarcinomatous tissue (11.94 +/- 1.77 pmol/g wet wt) and colon polyps without focus of carcinoma (10.71 +/- 1.50 pmol/g wet wt) were found to be significantly higher than those in the mucosal layer (6.86 +/- 0.64 pmol/g wet wt) and muscle layer (8.30 +/- 0.68 pmol/g wet wt) of normal colon. These data suggest that the production of beta-endorphin-like immunoreactivity is specifically increased in some adenocarcinomas and adenomatous polyps and may be related to the alteration of bowel habits. Gel exclusion chromatography of beta-endorphin-like immunoreactivity revealed three peaks corresponding to beta-endorphin, beta-lipotropin, and an immunoreactive form between the two. In the mucosal layer and muscle layer of the colon, a broad major peak was eluted at the position of beta-endorphin, and minor peaks were eluted at the position of beta-lipotropin and between beta-endorphin and beta-lipotropin. In adenocarcinoma and polyp, the peak size corresponding to authentic beta-lipotropin was greater than that of beta-endorphin. This study demonstrated that beta-endorphin-like immunoreactivity existed at a high concentration in some colon adenocarcinomas and polyps whose elution patterns were different from those of normal colon tissue.