[Clinical application of ischemic microwave coagulation therapy for malignant liver tumor]

By means of ischemic coagulation of the hepatic artery and portal vein in a microwave coagulation experiment of in vivo swine [correction of bovine] liver, we confirmed approximate doubling of the coagulation diameter compared to the usual coagulation. Based on this fact, for treatment of patients with metastatic liver tumor, we developed an ischemic percutaneous microwave tumor coagulation method using IVR method and applied it in one case, and performed laparotomy microwave tumor coagulation in three cases. We performed the ischemic percutaneous microwave tumor coagulation method on one of the cases. Coagulation was performed for one minute at a dose of 100 W for treatment of metastatic liver tumor of 2 cm in diameter via laparotomy. The postoperative CT showed an extensive coagulation larger than 3 cm. A 2 cm liver tumor was coagulated under balloon ischemia of the hepatic vein and hepatic artery for 13 minutes at a dose of 60 W. The maximum coagulation diameter was 5 cm. Extensive coagulation was possible with percutaneous microwave tumor coagulation through ischemia.

Binding affinity of Cu(II)-VP-16 (etoposide) complex and its analogues to DNA and hydroxyl radical generation during DNA strand breaks

Conformational effects and affinities of VP-16 (etoposide) and its derivatives to DNA in the presence of Cu(II) ion were examined by circular dichroic (CD) spectra. The Cu(II)/Cu(I) redox kinetics and the hydroxyl radical (.OH) generation from the Cu(II)-complexes were estimated by the stopped-flow kinetics. Based on the results, DNA-cleaving activity of Cu(II)-complexes of VP-16 has been shown to be related with binding affinity of the complex to DNA, Cu(II)/Cu(I) redox and .OH generation, emphasising the mechanism of generated .OH attack to DNA.

[Good response in case of hepatocellular carcinoma; a case report of interdisciplinary local therapy]

A 47-year-old male patient with chronic hepatitis had a high AFP level during the follow-up period. Abdominal CT revealed at S5, which led to a diagnosis of hepatocellular carcinoma. In August 1992, partial resection of S5 was performed, and ethanol was injected into the tumor at S2. In July 1993, recurrent tumors were observed at S5 and S3. PEIT was performed for each lesion. In December 1994, multiple recurrence was observed and 4 mg SMANCS was injected through the proper hepatic artery. In July 1995, another 4 mg of SMANCS was injected into the tumors. In June 1996, only a 20 mm lesion at S5 remained while the other lesions disappeared. Under general anesthesia, the patient underwent percutaneous microwave tumor coagulation. In December 1997, the AFP level was normal, and imaging revealed disappearance of the recurrent tumor. Selection of local therapy for hepatocellular carcinoma achieved long survival in our case considering the QOL and frequent therapy administration.

Novel germline mutations of hMSH2 in a patient with hereditary nonpolyposis colorectal cancer (HNPCC) and in a patient with six primary cancers

We screened for germline mutations of mismatch repair genes, hMLH1 and hMSH2, in five Japanese families carrying hereditary nonpolyposis colorectal cancer (HNPCC) and in a patient with multiple primary cancers. Screening the entire coding regions of both genes using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis, we found two novel germline mutations in hMSH2. One was a 1-bp insertion in exon 12, detected in a patient who had undergone surgery six times for independent tumors (four primary colorectal carcinomas, a small intestinal carcinoma, and an endometrial cancer). The other, in a second patient, was a missense mutation from CTT to TTT at codon 390 in exon 7 that resulted in substitution of phenylalanine for leucine. This conservative alteration was not found in any of 50 normal controls, but we cannot exclude the possibility that it may represent a rare polymorphism rather than a factor in the disease.

[A cooperative study on concomitant with low-dose divided administration of cisplatin (CDDP) and sustained drip infusion of 5-fluorouracil (5-FU) for unresectable advanced gastric cancer. Osaka Cisplatin Gastric Cancer Study Group]

For patients with unresectable gastric cancer registered between July 1994 and September 1995, the following dosage regimen was examined: a drip infusion of cisplatin (CDDP) at 7 mg/m2/day for 5 consecutive days and 2-day withdrawal a week for 3 weeks with concomitant sustained drip infusion of 5-FU at 300 mg/m2/day for 21 days. The whole cycle was repeated again after 2-week withdrawal. The antitumor effect was seen in 39.4% among 33 cases. With respect to histological classification, there was no difference in appearance of the effect between the moderately differentiated type at 62.5% and the low-differentiated type at 42.9%. The cases which became resectable after the administration included those in which the tumor disappeared completely in the resected specimens. As adverse reactions encountered in the cases above Grade 3, anorexia, nausea and vomiting and diarrhea were seen as clinical symptoms in 10, 5.3 and 11.8%, respectively. As laboratory test values, decrease in hemoglobin, leukocytopenia and thrombocytopenia were seen in 16.7, 15.8 and 5%, respectively, while renal or liver dysfunction did not occur. This dosage regimen was considered useful for unresectable advanced gastric cancer, although myelosuppression should be watched carefully.

An evaluation of CA125 levels in 291 normal postmenopausal and 20 endometrial adenocarcinoma-bearing women before and after surgery

Two hundred ninety-one normal postmenopausal women without hormone replacement therapy were studied for their blood levels of CA125. The levels ranged from 0.1 to 31.8 U/ml (mean+/-SEM 5.5+/-0.3 U/ml). Twenty patients with endometrial adenocarcinoma who had preoperative CA125 levels below 50 U/ml were also studied. The levels of CA125 in the latter group ranged from 2.1 to 43.0 U/ml (17.2+/-2.3 U/ml) and the difference of the mean value of the two groups was statistically significant (P < 0.001). The CA125 levels in normal postmenopausal women have a weak negative correlation with their age (CA125 = -0.025 x age + 6.9, P < 0.001), whereas in cancer patients, a positive correlation was seen (CA125 = 0.6 x age + 11.5, P < 0.05). Patients with endometrial cancer showed a decrease in their CA125 levels after a hysterectomy and salpingo-oophorectomy (6.5+/-1.2 U/ml, P < 0.0001). These results confirmed that the normal range of the CA125 of menopausal women is much lower than that of cycling women and each laboratory should establish its own normal range for the population. Also, it was suggested that CA125 levels which apparently fall within the normal range but are high, however, for the respective age, may indicate that an extensive search for an endometrial malignancy is necessary.

Functional evaluation of flail hip joint after periacetabular resection of the pelvis

Five patients subjected to flail hip joint after resection of primary bone tumor of the pelvis involving acetabular region were examined with respect to function. When a thick portion of the supraacetabular pelvic neck was left in place, the operated legs functioned well regardless of whether the head of the femur was placed anterior or posterior to the iliac wing. In a patient who had only a thin portion of the iliac wing left in place and in those who underwent total excision of the ilium or hemiresection of the pelvis, the function of operated legs was poorer than with a thick portion of the supraacetabular pelvic neck left in place, but still more than 50% of leg function remained. Although flail hip joint results in a larger leg-length discrepancy than do other techniques, it enables favorable healing of the operative wound. Therefore, this method should be considered for women or sedentary patients with primary bone tumor of the pelvis involving acetabular region.

[Gene therapy by in vivo interferon-gamma gene transfer to murine bladder tumor]

For the clinical application of the cytokine gene therapy, the antitumor effects of systemic administration of Interferon-gamma (IFN-gamma) and those of in vivo direct IFN-gamma gene transfer to the tumors of mouse bladder carcinoma (MBT2) were compared. After the subcutaneous inoculation of MBT2 cells into mice, 10(2), 10(3) or 10(4) units of IFN-gamma were injected intraperitoneally (i.p.) or subcutaneously (s.c.). Neither i.p. nor s.c. injection of IFN-gamma resulted in tumor suppression or prolonged the survival time of tumor-bearing mice. The effect of in vivo direct IFN-gamma gene transfer by a retrovirus vector to MBT2 tumors was also evaluated. After the subcutaneous inoculation of MBT2 cells into mice, a virus culture supernatant containing IFN-gamma gene was injected into the same tumor site once a day for 3 days. In 50% of the mice in the treatment groups with IFN-gamma gene induction, no tumor formation was observed. Tumor-free survival and actuarial survival in the treatment groups were significantly longer than those in the control group. These results showed the possibility of in vivo direct IFN-gamma gene transfer into tumors and were encouraging for the execution of tumor cell-targeted IFN-gamma gene therapy against human bladder cancer.

[Preoperative chemoradiation therapy for advanced rectal cancer]

Preoperative concurrent chemoradiation therapy with 5-fluorouracil and cisplatin was applied for advanced rectal cancer. Eligible criteria were as follows: no previous treatment, 4 more than hemicircular occupation, T3 or more invasion to adjacent organs or lymph node metastasis on CT scan, tumor fixation by digital examination. Eleven patients were enrolled with this regimen consisting of 5-FU; 500mg/day x5/w x4, CDDP; 10mg/day X 5/w x4 and radiation; 2Gy x 5/w x 4. As a toxicity, grade 2 leukopenia in 2 cases, grade 2 GI symptoms in one case and radiation dermatitis was observed in 8 cases. As a local response, there were PR in 10 cases and NC in 1 case. Surgical resection was performed on 8 patients. Histological responses in the resected specimens were grade 2, 5 cases; grade 1b, 1 case; and grade la, 2 cases. Operative radicalities were grade A, 3 cases; grade B, 3 cases; and grade C, 2 cases. Preoperative chemoradiation is one of the effective options in multimodal treatment for advanced rectal cancer.

[Local control of hepatic malignant tumors by percutaneous microwave]

We investigated the effects of percutaneous microwave coagulation under general anesthesia in the local control of hepatic malignant tumors. Coagulation at 60 W was done for normal liver of living swine using a percutaneous electrode. Wide-range coagulation at the tip of an electrode, 3 mm in diameter, was conducted. Clinically, echo-guided percutaneous microwave tumor coagulation was done for a total of 11 lesions in 5 patients with hepatocellular carcinoma and 4 with metastatic tumors in the liver under general anesthesia. Coagulation at 60 W of the liver of living swine for 1.5 and 10 min, using a percutaneous electrode, produced a maximal coagulation of 10, 20 and 30 mm, respectively. The trial electrode permitted coagulation almost at the tip of the electrode only. Percutaneous microwave coagulation of 11 lesions of the clinical cases resulted in complete coagulation in 7 lesions and incomplete coagulation in 4. The lesions showing complete coagulation were all less than 23 mm.

[Complication of reservoir hepatic artery infusion chemotherapy and additional treatments]

In 54 patients who underwent hepatic artery infusion chemotherapy for hepatic tumors at our hospital between January 1990 and December 1996, we investigated the complications of this therapy and the therapeutic techniques following its discontinuation. The arterial infusion was discontinued in 36 of the 54 patients; 13 due to death (mean survival period: 15.7 months), and 23 in whom occlusion of the reservoir, etc. made it impossible to use arterial infusion (mean period of use: 13.8 months), and the minimum duration of use was 41 days and maximum duration of use 992 days. The most common complication of the reservoir hepatic artery infusion was reservoir occlusion (14.8%). Another serious complication was reservoir deviation outside the blood vessel in two patients; deviation in to the gastric lumen in one case and intraperitoneal deviation in the other. Four hepatocellular carcinoma patients, in whom it became impossible to use the reservoir due to its occlusion, underwent re-hepatectomy. Three of them survived for more than two years following supplemental local therapy, including subarterial injection, TAE, PEIT, microwave tumor coagulation (MTC). Of four patients with colon cancer metastasizing to the liver, one could undergo re-hepatectomy, one received subarterial injection, and two have survived without relapse. Two of three patients with breast cancer underwent systemic chemotherapy and endocrine therapy successfully, while the third one underwent subarterial injection and TAE, and is still under observation. Hepatic artery infusion should sometimes be discontinued owing to complications caused by various factors. Even if it becomes impossible to use the reservoir, local therapeutic techniques, including re-hepatectomy, TAE, PEIT, MTC, etc., may be performed in some patients. These findings suggest that it is necessary to review the interdisciplinary treatment so as to be appropriate to the primary disease.

Breaks in double-strand DNA by Cu(II) complexes of etoposide (VP-16) and its derivatives, as evaluated by S1 nuclease treatment

Single-strand breaks (ssb) in double-strand (ds) DNA produced by hydroxyl radicals (.OH) generated by Cu(II) complexes of podophyllotoxin (PD)-related compounds were evaluated using S1 nuclease digestion. Cu(II) complexes of VP-16 (etoposide, 4'-demethylepipodophyllotoxin-9-(4,6-O-ethylidene-beta-D-glucopyra noside)), 4'-demethylepi-PD (DEPD), and syringic acid (SA) exhibited both ssb and ds breaks (dsb) in ColE1-HaeII and pBR322-BglI DNA fragments, in which the number of ssb was found to be more than three times and four times greater than that of dsb, respectively. Cytosine (C)-methylation of cytosine-guanine doublet (CpG) in pBR322-BglI DNA inhibited both ssb and dsb within DNA segments by .OH generated by the Cu(II) complexes.

Ca2+-ATPase inhibitors and Ca2+-ionophore induce osteoclast-like cell formation in the cocultures of mouse bone marrow cells and calvarial cells

Osteoclasts which derive from hemopoietic cells are multinucleated cells responsible for bone resorption. We found that cyclopiazonic acid (CPA), thapsigargin (TG), and 2,5-di-(t-butyl)-1,4-hydroquinone (BHQ) induced osteoclast-like cell (OCL) formation in cocultures of mouse calvaria-derived stromal cells and hemopoietic cells such as bone marrow cells and spleen cells. OCLs induced by these compounds showed typical characteristics of osteoclasts such as tartrate-resistant acid phosphatase activity and pit forming activity. These compounds are known as endoplasmic reticulum (ER)/sarcoplasmic reticulum (SR) Ca2+-ATPase inhibitors that increase intracellular Ca2+ levels by inhibiting Ca2+-ATPase activity located in the membrane of ER/SR. Ca2+-ionophores such as ionomycin which increase intracellular Ca2+ levels also stimulated OCL formation in the cocultures. Differentiation of hemopoietic cells into OCLs induced by these compounds required the presence of calvarial cells. These results indicate that an increase of intracellular Ca2+ levels may be a part of signaling pathways to induce osteoclast differentiation in the presence of calvarial cells.

[Preoperative synchronized chemoradiation therapy for advanced esophageal cancer]

Synchronized chemoradiation, where 5-FU and CDDP were synchronously administered in the same schedule with radiation therapy, was applied for advanced esophageal cancer in neoadjuvant fashion. Ten patients with advanced esophageal cancer were enrolled for this regimen consisting of 5-FU; 500 mg/day x 5/w x 4, CDDP; 10 mg/day x 5/w x 4 and radiation; 2 Gy x 5/w x 4. Tumor regression was achieved in all cases. In terms of toxicity, bone marrow suppression of more than grade 3 was observed in 60% of the cases, though it was safely controlled. Radical operation was performed on 8 cases. Histological responses in the resected specimen were as following: grade 3, 3 cases; grade 2b, 4 cases; grade 2a, 1 case; and 6 node-negative cases were found. As a postoperative complication, minor leakage occurred in 62.5%, while no major complications such as pneumonia were encountered. This neoadjuvant synchronized chemoradiation improved curability of the salvage operation and permitted reduction surgery for high-risk patients.

A novel thromboxane synthetase inhibitor, DP-1904, inhibits human blood eosinophil degranulation

Eosinophils have been recognized to be associated with various immune responses and disease processes including bronchial asthma. Eosinophils release a number of cytotoxic and neurotoxic mediators. However, the factors regulating such release and the underlying mechanisms are unclear. In this study, we investigated the effect of a selective and potent thromboxane synthase inhibitor, DP-1904, on the release of eosinophil cationic protein (ECP) in platelet activating factor (PAF) and IgG-stimulated human blood eosinophils. PAF (1 microM) and IgG both released ECP which constituted about 25-30% of the total ECP content. The control protein, ovalbumin, did not release any ECP over the basal values. DP-1904 in two different concentrations, 10 microM and 100 microM, significantly attenuated the release of ECP in response to PAF or IgG. The mean percent inhibition by 10 microM DP-1904 was 49 +/- 10 and 31 +/- 2 against PAF and IgG-induced ECP release, respectively. However, at 100 microM DP-1904 the percent inhibition was 76 +/- 14 and 67 +/- 2, respectively. These data suggest that TXA2 is an important mediator in the regulation of eosinophil degranulation, and DP-1904 thus might prove beneficial in the treatment of bronchial asthma.

[Effect of FUT-187, oral serine protease inhibitor, on inflammation in the gastric remnant]

Excessive enterogastric reflux following partial gastrectomy is believed to be responsible for the cause of inflammation in the gastric remnant. We examined the effect of FUT-187, a synthetic serine protease inhibitor, on symptoms and endoscopic findings in 33 patients who were diagnosed endoscopically as postgastrectomy gastritis. Patients took 50 mg FUT-187 orally after each meal and at bedtime for 8 weeks. Before treatment, 30 patients (91%) suffered from several symptoms including regurgitation and/or bitter taste in the mouth (49%), epigastric pain (42%) and nausea (36%). From endoscopic observation, erythema was detected in 32 patients, edema in 23 patients and erosion and/or ulcer in 9 patients. After treatment the global improvement rating for subjective symptoms was 76.7% (23/30) and the improvement of endoscopic findings was 63.6% (21/33). Diarrhea was observed in one patient but could be easily controlled by discontinuation of the drug. Our results suggest that FUT-187 can be a useful drug for the treatment of postgastrectomy gastritis with its efficacy and safety.

Biodegradability of oxidized poly(vinyl alcohol)

Poly(vinyl alcohol) dehydrogenase (PVADH) purified from Pseudomonas sp. 113P3 catalyzed an oxidation of poly(vinyl alcohol) (PVA) in the presence of pyrroloquinoline quinone (PQQ) to give a beta-diketone structure on PVA. Although PVADH oxidized not only enzymatically oxidized PVA but also chemically oxidized PVA, PVA-degrading microorganisms, Pseudomonas sp. 113P3 and Arthrobacter tumescens sp. 52-1 grew on the enzymatically oxidized PVA, but not on the chemically oxidized PVA. This suggests that the growth of PVA-degrading microorganisms is affected by the structure of oxidized PVA.

[Preoperative chemoradiation therapy for lower rectal cancer]

To identify appropriate candidates with rectal cancer for preoperative chemoradiation therapy, the local recurrence rate and clinicopathological characteristics of 232 patients with rectal cancer undergoing curative resection in our department were investigated. The local recurrence rates were 3.8%, 10.8% and 16.5% in the Rs, Ra and Rb lesions, respectively. Regarding lower (Rb) rectal cancer, depth of lesion (> a1) and nodal metastasis consisted of high factors for local recurrence. Basing on these results, entry criteria for preoperative chemoradiation therapy were established, and concurrent chemoradiation therapy with fluorouracil and cisplatin was delivered preoperatively in 9 primary cases of locally advanced rectal cancer and 3 cases with local recurrence. A partial response was obtained in 7 of 12 cases with a response rate of 58%, size-reduction of the distant metastatic lesions was found in 2 cases, and clinical symptoms were improved in all cases. The histological responses of the 6 resected cases were Grade 2 in 2 cases and Grade 1b in 4 cases. The toxicities of this chemoradiation regimen were well tolerable. As a postoperative complication, infection of the perineal wound was most frequent. Preoperative chemoradiation therapy with the present regimen would be a useful adjuvant treatment for advanced lower rectal cancer.

[Evaluation of percutaneous microwave hepatic tumor coagulation therapy (PMTC) under general anesthesia from viewpoint of quality of life (QOL)]

We evaluated clinical benefits (QOL and local control rate) of percutaneous microwave coagulation therapy conducted with general anesthesia. Five cases with hepatic tumor (3 cases with hepatocellular carcinoma, 2 cases with metastatic hepatic tumor) were enrolled. The day following treatment all patients were virtually free of complaints with performance status ranging 0 to 1, and they were discharged from the hospital within 1 week. Four of five cases could be controlled solely with this treatment: one case showed local relapse, the tumor size of which exceeded 3 cm. PMTC may be one of the most beneficial local treatments for malignant hepatic tumor, since it shortens hospital stay with a good QOL status, and is applicable to metastatic tumor.

[A case resectable hepatic metastases of breast cancer following intrahepatic arterial chemotherapy]

A 38-year-old woman who had undergone Patey's operation for left breast cancer in July 1990 was admitted in December 1992 for hepatic metastases. Due to bone metastasis (Th10), oophorectomy and hepatic arterial cannulation were performed. Hepatic arterial chemotherapy and oral chemoendocrine therapy yielded a partial response for liver and unclear metastasis of the bone. She had arterial and oral administration after a hepatectomy in October 1994. The patient has had no recurrent signs now (July 1996). We experienced 522 patients with breast carcinoma and 14 cases (2.7%) of all having hepatic metastases. Hepatic arterial chemotherapy was done in three patients. Although one of them had a complete response, she died after 35 months because of bone, brain and liver metastases. Another case was underwent hepatectomy after arterial chemotherapy, but recurrent liver and bone tumors soon appeared. The mean survival period of 15 hepatic metastases, including the case under study here was 9 months, and the one-year survival rate was 23.4%.

Adhesion through the interaction of lymphocyte function-associated antigen-1 with intracellular adhesion molecule-1 induces tyrosine phosphorylation of p130cas and its association with c-CrkII

The B-lymphoblastoid cell line JY undergoes homotypic aggregation in a lymphocyte function-associated antigen-1 (LFA-1)-mediated, intracellular adhesion molecule-1 (ICAM-1)-dependent manner when stimulated with phorbol 12-myristate 13-acetate or anti-LFA-1 antibodies. Under conditions that lead to cell aggregation, we observed rapid tyrosine phosphorylation of p130cas, a protein previously identified to be phosphorylated on tyrosine in both v-src- and v-crk-transformed cells. Phosphorylation of p130cas was dependent on binding of LFA-1 to its ligand, ICAM-1, as demonstrated by the use of anti-ICAM-1 antibodies. Several observations suggest that this event may be an important step in the signaling pathway initiated by LFA-1. p130cas phosphorylation was rapidly reversible upon disengagement of the LFA-1-ICAM-1 complex and required cell adhesion since binding of phorbol 12-myristate 13-acetate-stimulated JY cells to purified ICAM-1 or cross-linking of either LFA-1 or ICAM-1 was not sufficient to induce phosphorylation of p130cas. The integrin-stimulated phosphorylation of p130cas created binding sites that were recognized in vitro by the SH2 domain of c-CrkII, a key adaptor protein involved in cell differentiation and transformation. Moreover, we also showed that the LFA-1-stimulated tyrosine phosphorylation of p130cas induces the formation of a p130cas.CrkII and p130cas.CrkL complex in intact cells. This observation suggests that adhesion mediated by the interaction of LFA-1 and ICAM-1 initiates a signaling cascade that involves the activation of protein tyrosine kinases and leads to the regulation of protein-protein interaction via SH2 domains, a key process shared with growth factor signaling pathways.

ErbB-2, a c-erbB-2-coded protein, is expressed in metastatic cells of adenocarcinoma of endometrium, cervix and ovaries

Ten cases of gynecologic malignancies, including three endometrial, two ovarian and four cervical carcinomas, were studied for the expression of a 185 kDa protein (ErbB-2), coded by a proto-oncogene, c-erbB-2, in primary lesions as well as in metastatic lesions. Positive immunoreactivity was observed in all primary adenocarcinomas but not from squamous cell carcinomas. Many adenocarcinoma cells in distant metastatic sites or in tertiary lymph nodes were strongly stained for ErbB-2. These metastatic cells also showed an expression of proliferating cell nuclear antigen (PCNA). Detection of ErbB-2 mRNA by a reverse-transcription polymerase chain reaction showed that the transcription occurred exclusively in adenocarcinomas. To our knowledge, this is the first report demonstrating ErbB-2 expression in distant metastatic lesions of gynecologic cancers.

[Study on therapeutics adopted after occlusion of intraarterial reservoir in patients with liver tumor]

Over the last 5 years, we experienced thirty-nine patients with liver tumors undergoing implantation of an intraarterial reservoir through the gastroduodenal artery. Nine of the 39 patients had hepatocellular carcinomas, while the rest had metastatic liver tumors. In 32 patients, intraarterial chemotherapy via an implanted reservoir was discontinued either because of death in 20 patients with an average survival period of 11.7 months or because of occlusion of an intraarterial line in 12 patients with an average treatment period of 20.2 months. Regarding treatment modalities adopted for intraarterial therapy, transcatheter arterial embolization, surgical resection, microwave tumor coagulation, ethanol injection therapy, and a subselective intraarterial chemotherapy were performed in 3 patients with hepatocellular carcinomas. All of them survived more than 2 years after disuse of the reservoir. Out of 5 patients with metastatic liver tumors of colorectal cancer, one patient underwent additional surgical resection, two patients had no therapy who survived only two or three months, and two patients were still alive without additional therapies. Of four patients with metastatic liver tumors, 3 from breast cancer and one from leiomyosarcoma of stomach were treated with systemic chemotherapy or subselective intraarterial chemotherapy combined with radiation therapy. The average survival period of these 12 patients was 16.2 months, and 7 of them are still alive.

[Long-term survival in two cases of multiple liver metastasis successfully treated with intraoperative ultrasound-guided microwave tumor coagulation (MTC)]

Since April 1990, multiple metastatic liver tumors have been treated with intraoperative ultrasound-guided microwave tumor coagulation (MTC) in combination with postoperative intraarterial chemotherapy. Twenty-four patients have been enrolled in this therapeutic modality and two of five patients treated in 1990 achieved long-term survival. In case 1, a 67-year-old woman was diagnosed as bearing gastric leiomyosarcoma with multiple liver metastasis. Total gastrectomy was performed, and six hepatic lesions were treated by MTC along with implantation of an intraarterial reservoir. Postoperative intraarterial chemotherapy was administered in a selective or subselective manner. Her survival time was 4 years and 6 months. In case 2, a 47-year-old man was diagnosed as having liver metastasis from descending colon cancer 1 year and 5 months after left hemicolectomy. When he was laparotomized for the treatment of adhesive ileus, three metastatic liver tumors were treated with MTC. Afterward, he underwent hepatic resection, intraarterial and intraportal chemotherapy. He survived for 5 years and 5 months after being diagnosed with liver metastasis. MTC is one of the useful modalities for the treatment of multiple liver metastasis.

[Estramustine phosphate, estrogen conjugated with nitrogen mustard inhibits the growth of endometrial cancer cells in vitro]

Estra-1,3,5 (10)-triene-3,17-diol (17 beta)-, 3-[bis(2-chloroethyl) carbamate] (Estramustine EM) was tested for its anticancer effect on human endometrial cancer cell lines: Ishikawa and its estrogen (E) independent sub-clone EIIL (Estrogen Independent Ishikawa Line). The results showed: (1) EM inhibited growth of both cell lines in a dose dependent manner giving ID50 for Ishikawa as 12 microM and for EIIL as 65 microM. (2) The addition of EM to the culture medium caused cell detachment and death associated with a breakdown of DNA to approximately 90 base pair fragments. (3) Reverse transcription-polymerase chain reaction to examine expressions of c-erbB-2, nidogen and fas showed that EM completely abolished fas expression and resulted in a 40% decrease in nidogen expression in Ishikawa but not in EIIL. No change was seen in c-erbB-2 expression. The present data indicate that the E component of EM does not stimulate the growth of Ishikawa or EIIL. Since the growth of both cell lines was inhibited but apparently in an E receptor (ER) dependent manner, EM may be of value in an adjuvant therapy for endometrial cancer, especially an ER positive one.

Possible role of thromboxane A2 in hyperresponsiveness of isolated rat lung tissue in a Sephadex-induced eosinophilia model

Antigen-stimulated contraction and release of chemical mediators were examined in saline- or Sephadex-treated rat lung parenchymal strips. Sephadex treatment caused eosinophilia in the blood and the lung tissue. Antigen challenge of the isolated parenchymal strips in Sephadex-treated rat was followed by passive sensitization, resulted in an augmented contraction and elevated releases of thromboxane (TX) B2 and peptide-leukotrienes (p-LTs) in bath fluid compared with those of saline-treated control. Although 5-hydroxytryptamine (5-HT) and histamine were significantly released after antigen challenge, the levels were not different between saline- and Sephadex-treated groups. DP-1904, a selective thromboxane synthetase inhibitor, and methysergide but not atropine significantly reduced the augmented contraction and inhibited the elevated TXB2 release in the Sephadex-treated group. Similar increased contraction and the elevated TXB2 release above were observed when Sephadex-treated rat lung strips were stimulated by exogenous 5-HT and LTD4. These augmented contractions were closely correlated with the increase in TXB2 level (r = 0.83; p < 0.01). In addition, contraction to U-46619, a thromboxane mimetic, was significantly greater in Sephadex-treated rat lung strips. Our results indicate that the ability of Sephadex-treated rat lung tissue to synthesize newly generated mediators such as TXA2 and p-LTs is increased, and the spasmogenic susceptibility of the lung tissue to TXA2 itself is modified by Sephadex treatment, suggesting these are due to the augmented contraction in an established hyperresponsiveness state induced by Sephadex.

[Establishment of metastatic sub-clone from estrogen independent Ishikawa cells and its characterization in vitro and in vivo]

An estrogen (E) independent sub-clone (EIIL) was separated from a human endometrial carcinoma cell line, Ishikawa, by culturing the wild type under an E free condition for 350 days. The cells were then implanted into nude mice subcutaneously and tumors allowed to develop for 35 days. The primary lesions were then excised to stimulate recurrence. One animal developed recurrence with multiple distant metastases. The primary tumor and metastatic tumors from the animal were studied for ErbB-2 expression by immunohystochemical techniques or by a reverse transcription followed by polymerase chain reaction (RT-PCR). Expressions of epidermal growth factor (EGF) receptors, aromatase, nidogen, E receptors, hepatocyte growth factors (HGF) and beta-actin were also examined. The results showed that metastatic lesions expressed high levels of ErbB-2, nidogen and aromatase but unchanged levels of EGF receptors and HGF. The metastatic lesions expressed one third of the E receptors which were detected in the EIIL in vitro. These observations suggest that a decrease in ER along with increased expression of nidogen and aromatase is associated with the process of metastasis and the model appears to be of value in studying the process of the acquisition of a metastatic phenotype.

Frequent loss of heterozygosity at telomeric loci on 22q in sporadic colorectal cancers

To date, several tumor-suppressor genes responsible for the tumorigenesis of colorectal cancer have been identified. However, studies of loss of heterozygosity (LOH) have suggested several chromosomal regions which may contain additional tumor-suppressor genes for colorectal cancer. To determine the extent and variation of allelic loss on 22q, on which LOH has been frequently observed, a total of 68 sporadic colorectal cancers was examined for LOH on the chromosome arm by means of 16 polymorphic DNA markers. LOH was observed in 28 tumors (41%), of which 9 showed LOH at all informative loci. The remaining 19 tumors showed variable patterns of partial loss on 22q, delimiting the smallest region of overlap (SRO) between D22S90 and D22S94. Moreover, LOH within the SRO correlated with a progression in terms of Dukes' stages. These results suggest that an additional tumor-suppressor gene for colorectal cancer may exist on 22q distally to the NF2 locus and that inactivation of the gene may possibly play a role in the progression or metastasis of colorectal cancers.

[A case of pulmonary metastasis from colon cancer successfully treated with high-dose 5'-DFUR]

We report a case, showing a complete response to high-dose 5'-DFUR, with pulmonary metastasis from colon cancer. A 52-year-old male patient underwent right hemicolectomy for ascending colon cancer in August, 1991. A recurrence of colon cancer developed in the left lower lung 16 months after surgery, and 5'-DFUR was administered at a dose of 1,600 mg/body/day. The pulmonary metastatic lesion was undetectable on chest X-ray film 9 weeks after the start of this therapy. The dose of 5'-DFUR was then reduced to 600 mg/body/day. Although this condition was maintained for 22 weeks, chest X-ray film again showed the metastatic lesion at the same site in the lung as before. The pulmonary metastasis was resected completely in April, 1994. This is suggested to be an effective therapy for pulmonary metastasis from colon cancer.

Hydrophobic blue pigment formation from phosphatidylgenipin

Phosphatidylgenipin, synthesized via the transphosphatidylation reaction of 1,2-dipalmitoyl-3-sn-phosphatidylcholine to genipin by phospholipase D, was found to react with L-phenylalanine in chloroform and gave a clear blue solution. This blue solution was also formed in following organic solvents: ethanol, ethyl acetate, diethyl ether, benzene, and hexane. However, genipin and L-phenylalanine did not give any colored product under the same conditions. The blue pigment resulted from phosphatidylgenipin and L-phenylalanine showed lambda max at 615 nm in chloroform, and had a similar blue color to an aqueous solution of the natural blue pigment "gardenia blue." This is an example for the preparation of a hydrophobic pigment from a phosphatidyl derivative of a water-soluble compound.

[Microwave tumor coagulation (MTC) in liver tumor: indication and percutaneous approach]

Indications for microwave tumor coagulation (MTC) and percutaneous approach in liver tumor were investigated. The study population comprised 26 patients with unresectable liver tumor (4 with hepatocellular carcinoma, 22 with metastatic liver tumor) who underwent MTC at our department after April 1990. Concomitant therapies were alcohol injection in 2 patients, hepatectomy in 12 and selective arterial chemotherapy in 20. Percutaneous MTC was performed on 2 patients with a single lesion under general anesthesia. Following tip coagulation electrode penetration under echo guidance, the lesion was thermally coagulated at 60W. To establish indications for MTC by the effect of thermal coagulation, survival periods were compared by underlying disease, number of masses coagulated, and maximum tumor size, in 23 patients who had undergone MTC at least 1 year previously. Thirteen of these 23 survived for 1 year or longer, including all 3 with hepatocellular carcinoma, 3 with breast cancer, 2 with leiomyosarcoma (gastric, small intestine), 4 of the 10 with colon cancer and 1 of the 2 with pancreatic cancer. According to evaluation of the degree of coagulation, complete coagulation was obtained in 11 of 23, all of whom had at most 6 tumor masses (of up to 3 cm in diameter) coagulated, and 9 of whom survived for 1 year or longer. Percutaneous MTC, of low invasiveness, proved useful as a tool of regional cancer therapy.

[Cyclooxygenase in ooplasm is essential for early embryonal differentiation but not for successful fertilization in the mouse]

It has been known that inhibition of prostaglandin (PG) synthesis interferes with successful implantation. The present study dealt with the chronology in cyclooxygenase (COX) expression and the effects of inhibition in mouse oocytes in the perifertilization period. COX protein was detected in both oocytes and fertilized eggs whereas the mRNA was not found by a high sensitivity RT-PCR only in blastocysts. Oocytes which were sham operated or micro-injected with preabsorbed anti-COX monoclonal antibody (hPES01) or non-immune IgG were fertilized and developed to two-cell embryos, whereas hPES01 injected oocytes were fertilized but failed to differentiate (p < 0.05 chi 2-analysis). This inhibitory effect on early embryonal development of COX inhibition was also seen in indomethacin pre-cultured oocytes which were successfully fertilized but failed to develop further. We concluded that the COX gene which is one of the immediate early genes is not transcribed in the perifertilization period but the enzyme which remains in the cytoplasm and the presence of intact COX before fertilization are essential for early embryonal differentiation.

[Gonadotropin receptor system and its signal transduction pathway]

Recent advances in genetic studies have elucidated structure of gonadotropin receptors. This transmembrane receptor contains seven transmembrane domains and induces multiple biological changes in granulosa/theca cells resulting in follicular maturation in women. The signal transduction involves G protein mediated systems, cAMP mediated systems and phospholipase C systems. This paper reviews recent advances in gonadotropin receptor system and its signal transduction pathway.

Catabolism of heme moiety of hemoglobin.haptoglobin in rat liver cells in vivo

After intravenous administration of [3H-heme,14C-globin]hemoglobin.haptoglobin or [59Fe-heme]hemoglobin.haptoglobin to rats, the radioactive materials extracted from the liver homogenate or its subcellular fractions were subjected to a gel filtration column. In addition to the 82-kDa component, we found three metabolites of heme moiety of the complex in the subcellular fractions. Intact hemoglobin.haptoglobin complex with 3H, 14C, and 59Fe radioactivities, an 82-kDa component with 3H, 14C, and 59Fe radioactivities, a 40-kDa component with 3H and 59Fe radioactivities, a lower molecular weight component with 3H and 59Fe radioactivities, and a component with 3H and 59Fe radioactivities bound to the microsome, which are referred to as peaks A, B, C, D, and E, respectively. Using a differential centrifugation technique, most of peak B was found in the mitochondria-lysosomal fraction. Peaks C and D were in the 82,500 x g supernatant fraction, while peak D was also found in the mitochondria-lysosomal fraction. The molecular weight of peak C was approximately 40 kDa, and the 3H radioactivity of peak C was eluted at the same fraction as glutathione S-transferases using both gel filtration and ion exchange chromatography. Peak E that was solubilized from the microsomes was found at the microsomal heme protein fraction on gel filtration chromatogram. Some of the 3H radioactivity in the microsomes was partially co-purified with cytochrome b5 fraction. These results indicate that there are at least four metabolites of heme moiety of hemoglobin.haptoglobin complex in rat liver cells during its catabolism and suggest that some of the heme derived from catabolized hemoglobin.haptoglobin complex binds to glutathione S-transferases in the cytosol and is incorporated into apoheme proteins in the microsomes or at least apocytochrome b5.