Cisplatin-based neoadjuvant chemotherapy for invasive bladder cancer

Between February 1988 and March 1993, 24 patients with locally advanced bladder cancer (stages T2-4N0-3M0) were included in this study. Combination chemotherapy consisting of methotrexate, vinblastine, epirubicin (doxorubicin) and cisplatin (M-VAC) was given to the patients in a neoadjuvant setting. The clinical stage was T2N0M0 in eight patients, T3aN0M0 in three, T3bN0M0 in seven, T4N0M0 in five and T4N3M0 in one. After chemotherapy, total cystectomy was performed in 20 patients and partial cystectomy 4. Of 24 patients, one (4%) showed a pathological complete response, and eight (33%) had a pathological partial response, for an overall response rate of 38% (95% confidence limits 20 to 57%). Nine patients who achieved a pathological response to chemotherapy had a significantly higher survival rate than the nonresponders (p <0.01). In the relationship between the clinical stage and the response to chemotherapy, clinical T2 and T3a diseases were more likely to respond to chemotherapy than clinical T3b and T4 diseases, with a response rate of 64% and 15%, respectively. While a positive relationship between the pathological response and survival was observed, adequate follow-up is needed to assess the ability of neoadjuvant chemotherapy to improve the prognosis of patients with locally advanced bladder cancer.

Age-related changes in bronchial hyperreactivity to methacholine in asthmatic children

To evaluate the influence of aging on bronchial hyperreactivity (BHR) during the childhood period, age-related changes in bronchial reactivity to methacholine (BRm) in children from 2 to 13 yr of age were studied using the same method, employing a methacholine inhalation challenge with transcutaneous oxygen pressure (tcPO2) monitoring. Three hundred and thirty-nine asthmatic subjects (male:female = 200:139, aged [mean +/- SEM] 7.2 +/- 0.2 yr) and 107 age-matched controls (male:female = 55:52, aged 5.3 +/- 0.3 yr) were enrolled in this study. TcPO2 was measured by a tcPO2 monitor, and subsequent doses of methacholine were then doubled until a 10% decrease in tcPO2 from its baseline value was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (Dmin-PO2) was considered to represent the BRm. For the sake of comparison, respiratory resistance (Rr) in subjects more than 6 yr old was measured by the oscillation technique during methacholine inhalation challenge, and the threshold point of Rr (Dmin-Rr) was also considered to represent the BRm. In the asthmatic children aged 2 to 7 yr, Dmin-PO2 decreased significantly from 12.2 +/- 2.1 to 3.1 +/- 0.8 units, but after age 8 yr the values gradually increased from 3.1 +/- 0.7 to 6.4 +/- 1.6 units. In children aged 6 to 13 yr, Dmin-Rr showed the same increase as Dmin-PO2, from 2.0 +/- 0.5 to 5.8 +/- 1.4 units. These age-related changes in BRm reflected in both Dmin-PO2 and Dmin-Rr were also seen in the age-matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)

[The limitation of synchronization of pressure support ventilation (PSV) in ARDS]

PSV has been increasingly used as a partial ventilatory support for various types of respiratory failure. We experienced premature breath termination and double triggering in a patient with ARDS during PSV, and investigated the cause of this phenomenon using respiratory muscle pressure (Pmus). The analysis confirmed that the respiratory muscles and the ventilator did not coordinate synchronously in the patient with very low compliance of the respiratory system. The limitation of synchronization was attributable to fixed flow termination criteria in the present PSV algorithm. When dissynchronization is not manageable, other ventilatory modes (eg, APRV, PCV) allowing spontaneous ventilation should be considered as an alternative.

EEG in successful aging; a 5 year follow-up study from the eighth to ninth decade of life

Fifteen out of 25 successfully aged individuals completed a 5 year EEG follow-up study from the eighth to ninth decade of life with comprehensive neuropsychological investigation. One subject suffered from stroke and one developed symptoms of dementia during the follow-up. Of 13 subjects who completed the follow-up as being healthy, MRI showed subtle enlargement of ventricles or subarachnoid spaces and mild signal hyperintensities in a few regions in 2 subjects. General cognitive decline was not observed (WAIS-R IQ: 113.4 at entry, 114.3 five years later). There were no EEG dominant frequencies below 8 c-sec and no more background slowing than a few theta waves per 10 sec, either at entry or 5 years later. Intermittent slowing was observed in 9 subjects at entry and in 8 subjects 5 years later. The prevalence of intermittent slowing was suggested to increase with advancing age when compared to previous studies with younger elderly. However, intermittent slowing occurred only a few times in an EEG test and lasted for less than 2 sec. Moreover, the presence of intermittent slowing did not correlate with any neuropsychological decline or any MRI change. This type of intermittent slowing was regarded as non-specific and clinically silent.

Sperm immobilizing antibodies interfere with sperm migration from the uterine cavity through the fallopian tubes

PROBLEM

It is well known that sperm migration in cervical mucus is impaired by sperm immobilizing antibodies secreted in the mucus. However, it is not clear yet whether sperm migration from the uterine cavity through the fallopian tubes to the peritoneal cavity is impaired by sperm immobilizing antibodies. To test the possible impairment of sperm migration in the tubes, laparoscopic examinations were carried out and the presence of motile sperm in the peritoneal fluid after intra-uterine insemination was investigated.

METHOD

Peritoneal sperm recovery tests were performed in 28 infertile women with sperm immobilizing antibodies in their sera, and the results were compared with those in 322 infertile women without the antibodies. Both the sperm immobilizing antibody titers (SI50) and complement activities (C'H50) in peritoneal fluid were compared with those in patients' sera. In some experiments, the supernatant of the peritoneal fluid was used as a source of complement for the sperm immobilization tests instead of guinea pig serum.

RESULTS

Among couples with normal semen characteristics by the criteria of WHO, sperm recovery in the peritoneal fluid was observed in only 3 (11.1%) of 27 patients with sperm immobilizing antibodies, compared with 72 (34.0%) of 212 patients without the antibodies (P < 0.025). The antibody titers of the patients with the sperm recovery were very low by the quantitative sperm immobilization test. In most patients, a similar amount of sperm immobilizing antibodies was present in the peritoneal fluid and the sera. Though the complement activities in the peritoneal fluid were less than those in sera, the former were still found to be sufficient to immobilize sperm in vivo.

CONCLUSIONS

These results suggest that the complement-dependent sperm immobilizing antibodies could interfere with sperm migration in the female genital tract at the level of the fallopian tubes.

Inhaled indomethacin prevents bronchoconstrictive response to distilled water but not to histamine in children with asthma

We evaluated the effect of inhaled indomethacin, a nonsteroidal antiinflammatory drug (NSAID), against bronchoconstriction induced by ultrasonically nebulized distilled water (UNDW) in children with asthma. Ten children with asthma (eight males and two females, with a mean +/- SEM age of 10.7 +/- 0.7 yr), who had a decrease in FEV1 of at least 20% after UNDW inhalation, were enrolled in this study. These subjects were pretreated with inhaled indomethacin (3 mg/m2 body-surface area) or placebo (0.9% saline) according to a single-blind, randomized, crossover design, and underwent a UNDW challenge test 15 min after the pretreatment. Furthermore, to study the possibility that indomethacin has a direct effect on airway smooth muscle, bronchial provocation with histamine was performed in seven subjects on two further days after pretreatment with indomethacin or placebo. Inhaled indomethacin had no effect on baseline pulmonary function, but did prevent the UNDW-induced decline in FEV1 (p < 0.01). Inhaled indomethacin did not modify the bronchoconstrictor response to histamine, indicating that a direct effect of this agent on airway smooth muscle is unlikely. The inhibition of local prostaglandin synthesis in the airways may be involved in the effect of indomethacin.

Direct production of the Fab fragment derived from the sperm immobilizing antibody using polymerase chain reaction and cDNA expression vectors

PROBLEM

Sperm immobilizing antibodies cause infertility mainly through complement dependent sperm immobilization. To analyze any effect of sperm immobilizing antibody on fertilization, we had already established cell lines that secrete IgM monoclonal antibody (MAb H6-3C4) and IgG monoclonal antibody (MAb EnBCMGS). The latter was a class-switched recombinant IgG antibody that shares the same variable region as MAb H6-3C4. The biological effects of the IgG antibody were also reported previously to eliminate sperm immobilizing or sperm agglutinating activities. However, the method of chemical digestion of IgG had some disadvantage to prepare the purified Fab fragment stably and in large quantities. This time we report a unique method to obtain the recombinant Fab fragments (Fab EnBCMGS) using polymerase chain reaction (PCR) and cDNA expression vectors.

METHOD

Two kinds of PCR primers were designed to make a truncated heavy chain (Fd) gene of MAb EnBCMGS. The amplified Fd gene and light chain gene were ligated into cDNA expression vectors and then transfected into mammalian cells.

RESULTS

Expression of the Fd gene and light chain gene were confirmed by Northern blotting. Secretion of the recombinant Fab fragment from mammalian cells was also confirmed by Western blotting. The Fab fragment showed biological activity as is expected by FACS analysis.

CONCLUSION

This method enables the stable production of genuine Fab fragments of IgG in mammalian cells without any chemical treatment that may be time consuming and affect the quality of the Fab fragments.

A clinical study of upper urinary tract calculi treated with extracorporeal shock wave lithotripsy: association with bacteriuria before treatment

To study the characteristics of upper urinary tract calculi associated with bacteriuria, we determined the relationships between the frequency of bacteriuria and some clinical factors such as location and size of calculi. Nine hundred and fifty-eight patients, 596 with renal calculi and 362 with ureteral calculi, were subjects in the present study. Bacteriuria was found in 75 patients, 57 with renal calculi (10%) and 18 with ureteral calculi (5%). The frequency of bacteriuria was significantly higher in patients with renal calculi than in those with ureteral stones (p < 0.05). In the patients with renal calculi, bacteriuria was most frequently associated with stones having a diameter of > 30 mm (19%), and secondarily with stones of 20-30 mm (12%). In contrast, the presence of bacteriuria was not related to the size of ureteral calculi. In conclusion, patients with renal stones of > 20 mm diameter have an increased risk of bacteriuria.

Effect of inhaled furosemide on lung clearance of technetium-99m-DTPA

The diuretic furosemide has been reported to have a protective effect on allergic asthmatic reactions. This study was performed to investigate the effect of aerosolized furosemide on the lung clearance of 99mTc-diethylene triamine pentaacetic acid (99mTc-DTPA).

METHODS

Pulmonary clearance rates of 99mTc-DTPA were measured by a computerized gamma camera with and without the inhalation of aerosol furosemide in 6 nonsmoking normal volunteers (Group 1), 7 smokers without pulmonary disease (Group 2) and 11 patients with asthma (Group 3).

RESULTS

None of the six normal volunteers showed significant effects of inhaled furosemide on the 99mTc-DTPA clearance rates. Three of seven smokers presented an accelerated 99mTc-DTPA clearance by inhaled furosemide and the other four showed no significant change of 99mTc-DTPA clearance by furosemide inhalation. However, in 10 of 11 patients with asthma, there was significant suppression of 99mTc-DTPA clearance by furosemide inhalation.

CONCLUSION

Asthmatics possess a furosemide-sensitive mechanism. Pulmonary aerosol scintigraphy with 99mTc-DTPA will be useful in predicting the effect of inhaled furosemide therapy.

Fever after extracorporeal shock wave lithotripsy for patients with upper urinary tract calculi associated with bacteriuria before treatment

The present study was carried out to determine the relationship between fever (> or = 38 degrees C) after extracorporeal shock wave lithotripsy (ESWL) and the history of bacteriuria before ESWL. The subjects of this study comprised 958 patients. Significant bacteriuria before ESWL was found in 75 patients. These patients were treated with antibiotics and underwent ESWL after bacteriuria disappeared. Despite treatment with antibiotics, the patients with bacteriuria before ESWL had a significantly higher incidence of fever after ESWL than those without bacteriuria. Among the 14 patients whose high fever persisted after ESWL, the patients with bacteriuria included 7 (50%) with stones > 20 mm in size. The patients with stones > 20 mm and bacteriuria before ESWL had a high risk of persistent high fever after ESWL.

[Clinical studies on treatment by ESWL using EDAP LT-02 for upper urinary tract calculi]

From July 1993 through March 1994, 512 ESWL therapy was performed on upper urinary tract calculi in 277 renoureteral units using an EDAP LT-02 Lithotripter. Of these cases, 244 renoureteral units which were followed up for more than 3 months after ESWL were examined. These included 124 renal stones and 100 ureteral stones. Complete removal or sufficient stone disintegration was obtained in 66.7, 98.0 and 94.1% in the R1, R2 and R3 groups of renal stones, respectively, and in 92.4, 87.5 and 100% in the U1, U2 and U3 groups of ureteral stones, respectively. The over-all stone-free and success rates were 78.2 and 95.2%, respectively for renal stones and 93.0% and 94.0% respectively for ureteral stones. These results were better than those obtained by LT-01 in our experiences. The newly built-in coaxial X-ray system greatly contributed to these high success rates. As side effects, there were no serious complications. It is concluded that ESWL using an EDAP LT-02 is safer and more effective for the treatment of upper urinary tract calculi.

The effects of patients' sera with sperm-immobilizing antibodies on sperm of the Japanese monkey

In order to study the interspecies cross-reactivity of sperm-immobilizing antibodies found in sera of women who were infertile for unknown reasons, we used the sperm-immobilization test to examine the effects of patients' sera with or without sperm-immobilizing antibodies on the sperm of the Japanese monkey (Macaca fuscata). Fourteen of 17 antibody-positive sera and 7 of 14 antibody-negative sera showed sperm-immobilizing activity with regard to monkey sperm. The sperm-immobilizing antibody that was active against both human and monkey sperm could be absorbed only by sperm from each corresponding species. The periodate treatment of human or monkey sperm markedly diminished their antibody-absorbing capabilities. Human and mouse monoclonal antibodies having sperm-immobilizing activity with regard to human sperm showed no sperm-immobilizing activity with regard to monkey sperm. These results indicate that the sperm-immobilizing activity of the sera of infertile women against human and monkey sperm might be due to antibodies with different specificities, which recognize a unique carbohydrate antigen epitope expressed in the sperm of each species.

Respiratory muscle pressure analysis in pressure-support ventilation

The extent to which respiratory muscles are exerted during partially supported ventilation is difficult to differentiate, because these muscles and the ventilator work simultaneously to produce ventilation. We have developed a new method for determining the pressure developed by the respiratory muscles in partially supported ventilation. In seven patients on pressure-support ventilation (PSV), pressure, flow, and lung volume change were measured at the airway opening. Various PSV levels (0-15 cmH2O) were applied to each patient in random order. By utilizing a model of respiratory mechanics, we calculated the pressure developed by the respiratory muscles and the inspiratory work performed by the muscles from the measured parameters by use of the resistance and elastance of the respiratory system obtained during controlled ventilation. Increasing PSV from 0 to 15 cmH2O modulated the resultant breathing pattern, i.e., increasing tidal volume and decreasing respiratory rate. The respiratory muscle pressure, although less negative, had a shape that corresponded to the shape of airway occlusion pressure at each PSV level, and both pressures decreased concomitantly with increasing PSV. The respiratory muscle work progressively decreased with increasing PSV. This analysis enabled clear and continuous quantifications of the respiratory muscle force generation and inspiratory work during partially supported ventilation.

Effect of inhaled amiloride on water-induced bronchoconstriction in asthmatic children

To determine whether the inhaled diuretic, amiloride, can modify bronchoconstriction induced by ultrasonically nebulized distilled water (UNDW) in asthmatic children, a double-blind, randomized, placebo-controlled study was done. The UNDW inhalation challenge was performed in 12 asthmatic children (nine boys and three girls; mean age +/- SEM, 11.2 +/- 0.75 yr), who had at least a 20% fall in FEV1 after UNDW inhalation. On separate days, these subjects underwent UNDW inhalation challenge after inhalation of amiloride (0.3 mg/m2 body surface area) or placebo (0.9% saline). Neither bronchodilation nor bronchoconstriction after amiloride inhalation was observed. The mean value and SEM of the UNDW PD20 after placebo inhalation was 4.55 +/- 0.80 ml. After inhalation of amiloride, PD20 increased to 7.93 +/- 0.75 ml (p < 0.01). We concluded that inhaled amiloride exerted a protective effect against UNDW-induced bronchoconstriction in asthmatic children.

Age-related changes in bronchial hyperreactivity during the adolescent period

To evaluate the influence of bronchial hyperreactivity on the improvement of asthma seen during adolescence, age-related changes of bronchial reactivity to methacholine (BRm) in adolescence were evaluated in two studies. Study 1 included 261 asthmatic children and 89 controls, aged 6-26 years, and in Study 2, yearly BRm variations from age 11 to 16 years of 23 asthmatic children of study 1 were studied. Methacholine inhalation challenge was performed by using an oscillation method; that is, respiratory resistance (Rrs) was directly measured by an oscillation technique, and subsequent doses were then doubled, until a twofold increase in Rrs from the baseline was reached. The cumulative dose of methacholine at the inflection point of the Rrs was considered to represent the BRm. From ages 6 to 9, Dmin in the asthmatic children were low (from 2.07 units to 1.38 units), but after age 12, the value gradually increased, and finally became sustained after age 16 (from 2.27 units to 4.80 units). These same age-related changes were seen in the age-matched controls. From ages 6 to 11, Dmin in the control children were also low (from 8.07 units to 12.9 units), but after age 12, Dmin gradually increased, and finally became sustained after age 16 (from 18.5 units to 43.2 units). However, for each year, the Dmin of the asthmatic children were significantly lower than those of the controls. Further, the mean of yearly Dmin variation from age 13 was less than that of younger subjects (from 0.65 unit/year to 0.92 unit/year, from 1.16 units/year younger subjects (from 0.65 unit/year to 0.92 unit/year, from 1.16 units/year to 4.16 units/year, respectively). We, therefore, concluded that the natural age-related BRm changes and the increased stability of yearly BRm variation that occur in adolescence may play a role in the improvement of childhood asthma seen during this period.

Horizontal component of electro-oculogram as a parameter of arousal in dementia: relationship between intellectual improvement and increasing arousal under pharmacotherapy

Although nootropics and metabolically active compounds sometimes attenuate intellectual deficits of dementia patients, this mechanism has not been discussed or investigated. The authors hypothesized that these compounds act to enhance attention and/or concentration by increasing the arousal level, and then improve intellectual functions. Based on this hypothesis, the authors investigated the arousal level and the improvement of intellectual functions in ten patients with Alzheimer type dementia and ten patients with multi-infarct dementia before and after 3 months pharmacotherapy using bifemelane hydrochloride. They then analyzed whether the increases in arousal level involves or relates to the improvement of intellectual functions. On the 20 patients, psychological tests were carried out, and the arousal level was evaluated using the frequency of rapid eye movements in the electro-oculogram (EOG) before and after 3 months administration of bifemelane hydrochloride. As a result, a significant positive correlation was observed between the improvement on the Hasegawa's dementia scale and the rate of increase in rapid eye movements in the EOG. The EOG monitoring can be a great help in establishing an objective evaluation method on drug efficacy.

[The correlation between changes in EEG and eye movement (EOG) accompanied by lowered arousal level]

We investigated the correlation between the components of spontaneous eye movement (EOG) and EEG in six healthy individuals. The study was conducted in three periods; from the resting to drowsy stage, from the drowsy to spontaneous awakening stage, and in the forced waking stage. EEG, as registered from bipolar electrodes attached between the left parietal region (P3) and the left occipital region (O1), was monitored continuously by the FFT method with a segment of 12.8 seconds. Rapid eye movement and slow eye movement were observed simultaneously. In conclusion, even when the arousal level varies considerably, there is a close correlation between frequency of rapid eye movement and EEG patterns of 10.16 integral of 10.94 Hz & 17.97 integral of 19.53 Hz (simple correlation p < 0.01). Additionally, during the forced waking period (after stage 2), delta and theta bands increased in cases along with sleepiness. Even if the depth of sleep was the same, one's mood upon awakening was determined by the frequency of slow waves before awakening.

[A clinical study on upper urinary tract calculi treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy, with regard to bacteriuria before ESWL treatment]

To study a clinical problem in urolithiasis complicated with bacteriuria treated by extracorporeal shock wave lithotripsy (ESWL), we studied relationships between the frequency of bacteriuria and some clinical factors such as sex, location of, size of and composition of calculi in patients with upper urinary tract calculi. We also evaluated whether bacteriuria caused fever elevation after ESWL monotherapy. Six hundred seventy patients with upper urinary tract calculi, 440 renal calculi and 230 ureteral calculi, were subjected to the present study. The results were summarized as follows: 1) Bacteriuria was found in 40 of 440 patients with renal calculi (9%) and 12 of 230 patients with ureteral calculi (5%). 2) The frequency of bacteriuria was significantly higher in female (11%) than in male (6%) (p < 0.05). 3) Ten strains of Pseudomonas aeruginosa, 7 of Escherichia coli and 6 of Proteus mirabilis were isolated in patients with bacteriuria. 4) On the location of renal calculi in patients with bacteriuria, 37 out of 40 patients (93%) were found in R2. In contrast, bacteriuria was the most frequently found in DS 6 (19%), whereas the positive rates were about 10% in DS 3 (7%), DS 4 (*7%) and DS 5 (9%). The presence of bacteriuria was not related to the location of calculi or the size of calculi in patients with ureteral calculi. 5) Most of the calculi with bacteriuria were composed of magnesium ammonium phosphate or the mixture of calcium phosphate and carbonate with or without oxalate. 6) Patients with bacteriuria had a significantly higher rate of fever elevation after ESWL than those without bacteriuria (p < 0.01).

Responders and non-responders to bifemelane hydrochloride in Alzheimer-type and multi-infarct dementia

Although metabolically active compounds sometime attenuate cognitive deficits of dementia patients, this mechanism has not been discussed or investigated. We hypothesized that these compounds improve cognitive disorders not by directly acting on this cognitive function, but by increasing the arousal level. Based on this hypothesis, we investigated the change of arousal levels and the improvement of intellectual functions in 10 patients with Alzheimer-type dementia (ATD) and 10 patients with multi-infarct dementia (MID) before and 3 months after pharmacotherapy using bifemelane hydrochloride. For each patient, a psychological test battery was carried out and the arousal level was evaluated using the frequency of rapid eye movements in the electro-oculogram (EOG) and the frequency analysis of electroencephalogram (EEG) before and after the treatment. Evaluation of the cognitive improvement was made and eight out of the 20 patients were regarded as responders to the treatment. The frequency of small rapid eye movements (SREM) in the EOG increased significantly only in responders and the rate of change in SREM appearance in responders was significantly different from that in non-responders. This finding suggests that a part of the intellectual improvement in ATD and MID results from the increased level of arousal.

Plasma theophylline concentrations and airway function in asthmatic children receiving standard and modified RTC therapy

The effects of three different dosage schedules for sustained-release theophylline (Theolong) were investigated in children with asthma. With regimen II (unequal doses at 0800 h and 2000 h), the maximum plasma theophylline concentration following the evening dose was significantly higher than that following the morning dose, and also was larger than that following the evening dose with regimen I (equal doses at 0800 and 2000 h). With regimen III (equal doses at 0600 h and 2100 h), the mean theophylline concentration-time curve showed a single large peak at 1100 h, whereas with regimen I, there were two peaks at 2300 and at 1400 h. Knowledge that a change of the dosage schedule can affect the pharmacokinetics of theophylline in this way should aid physicians in its safe and effective use.

[11 cases of anaphylaxis caused by grand keyhole limpet (abalone like shellfish)]

We reported 11 cases of patients who developed moderate to severe anaphylactic reactions induced by the ingestion of grand keyhole limpet (GKL) and abalone. Specific IgE-mediated hypersensitivity to these shellfish was demonstrated by history, skin prick test, RAST and immunoblotting. The RAST inhibition technique revealed cross antigenicity between GKL, abalone and keyhole limpet hemocyanin. By immunoblotting analysis, the major antigens of GKL are shown in the MW range of about 38 Kd and 80 Kd.