Trends of survival in neuroblastoma and independent risk factors for survival at a single institution

To assess the progress of survival in neuroblastoma which varies with many risk factors and to evaluate the influence of these factors on survival as independent risk factors. The study subjects were 159 neuroblastoma patients seen from 1965-1994 at the oldest and largest children's hospital in Japan. Trends of survival in three treatment eras-1965-81, 1982-86, 1987-94-were assessed by the Kaplan-Meier method for different sex, age at diagnosis, the clinical stage, the site of onset, and the histological type. Then the influence on survival of these factors as independent prognostic variables was evaluated by the Cox proportional hazards regression analysis. Age at diagnosis, the clinical stage, the site of onset, the histological type, and the treatment era were independent risk factors in the order of their influence on survival. Unfavorable survival outcomes were obtained for patients with age at diagnosis above 1 year, the clinical stage of VI by the Evans classification, adrenal onset, and neuroblastoma rather than ganglioneuroblastoma. Survival improved from the first to the second and from the second to the third treatment era. Improvement of survival in neuroblastoma took place during the past 3 decades. Age at diagnosis, the clinical stage, and the histological type have still remained overwhelming prognostic factors over the progress in treatment.

Improved protocol for an oxygen electrode method for determining hydrogen peroxide in foods

An oxygen electrode method for determining residual hydrogen peroxide in foods has been further improved. Pretreatment, which includes extraction and neutralization, is done in a hydrogen peroxide extraction apparatus with nitrogen gas bubbling. The hydrogen peroxide concentration of the sample is corrected by subtracting the sample blank value, obtained for the sample through catalase treatment. Bubbling with nitrogen gas effectively minimized the sample blank value, making this method suitable for accurate determination of trace amounts of hydrogen peroxide in foods. Recoveries of hydrogen peroxide added at 1-10 micrograms/g were 77.8-107.1% by the present method. These recoveries are similar to or higher than those by the Japanese standard method and by another modified oxygen electrode method. Concentrations of naturally occurring hydrogen peroxide in solid foods were < 0.87 microgram/g by the present method, lower than those by either the standard method or another modified oxygen electrode method.

Pentaerythritol tetranicotinate (niceritrol) decreases plasma lipoprotein(a) levels

We determined the most effective dosage of pentaerythritol tetranicotinate (niceritrol) to reduce plasma lipoprotein(a) [Lp(a)] levels in 44 Japanese patients (16 men and 28 women; mean age, 59.2 +/- 10.8 years) with hyperlipidemia types IIa, IIb, and IV. Patients received oral niceritrol at a dosage of 750 mg (3 tablets)/d for 8 weeks, followed by 1,500 mg (6 tablets)/d for 8 weeks. Administration of niceritrol 750 mg/d for 8 weeks decreased total and low-density lipoprotein (LDL) cholesterol in patients with type IIa hyperlipidemia and decreased triglycerides in patients with type IV hyperlipidemia, but did not affect Lp(a). However, niceritrol 1,500 mg/d for 8 weeks decreased Lp(a) in patients with initial Lp(a) levels greater than 30 mg/dL in addition to decreasing total and LDL cholesterol and triglycerides. These results suggest that the effective dosage of niceritrol to reduce the serum Lp(a) concentration in Japanese hyperlipidemic patients with a high Lp(a) level (> or = 30 mg/dL) is greater than 1,500 mg/d.

[Organ preservation in the treatment of malignant solid tumors in children]

Organ preservation is one of the requirements for maintaining the high quality of life after the treatment of malignant solid tumors in children. We analyze our recent results of renal preservation in the abdominal neuroblastoma and describe 3 cases of successful organ preservation in pelvic malignancy. Between 1982 and 1996, 29 patients with adrenal or retroperitoneal neuroblastoma, that extended into the surrounding tissues and organs and/or to the contralateral side, underwent delayed primary excision. Before 1982, 9 patients were treated and only one ipsilateral kidney was preserved. On the other hand, 13 of 20 kidneys were preserved after 1987. Adoption of cis-platinum deepened our awareness of preserving the kidney. Furthermore, we have altered our strategy since 1987 to continuing preoperative chemotherapy until the size of the tumor becomes as small as it is estimated completely resectable by our own index, which is derived from computed tomography. Kidneys are shielded during intraoperative irradiation, and the tumor relapsed from the shielded area of retroperitoneum in one patient. Four of 14 preserved kidneys became atrophic and lost their function. The bladder and the rectum were left intact at tumor resection after intensive chemotherapy in two patients with pelvic (one retroperitoneal and one vaginal) rhabdomyosarcoma. A yolk sac tumor of the vagina responded completely to chemotherapy with cis-platinum, etoposide and bleomycin. The patient has survived 7.5 years without any local and distant relapse in spite of the fact that surgery, aside from several diagnostic biopsies, was not undertaken.

Clinical application of minimal residual neuroblastoma cell detection by reverse transcriptase-polymerase chain reaction

The highly sensitive method to detect neuroblastoma (NB) cells using reverse transcriptase polymerase chain reaction (RT-PCR) was applied in the practical clinics, and its efficacy was assessed in the present study. Human tyrosine hydroxylase (TH), a rate-limiting enzyme in the catecholamine biosynthesis, was used as the marker for NB cells, and the expression of THmRNA was examined in 13 samples (four peripheral blood and nine bone marrow) harvested from seven patients (four with stage IV, one with stage III, two with stage II) using RT-PCR with our original primers. The positive signals for NB cells were detected in four samples (one peripheral blood and three bone marrow) by the PCR method, but were undetectable by the conventional histological examinations. In the present series, a case that showed a positive signal for NB cells in the peripheral blood showed a remarkably unfavorable clinical course, indicating that the circulating NB cells detected by the PCR method can be a sign of the progressively advanced NB, and may define a new prognostic factor suggesting higher risk. In another case, the PCR detection for the residual NB cells in the bone marrow provided important supporting evidence to determine the necessity of the additional chemotherapy and the suitable timing for bone marrow transplantation. This detection also guaranteed the safety of the bone marrow for transplantation. The PCR method was considered to be very beneficial in the selected cases. However, some problems such as the false-negative results in the negative urinary vanillylmandelic acid secretor were also highlighted in the present study.

[Diagnostic imaging of renal pedicle injury]

We reviewed the radiological findings of 8 patients with renal pedicle injury admitted to our emergency center from January 1986 through September 1995 and compared them with the previously reported findings. The patients included 3 with renal artery occlusion and 5 with avulsion or disruption of renal pedicle vasculature. Extended retroperitoneal hematoma such as contralateral pararenal or central parahilar hematoma was visualized in all 5 cases with avulsion or disruption of renal pedicle vasculature. Although lack of contrast enhancement of injured renal parenchyma is a hall-mark of renal pedicle injury, three cases did not demonstrate this typical finding. In these three cases, one showed partial and the others showed total enhancement of the injured renal parenchyma on contrast enhanced CT. Partial enhancement in one case was found to represent total occlusion of the main renal artery and an intact accessory polar branch on angiography. The other two cases showed total enhancement of the renal parenchyma, with renal vein perforation done and complete disruption of the main renal artery and vein in the other. The latter findings were thought to be due to the maintenance of vascular flow surrounded by hematoma. In conclusion, when central parahilar hematoma is identified, the possibility of renal pedicle injury should be considered even if the renal parenchyma is well enhanced.

Japanese Biliary Atresia Registry, 1989 to 1994

The Japanese Biliary Atresia Society founded in 1980 for the aim of investigations of all aspects of biliary atresia (BA), started a nationwide registry of BA patients in 1989. A total of 626 cases were registered from 1989 to 1994. The male to female ratio was 0.58. Corrective surgery was performed in 603 patients. Regarding the type of obstruction, 63 cases were Type I, atresia of the common bile duct, 9 were Type II, atresia of the hepatic ducts, and 543 were Type III, atresia of the porta hepatis. As initial corrective procedures, original Roux-en Y, Suruga II and Roux-en Y with intestinal valve were mainly employed. Jaundice cleared in 346 patients (57%) and decreased in 131, while it persisted in 120. The 5-year-follow-up showed that 34 patients, 49% of the patients who were followed up, were alive without jaundice, while 28 (41%) are dead. Thirty five, 33% of the patients who were entered to the Registry, were lost to follow-up.

[A case of malignant esophageal stenosis with esophagobronchial fistula treated with a covered wallstent]

A polyurethane-covered Wallstent was used for a esophagus cancer patient with malignant esophageal stenosis associated with esophagobronchial fistula. Stent placement was successfully performed with no procedure related-complications. Following the procedure the patient could eat a normal diet. The insertion of a polyurethane-covered Wallstent is a safe and effective treatment for malignant esophageal stenosis with esophagobronchial fistula.

Effect of morphine on secretion of amylase from isolated parotid acini

The effect of morphine on amylase secretion was studied in isolated rat parotid acinar cells. It was found that aluminum fluoride (AlCl3/NaF) and dibutyryl-cyclic AMP but not by cyclic AMP, enhanced amylase secretion. Cyclic AMP was effective in enhancing secretion following permeabilization of cells with alpha-toxin. Following treatment of cells with alpha-toxin, both GTP and GTP-gamma-S also enhanced secretion. Morphine reduced AlCl3/NaF- or GTP-induced secretion of amylase, but was without effect on GTP-gamma-S-induced secretion. Photoaffinity labeling by the use of [32P] 4-azidoanilido GTP revealed its incorporation into 43 kDa and 31 kDa proteins. Incorporation was further enhanced with AlCl3/NaF. Morphine reduced labeling of the 43 kDa protein. Immunoblot analysis identified the 43 kDa GTP binding protein as Gs. When [gamma 32P] GTP was preloaded into permeabilized acinar cells and its hydrolysis measured, morphine stimulated and AlCl3/NaF inhibited GTPase activity. These results suggested the involvement of Gs in secretion of amylase. Furthermore, morphine reduced secretion of amylase by stimulating GTPase activity and by reducing the incorporation of GTP into Gs.

Cone ERGs to flash trains: the antagonism of a later flash

The human cone electroretinogram (ERG) to flash trains and double flashes at different interflash intervals was studied. A double ganzfeld stimulator was used in which computer controlled flashes were presented independently in the presence of strong rod saturating backgrounds. Corneal ERGs were examined at different frequencies of flash train presentations. Flash trains with individual flashes of high frequency (100 Hz) simulate a cone ERG to light pulses of long duration by producing a corneal positive off-response (d-wave) time locked to the cessation of the train. A second flash can reduce and delay the cone b-wave produced by a first flash. This effect is maximal when the second flash occurs 10-12 msec later. There is an antagonistic mechanism in the cone system of the retina which can catch and reduce the cone b-wave produced by an earlier flash.

[Portal hypertension after successful hepatic portoenterostomy in biliary atresia]

Sixty percent of 139 patients with biliary atresia who underwent hepatic portoenterostomy (Kasai operation) from 1965 to 1994 became jaundice-free after the operation. Portal hypertension, which was confirmed by endoscopic observation of esophageal varices and/or thrombocytopenia (less than 100 x 10(3)/mm3), developed in 50% of unicteric long-term survivors. Esophageal varix was found initially between 11 months and 5 years of age in more than 70% of these portal hypertensive patients. On the contrary, thrombocytopenia developed at 6 years or older age in 63% of the patients. The incidence of portal hypertension was significantly lower in the patients whose serum bilirubin decreased less than 2mg/dl at 3 months after surgery than in the patients whose bilirubin stayed over 2mg/dl at the same postoperative time. Furthermore, re-do operation related significantly to the incidence of portal hypertension in jaundice-disappeared patients. Prophylactic endoscopic injection sclerotherapy and/or variceal ligation were sufficiently effective in the management of esophageal varices. Partial splenic embolization as well as splenectomy seems to be a treatment of choice for hypersplenism.

cDNA cloning and functional analysis of the p97 subunit of the 26S proteasome, a polypeptide identical to the type-1 tumor-necrosis-factor-receptor-associated protein-2/55.11

Molecular cloning of cDNA for a new regulatory subunit, designated p97, of the human 26S proteasome showed that the polypeptide consists of 908 amino acid residues with a calculated molecular mass of 100184 Da and an isoelectric point of 4.94. Computer analysis showed that p97 is very similar to type-1 tumor-necrosis-factor (TNF)-receptor-associated protein (TRAP)-2 and 55.11, both of which were identified recently as binding proteins of the cytoplasmic domain of type-1 TNF receptor by yeast two-hybrid screening. This finding suggests that the 26S proteasome might serve as a mediator molecule in the TNF signaling pathway in cells. Computer-assisted similarity analysis also revealed the high sequence similarity of p97 with a yeast protein whose function is yet unknown, the gene for which is here termed NAS1 (non-ATPase subunit 1). Disruption of NAS1 resulted in several phenotypes, including lethality and temperature-sensitive growth, depending on the genetic background of the cells used. The human p97 cDNA suppressed the growth defect of nas1 disruptant cells, when expressed from single-copy or multi-copy vectors, indicating that p97 is functionally equivalent to yeast Nas1p. Culturing of the temperature-sensitive nas1 cells at the restrictive temperature promoted the accumulation polyubiquitinated cellular proteins, implying that the 26S proteasome requires a functional Nas1p subunit for ubiquitin-dependent proteolysis. These results indicate that p97/Nas1p plays an important regulatory role in the function of the 26S proteasome.

An ultrastructural study on experimental autoimmune myocarditis with special reference to effector cells

The previously described animal model of autoimmune myocarditis induced by immunization of Lewis rats with cardiac myosin was investigated pathologically, ultrastructurally and immunohistologically. Cardiac dendritic cells and infiltrating macrophages were dominantly encamped at the front of the myocarditis. The macrophages accompanied by neutrophils infested cardiocytes, forming rosette figures as a sign of active cardiocytolysis. The dendritic cells reached into intact muscle at a short distance from the inflammation. T cells, the most important candidate for effector cells in this animal model, were generally found at a distance from active muscle necrosis.

[31P-MR spectroscopy of bone and soft tissue lesions]

We studied 24 patients with bone and soft tissue lesions using 31P-MR spectroscopy (MRS). On image selected in vivo spectroscopy (ISIS) localized spectra, spectroscopic parameters were calculated: PME/noise ratio, gamma NTP/noise ratio, PME/gamma NTP and total metabolite signals (TMS). PME/noise, PME/gamma NTP and TMS were higher in malignant lesions than in benign ones. We set the criterion for malignancy as follows: PME/noise > 2.0 and gamma NTP/noise > 2.0 and PME/gamma NTP > 1.0. The accuracy of this criterion was 0.91 for malignant lesions and 1.0 for benign lesions. In six malignant tumors, MR spectra were obtained before and after chemotherapy. They were compared with the degree of tissue degeneration evaluated on pathological specimens. TMS after chemotherapy were markedly reduced in 3 cases. TMS seemed to reflect the degeneration of tumors. It could be said that MRS is a useful tool in differentiating from benign tumor lesions malignant bone or soft tissue lesions and in monitoring the effect of chemotherapy.

[Ultrasonography of pediatric right lower abdominal pain: correlation with clinical and pathological results]

Right lower abdominal pain is a common problem in the pediatric population. Ultrasonography (US) is a well-accepted imaging modality in the clinical management of this problem. One hundred and six consecutive pediatric patients with right lower abdominal pain were prospectively evaluated. There were 54 boys and 52 girls, with ages ranging from 3 to 15 years (mean: 9.9 years). Final diagnoses were established based on pathological findings or clinical follow-up. US had sensitivity of 90%, specificity of 98%, and accuracy of 94% in the diagnosis of acute appendicitis. Among all true negative cases (n = 55), there was a variety of US findings other than appendiceal abnormality in 21 cases including intestinal and/or mesenteric (n = 19), gallbladder (n = 1), and ovarian (n = 1) abnormalities. All 21 cases were managed medically without complication. We conclude that US of pediatric right lower abdominal pain is a reliable imaging modality not only for the diagnosis of surgical cases but for eliminating the unexpected surgical intervention.

Visual findings and histologic diagnosis of pelvic endometriosis under laparoscopy and laparotomy

OBJECTIVE

To assess the diagnostic value of visual findings in the diagnosis of endometriosis from the histological point of view.

STUDY DESIGN

212 specimens from 107 patients with benign (74.8%) or malignant (25.2%) disease were obtained by biopsy or resection under laparoscopy (65 patients) or laparotomy (42 patients). Ages ranged from 19 to 62 (mean age 36.4). Visual findings were classified according to the criteria established by the Endometriosis Committee of the Japan Society of Obstetrics and Gynecology in 1993. Specimens were stained with hematoxylin-eosin, and 15 cases with periodic acid-Schiff stain or silver impregnation stain.

RESULTS

Among pigmented lesions, endometriosis was found in 73.0% of specimens from the pelvic peritoneum and in 56.4% of those from the ovaries. Blueberry spots in the pelvic peritoneum as well as ovarian chocolate cysts showed the highest positive rate. In the presence of multiple or complex pigmented lesions of the pelvic area, the rate was still higher (88.6%). Those rates were due to our inclusion of inaccurate and incomplete biopsy specimens. Endometriosis of nonpigmented lesions was found in only 11 patients (12.0%) who also had pigmented lesions and/or adenomyosis.

CONCLUSION

The laparoscopic diagnosis of endometriosis can be made only when multiple complex pigmented lesions are observed, but, otherwise, histopathological confirmation is necessary.

[The use of high concentration ferric ammonium citrate (FAC) solution as a negative bowel contrast agent: application in MR cholangiography]

Ferric ammonium citrate (FAC) can be used as a negative contrast agent on T2- weighted images, with the use of a high concentration resulting in a significant T2 shortening effect. Ten healthy volunteers underwent MR cholangiography (MRC) using Turbo Spin Echo. High-concentration FAC was administered at a normal dosage, but was diluted in a smaller amount of water than usual. Although all precontrast images showed high intensity intestinal fluid, which aggravated visualization of the bile duct, all postcontrast images obtained 6 to 14 minutes after administration showed blackening out of the fluid, improving the overall image quality of MRC.

Antireflection coating with fluoropolymer for a novel organic nonlinear optical crystal: 8-(4'-acetylphenyl)-1,4-dioxa-8-azaspiro[4.5]decane (ADPA)

Prior to the frequency doubling of a laser diode through a ring resonator, reflection loss on the surface of a novel organic second-order nonlinear optical crystal, 8-(4'-acetylphenyl)-1,4-dioxa-8-azaspiro[4.5]decane (APDA), was decreased. An optically flat crystal surface with a flatness of λ/10 (λ = 633 nm) and surface roughness of 1.5 nm rms was obtained when an ultraprecision diamond turning lathe was used to machine the crystal surface. After this surface was coated antireflectively with an amorphous fluorinated polymer, Teflon AF-2400, the transmittance at 810 nm was increased to 98%. A laser-diode-pumped ring resonator was built with this crystal, and a blue second-harmonic emission at 405.5 nm wassuccessfully generated.

[High concentration ferric ammonium citrate (FAC) solution as a negative bowel contrast agent]

Various concentrations of ferric ammonium citrate (FAC) solution were scanned with conventional SE, Turbo SE (TSE) and STIR sequences on a 0.5-T MR unit. High-concentration FAC solution showed significant signal loss on T2-weighted images. Signal loss was more prominent on heavily T2-weighted images with longer TR/TE using the TSE sequence. T1-weighted images did not show significant signal loss even with high-concentration solution. On STIR images, remarkable signal loss occurred at twice the concentration that had a T1 value similar to fat. We concluded that high-concentration FAC solution may employ as a negative contrast agent in upper abdominal MR imaging.

Effects of 15-deoxyspergualin on experimental autoimmune giant cell myocarditis of the rat

BACKGROUND

The benefits of immunosuppressive therapy for human myocarditis are controversial. The effects of a new immunosuppressant agent, 15-deoxyspergualin (DSG), on rats with experimental autoimmune myocarditis (EAM), an animal model of human giant cell myocarditis, were examined.

METHODS AND RESULTS

Lewis rats were immunized with cardiac myosin in Freund's complete adjuvant on day 0. In the first experiment, the effective doses of DSG required to prevent EAM were investigated. Rats were placed into one of five groups: the control group (A) was administered saline from days 1 to 10; group B, 0.3 mg/kg per day of DSG; group C, 1.0 mg/kg per day of DSG; group D, 3.0 mg/kg per day of DSG, and group E, 10.0 mg/kg per day of DSG. Rats were killed on day 28. The heart weight/body weight ratios of the rats of groups D and E were significantly lower than that of the control group. Macroscopic and microscopic scores for myocarditis decreased in groups D and E. In the next experiment, the effects of delayed administration of DSG in preventing autoimmune myocarditis were studied. Two groups of rats received 3.0 and 10.0 mg/kg per day of DSG from days 6 to 15, respectively. Two other groups of rats received the same doses of DSG from days 11 to 20. No preventive effect of delayed DSG treatment was observed. The effects of long-term, delayed initiation therapy then were evaluated. Rats were administered 10.0 mg/kg per day of DSG from days 6 to 25. The heart weight/body weight ratio and macroscopic and microscopic scores of the rats so treated significantly decreased compared with the controls.

CONCLUSIONS

It was demonstrated that DSG can prevent the development of cardiac myosin-induced autoimmune myocarditis.

Hereditary abnormality of luteinizing hormone resulting in discrepant serum concentrations determined by different assays

We herein report familial defects in the molecular structure of luteinizing hormone (LH). The propositus was a 29-year-old women with repeated abortion in whom the serum LH concentration was extremely low determined by an immunoradiometric assay utilizing two monoclonal antibodies for the intact LH dimer and beta-subunit of LH (SPAC-S kit). Further studies on the serum LH concentration in this propositus by five different assay systems gave various results ranging from low to normal values. Bioassay of the propositus's LH using C57 black mice showed normal in biological activity. These data suggest that LH in the propositus is abnormal in terms of its molecular structure located in the bond region between alpha and beta subunits. A family study showed that the bioactivity of LH was normal in all family members. The serum LH was not detected in either the propositus or her brother with the SPAC-S kit even after the administration of LHRH, while the serum LH concentrations in the father, mother and sister were approximately half the normal range, indicating that the defect is hereditary and the mode of inheritance is autosomal dominant: the propositus and brother were homozygously affected, and the parents and sister heterozygously affected.

Sacroperineal anorectoplasty using intraoperative ultrasonography: evaluation by computed tomography

A new operative technique that uses ultrasonography during sacroperineal or sacroabdominoperineal anorectoplasty was performed on seven patients with an intermediate or high anorectal malformation. Ultrasonography was used for the purpose of making a pull-through tunnel under visual guidance. The results of this technique were evaluated by computed tomography scanning to find the anatomic position of the pulled-through rectum in relation to the anal sphincter muscle. Postoperative computed tomography scans showed that the rectum was correctly placed in the center of the sphincter muscle in all patients.