The effect of N-acetylneuraminic acid on the mucociliary transport impaired by cigarette smoke

Cigarette smoke exposure impaired the mucociliary transport on the tracheal mucosa of pigeons. N-acetylneuraminic acid (NANA), but not lactose, dose-dependently protected against the impairment of the mucociliary transport. The results suggest that NANA, a representative sialic acid existing on the airway epithelium, may participate the defence mechanism in the respiratory tract against irritant gases.

Preoperative hyperthermia combined with radiotherapy and chemotherapy for patients with incompletely resected carcinoma of the esophagus

Two hundred eighty-nine patients with squamous cell carcinoma of the esophagus underwent subtotal esophagectomy from December 1965 to June 1986. Resection of esophageal carcinoma was absolutely noncurative in 64 patients (20%) due to invasion to the surrounding structures. These 64 patients were subdivided as follows into three groups based on the type of preoperative treatment: Group I included 16 patients without preoperative treatment; Group II included 38 patients with preoperative radiotherapy combined with chemotherapy (average doses: radiation 37.3 Gy, 1-(2-tetrahydrofuryl)-5-fluorouracil [tegafur] 8.4 g); Group III included 10 patients who underwent preoperative hyperthermia (42 degrees C to 45 degrees C) combined with chemotherapy and radiotherapy (average doses: radiation 33 Gy, bleomycin 33.9 mg, or cis-diamine dichloroplatinum 75 mg, hyperthermia 6.2 times). There were no significant differences in terms of postoperative therapy among the three groups. The median survival times for patients in Groups I, II, and III were 6, 7.5 and 11 months, respectively. The 2-year survival rates for patients in Groups I, II, and III were 0, 15.6%, and 34.3%, respectively. The prognosis in Group III was superior to that for Group I (P less than 0.05) and Group II. These results suggest that preoperative hyperthermia combined with radiotherapy and chemotherapy could prolong survival even in patients who have had noncurative resection.

Heat, drugs, and radiation given in combination is palliative for unresectable esophageal cancer

From April 1966 to April 1986, 101 men and women with unresectable squamous cell carcinoma of the esophagus were treated in our clinic. Since 1983, 21 were treated with a combination of hyperthermia, chemotherapy, and radiotherapy (group I). Before 1983, for another 80 patients, radiation plus chemotherapy had been prescribed (group II). Nine of 21 patients in group I had an unresectable carcinoma due to an advanced tumor, 9 had an associated severe clinical status, and 3 refused surgery. Out of 80 in group II, 50 had a far advanced tumor, 21 had a poor clinical condition, and 9 refused operation. With regard to staging, for 21 in group I, 6 were classified as Stage I, 5 as Stage II, 7 as Stage III, and 3 as Stage IV. As to the 80 in group II, those in Stage I, II, III, and IV accounted for 8, 22, 39, and 11, respectively. The median doses of each modality, for patients in group I, were 6 times of hyperthermia at 42-45 degrees C for 30 minutes, 40 Gy of X ray and 30 mg of bleomycin. For patients in group II, a median dose of 56 Gy of X ray was given. Response rates determined by esophagograms and endoscopies for the patients in groups I and II were 76.2% (16/21; 4 CRs, 12 PRs) and 39.2% (31/79; 2 Crs, 29 PRs), respectively (p less than 0.001). The effective rates determined by improvement in quality of life (relief of pain and dysphagia) for groups I and II were 61.9% and 37.2%, respectively. A longer survival was obtained for patients in group I (median survival: 9 months vs 6 months). Especially for the patients classified as Stage I, a significantly longer survival was obtained with a combination of hyperthermia, chemotherapy, and radiotherapy (p less than 0.01).

20-Hydroxyecdysone accelerates the flow of cells into the G1 phase and the S phase in a male accessory gland of the mealworm pupa (Tenebrio molitor)

The cells of the bean-shaped accessory glands of mealworms proliferate through the first 7 days of the 9-day pupal stage. Immediately after larval-pupal ecdysis, 25-27% of the cells were in the G1 phase, 60-65% were in the G2 phase, and the balance were in S phase. Over the first 4 days of normal development, the S fraction gradually increased, to reach its highest level in the mid-pupa at the time of the major ecdysteroid peak (Delbecque et al., 1978). Thereafter, the S fraction declined until over 95% of the cells had accumulated in G2 on Day 8. When 0-day pupal glands were explanted into Landureau's S-20 medium for 6 days, the G1 fraction remained fairly constant (25-30%) while S and the G2 fractions fluctuated. On the first day in vitro, the G2 fraction declined and the S fraction rose. On the second day in basal media, the S fraction fell and G2 rose correspondingly until 70% of the cells reached G2 when cycling stopped on the third day. With addition of 20-hydroxyecdysone to 0-day cultures, the S fraction increased quite sharply. It remained large for all 6 days of the experiment in the continuing presence of hormone. A 1-day pulse of hormone produced a transient increase in S. We blocked cell cycling with hydroxyurea in a stathmokinetic experiment and showed that 20-hydroxyecdysone accelerated the flow of cells from the G2 phase to the G1 phase by 2.5-fold. An increase in the G1 fraction was detected within 10 hr of hormone administration and the effect was dose-dependent with an ED50 of 5 X 10(-7) M for 20-hydroxyecdysone. We conclude that 20-hydroxyecdysone acts at a control point in the G2 phase. Incubation of the glands with 20-hydroxyecdysone for only 30-60 min followed by washout stimulated the flow from G2 to G1 and the effect persisted after transfer of the tissues to hormone-free media. Dose-dependent stimulation also occurred with ponasterone A (ED50 3 X 10(-9] but not with cholesterol.

[Clinical studies on effect of cefbuperazone on surgical infections]

We conducted clinical studies on the efficacy and safety of cefbuperazone (CBPZ) on surgical infections with the following results. 1) In evaluable 32 patients, CBPZ was evaluated to be clinically effective in 23 (71.9%) and the efficacy rate was better in those who were administered 4 g/day of CBPZ (87.5%, 14/16) than in those who were given 2 g/day (57.1%, 8/14). 2) Antibacterial activity of CBPZ was evaluated in 41 isolated bacterial strains. Pathogen eradication rate by bacterial species was 75.6% (31/41). CBPZ exerted excellent antibacterial effects on Escherichia coli (100%, 8/8) and anaerobic bacteria such as Bacteroides (88.9%, 8/9). Resistant bacteria to CBPZ were Enterococcus faecalis and Pseudomonas aeruginosa. 3) No serious side effects were noted in any of the 34 patients who entered in this study. Abnormal laboratory test results were noted in 2 patients (5.9%) and they were transient elevation of transaminases and alkaline phosphatase. From the results shown above, CBPZ appears to be a highly useful antibiotic for the treatment of surgical infection.

Lethal effect of hyperthermochemoradiotherapy on cultured transformed cells

Hyperthermia alone had a lethal effect on V-79 cells. Temporary exposure to hyperthermia resulted in substantial decreases in cell growth, in a time (20-120 min)- and temperature (39-44 degrees C)-dependent manner. A precipitous fall in cell growth occurred when cells were incubated at temperatures between 42 and 43 degrees C. Concomitant application of hyperthermia, bleomycin and irradiation (hyperthermochemoradiotherapy) led to a maximal effect, compared with findings in cells treated with a single or two modalities, in vitro as well as in vivo and in clinical cases. To produce a similar situation of tumor cell growth in vivo, multicellular tumor spheroids (MTS) were developed by culturing tumor cells on soft agar. The effect of various treatments on the cells was then determined. Hyperthermia had a greater effect on the inner layer (hypoxic state) of MTS than on the outer layer, while radiotherapy was more effective on the outer layer (aerobic state). The synergistic effect of the combination with hyperthermia and irradiation was exhibited in all layers of MTS. Hyperthermochemoradiotherapy may prove to be an effective and safe form of adjuvant therapy for treating clinical carcinoma.

Two-stage operation for poor-risk patients with carcinoma of the esophagus

We have devised a two-stage operation for poor-risk patients with carcinoma of the thoracic esophagus. The first-stage operation consists of a right thoracotomy, subtotal esophagectomy, and lymph node dissection. Two to three weeks later, the second-stage operation of esophageal reconstruction with gastric tube is performed under laparotomy. During this 3-week period of no esophagus, the nutritional status can be adequately maintained by intravenous hyperalimentation. We describe herein the technique, postoperative complications, and mortality of our two-stage operation as compared with events during an ordinary one-stage operation for carcinoma of the thoracic esophagus.

8-Bromoguanosine 3':5'-cyclic monophosphate decreases intracellular free calcium concentrations in cultured vascular smooth muscle cells from rat aorta

The effects of 8-bromoguanosine 3':5'-cyclic monophosphate (8-Br cGMP) on intracellular free calcium concentrations ([Ca2+]i) in cultured rat aortic vascular smooth muscle cells (VSMCs) loaded with fura-2 were recorded microfluorometrically. Irrespective of whether VSMCs were at rest (in 5 mM K+ PSS), under Ca2+ depletion (in Ca2+-free medium for 10 min) and K+ depolarization (in high K+ PSS), [Ca2+]i was actively reduced and reached a new and lower steady-state level with the application of 8-Br cGMP. This may be the first and direct evidence that cGMP, a putative mediator of various vasodilators, actively reduces [Ca2+]i in VSMCs.

Secretomotor and mucolytic effects of mabuterol, a novel bronchodilator

Action of mabuterol, a novel bronchodilator, on the respiratory secretion system was investigated, and the following effects were confirmed: 1) increase of output volume, amounts of protein and pulmonary surfactant in respiratory fluid; 2) decrease of sputum viscosity; 3) fragmentation of the sputum structure and 4) promotion of the mucociliary transport of particles. The results in the present study may, at least partly, substantiate clinical efficacy such as improvement of pulmonary function, favourable effects on expectoration and amelioration of symptoms observed in patients with chronic obstructive pulmonary disease.

Survival rates of women with carcinoma of the esophagus exceed those of men

Postoperative complications, mortality and survival rates and nuclear deoxyribonucleic acid (DNA) content of cancer cells for 212 male and 47 female patients with carcinoma of the esophagus were studied. There were no differences in age, site and length of carcinoma, histologic type, invasion to the adventitia, metastases to the lymph node, staging and postoperative complications. However, survival time for female patients was significantly longer than in males. In studies of cell nuclear DNA content, the incidence of more favorable DNA type (relatively regular in DNA distribution) was relatively high while the incidence of the unfavorable DNA type (widely scattered DNA distribution) was relatively low in female patients when compared with male patients. These findings suggest that tumor factors warrant attention when studying the clinical differences in males and females with carcinoma of the esophagus.

Transnodal cancer chemotherapy for metastatic lymph nodes in rats

The antitumor effects of transnodal cancer chemotherapy were studied using rat models. After inoculation of AH-66 tumor cells into the iliac lymph nodes (target lymph node), emulsionized bleomycin (BLM emulsion) or BLM water solution was injected into an intact popliteal lymph node and chronological changes in BLM levels in the target lymph node were measured. In the target lymph node of the iliac lymph node, the level of BLM emulsion continuously was greater than 2 micrograms/g for 9 hours after the injection, while the level of BLM water solution decreased rapidly. The antitumor effects were quantitatively estimated in the tumor of the target lymph node. The ratio of necrotic area in the BLM-emulsion-treated group was significantly greater than that in the emulsion- or saline-treated groups. Survival rate in rats treated with BLM emulsion was significantly higher than that in control groups and was slightly higher than that in the group given BLM water solution iv. The concentration of BLM in the serum and lung in case of transnodal administration of BLM was much lower than that in rats given an iv administration of BLM water solution. These findings suggest that transnodal administration of BLM emulsion is an effective and safe treatment for metastatic lymph nodes, at least in rats.

Intra-epithelial carcinoma concomitant with esophageal squamous cell carcinoma

A review of 222 cases of squamous cell carcinoma of the esophagus revealed 67 (30.2%) with intra-epithelial carcinoma, contiguous with the main lesion. The incidences of such lesions were 10.9% and 68.0% in those given and not given preoperative irradiation, respectively. The 222 tumors were grouped into five categories, according to depth of invasion of the main lesion, those restricted to the mucosa, submucosa, proper muscular layer, and those invading the adventitia and neighboring structures. The rates of occurrence of intra-epithelial carcinoma were 87.5, 65.0, 26.9, 18.8, and 17.7%, respectively. Of the 67 with intra-epithelial carcinoma, the incidences of both proximal and distal location of such lesions were 85.7% in mucosal carcinoma, 84.6% in submucosal carcinoma, 71.4% in cancer restricted to the proper muscular layer, 50.0% in cancer invading the adventitia, and 9.1% in cancer invading the neighboring structures. Intra-epithelial carcinoma may thus originate from field carcinomatous transformation rather than from an intra-epithelial spread of the main lesions. These observations also support the concept of the field origin of carcinogenesis in the esophagus.

Adenosine decreases intracellular free calcium concentrations in cultured vascular smooth muscle cells from rat aorta

Using an intracellularly trapped dye, quin 2, effects of adenosine on intracellular free calcium concentrations ([Ca2+]i) were recorded, microfluorometrically, using rat aortic medial vascular smooth muscle cells (VSMCs) in primary culture. Regardless of whether cells were at rest (in 5 mM K+), at K+-depolarization (in 55 mM K+) or at Ca2+ depletion (in Ca2+-free media), adenosine induced a rapid reduction of [Ca2+]i, following which there was a gradual increase to pre-exposure levels, in cells at rest and in the case of Ca2+ depletion. Only when the cells were depolarized (55 mM K+) did adenosine induce a new steady [Ca2+]i level, lower than the pre-exposure value. These findings indicate that decrease in [Ca2+]i by adenosine is one possible mechanism involved in the adenosine-mediated vasodilatation, and that adenosine decreases [Ca2+]i by direct extrusion, by sequestration, or by inhibiting the influx of Ca2+ into VSMCs.

Effect of azelastine on the release and action of leukotriene C4 and D4

The effect of azelastine on the release of leukotriene C4 and D4 (LTC4 and LTD4), and the antagonistic action of the drug against the leukotrienes were determined by using in vitro tests and compared with those of ketotifen and chlorpheniramine. Azelastine inhibited LTC4 and LTD4 release from guinea pig lung fragments passively sensitized with homologous anti-ovalbumin IgGl-b antibody. The 50% inhibitory concentration (IC50) of azelastine was 6.4 X 10(-5) M for a 15-min preincubation or 4.7 X 10(-5) M for a 30-min preincubation. Ketotifen and chlorpheniramine were inhibitory only at the highest concentration tested (3 X 10(-4) M), giving inhibitions of 35.6 and 21.3%, respectively. Azelastine also inhibited calcium ionophore A23187-induced release of leukotrienes from human polymorphonuclear leukocytes; the IC50 values were 3.6 X 10(-5) M for 15 min and 2.3 X 10(-6) M for 30 min of preincubation. Ketotifen and chlorpheniramine were inhibitory only after a 30-min preincubation, with IC50 values of 2.1 X 10(-5) and 5.9 X 10(-5) M, respectively. The potent inhibition by azelastine might be partly a result of the inhibition of 5-lipoxygenase, since 5-hydroxyeicosatetraenoic acid formation in rat basophilic leukemia cell homogenate was inhibited by azelastine. Pretreatment of guinea pig ileum with azelastine antagonized LTC4- and LTD4-induced contraction of the ileum with IC50 values of 7.0 X 10(-6) and 1.1 X 10(-5) M, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Destruction of VX2 tumor in rabbits by hyperthermia plus bleomycin suspended in sesame oil

The combined antitumor effects of local hyperthermia and a simultaneous injection of bleomycin suspended in sesame oil (BLM-sesame oil) into the proper hepatic artery were studied in a model of liver cancer in rabbits. Fourteen days after inoculation of VX2 carcinoma into the left anterior lobe, 107 rabbits were used for the experiments. Local hyperthermia of 43-47 degrees C for 20 minutes was administered directly to the liver tumor via a 915 MHz microwave. In a preliminary study, administration of sesame oil alone into the proper hepatic artery led to a peripheral hepatic artery embolization, as evidenced by microangiography, and to the inhibition of tumor growth. The tumor-bearing rabbits were placed into groups of six. The first group was treated with hyperthermia, the second with a saline solution of bleomycin given intra-arterially, the third with a combination of hyperthermia and a saline solution of bleomycin given intra-arterially, the fourth with BLM-sesame oil given intra-arterially, the fifth with a combination of hyperthermia and sesame oil given intra-arterially, and the sixth with a combination of hyperthermia and BLM-sesame oil given intra-arterially. Consequently, the concomitant application of hyperthermia and intra-arterial injection of sesame oil led to a prominent inhibition of tumor growth, as compared with each modality alone (P less than 0.001). The most significant effect was obtained in the case of a combination of hyperthermia and BLM-sesame oil, as compared with a combination of hyperthermia and sesame oil (P less than 0.001). Local hyperthermia concurrent with the blockage of blood flow supplying the tumor led to a prominent inhibition of tumor growth, and addition of bleomycin to this regimen had an even greater antitumor effect. Thus, a combination of hyperthermia and chemoembolization with BLM-sesame oil is an effective treatment for liver cancer, at least in rabbits.

Combined effects of hyperthermia, bleomycin, and X rays on Ehrlich ascites tumor

The combined effects of water-bath hyperthermia at 42.5 degrees C for 30 min, 1/10 LD50 Bleomycin iv, and 200 rad x irradiation were studied in DDD strain male mice with Ehrlich ascites tumor. The objective was to acquire data on the optimum regimen for a combined administration of these three modalities. The treatments were given 10 days after the inoculation of 2 X 10(6) of the cells into the right hind limb. Concomitant application of the three modalities led to an 80% regression. A single modality produced no significant effect and a 30-50% regression occurred when only two modalities were combined. To assess the influence of timing and sequence, hyperthermia was applied at 1, 2, 4, and 6 hr before, after, or simultaneously with the combination of Bleomycin and 200 rad X ray. A significant effect was obtained in the case of concomitant application of the three and hyperthermia was effective when applied within 2 hr before or after administration of Bleomycin plus irradiation. This enhancement disappeared at 4-hr intervals.

[Effects of ambroxol on pulmonary surfactant--analysis of the fatty acid composition of phosphatidylcholine in the sputum and normal respiratory tract fluid in rabbits]

The mechanism of action of secretagogic expectorants (ex., ambroxol) has not been clarified. Recently, attention has been directed to the relationship of their action to pulmonary surfactants. In the present study, the fatty acid (FA) composition of phosphatidylcholine (PC), which is the main physiological surfactant, was investigated using sputum, respiratory tract fluid, mucin-like substance, lung washings and lung tissue of rabbits. Effects of ambroxol (20 mg/kg, i.s.) on several parameters such as output volume, FA contents of PC, protein content and viscosity of respiratory tract fluid of rabbits were also investigated. In respiratory tract fluid, lung washings and mucin-like substance of rabbits, saturated FA, especially C16:0, were predominant components of PC; while in sputum and lung tissue of rabbits and respiratory tract fluid of hens, unsaturated FA, especially C18:1 and C18:2, were more predominant components in comparison with those in the above specimens. Ambroxol significantly increased the contents of C16:0, saturated FA and total FA of PC, and it also increased protein content with an increase in the viscosity of respiratory tract fluid. These results suggest that in the respiratory tract fluid of rabbits, PCs are pulmonary surfactants, and the increasing secretion of pulmonary surfactant is likely to be involved in the expectorant action of ambroxol.

Histopathological evaluation of hyperthermo-chemo-radiotherapy for carcinoma of the esophagus

The effectiveness of preoperative hyperthermo-chemo-radiotherapy for 25 patients with carcinoma of the esophagus was histopathologically compared with findings in 104 patients treated preoperatively with irradiation only. The preoperative hyperthermo-chemo-radiotherapy increased the rate of "markedly effective" in the resected tissue, when compared with findings in cases of irradiation only. With regard to long survival rates, the 5-year survival rates of patients classed as "markedly effective" with preoperative combined therapy exceeded events in patients classed as "moderately effective," and "ineffective," with statistical significance. Preoperative hyperthermo-chemo-radiotherapy is the recommended treatment for patients with carcinoma of the esophagus.

Superficial spreading esophageal cancer controlled by hyperthermo-chemo-radiotherapy: a case report

Hyperthermo-chemo-radiotherapy (HCR) was prescribed for a patient with superficially spreading esophageal cancer, since severe lung dysfunction presented too great a surgical risk. Viable cancer cells completely disappeared after HCR and 8 months later, at this writing, the patient is living in good condition. Conservative treatment with HCR for patients with esophageal cancer is effective for carefully selected patients.

[Hyperthermia combined with chemotherapy and irradiation for esophageal carcinoma]

For clinical application in cases of carcinoma of the esophagus, we developed an endotract electrode ("applicator") for radiofrequency (RF) and an RF-generator (13.56 MHz) automatically controlled by a computer monitoring the temperature of the lesion. We then designed a combined therapy of hyperthermia, chemotherapy and radiotherapy (so-called hyperthermo-chemo-radiotherapy: HCR), on the basis of the additive or synergistic effects of hyperthermia combined with radiation and/or anticancer drugs. We applied this combined therapy to patients with esophageal carcinoma, using our newly developed heating system. HCR therapy was preoperatively performed on thirty-three patients with esophageal carcinoma. In the histopathological study of resected specimens, seven out of thirty-three patients (21.2%) showed markedly effective improvement, in seventeen (51.5%) the effects were moderately effective and in nine (27.3%) there were no apparent effects. The effectiveness (markedly + moderately effective/all cases) of preoperative HCR therapy was 72.7% (24/33), and significantly higher than the 50% (54/108) obtained in one hundred and eight patients who were preoperatively prescribed radiotherapy alone or in combination with chemotherapy. We then applied the combined therapy with hyperthermia to sixteen patients with unresectable esophageal carcinoma and eleven of these patients (68.8%) showed partial and moderate responses in esophagography. This combined therapy with hyperthermia is highly effective, and shows great promise for treating patients with esophageal carcinoma.

[Experimental study of hyperthermo-chemo-radiotherapy on transformed cells]

The combined effects of hyperthermia, chemotherapy with bleomycin and irradiation (hyperthermo-chemo-radiotherapy) on the growth of transformed cells, spontaneously established from Chinese hamster fibroblasts, were studied in vitro. Concomitant application of the 3 modalities with hyperthermia at 42 degrees C for 30 minutes, treatment with 0.02 microgram/ml of bleomycin for 60 minutes and 2-Gy irradiation led to the best effect with an 89% cytotoxicity, compared with those in cells treated with a single modality or 2 modalities. To determine the role of hyperthermia and irradiation in this enhanced cytotoxicity, the response of the cells to each modality was compared between hypoxic cells in the inner layer and aerobic cells in the outer layer of multicellular tumor spheroids. The hypoxic cells were very sensitive to hyperthermia and also the aerobic cells were very sensitive to irradiation, which appeared to be one of the mechanisms for the enhanced effects obtained with these 2 modalities.

Preoperative irradiation for carcinoma of the esophagus

Preoperative irradiation for carcinoma of the esophagus is tentatively recommended in many, but not all, institutes. For precise appraisal of the effect of preoperative irradiation for carcinoma of the esophagus, the effects of preoperative irradiation, as related to mortality and the long term results, were evaluated in 167 patients who underwent subtotal esophagectomy. Although postoperative pulmonary complications occurred at a higher rate in patients given irradiation preoperatively, the mortality was much the same in irradiation and nonirradiation groups. In 15 (14.4 per cent) of 104 patients given radiation therapy preoperatively, no viable cancer cells were present in the resected tissues and the five year survival rate of these patients was 45.1 per cent. Thus, when the cancer cells are completely damaged, the survival time is extremely enhanced. The findings of our study suggest that the aim of preoperative irradiation should be a complete destruction of the cancer cells.

Prognostic factors of esophageal carcinoma: univariate and multivariate analyses

The correlation of 5-year survival rate with various clinical and histopathological factors was studied using univariate and multiple analyses of 128 patients who had undergone resection for esophageal carcinoma between 1965 and 1978 in the Department of Surgery, Kyushu University Hospital. The depth of penetration, lymph node metastasis, lymphatic or vascular invasion, and INF had a significant correlation with 5-year survival in the univariate analysis; however, only depth of penetration and lymph node metastasis were prognostic factors with a significant difference, in the multivariate analysis. In 55 patients in whom the cell nuclear DNA content had been determined, the DNA pattern was the greatest prognostic factor (p less than 0.01), in multivariate analysis. We propose that the DNA distribution in the malignant cells should be examined as a most pertinent prognostic factor.

[Experimental study on the treatment of metastatic lymph nodes with local hyperthermia and temperature-sensitive liposomes containing bleomycin]

The therapeutic effects of combined treatment with hyperthermia (HT) and temperature-sensitive liposomes (TSL) containing Bleomycin (BLM) were evaluated in metastatic lymph nodes of AH-66 ascites tumor in rats. As a model for metastatic lymph nodes, 4 X 10(6) cells of AH-66 were inoculated into the right popliteal lymph nodes of rats. Seven days after inoculation, when the tumor in popliteal lymph nodes was approximately 8 mm in diameter, TSL-BLM was injected subcutaneously into the right foot pad, and local hyperthermia at 43 degrees C was applied for 20 minutes. The most obvious suppression of tumor growth and excellent survival rate were obtained in rats which received both TSL-BLM and HT, compared with groups receiving HT or TSL-BLM alone. These findings suggest that the combination of TSL-BLM and HT provides an effective cancer chemotherapy for patients with metastatic lymph nodes.

Radiation-induced esophageal carcinoma responded well to hyperthermic chemotherapy--a case report

A 66-year-old man with multiple malignant lesions of the esophagus, as apparently induced by irradiation of 60 Gy of 60Co for a mediastinal tumor at the age of 36 y.o., was a poor operative risk because of severe lung disease. This man was treated with a combination of hyperthermia, oral administration of oil Bleomycin-polyacrylate paste and intravenous infusion of cis-Platinum. During 20 administrations of hyperthermia conducted at 42-45 degrees C for 30 min, 600 mg of oil Bleomycin and 200 mg of cis-Platinum, no complications occurred and the heat treatments were completed with no side effects. Repeatedly performed esophagogram and endoscopy showed a complete disappearance of three of the four lesions and a marked regression in the other one. There has been no regrowth or distant spread of the carcinoma up to the present 10 months of follow up. This combination of hyperthermia and chemotherapy may prove to be the optimal strategy for treatment of unresectable esophageal cancer, particularly when radiotherapy is contraindicated.

Surgical treatment of concurrent cancer of the esophagus and stomach

Out of a total of 250 resections for carcinoma of the esophagus done in our department between 1965 and 1983, there were 11 patients with a concurrent esophageal cancer, nine being gastric cancer and seven of them early gastric cancer. In these nine, four underwent resection of the esophagus and lesser curvature of the stomach with gastric tube reconstruction. Two of the four patients are alive 10 and 3 yr postoperatively. We hold the view that detailed preoperative gastric examination is most important to plan the surgical repair and that the small gastric tube may serve as a substitute by resecting the lesser curvature of the stomach in cases of early proximal gastric cancer.

Synergistic effect of K-18 and concomitant hyperthermia for treatment of Lewis lung carcinoma in mice

We investigated the synergistic anti-tumor effects of K-18 (conjugate of human gamma-globulin and melphalan) and concomitantly administered hyperthermia on Lewis lung carcinoma in mice. The antitumor effect of a subeffective dose of K-18 or an equivalent dose of melphalan alone was enhanced by local hyperthermia. K-18 administration demonstrated a greater potentiation for inhibition of tumor growth than that of melphalan alone. Local hyperthermia plus K-18 reduced the dose of melphalan required for tumor growth inhibition by melphalan alone. The combined application of K-18 and hyperthermia for treating cancer warrants further study.

Preoperative hyperthermo-chemo-radiotherapy effective for carcinoma of the esophagus

We prescribed hyperthermo-chemo-radiotherapy preoperatively for 13 patients with esophageal carcinoma. Viable cancer cells disappeared in four out of 13 patients, and all of these four patients survive without recurrence 3 to 34 postoperative months, at this writing. In another seven out of the 13, cancer cells were extensively damaged, despite the presence of a small number of viable cancer cells, and three out of these seven died with a recurrence. For two, the treatment was ineffective, and they died of liver metastasis and a local recurrence, respectively. These findings suggest that preoperative hyperthermia combined with chemotherapy and radiation is highly effective for treatment of carcinoma of the esophagus.

Induction of enterokinase in the rat small intestine following hypersecretion of trypsinogen by chronic trypsin inhibitor feeding

The interrelationship between trypsin/trypsinogen and enterokinase (EK) was studied in rats following induction of trypsinogen hypersecretion by various agents. Both soybean trypsin inhibitor and para-aminobenzamidine increased intraluminal tryptic activities to a level about twice that found in the control rats. This resulted in an increase in the mucosal and the intraluminal contents of EK in the rat small intestine. On the other hand, in cholecystokinin-treated rats, although there was an increase of intraluminal trypsin, the increase was about 80% less than in the inhibitor-fed rats. Under this condition, there was no effect on the mucosal or the intraluminal EK. These results suggested that substantial increase in intraluminal trypsin/trypsinogen levels (two-fold over control) will increase the mucosal and the intraluminal concentrations of EK in the rat small intestine. Our observation extends previous reports that a decreased level of trypsin/trypsinogen, such as in pancreatic insufficiency, leads to a decrease in mucosal EK. These observations, when taken together, strongly support the modulating role of intraluminal trypsin/trypsinogen levels in controlling the EK concentrations in the small intestine.

Breath hydrogen test in infants and children with blind loop syndrome

Breath hydrogen production after oral lactose loading was examined in infants and children with stagnant loop syndrome, blind loop syndrome, or both. All six infants under 3 years of age had bacteriological evidence of small intestinal colonization. The characteristics of the breath hydrogen test in this syndrome are: (a) extremely high basal excretion of breath hydrogen (after overnight fasting); (b) an earlier and greater breath hydrogen value (0.293 +/- 0.201 ml/min/m2: mean +/- SD) after oral lactose administration than formed in lactose malabsorption alone (0.050 +/- 0.041 ml/min/m2); and (c) the observation of a sustained hydrogen rise over several hours. This investigation demonstrated that the breath hydrogen test is a promising and noninvasive tool for diagnosing blind (or stagnant) loop syndrome.

Total parenteral nutrition with a new amino acid solution for infants

The currently available, commercially prepared amino acid mixtures for intravenous usage do not result in completely normal plasma amino acid patterns. Taking into consideration the known imbalances that occur with the commercial preparations, we designed a new amino acid solution (AF). This solution was prepared to contain a low concentration of those amino acids usually found in increased concentrations in plasma during the course of total parenteral nutrition (TPN) with a commercially prepared product (CF) and a high concentration of branched-chain amino acids and arginine. Plasma amino acid concentrations were determined for nine infants receiving CF (Group A) and eight infants receiving AF (Group B) as the protein source while on TPN for 5 days. These data were compared to 2-h postprandial values obtained from breast-fed, growing infants serving as controls. In comparison with controls, the plasma concentrations of threonine, glycine, methionine, phenylalanine, tryptophan, and lysine were higher in infants in group A, while those of taurine, alanine, valine, cystine, isoleucine, and proline were lower. In group B, the levels of valine and leucine were slightly higher, while those of alanine, cystine, tyrosine, histidine, and proline were lower. Mean nitrogen balances in groups A and B were + 112 and + 170 mg/kg/day, respectively. Therefore, our new amino acid solution may be better for infants receiving TPN.

Patterns of recurrence after curative resection for carcinoma of the thoracic part of the esophagus

Two hundred patients with a previously untreated carcinoma of the thoracic portion of the esophagus and who underwent curative or noncurative resection were retrospectively evaluated. The patterns of recurrence were compared with the pathologic findings at operation. In 30 of 90 (33.3 per cent) patients in the curative resection group and 68 of 110 (61.8 per cent) of those in the noncurative resection group, there was a recurrence. Hematogenic recurrence was most frequent in instances of blood vessel invasion of the carcinoma detected at the time of the operation, and death occurred during the early postoperative period. Lymph node recurrence was most frequent in instances of lymphatic invasion or blood vessel invasion, or both, and the postoperative survival time in such patients was double that seen in those with a hematogenic-related recurrence.

Endotract antenna for application of hyperthermia to malignant lesions

As hyperthermia treatment for deeply located malignant lesions is most difficult, two types of endotract antenna were devised, one constructed for radio frequency and the other for administration of microwave to tumors of the esophagus and colorectum. Well-controlled temperatures can be applied to the narrowed pyloric canal of dogs with these two instruments, which appear to have great promise for clinical application.

Delayed anastomosis of the cervical portion of the esophagus in bypass operations for unresectable carcinoma of the esophagus

To prevent the high incidence of anastomotic leakage in a bypass operation for unresectable carcinoma of the esophagus, we devised a two stage bypass procedure, in which the anastomosis of the cervical portion of the esophagus to the gastric tube is delayed for about two weeks after the first operation. With this approach, the short segment of the cervical part of the esophagus adequately adheres to the surrounding tissue by the time of the second operation, and the anastomotic site no longer responds to the strong force accompanying deglutition. One-half of the anastomotic leaks which occurred on the one stage procedure was reduced to nil when the two stage approach was done.

Hyperthermo-chemo-radiotherapy for carcinoma of the esophagus

Hyperthermo-chemo-radiotherapy was prescribed preoperatively for eight patients with carcinoma of the esophagus. Histological study of the resected specimens showed marked effect in two, moderate effect in four and slight effect in two. In those with marked effect, there were no viable neoplastic cells, and severe necrosis and complete destruction were evident on the mucosal surface. These two patients have had no recurrence, now at 27th and 31st postoperative months. Those findings suggest that hyperthermo-chemo-radiotherapy is effective for selected patients with carcinoma of the esophagus.

Cough dynamics in oesophageal cancer: prevention of postoperative pulmonary complications

The value of the cough reflex and its pressure and flow in the immediate postoperative period was measured in patients who underwent subtotal oesophagectomy and reconstruction for oesophageal cancer and other thoracic surgery. Twenty-two patients with subtotal oesophagectomy and reconstruction were found to have an extensive reduction in cough reflex and force, compared with those who had undergone pulmonary lobectomy. Damage to the vagal nerve caused by dissection of the paratracheal lymph nodes, and injury to the diaphragm during operation for oesophageal cancer appeared to be responsible for the inability to cough. It was of interest that the patients who showed a high value of cough reflex and force in the immediate postoperative period had few pulmonary complications. The postoperative measurement of cough ability may be a useful indicator for safe extubation of the intratracheal tube, as a means of preventing pulmonary complications after thoracic surgery. Continuous mechanical ventilation and frequent suction to remove retained secretions are strongly recommended for the patients who are unable to cough properly.

Problems in esophageal bypass for unresectable carcinoma of the thoracic esophagus

The clinical evaluation of esophageal reconstruction in both resectable and unresectable carcinoma of the thoracic esophagus is described. Our operative technique for obtaining a long gastric tube and creating and end-to-side anastomosis has been highly successful, and the anastomotic failure rate was remarkably lowered in patients with resectable carcinoma of the esophagus. However, anastomotic leakage remains a serious problem for those undergoing esophageal bypass for unresectable carcinoma of the esophagus. The most likely cause of anastomotic failure after bypass seems to be the tug on the anastomosis with each swallow.

Postoperative long-term immunochemotherapy for esophageal carcinoma. 5 year survival

Two groups of patients with esophageal carcinoma were studied retrospectively: Group I as controls, included 50 patients who underwent esophageal resection mainly combined with preoperative radiation therapy during the period from 1965 to 1971; and Group 2 included 83 patients who were given the same treatment plus post-operative radiation and adjuvant postoperative long-term cancer immunochemotherapy during the period from 1972-1979. The one, two and five-year survival rates were 32.0, 14.0 and 12.0 per cent in Group 1, and 55.4, 35.8 and 21.5 per cent in Group 2 respectively. There were significant differences in one-year (p less than 0.02) and two-year (p less than 0.05) survival rates between the two groups. We also found that adjuvant therapy was effective in patients with no lymph node metastasis, while it was less effective in those with lymph node metastases.

Clinical efficacy of the stapled anastomosis in esophageal reconstruction

We have clinically evaluated Russian and American stapling devices used for esophageal reconstruction and compared the results following stapled anastomosis with those following hand-sutured procedures, both performed by the same surgeon. With the Russian stapler, anastomoses performed in 17 patients with carcinoma of the thoracic esophagus resulted in only one (5.9%) anastomotic leak; in 12 hand-sutured anastomoses and in 11 anastomoses done with an American stapler, no anastomotic complication occurred. Thus, a long gastric tube with good blood supply is of paramount importance, and if the technical details of surgical stapling can be overcome, a stapled anastomosis appears to be as safe as a manual suturing for patients undergoing esophageal reconstruction.

Failure of p-aminobenzoic acid screening test to diagnose pancreatic insufficiency in Shwachman's syndrome

The 6-h urine recovery of p-aminobenzoic acid (PABA) following the administration of a standard dose of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTPABA) was performed in 13 control subjects and two siblings with Shwachman's syndrome. The control subjects showed a recovery of 67 +/- 12.1% (mean +/- 1 SD) of the administered dose, consistent with previously reported values. Unexpectedly, the recovery of PABA in two siblings with Shwachman's syndrome was found to be 67 and 63%, respectively. The values are well within the normal range. In these siblings, fecal chymotrypsin activities were very low when measured with N-acetyl-L-tyrosyl-ethyl ester (ATEE) as substrate, but were normal when BTPABA was the substrate. The duodenal juice of the younger affected child following pancreozymin-secretin stimulation showed very low chymotrypsin activity against ATEE, BTPABA, and N-benzoyl-L-tyrosyl-ethyl ester. These findings suggest that there may be BTPABA-splitting activity in the lower bowel of these siblings with Shwachman's syndrome. This activity might be that of enteric bacteria or of the intestinal mucosa.