Enzyme-linked immunosorbent assay (ELISA) for detecting antisperm antibodies in mice with testicular autoimmunity

We developed an ELISA for measuring antisperm antibodies in the mouse by using serum samples obtained from mice immunized with murine testicular antigens in complete Freund's adjuvant (CFA) as well as from mice rendered vasectomized. Sperm antigens used were syngeneic epididymal spermatozoa and two types of soluble, murine testicular antigens prepared in our laboratory. This study deals with a) the sequential changes of antisperm antibody levels following immunization; b) determination of immunoglobulin classes of these antibodies; c) a correlation between the absorbance values and the endpoint titers of antisperm antibodies; and d) comparison of endpoint titers of antisperm antibodies detected by ELISA with those by immunoperoxidase staining method in immune and nonimmune sera. It is suggested that serum dilution as high as 1/800 or more is required for detecting antibody titers of immune sera, because nonimmune mouse sera reveal a definite, although low, level of absorbance value at a serum dilution of 1/400 or less.

[Results of intra-arterial infusion chemotherapy of colorectal cancer in patients with metastatic liver cancer]

Fifty-nine colorectal cancer patients with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to February 1989 were reviewed. Excisions of metastatic liver cancer were performed in 36 patients and 23 had nonresectable metastatic liver cancer. Catheter troubles, including severe infection (8), extravasations (3), obstruction (1) and other problems (1) occurred in 13 (22.0%) patients, and 6 patients (10.2%) were unable to receive IAIC. Three patients did not undergo IAIC because of hepatitis or other reasons. Serious complications following IAIC, including sclerosing cholangitis (6), extravasations (6) and obstructions (3) were observed in 15 patients (30.0%). Results of IAIC were discussed in 21 patients undergoing hepatic resection and 17 patients with nonresectable metastatic liver cancer. 5-Fluorouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps every week or every two weeks. Total infused doses of 5-FU ranged from 500 to 15,000 mg (mean: 8,300 +/- 3,400 mg) and those of MMC were from 26 to 144 mg (mean: 58.8 +/- 32.7 mg) in 21 patients undergoing hepatic resections, whereas 1,500-26,250 mg (mean: 11,000 +/- 7,800 mg) of 5-FU and 0-130 mg of MMC (mean: 57.3 +/- 33.3) were infused in 17 patients with nonresectable liver cancer. Seven patients (33.3%) had recurrent liver cancer during 7-31 months (mean: 16.2 +/- 6.0 m) follow-up after hepatic resections, whilst only 3 of 13 patients (23.1%) with solitary liver metastasis had recurrent liver cancer. Three of these recurrent liver cancer patients (37.5%) underwent hepatic re-excision. Seven of 17 nonresectable patients (41.2%) were responders. Three patients completely responded (CR) and 4 responded partially (PR). Another study is needed to clarify the effect of IAIC in survival. IAIC should be undertaken as a treatment not only for patients with nonresectable metastatic liver cancer, but also for those with resectable metastatic liver cancer in order to prevent hepatic recurrence.

[Complications of intra-arterial infusion chemotherapy in patients with colorectal cancer with liver metastasis, with special reference to IA-5-FU induced sclerosing cholangitis]

Fifty-nine colorectal cancer patients with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to February 1989 were reviewed. Excisions of metastatic liver cancer were performed in 36 patients and 23 had nonresectable metastatic liver cancer. Catheter troubles, including severe infections (8), extravasations (3), obstruction (1) and other (1) occurred in 13 (22.0%) patients, and 6 patients (10.2%) were unable to receive IAIC. Three patients did not undergo IAIC because of hepatitis or other reasons. Serious complications following IAIC, including sclerosing cholangitis (SC) (6), extravasations (6) and obstructions (3) were observed in 15 patients (30.0%). 5-Flourouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps weekly or every two weeks. Total infused doses of 5-FU ranged from 7,000 to 26,250 mg (mean: 11,800 + 7,700 mg) and those of MMC from 24 to 84 mg (mean: 45.3 + 25.8 mg) in 6 patients (12%) with SC, 4 resectable and 2 non-resectable cases. All six patients with SC had cholangiographic abnormalities of the biliary tract by endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), but serial CT examination of the liver did not show any progression of the tumor at the hilum in these patients. Segmental stricture at the common hepatic duct and bifurcation appeared specific to IA-5-FU induced SC. Obstructive jaundice occurred in 3 patients. Four patients had epigastralgia and 3 exhibited elevated alkaline phosphatase level prior to the cholangiographic examination. The elevated level of alkaline phosphatase was reversible in one patient without obstructive jaundice. Although the relation of the sclerosing process to IA-5-FU dose is not yet clear as well as IA-FUDR, it should be important to make an early detection of SC by ERCP and also to discontinue IAIC as soon as possible. In our opinion, SC may relate to the arterial delivery of 5-FU. In order to prevent SC, devascularization of the right hepatic artery via surgical procedures may well be effective, because retrograde flow from the right hepatic artery was confirmed by several clinical and anatomical studies.

Preoperative ultrasonography screening for liver metastases of patients with colorectal cancer

The clinical value of preoperative ultrasonography in screening for synchronous liver metastases was prospectively evaluated in 338 patients with colorectal cancer. Synchronous liver metastases were observed at laparotomy in 11.5% (39/338) of the patients. The liver metastases had been found by preoperative ultrasonography in 30 patients and missed in nine. The overall accuracy rate, sensitivity and specificity, and the positive and negative predictive values of this modality were 0.970, 0.769, 0.997, 0.968 and 0.971, respectively. In detecting liver metastases, the results were superior to those of biochemical blood tests and measurements of carcinoembryonic antigen serum levels. The accuracy of the ultrasonography was also superior to that of these other tests combined. The results indicate ultrasonography to be an indispensable preoperative examination for patients with colorectal cancer.

Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection

Two hundred thirty two patients with rectal cancer at or below the peritoneal reflection, who underwent extended systematic lymphadenectomy, especially lateral node dissection, were reviewed with respect to survival rate, degree of surgical technique, and mode of recurrence. On the basis of the extent of lateral node spread, two types of lateral node dissection were performed, consisting of preservation of internal iliac vessels (conventional) and en bloc excision of these vessels (extended). The overall disease-free five-year survival rate was 69.4 percent in all patients--75.8 percent for those who underwent extended resection and 67.4 percent for those who underwent conventional resection an excellent survival rate of 49 percent of patients with lateral node metastasis was obtained. The analysis was carried out with regard to prognostic factors such as number of node metastases, obesity index, mode of recurrence, etc. We would recommend that systemic lymphadenectomy with lateral node dissection be performed for advanced rectal cancer at or below the peritoneal reflection.

[The value and limit of extended surgery in colorectal cancer]

Since the majority of colorectal cancers are well differentiated adenocarcinomas and grow rather slowly and well limited, surgery is the most available and favored treatment. The cancer-related 5-year survival rates of patients having undergone an extended operation versus those undergoing the conventional operation in our hospital (1969-1983) were 86% and 70% for Dukes B stage, and 60% and 38% for Dukes C stage. The survival superiority of the extended operation was confirmed as statistically significant (p less than 0.05). However, this survival advantage not true for patients with lateral lymphnode metastasis. A more extended operation with lateral dissection cutting the iliac internal vessels was performed for patients suspected of having lateral metastasis. Reduction of the incidence of local recurrence is really observed by this procedure. Urine-voiding and sexual dysfunction were observed more frequently in patients with the extended operation than the conventional one. By selectively preserving only 4th pelvic nerve, it becomes possible to preserve the urine voiding function without losing the benefits of the extended operation. In cases of far advanced cancer invading to adjacent organs, value of combined resection was also confirmed. Metastatic lesions to the liver or the lung should be removed by enucleation or partial resection of these organs, unless a multiple case. The 5-year survival of patients were 35% for liver metastasis and 40% for pulmonary metastasis.

Differential effect of cyclosporine in vivo on the distribution of T cell subsets in the thymus, spleen, and lymph nodes

Cyclosporine treatment of BALB/c mice (at a dose of 20 mg/kg every other day for 3 weeks) caused a remarkable reduction in the PNA-, L3T4+Lyt-2- subset of thymocytes. A significant reduction of the L3T4+Lyt-2-subset was also observed in both the lymph node and spleen cells of CsA-treated mice, though the degree of the reduction was lower than that in thymocytes. Both lymph node and spleen cells from CsA-treated mice showed a significant increase in the percentage of Thy-1.2 negative, L3T4-Lyt-2- cells (perhaps B cells). Thymocytes from CsA-treated mice showed a reduction in the in vitro proliferative responses to Con A and PHA. On the other hand, there was a slight, but not significant, decrease in the responses of lymph node cells to Con A, PHA and LPS. Spleen cells from CsA-treated mice showed a significant reduction in the responses to Con A and PHA, though the degree of the reduction was lower than that of thymocytes. There was a significant decrease in the proliferative response of spleen cells to LPS. These results suggest that CsA affects both thymus and spleen cells in vivo, preferentially impairing the L3T4+Lyt-2- subset (helper T cells or their precursors) within the thymus. The lymph node cells seem to be relatively spared from the in vivo effect of CsA compared with cells in the thymus and spleen.

An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy

Records of four hundred thirty-seven patients with lower and middle rectal cancer who underwent resection for cure at National Cancer Center Hospital from 1969 to 1983 were reviewed. There were significantly lower recurrence rates in the extended excision group compared with the conventional excision group. The recurrence rates between these two groups with Dukes' A were 0 percent (0 of 23) vs. 5.2 percent (5 of 96), those with Dukes' B were 6.3 percent (5 of 80) vs. 21.9 percent (14 of 64), Dukes' C were 23.6 percent (20 of 89) vs. 32.8 percent (28 of 85). The differences between the two groups with Dukes' B and C were statistically significant (P less than .05). The cumulative five-year survival rates in the extended excision group were 94 percent with Dukes' A stage, 88 percent with Dukes' B stage, and 61 percent with Dukes' C stage, compared with 91 percent (Dukes' A), 74 percent (Dukes' B), and 43 percent (Dukes' C) in the conventional excision group. There were also statistically significant differences between the two groups with Dukes' B and C stages (P less than .05). Although wide iliopelvic lymphadenectomy was successful as far as decreasing the incidence of local recurrence and also in prolonging survival, there were increased incidences of urine-voiding failure (loss of sense of bladder being full of urine detected in 39.4 percent of the extended excision group vs. 8.8 percent of the conventional excision group) and sexual impotency (76 percent vs. 37.5 percent).

En bloc excision of lower ureter and internal iliac vessels for locally advanced upper rectal and rectosigmoid cancer. Use of ileal segment for ureteral repair

Eight patients who received en bloc excision of the ureter and internal iliac vessels for locally advanced upper rectal and rectosigmoid cancer were reported. Indications, techniques, functional results of the ileal ureter, and prognosis of these patients are discussed. Although three patients died of recurrent tumor--one of transperitoneal spread and two of liver metastasis--none of them developed local recurrent growth. As a replacement for the resected ureter, ileal substitution was applied in all eight patients--unilateral in six patients and bilateral in two. Serum creatinine and electrolyte patterns were within the normal range in all patients. A voiding cystogram showed no reflux to the anastomosed ureter, and a mild reflux to the ileal segment. The patients had excellent prognoses with regard to local control and also satisfactory functional results with the ileal ureter. The authors recommend that this procedure be applied to patients with locally advanced cancer such as those in this series.

[Results of intra-arterial infusion chemotherapy in colorectal cancer patients with metastatic liver cancer]

Thirty-eight colorectal cancer patients (pts) with metastatic liver cancer who underwent intra-arterial infusion chemotherapy (IAIC) at the National Cancer Center Hospital from May 1986 to April 1988 were reviewed. Excisions of metastatic liver cancer were performed in 23 pts and 15 pts had nonresectable metastatic liver cancer. Catheter troubles including infections and obstructions occurred in 7 pts, and 4 pts (10.5%) were unable to receive IAIC. Fifteen resectable cases and 12 nonresectable cases were discussed. 5-Fluorouracil (5-FU) (700 mg/m2) and mitomycin C (MMC) (7 mg/m2) were infused through implantable pumps every week. Total infused doses of 5-FU and MMC were 0.5-12.2 g (mean, 5.3 +/- 3.8 g) and 4-144 mg (mean, 51.1 +/- 41.9 mg) in pts with 15 resectable cases, whereas 1.5-20.7 g (mean, 7.8 +/- 3.8 g) and 18-128 mg (mean, 49.7 +/- 29.2 mg) in 12 nonresectable cases. Four of 34 pts (11.8%) with IAIC had major complications; 2 obstructive jaundice, 1 gastric perforation, 1 toxic dermatitis. Four pts (26.7%) had recurrent liver cancer during 6-20 months follow-up after hepatic resection. Three of 12 nonresectable pts were responders (25.0%). Two completely and another partially responded. Another study is needed to clarify the effect of IAIC in survival. IAIC should be done not only for the treatment of nonresectable metastatic liver cancer, but also for resectable metastatic liver cancer in pts with colorectal advanced cancer.

Multidisciplinary treatment for resectable pancreatic cancer

Since November 1983, a multidisciplinary protocol for the treatment of pancreatic carcinoma has been used for eight patients at the National Cancer Center Hospital. This therapy includes an extended pancreatic resection, intra-operative irradiation with 3,000 rad of electrons using a microton, and an intra-operative hepatic arterial or portal infusion of mitomycin C, 10 mg. Furthermore, post-operative chemotherapy with mitomycin C (10 mg to 10 mg x 3) is added by Seldinger's method or intravenously (i.v.). The post-operative course was uneventful in all eight patients. Although the number of patients treated is small, the one-year survival rate was 86%. This rate is markedly better than the 28% after conventional radical pancreatectomy from 1962 to 1983. According to our experience, pancreatic carcinoma is unlikely to be cured by only radical operative procedures. A multidisciplinary treatment protocol as an adjunct to radical surgery appears necessary for a good prognosis of this disease.

Distinct antitumor mechanisms of recombinant murine interferon-gamma against two murine tumor models

The antitumor activity of recombinant murine interferon-gamma (rMuIFN-gamma) against B16 melanoma and EL4 thymoma, which display different sensitivities in in vitro tests, was studied. In antiproliferation tests, B16 cells were highly sensitive to rMuIFN-gamma and growth was markedly inhibited at as low as 10 U/ml, whereas EL4 cells resisted treatment even at concentration as high as 10(4) U/ml. One of these two tumors was inoculated i.d. into C57BL/6 mice and then rMuIFN-gamma (10(4) units) was repeatedly injected s.c. starting 1 day after the tumor inoculation. For the B16-bearing mice, tumor growth was markedly suppressed and the mean survival period was prolonged, but cured mice were not observed. For mice bearing EL4 cells, the therapeutic effects were more pronounced and cured mice were observed. The EL4-cured mice showed in vivo protective immunity against EL4 tumors but not against P815 tumors, indicating tumor specificity. Histologically, a large number of lymphocytes had infiltrated the necrotic tumor mass. These results indicated that rMuIFN-gamma may have not only a direct effect but also an indirect effect in host-mediated murine response on the growth of murine tumor cells under in vivo conditions.

Differential efficacies of recombinant murine interferon-gamma and recombinant human interleukin 2 against EL4-bearing mice

The effects of treating tumor-bearing mice with recombinant murine interferon-gamma (rMuIFN-gamma) and recombinant human interleukin-2 (rIL2) were compared using EL4 thymoma with the same mouse model. Successive administration of rMuIFN-gamma (10(4) units) starting 1 day after tumor inoculation was highly effective, while rIL2 (5 x 10(4) Jurkat units) starting 7 days later produced potent suppression of tumor growth leading to complete cure in about 50% of the mice treated with either of two agents. These results showed that the effectiveness of these lymphokines differed depending on the time of their administration. Furthermore, the therapeutic effect of rIL2 against tumor-bearing mouse was poorer in T-cell-deficient nude mice than in B6 mice and NK-cell-deficient beige mice, whereas the effect of rMuIFN-gamma was poorer in beige mice than in B6 and nude mice. These results suggest that the role of NK cells in the tumor regression caused by the treatment of rMuIFN-gamma is much more important than that of other activated lymphocytes, and that the antitumor activity of rIL2 may be due to the generation of T-cell-related lymphocytes. Our results reveal that combination therapy with rMuIFN-gamma and rIL2 can induce a synergistic effect on EL4-bearing mice.

[Significance of combination therapy involving aggressive resection and arterial infusion in hepatic metastasis from colo-rectal cancer]

During the past 13 years, 125 patients with liver metastasis from colorectal cancer underwent hepatic resection. Among these patients, 90 received potentially curative hepatectomy except for twelve patients who received curative hepatectomy combined with hepatic arterial infusion therapy and 23 patients who received non-curative surgery. The results of surgical treatment, and modes of recurrence following hepatectomy were studied in these 90 patients. The overall 5-year survival rate was 38.6%. Recurrent tumor developed in 59 patients, 42 being found in the remnant liver (47%), 15 in the lung (17%) and 8 at the primary site. The survival rate of the 43 patients who received systemic chemotherapy after hepatectomy was similar to that of the 24 patients who received no chemotherapy. According to this analysis, we have designed a chemotherapy protocol involving infusion through hepatic artery using on Infusaid port, to prevent regrowth in the remnant liver and pulmonary metastasis. In our program, MMC 10mg and 5-FU 750 to 1,000 mg/body were given through the Infusaid port, and HCFU 400 mg orally. Although the follow-up period has been short, no regrowth in the remnant liver has developed in 12 patients who received this treatment.

Neutralizing monoclonal antibodies against recombinant human interleukin-2

A series of hybridoma cell lines which produce monoclonal antibodies (MAbs) against recombinant human interleukin-2 (rIL-2) have been established by fusion of murine myeloma cell line P3-NS1-1-AG4-1 and spleen cells of BALB/c mice which had been immunized with rIL-2. 48 hybridoma strains were selected by a solid-phase screening method which produced MAbs reacting with IL-2: four MAbs, L-15, L-20, L-34, and L-61, exhibited strong inhibition of the proliferating effect of rIL-2 on IL-2-dependent cell lines, NK7 and CTLL-2. L-61, the most potent MAb among them, also neutralized natural human IL-2, while the other three MAbs were unreactive. All the four MAbs were specific to human IL-2: they did not cross-react with mouse or rat IL-2. These MAbs are expected to be useful tools in the investigation of IL-2 function.

[Recovery in aphasia (Part 3)--Study by multivariate analysis]

In order to elucidate the factors which have influence on the prognosis of aphasia, correlation between recovery rate of aphasia and the five factors, i.e. initial evaluation of speech test, age, educational level, time between onset and institution of therapy and size of abnormal findings in CT (computed tomography), was studied in 76 right-handed aphasic patients, using multivariate analysis. Cluster analysis and factor analysis were used for analysis of five factors and multiple regression analysis was used for estimation of recovery rate of aphasia. The method of calculation of recovery rate of aphasia is the same to our previous report. The results obtained were as follows: As to analysis of factors, first similarity group among initial evaluation of speech test, recovery rate of aphasia and educational level and second similarity group among time between onset and institution of therapy, size of abnormal findings in CT and age were observed. As to the estimation of recovery rate of aphasia, multiple correlation coefficient of regression analysis using five factors were 0.758, 0.444, 0.627, 0.620, 0.810 and 0.375 respectively in total score, hearing, speaking, reading, writing and calculation on standard language test of aphasia. As to the weight or partial correlation coefficient of regression analysis to the five factors, initial evaluation of speech test, time between onset and institution of therapy and educational level were 129.46, -49.93 and 45.65 respectively and the one of the size of abnormal findings in CT was not high. Stepwise multiple regression analysis of five factors were made.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pelvic exenteration in advanced and or recurrent rectal cancer]

Operative procedures of pelvic exenteration which were performed on a 54 yrs male patient with irradiated rectal cancer involving the prostatic gland, perineal skin and gluteal muscles were demonstrated by cinema. Perianal fistula formation and hard fibrotic adhesion between the distal rectum and the sacrum were also seen. As a result, combined resection of the perianal skin, gluteal muscles and distal sacral bone (fourth and fifth sacral and coccygeal vertebrae) was carried out. Fifty four total pelvic exenteration were performed at National Cancer Center Hospital from 1962 to 1985. The procedures were performed as a definitive treatment for the primary tumors in 35 cases (31 males and 4 females) which corresponds to 2.7% of operated primary rectal cancer at the same period and for the locally recurrent cancer in 19 cases (13 males and 6 females). By post operative histopathological examination 35 operations, 28 of 35 primary and 7 of 19 recurrent cases, were assessed as potentially curative. Hospital death rate was 13%; i.e. 7 cases (1 of 35 primary and 6 of 19 recurrent cases). Postoperative survival rates of the 54 patients were calculated by Kaplan-Meier's method. There were 17 survivors among 35 curatively operated patients and 5 yr survival rate was 34%. On the other hand, though 6 patients are surviving, there is no long term survivor (more than 35 months) among 21 patients who were treated by palliative resection.

[Immunohistochemical study of oncogene-related products in human gastrointestinal malignancies--expression of ras p 21, fes p 85 and EGF receptor]

An immunohistochemical examination by the avidin-biotin-peroxidase complex method was carried out to assess the expression of oncogene-related products, i.e., ras p 21 protein, fes p 85 protein and epidermal-growth-factor (EGF) receptors, in human gastrointestinal malignancies. The presence of ras p 21, fes p 85 and EGF receptors was detected in 48%, 62%, and 62% of 29 colorectal carcinomas and in 65%, 65% and 40% of 20 gastric cancers, respectively. More than one oncogene protein was demonstrated in 18 of 29 colorectal carcinomas and in 10 of 20 gastric cancers. These results suggest that multiple oncogenes are important in the occurrence and progress of gastrointestinal malignancies.

[Adjuvant chemotherapy of colorectal cancer--results of prospective randomized trials]

The group of research for colorectal cancer treatments-Kajitani-group (chief T. Kajitani) has carried out the co-operative study for the evaluation of adjuvant chemotherapy after curative resection of colorectal cancer. During the period 1975 and 1978, a series of 1,156 cases of cancer of colon and rectum were entered into the prospective randomized controlled study which consisted of three treatment programs. There included chemotherapy of 2 modes of regimen combining MMC with Tegaful and non adjuvant treatment as control. In colon cancer, adjuvant chemotherapy combining MMC with Tegaful was effective on the increasing of survival rates, especially significantly (p = 0.017) in the cases of Dukes B stage (85-88% vs 69.2% in survival rates of 8 year). In rectal cancer, systemic intravenous administration of MMC 4 mg, two times a week for immediately postoperative three weeks, combined with postoperatively prolonged oral administration of Tegaful 800 mg/day more than three months was also significantly effective, especially in the cases of Dukes C stage (52.3% vs 40% in survival rates of 8 year). However, the analysis of recurrence did not prove that the intra-operative local intra vessel administration of MMC 10 mg was useful for the prevention of liver metastasis in colon cancer or pelvic recurrence in rectal cancer respectively.