Tumor necrosis factor-alpha stimulates the production of squamous cell carcinoma antigen in normal squamous cells

Squamous cell carcinoma (SCC) antigen, a tumor marker of squamous cell carcinoma, is also increased in several nonmalignant skin lesions, e.g. pemphigus. The aim of the present investigation was to determine if tumor necrosis factor-alpha (TNF-alpha), one of the important environmental factors, stimulated the production of SCC antigen in the normal squamous cells. The exposure of normal human epidermal keratinocytes to TNF-alpha (100 IU/ml) for 72 h greatly increased the SCC antigen production. The stimulatory effect of TNF-alpha (1,000 IU/ml) on the production of SCC antigen was also observed in the normal squamous epithelium tissue. These results would be helpful for understanding the increase of SCC antigen in several nonmalignant skin disorders.

Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps

BACKGROUND

Monopolar hot biopsy forceps (HBF), bipolar HBF, and cold biopsy forceps (CBF) followed by bipolar electrocoagulation are used clinically to simultaneously perform a biopsy and coagulate diminutive colon polyps and angiomata. Our purpose was to conduct a randomized, controlled study to evaluate the safety of these different techniques in the canine right colon.

METHODS

After right colotomy in 8 mongrel dogs, colonic mucosa was grasped en face, tented, and biopsy performed in randomized order. The dogs were sacrificed after nine days and the biopsy sites were identified and histologically examined.

RESULTS

Monopolar HBF caused an overall mean rate of acute serosal whitening of 29% compared with 0% for bipolar HBF and CBF and 6% for CBF/bipolar probe. Histologically confirmed transmural injury 9 days after biopsy occurred in 44% of monopolar HBF compared with 5% of bipolar HBF, 0% of CBF, and 50% of CBF/bipolar probe.

CONCLUSIONS

Monopolar HBF had significantly higher rates of acute serosal whitening and histologic transmural damage than bipolar HBF or cold biopsy alone. On the basis of these results, monopolar HBF should be avoided for coagulation of small or flat right colon lesions such as diminutive polyps or angiomata.

Elevated levels of syndecan-1 expression confer potent serum-dependent growth in human 293T cells

Syndecan-1 is the best studied integral membrane proteoglycan and functions to modulate epithelial cell attachment and physiology. Extracellularly, syndecan-1 binds both growth factors and extracellular matrix components, and intracellularly, its cytoplasmic portion interacts with cytoskeletal components. To investigate the possible role of syndecan-1 in epithelial cell transformation that is characterized by alteration in extracellular matrix interactions and cytoskeleton architecture, we established stable transfectants of syndecan-1 in a highly transformed human renal epithelial line expressing two viral oncogenes, adenovirus E1a and SV40 large T antigen (293T cell line). Expression of syndecan-1 core protein and appropriate posttranslational attachment of glycosaminoglycan chains was confirmed by enzymatic digestion and Western blot analysis. Overexpresser cells grew at a significantly faster rate than the vector-transfected control cells in serum-rich media but showed a proliferative disadvantage in serum-reduced media. In addition to this serum dependency, syndecan-1 overexpression caused a partial reversal of the transformed phenotype with the expressing clones becoming more anchorage dependent and less motile than the vector-transfected counterparts. Surprisingly, the overexpressers were more tumorigenic when injected s.c. into nude mice. These results indicate that syndecan-1 expression plays a role in the control of cell proliferation and suggest that serum-dependent growth may be the more reflective of tumorigenicity in nude mice.

Multilevel cervical spondylosis. Laminoplasty versus anterior decompression

Poor overall outcome and a high incidence of postoperative kyphosis and progressive myelopathy have driven surgeons away from decompressive laminectomy as a treatment for multilevel cervical spondylosis. Dr. Henry Bohlman advocates anterior decompression and fusion as the best approach to the pathophysiology of this disorder, while Dr. Kiyoshi Hirabayashi believes that laminoplasty represents an excellent strategy for patients with degenerative disease, as well as those with ossification of the posterior longitudinal ligament.

[A 86-year-old woman with dementia, gait and speech disturbance, and right hemiparesis]

We report a 86-year-old woman who developed dementia, gait disturbance, speech disturbance, and right hemiparesis. The patient was well until March of 1979 when upon wakening up on one morning she noted slurring of her speech and weakness in her left upper and lower extremities. These symptoms cleared up during the next several months, however, she noted weakness in her left leg again in May 1985. In 1988, her posture became stooped and she walked in small steps. In 1990, she developed memory disturbance and difficulty in naming. In March 1993, she developed weakness in her right hand; she was treated with aspirin and amantadine HCl, however, she deteriorated during the next two week period, and was admitted to our hospital on March 27, 1993. On admission, she appeared alert, however, she could not answer verbally to questions; she could only utter unintelligible sounds. Apparently she was markedly demented. Her blood pressure was 170/98 mmHg, and general physical examination was unremarkable. Cranial nerves were grossly normal except for marked non-fluency in her word expression. She could not stand or walk, and apparently her right upper and lower extremities were paralyzed with some contracture. Deep reflexes were normally active without asymmetry. Chaddock sign was positive bilaterally. Sensory examination was difficult. Pertinent laboratory examination included WBC 13,000/microliters, BUN 152mg/dl, creatinine 3.75mg/dl, CRP 20.1mg/dl; a chest X-ray film revealed pneumonic shadow in the upper and the middle right lung fields. Cranial CT scan revealed multiple lacunar infarctions in both basal ganglia and cerebral white matters; periventricular lucency was also noted. She was treated with antibiotics and intravenous fluid. Acid-fast bacilli were recovered from sputum, and she was transferred to another hospital for the treatment of pulmonary tuberculosis. After its treatment she returned to our hospital on July 8, 1993, when her condition was complicated with aspiration pneumonia. On admission, she was semicomatose, and no intelligible words were heard. Right facial paresis of the central type was noted. She was unable to stand or walk, and her right upper and lower extremities were paretic. Deep reflexes were increased with extensor toe sign on the right. She was treated with chemotherapy and intravenous fluid, however, her clinical course was complicated with respiratory as well as urinary tract infections. She developed cardiac as well as renal failure and expired on September 25, 1993.(ABSTRACT TRUNCATED AT 400 WORDS)

Methylmalonic acidemia: brain lesions in a case of vitamin B12 non-responsive (mut0) type

Neuropathological findings were described in a 9-day-old female infant who died of the vitamin B12 non-responsive (mut0) type of methylmalonic acidemia (MMA). Widespread karyorhectic fragments of varying size and shape were noted throughout the brain, in particular densely accumulated in the cerebellar granular layers and the layer IV of the striate cortex. Bilateral or symmetrical necrotic foci were observed in various regions of the grey matter: Sommer's sector of the hippocampus, basal ganglia, thalamus, hypothalamus and brainstem. In the cerebral cortex small spongy necrotic foci were scattered mainly in the depths of gyri. Alzheimer type II astrocytes appeared in the preserved zone of the caudate nucleus. Myelinated nerve fibers in the brainstem were spongy or vacuolated, whereas peripheral myelin sheaths of cranial nerves were intact. Multiple hemorrhagic foci were noted in the cerebellum, predominantly the granular layers. The lymphoid tissue in the spleen and the thymus was hypoplastic. It may be difficult to explain exactly the mechanisms of the pathological changes observed here on routine light microscopy; the outcome of systemic ischemia/hypoxia before death cannot be completely ignored. But, it is suggested that widespread karyorhexis may occur selectively in specific cells (or cell groups), including immature neurons and other cellular components (glial and/or mesenchymal cells) among the patients with the mut0 type of MMA.

Free-space optical interconnections with liquid-crystal microprism arrays

Liquid-crystal microprism arrays are shown to be useful for providing electrically controlled alignment of optical beams and fixed various free-space optical interconnections. They can deflect closely spaced micro-optical beams individually to any position with high transmittance (95%), high deflection angle (~10°), and low voltage (<2.8 V(rms)). Various fixed optical interconnections can be made simply by changes in the voltages applied to the microprism.

Chronic effect of oral mexiletine administration on left ventricular contractility in patients with congestive heart failure: a study based on mitral regurgitant flow velocity measured by continuous-wave Doppler echocardiography

The long-term effect of mexiletine on left ventricular (LV) contractility in patients with congestive heart failure is not clear. The authors therefore measured LV contractility before and after continuous oral administration of mexiletine in patients with congestive heart failure accompanied by mitral regurgitation (MR) using Doppler echocardiography. The study population consisted of 8 patients with congestive heart failure (6 due to dilated cardiomyopathy and 2 due to old myocardial infarction) accompanied by significant functional MR who had more than 1000 ventricular premature contractions (VPCs) per day or Class IV Lown classification arrhythmias before mexiletine administration. The LV contractility was evaluated by calculating a Doppler-derived index, the rate of increase in LV pressure during the isovolumic contraction time (ICT delta P/delta t), which has been confirmed to be nearly equal to LV Max dP/dt. The increase in LV pressure (delta P) between 1 and 3 m/sec of the MR flow velocity as measured by continuous-wave Doppler echocardiography was calculated using the simplified Bernoulli's equation, and ICT delta P/delta t was derived by dividing delta P by the time required for this change. The left ventricular ejection fraction and the left ventricular and left atrial dimensions also were measured by echocardiography. These parameters were obtained before and after 2 to 4 weeks of daily oral administration of mexiletine 300 mg. Values of ICT delta P/delta t were 640 +/- 202 mm Hg/sec and 650 +/- 210 mm Hg/sec before and after mexiletine administration, respectively, showing no change.(ABSTRACT TRUNCATED AT 250 WORDS)

DNA rearrangements in Japanese facioscapulohumeral muscular dystrophy patients: clinical correlations

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant muscular disorder in which the disease locus has been mapped to chromosome 4q35-qter. In most patients, the DNA rearrangements associated with FSHD have been found in the EcoRI fragment detected by the p13E-11 probe, and deletions of the 3.2 kb repeat units within the fragment are thought to cause the disease. To examine FSHD-associated DNA rearrangements in the Japanese population, we performed Southern blot analysis of the genomic DNA, using the p13E-11 and pFR-1 probes, in 158 Japanese individuals, including 38 FSHD patients from 19 families. We found that all but one (a possible affected recombinant) of the Japanese FSHD patients (97.4%) had specific smaller (< 28 kb) EcoRI fragments which cosegregated with the disease; this included four patients who had severe inflammatory changes in the muscle and eight patients with de novo DNA rearrangements. We found no FSHD patient who had a fragment larger than 28 kb. By contrast, only two of 35 Japanese controls (5.7%) had EcoRI fragments smaller than 28 kb. Our patients showed anticipation, i.e. decreased size of the EcoRI fragment in parallel with earlier onset of the disease (r = 0.531, P = 0.003, with younger age at onset in children (17.8 +/- 7.0) than their affected parents (31.5 +/- 14.8) (P = 0.019). However, since each family had a specific small EcoRI fragment associated with the disease, the differing clinical severity within a family cannot be explained by the size of the fragment alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Linkage of Miyoshi myopathy (distal autosomal recessive muscular dystrophy) locus to chromosome 2p12-14

Miyoshi myopathy (MM) is a young-adult-onset, autosomal recessive distal muscular dystrophy initially affecting the plantar flexors. We analyzed 12 MM families, five with consanguineous marriage, for chromosomal linkage using polymorphic microsatellite DNA markers to map the MM gene. A significant lod score was obtained with the 2p12-14 locus D2S291 (Zmax = 15.3 at theta = 0). Two additional 2p12-14 markers, D2S286 (Z = 10.7 at theta = 0) and D2S292 (Z = 7.2 at theta = 0.05), also gave significant lod scores. These markers will be useful for diagnosis of symptomatic and presymptomatic patients, prenatal and carrier diagnosis of family members carrying MM, and ultimately identification of a gene responsible for MM.

[Latent impairment of left ventricular filling in hypertension without left ventricular hypertrophy and improvement by dipyridamole treatment: pulsed Doppler echocardiography study]

Left ventricular (LV) filling impairment in patients with hypertension (HT) not necessarily associated with LV hypertrophy has not been sufficiently investigated. Therefore, we examined the response of LV filling to isometric exercise in patients with HT without LV hypertrophy and LV filling abnormality at rest. We studied 25 patients (aged 40 to 66 years, mean 51 +/- 7 years) and 13 age-matched normal subjects. The HT patients were selected by the following criteria: 1) systolic blood pressure (sBP) over 160 mmHg and/or diastolic BP over 90 mmHg was observed at least three times during the last 6 months, 2) LV wall thickness was under 11 mm, and 3) the ratio of peak atrial LV inflow velocity (A) to peak early diastolic LV inflow velocity (E) was within the mean +/- SD of normal subjects. LV inflow was measured by pulsed Doppler flowmetry before and during handgrip exercise (50% maximal effort for one minute and a half) in the patients before [HT-D (-)] and after [HT-D (+)] dipyridamole (D) administration (0.28 mg/kg/4 min) and in the normal subjects (N). Doppler-derived indices were A, E, A/E, DR (the deceleration rate from peak to half of the early diastolic inflow velocity), % delta A/E (% change in A/E from baseline), and % delta DR (% change in DR from baseline). There was no significant difference in LV wall thickness between the HT and N groups. There was also no significant difference in A/E at rest between the three groups. Increase of sBP and heart rate were similar in all groups during handgrip exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Variable optical delay line based on a birefringent planar optical platform

A variable optical delay line is proposed for accurately adjusting optical signal timing in photonic systems. This delay line is based on a birefringent planar optical platform characterized by the multiple reflection of light beams. It consists of a birefringent plate, lambda/4 plates, mirrors, and a liquid-crystal layer. It can select an arbitrary delay from a set of discrete delays precisely determined by the thickness of the birefringent plate. A feasibility study confirms seven-step delay line operation with a 240-ps unit delay.

Estimation of the possible scale for holographic switches with liquid-crystal displays

Simulating the positions of output beams under the assumption that a liquid-crystal display acts as a binary phase modulator reveals that the number of the outputs increases almost linearly with the square root of the number of pixels assigned to an input. This result is confirmed by experiments, and it is estimated that 1016 outputs can be obtained when the number of pixels is 700 × 700. Holographic switches with liquid-crystal displays are therefore suitable for large-scale switches.

Randomized, controlled study of various agents for endoscopic injection sclerotherapy of bleeding canine gastric varices

The purpose of this study was to compare the relative efficacy and technical ease of use of eight different agents for endoscopic hemostasis and obliteration of bleeding gastric varices in a canine model, as no comparative data are available on gastric variceal sclerotherapy. Large bleeding gastric varices in 20 heparinized dogs were randomized to endoscopic injection treatment with one of the following agents: cyanoacrylate; a 1:1:1 mixture of sodium tetradecyl sulfate 3%, ethanol 98%, and normal saline solution; ethanolamine oleate 5%; sodium morrhuate 5%; sodium tetradecyl sulfate 1.5%; polidocanol 1%; normal saline solution with epinephrine 1:10,000; or normal saline solution (control). The number and volume of injections and the time required to achieve complete hemostasis were evaluated; follow-up endoscopy was performed at 1 month to assess gastric variceal obliteration. Cyanoacrylate was the best agent overall in terms of immediate efficacy, low volume requirement, time required for initial hemostasis, and reduction of gastric variceal size. Cyanoacrylate, tetradecyl sulfate, and polidocanol were the most effective agents for reducing gastric variceal size. Epinephrine was effective for controlling induced or secondary bleeding caused by puncture of the gastric varices with the sclerotherapy needle during intravariceal injections. Ongoing studies are evaluating combinations of agents with different mechanisms of action, such as epinephrine (for vasoconstriction to minimize secondary bleeding) plus alcohol, and/or tetradecyl sulfate (for variceal thrombosis and sclerosis).(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized, prospective study of cyanoacrylate injection, sclerotherapy, or rubber band ligation for endoscopic hemostasis of bleeding canine gastric varices

The purpose of this randomized, nonblinded study was to compare the effectiveness, safety, and technical ease of three different endoscopic techniques for the treatment of bleeding gastric varices in a canine model. Twenty dogs with large, bleeding gastric varices underwent endoscopic hemostasis with rubber band ligation, sclerotherapy, and cyanoacrylate injection. The time and number of attempts required to achieve definitive hemostasis were evaluated for each technique, and each method was assessed for ease of use. Ulceration rates, ulcer size and depth, and stigmata of ulcer hemorrhage were assessed at 1 week. Intravariceal sclerotherapy was the fastest and easiest to perform. Rubber band ligation was intermediate in technical ease, but it caused the largest and deepest ulcers and had the highest rates of stigmata of ulcer hemorrhage and secondary bleeding. Cyanoacrylate injection was the most cumbersome endoscopic method to perform. All three treatments were effective for controlling gastric variceal bleeding. Intravariceal sclerotherapy had the most favorable results overall because of its technical ease, efficacy, and modest complication rates.

Realignment of postoperative cervical kyphosis in children by vertebral remodeling

STUDY DESIGN

This study analyzed radiographically change in the sagittal curvature of the cervical spine after atlantoaxial (C1-C2) posterior fusion in children.

OBJECTIVES

This study clarified the process of spinal remodeling after postoperative cervical deformation in children.

SUMMARY OF BACKGROUND DATA

Postoperative spinal deformations in children are observed frequently. However, there have been only a few reports on postoperative changes in the sagittal curvature of the cervical spine and spinal remodeling after those changes.

METHODS

Between 1979 and 1991, there was a total of 12 children who underwent C1-C2 posterior fusions. The average age at the time of surgery was 9.8 years. The alignment of the cervical spine was classified into four groups (lordosis, straight, kyphosis, and swan-neck deformity). Radiographic findings suggestive of the remodeling were as follows: 1) new bone formation on the anterior vertebral cortex, and 2) increase in body/canal ratio (BCR). The follow-up period averaged 6.2 years.

RESULTS

Postoperative cervical malalignment (kyphosis or swan-neck deformity) occurred in four patients. In all four patients, new bone formation and increase in BCR at the apex of kyphosis were observed. Therefore, there was gradual improvement of the malalignment by vertebral remodeling. This phenomenon was not observed in eight patients with normal alignment.

CONCLUSION

Realignment of postoperative cervical kyphosis by vertebral remodeling was observed in children. The results of this study suggested that remodeling occurred even in the spine, which was similar to the remodeling in long bones.

[Phase II clinical study of RP56976 (docetaxel) in patients with carcinoma ovarii or carcinoma colli uteri]

An early phase II clinical study of RP56976 (docetaxel), a new semisynthetic agent, in patients with carcinoma ovarii or carcinoma colli uteri was undertaken by a cooperative study group of 23 institutes. Docetaxel was administered at an initial intravenous dose of 60 mg/m2 with dose-free intervals of 3-4 weeks, and its efficacy and safety were evaluated. Of the 47 patients with carcinoma ovarii enrolled, 44 patients were eligible and 36 patients completed the scheduled course of treatment. Of the 23 patients with carcinoma colli uteri enrolled, 20 patients were eligible and 15 patients completed the scheduled course of treatment. For antitumor efficacy in patients with carcinoma ovarii, 1 patient showed partial response (PR), 10 showed no changes (NC) (2 showed minor response (MR)), and 25 had progressive disease (PD). The overall response rate was 2.8% (1/36). Of patients with carcinoma colli uteri, 7 patients showed no changes (NC) (1 patient showed minor response (MR)), 8 patients had progressive disease (PD). Major adverse reactions included 64/65 (98.5%) leukopenia, 56/59 (94.9%) neutropenia, 40/60 (61.5%) decrease of hemoglobin, 12/64 (18.8%) thrombocytopenia, 30/65 (46.2%) anorexia, 23/65 (35.4%) nausea/vomiting, 37/65 (56.9%) alopecia, and 26/65 (40.0%) fatigue, all of which were mild.

An acidic polysaccharide with immunological activities from the root of Paeonia lactiflora

An acidic polysaccharide, called peonan PA, was isolated from the root of Paeonia lactiflora PALLAS. It was homogeneous on electrophoresis and gel chromatography, and its molecular mass was estimated to be 6.0 x 10(4). Peonan PA is composed of L-arabinose: D-galactose: D-galacturonic acid in the molar ratio of 2:1:10, in addition to small amounts of O-acetyl groups and peptide moieties. About forty percent of the hexuronic acid residues in peonan PA exist as methyl esters. Reduction of carboxyl groups, methylation analysis, lithium degradation and nuclear magnetic resonance studies indicated that its main structural features involve both alpha-1,5-linked L-arabino-beta-3,6-branched D-galactan type and alpha-1,4-linked D-galacturonan type structural units. The polysaccharide exhibited remarkable reticuloendothelial system-potentiating activity in a carbon clearance test and considerable anti-complementary activity.

The core structure of ginsenan PA, a phagocytosis-activating polysaccharide from the root of Panax ginseng

Controlled Smith degradation and limited hydrolysis of ginsenan PA, the main phagocytosis-activating polysaccharide isolated from the root of Panax ginseng C. A. Meyer, were performed. The reticuloendothelial system-potentiating and anti-complementary activities of the degradation products were investigated. Methylation analysis of the primary and secondary Smith degradation products indicated that the core structural features of ginsenan PA include a backbone chain mainly composed of beta-1,3-linked D-galactose. Almost half of the galactose units in the backbone carry side-chains composed of beta-1,6-linked D-galactosyl residues at position 6. Further 3,6-branching of D-galactose units was observed in a part of the side-chains. alpha-L-Arabinose units are connected mainly to the core galactose moieties via position 6. Removal of most of the arabinose units had a considerable effect on immunological activity.

Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids

Internal hemorrhoids are the most common cause of lower gastrointestinal bleeding. Although new anoscopic therapies are available, few comparative randomized studies have evaluated them in regard to long-term efficacy, recurrence rates, and safety. Our purpose was to compare the treatment of internal hemorrhoids with direct current (Ultroid, Cabot Medical, Langhorn, Pa.) and bipolar (BICAP, Circon ACMI, Stamford, Conn.) hemorrhoid probes. One hundred patients with symptomatic internal hemorrhoids were randomized: 50 to direct current electrocoagulation and 50 to bipolar electrocoagulation. Follow-up and treatment were at 3- to 4-weekly intervals; two to three hemorrhoid segments were treated at each session until relief of symptoms (bleeding, prolapse, and discharge) and a reduction in hemorrhoid size to grade 1 or 0 were noted. The hemorrhoids of 98% of all patients studied were grade 2 or 3; 2% of patients had grade 1 hemorrhoids and none had grade 4 hemorrhoids. At 1 year after treatment, most patients had no (69%) or only mild (23%) recurrence, and a few had severe, symptomatic (8%) hemorrhoid recurrence. A greater recurrence rate was noted after direct current treatment (34%) than bipolar treatment (29%). In contrast, rebleeding at 1 year occurred less frequently after direct current treatment (5%) than after bipolar treatment (20%). Our conclusions were as follows: (1) Both direct current and bipolar probes were effective for control of chronic bleeding from grade 1 to 3 internal hemorrhoids. (2) Bipolar probe was significantly faster than direct current probe. (3) Direct current treatment produced fewer complications than bipolar treatment (12% versus 14%). (4) Recurrence rates were low after 1 year with either device (8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy

Follow-up at an average time of 7.8 years postoperatively on open-door expansive laminoplasty (EL) was carried out to determine the long-term results of surgery. Thirty-three patients had ossification of the posterior longitudinal ligament and 18 had cervical spondylotic myelopathy. The average age at operation was 54.7 years. Japanese Orthopaedic Association scores and recovery rates increased during the 3 years after surgery and then plateaued. Radiographically, average spinal canal diameter remained enlarged past 5 years' follow-up. Factors leading to worsening of clinical symptoms included age greater than 60 years (4 patients), loss of sagittal canal diameter (2 patients), progression of ossification (4 patients), and minor trauma (1 patient). Postoperative motor paresis due to C5 and C6 root damage recovered to 4 (manual muscle testing) in all patients within 6 years. The conclusion is that open-door EL is safe and leads to good results that are maintained for over 5 years.

[Ovarian cancer]

Primary aggressive cyto-reduction followed by adjuvant chemotherapy has so far been the standard treatment modality for advanced ovarian cancer. However, as cisplatin-containing regimens have been shown to generate high efficacy rates, a new modality involving extirpation of the tumor after chemotherapy, rather than surgery as the first treatment, has become available for patients with stage III or IV ovarian cancer in whom tumor cells may remain after surgery. In our examination of 56 cases, higher efficacy rates, higher tumor-debulking rates, lower frequency of extended surgery and longer median survival time were obtained with preoperative chemotherapy in comparison with postoperative chemotherapy. These results were almost equivalent to those shown in the recent reports on preoperative chemotherapy for ovarian cancer: the efficacy rates have exceeded 80% against ovarian cancers except for mucinous adenocarcinoma and clear cell adenocarcinoma (70% of all ovarian cancers). In addition, preoperative chemotherapy has an advantage over postoperative chemotherapy in that the higher debulking rate may result in an improved quality of life. Moreover, the preoperative chemotherapy per se can be the best sensitivity testing, since chemotherapeutic effects can be determined during the following surgery. However, a large randomized trial is needed to definitely confirm the higher efficacy of preoperative chemotherapy over postoperative chemotherapy. Thus, it is considered that intensive induction chemotherapy followed by aggressive cyto-reduction can produce optimal cyto-reduction, which seems to offer a good prognosis. Thus, it should be the standard treatment modality for advanced ovarian cancer.