Liver abscess after percutaneous ethanol injection (PEI) therapy for hepatocellular carcinoma. A case report

We present a case of liver abscess after percutaneous ethanol injection (PEI) therapy for the treatment of recurrent hepatocellular carcinoma (HCC). The 56-year-old woman had a past history of cholecystoduodenostomy for cogenital dilatation of the bile duct, and pneumobilia was observed in the intrahepatic bile ducts prior to PEI. The abscess was successfully treated by percutaneous abscess drainage and antibiotic therapy. Klebsiella pneumonia, one of the most common causative organisms of biliary tract infection, was isolated from the abscess. Thus, biliary tract infection related to the previous biliary-enteric anastomosis operation may have been one of the causative factors in the liver abscess in this patient. The rare experience reported here suggests that a careful search for coexistent abscess at the time of PEI is important in HCC patients with biliary-enteric anastomosis, especially in those with pneumobilia.

Follow-up examination schedule of postoperative HCC patients based on tumor volume doubling time

The tumor volume doubling time of 27 recurrent hepatocellular carcinoma nodules measuring < or = 2.0 cm in diameter discovered after hepatectomy in 19 patients was analyzed by ultrasonography for 31 to 331 days. The tumor volume doubling time ranged from 39 to 420 days before specific treatment, with a mean of 112 days and a median of 80 days. It correlated with age and intrahepatic site of recurrence, which was sometimes the same lobe as that of the prior hepatocellular carcinoma, sometimes not. The tumor volume doubling time also tended to correlate with hepatitis C antibody status and initial tumor diameter. The tumor volume doubling time was, however, independent of sex, hepatitis B surface antigen status, number of recurrent tumors, initial serum alpha-fetoprotein level, interval between hepatectomy and recurrence detection, and associated liver disease. On the basis of the shortest tumor volume doubling time of the recurrent hepatocellular carcinoma nodules, we recommend that US and/or CT be performed at least every four months to screen for small recurrent carcinomas in postoperative patients.

[Immobilization of a sensitive plant, Mimosa pudica L., by volatile anesthetics]

The disappearance of thigmonastic mobility of a sensitive plant, Mimosa pudica L., caused by volatile anesthetic agents such as methoxyflurane, chloroform, halothane, enflurane or sevoflurane revealed that the response to anesthetic agents in plants maybe similar to that in animals. In terms of reversible anesthesia, animals seem to equal plants in order of potency of anesthetics, and the minimum immobilizing concentration (MIC; %) in the plant shows a good correlation with MAC in the human (MICplant = 5.8 MAChuman + 0.01, r2 = 0.946). These phenomena suggest the existence of a certain common mechanism in anesthesia between animals and plants.

Semiautomated 14C-thymidine incorporation assay for in vitro screening of anticancer drug

We developed a rapid screening test for anticancer drugs by using 14C-thymidine (14C-TdR), a microculture filtration plate and a radiochromatoscanner. Mitomycin C (MMC), tamoxifen and 5-fluorouracil (5FU) were used as the anticancer drugs against four human gastric cancer cell lines. The rates of cell inactivation (14C-TdR uptake) determined with the radiochromatoscanner were almost the same as those determined with the liquid scintillation counter. Comparing the rate of cell inactivation obtained by our method with that obtained by proliferative activity of cells derived from the cell count, both assays showed the approximately same results by tamoxifen and MMC but the rates of cell inactivation by 5FU in two cell lines obtained by the 14C-TdR uptake assay was considerably lower than those obtained by the cell count. These results show that the radio-labeled DNA precursor uptake assay is not suitable for metabolic inhibitors of DNA synthesis. Ninety six samples on a plate, however, were assayed semiautomatically and rapidly just as well as in the tetrazolium-based calorimetric (MTT) assay. Therefore, our 14C-TdR uptake assay system is useful for the cancer chemotherapeutic agents except the metabolic inhibitors of DNA precursors.

Health-risk appraisal applied to ordinary AMHTS

The main purpose of an automatic health testing system (AMHTS) has changed from early detection to primary prevention. Health-risk appraisal is now widely available as a tool of health education aiming at the modification of unhealthy lifestyles. However, the opportunity to offer appropriate health education was less frequent for those who had no particular findings during AMHTS. The results of an AMHTS should be evaluated from the viewpoint of health-risk appraisal, because the system is expected to supply useful information regarding one's lifestyle. Our system consists of two health-risk appraisal subsystems. One subsystem estimates the degree of improvement in medical indicators after a patient's lifestyle has been modified. The other subsystem predicts the occurrence of abnormal findings in medical indicators. These health-risk appraisal subsystems provide patients with information about their health-risks, based on their AMHTS results. Our health-risk appraisal subsystems should play an important role in future health education through the application of ordinary AMHTS.

Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis

For 104 consecutive patients with hepatocellular carcinoma (HCC) with portal tumor thrombus (PTT) seen in the past nine years, prognostic factors were analyzed retrospectively using Cox's multivariate analysis. There was a significant difference in survival rate with hepatic functional reserve (Child classification, P = 0.005), type of treatment (surgical vs non-surgical treatment, P = 0.009) and PTT grade (P = 0.04). The survival rates for patients with Child's A (n 49) or Child's B (n 55) were 60.8 vs 20.0% at one year, 41.6 vs 9.1% at two years and 35.4 vs 5.5% at three years. The survival rates of patients with surgical (n 32) and non-surgical (n 72) therapy were 71.7 vs 25.0% at one year, 58.5 vs 9.4% at two years and 53.6 vs 4.7% at three years. Among patients with PTT grades in the third or lower order branch (Vp1, n 29), the second order branch (Vp2, n 32) and the first or portal vein trunk (Vp3, n 43), the one-year, two-year and three-year survival rates were 61.6, 43.8 and 20.9%; 47.1, 27.5 and 6.2% and 42.8, 27.5 and 0%, respectively. When analysis was focused on 32 patients with Child's A and PTT (Vp1 plus Vp2) with respect to treatment, the survival rates in the surgical (n 22) and nonsurgical (n 10) groups were 86.1 vs 70.0% at one year, 71.5 vs 30.0% at two years and 64.3 vs 20.0% at three years (P < 0.05), respectively. In HCC patients with PTT, surgery seems to be indicated where hepatic function is well preserved and the PTT is localized in a peripheral portal branch.

Conversion of the Salmonella phase 1 flagellin gene fliC to the phase 2 gene fljB on the Escherichia coli K-12 chromosome

The Escherichia coli-Salmonella typhimurium-Salmonella abortus-equi hybrid strain EJ1420 has the two Salmonella flagellin genes fliC (antigenic determinant i) and fljB (determinant e,n,x) at the same loci as in the Salmonella strains and constitutively expresses the fliC gene because of mutations in the genes mediating phase variation. Selection for motility in semisolid medium containing anti-i flagellum serum yielded 11 motile mutants, which had the active fliC(e,n,x) and silent fljB(e,n,x) genes. Genetic analysis and Southern hybridization indicated that they had mutations only in the fliC gene, not in the fljB gene or the control elements for phase variation. Nucleotide sequence analysis of the fliC(e,n,x) genes from four representative mutants showed that the minimum 38% (565 bp) and maximum 68% (1,013 bp) sequences of the fliC(i) gene are replaced with the corresponding sequences of the fljB(e,n,x) gene. One of the conversion endpoints between the two genes lies somewhere in the 204-bp homologous sequence in the 5' constant region, and the other lies in the short homologous sequence of 6, 8, or 38 bp in the 3' constant region. The conversions include the whole central variable region of the fljB gene, resulting in fliC(e,n,x) genes with the same number of nucleotides (1,503 bp) as the fljB gene. We discuss the mechanisms for gene conversion between the two genes and also some intriguing aspects of flagellar antigenic specificities in various Salmonella serovars from the viewpoint of gene conversion.

A phase 2 study of cisplatin in patients with hepatocellular carcinoma

A phase 2 study of cisplatin was performed in 28 previously untreated patients with unresectable hepatocellular carcinoma. The drug was given intravenously at a dose of 80 mg/m2/day every 4 weeks. Of 26 patients evaluated, 4 (15.4%) showed partial responses lasting for > 3 months, while no patient achieved a complete response. Of 22 patients whose serum level of alpha-fetoprotein (AFP) was high (> 400 ng/ml) before treatment, 6 (27.3%) showed a > 50% reduction in serum AFP levels after treatment. The current study indicates that cisplatin is an anticancer agent worthy of further testing in patients with this disease.

A new cdc gene required for S phase entry of Schizosaccharomyces pombe encodes a protein similar to the cdc 10+ and SWI4 gene products

We have isolated a new cell division cycle gene (res1+) required for entry into S phase, as a multicopy dual suppressor of the pat1 and cdc10 mutants of the fission yeast Schizosaccharomyces pombe. The res1+ gene specifies a 72 kDa protein with two copies of the cdc10/SWI6 motif. A disruptant of res1+ grows poorly at 30 degrees C with severe heat- and cold-sensitivities, and completely arrests in G1 at 36 degrees C and 23 degrees C. The arrested disruptant retains a full conjugation ability. In addition to the cdc10/SWI6 motif, Res1 and SWI4 proteins share a remarkable homology in their amino-terminal region, whereas Cdc10 and SWI6 do so in their carboxy-terminal region. Moreover, the amino-terminal region is essential for the function of Res1 as it is for the function of SWI4. Furthermore, analogous to the relationship of SWI4 to SWI6, the res1+ gene effectively rescues cdc10 mutants, but the cdc10+ gene cannot rescue the res1- phenotype. Thus, striking similarities exist in both structural and functional relationships between Res1 and SWI4, and between Cdc10 and SWI6. In view of the fact that SWI4 and SWI6 form a transcription factor complex and activate promoters containing the SWI4/SWI6 dependent cell-cycle box, Res1 might be a putative association partner of Cdc10 which appears to be involved at least in the activation of promoters containing a MluI cell-cycle box.

Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors

Of 270 consecutive patients with hepatocellular carcinoma who underwent surgery, 50 who had recurrence and were subsequently treated with transcatheter arterial embolization were analyzed. The longest interval between surgery and recurrence in the 50 patients who underwent transcatheter arterial embolization was 7 yr. Recurrence was initially found in the remnant liver in all patients but one; extrahepatic metastases were detected in 13 patients (26%) during follow-up. A "multiple" type was the most common (64%) hepatic recurrence pattern on angiography, followed by the "solitary" (16%) and "tumor thrombus" (12%) patterns. Hepatic recurrence was most frequently found in the ipsilateral lobe (48%) relative to the site of the primary hepatocellular carcinoma. Multivariate analysis of the factors affecting survival after transcatheter arterial embolization indicated that recurrence pattern (p = 0.025) and distant metastases (p = 0.011) were significant. Of 13 patients with distant metastases, 11 had the "multiple" pattern of hepatic recurrence. Survival rates for all 50 patients after initial surgery and after transcatheter arterial embolization were 90% and 64%, respectively, at 1 yr; 52% and 24%, respectively, at 3 yr; and 27% and 5%, respectively, at 5 yr. On analysis of survival rates after transcatheter arterial embolization in 37 patients with recurrence only in the liver and of the response of recurrent hepatocellular carcinoma to transcatheter arterial embolization, a significant difference was noted between those with "partial response" and "progressive disease" (p less than 0.05) and between those with "no change" and "progressive disease" (p less than 0.05).

Prognostic factors in patients with hepatocellular carcinoma receiving systemic chemotherapy

A total of 71 consecutive patients with unresectable hepatocellular carcinoma were analyzed retrospectively to determine the significant prognostic factors. All the patients received systemic chemotherapy in a phase 2 study from 1980 to 1990, with no other anticancer treatment. Median survival time and 1-yr and 2-yr survival rates were 5.6 mo, 23% and 5%, respectively. By the univariate analysis, a performance status of 0-1 and tumor size less than 50% of the liver cross-sectional area were shown to be the factors most significantly favoring a better prognosis. By the multivariate analysis using the Cox proportional hazards model, a performance status of 0-1 (p less than 0.001), absence of tumor thrombus in the main portal trunk (p = 0.003) and age less than 60 yr (p = 0.036) were independent favorable prognostic factors. A prognostic index was calculated from these three factors according to the following equation: 1.8109 x (0 = performance status of 0-1 and 1 = performance status of 2-3) + 0.9322 x (0 = tumor thrombus absent in the main portal trunk and 1 = present) + 0.6996 x (0 = age less than 60 yr and 1 = age greater than or equal to 60 yr). This index was used to classify the patients into three groups with a good, intermediate and poor prognosis. The median survival times for these three groups were 9.8, 3.8 and 1.9 mo, respectively (p less than 0.01). The results of this study may be useful in the design and analysis of future clinical trials of systemic therapy for hepatocellular carcinoma.

Radiotherapy for bone metastases of hepatocellular carcinoma

Radiotherapeutic effects of 42 bone metastases in 26 hepatocellular carcinoma patients were retrospectively analyzed. Pain relief was observed in 79% of 37 bone metastases treated (29/37). Antitumor effects and improvement of paralysis were also observed in 88% (8/9) and 17% (1/6), respectively. The toxicities experienced were tolerable. Radiotherapy was an effective means of palliation in the treatment of hepatocellular carcinoma bone metastases.

A rapid anticancer drug screening assay by [14C] thymidine uptake in cultured human cancer cells

A rapid screening test by suppression of DNA synthesis in cancer cells was developed with [methyl-14C]-thymidine (14C-TdR), a microculture filtration plate and a radiochromatoscanner. Mitomycin, tamoxifen and 5-fluorouracil (5-FU) were tested against four human gastric cancer cell lines and HeLa cells. The tetrazolium-based colorimetric (MTT) assay underestimated cell inactivation by mitomycin in three cell lines compared with the cell count and the 14C-TdR assays. Inactivation by 5-FU in one cell line by 14C-TdR uptake was considerably lower than that by other methods. Thus neither the radio-labelled DNA precursor uptake nor the MTT assay is suitable for every anticancer drug but they are complementary.

The ste4+ gene, essential for sexual differentiation of Schizosaccharomyces pombe, encodes a protein with a leucine zipper motif

Ste4- mutants of Schizosaccharomyces pombe are unable to undergo both mating and meiosis. We have cloned the ste4+ gene and its cDNA. The gene encodes a 264 amino acid protein with a typical leucine zipper motif homologous with the jun family. However, unlike the jun family, this protein does not have a typical basic region that precedes the leucine zipper. The transcription of this gene absolutely depends on the ste11+ gene and increases several fold upon nitrogen starvation, a general signal for sexual differentiation. Whereas ste4+ is essential for mating and meiosis, its overexpression inhibits these processes.

A sensitive method for detecting the fermentation-inhibition antibody to Mycoplasma pneumoniae

The fermentation-inhibition (FI) test for Mycoplasma pneumoniae was improved by using a combination of guinea pig complement and gamma globulin-depleted horse serum in place of unheated whole horse serum employed in the conventional assay system. As the test antigen for the new FI assay system, M. pneumoniae filtrated through a 3.0 microns membrane filter was used. Owing to the strong augmenting effect of guinea pig complement, the FI activity of rabbit immune serum was increased 32-fold in the new system compared with the conventional system. Furthermore, IgM antibody, which is barely detectable by the conventional system, could easily be titrated by the new system. With this sensitive method, rapid rise of FI titer was clearly demonstrable in most children with acute M. pneumoniae infections, and a prevalence of FI or growth-inhibitory antibody among healthy adults in Japan (82%) was revealed.

Detection of hepatitis C virus infection by enzyme-linked immunosorbent assay system using core protein expressed in Escherichia coli

Enzyme-linked immunosorbent assay of the core protein of hepatitis C virus (HCV) expressed in E. coli led to detection of the antibody against this virus in patients with chronic hepatitis. Some of the negative results obtained using a different viral protein became positive with this E. coli-expressed viral protein, and were also positive for the viral RNA. Thus, use of the core protein of HCV facilitates accurate detection of HCV infection.

[The suppressive effects of smoking on antibody production in experimental hypersensitivity pneumonitis in rabbits]

Farmer's lung disease is one type of hypersensitivity pneumonitis (HP) in dairy farmers, and is usually caused by Micropolyspora faeni (Mf). It has been reported that the positive rate of precipitin antibody to Mf in smoking dairy farmers is one-eighth to one-half of that in nonsmoking dairy farmers. To clarify the mechanism of this phenomenon, by using an experimental HP model in rabbits, we investigated 1) the effects of short (5 weeks) and long (20 weeks)-term cigarette smoke exposure on the antibody formation, 2) the effects of 30 weeks of smoke exposure on the accessory cell function of alveolar macrophages (AM). Smoking exerted variable influences on antibody production, depending on the duration of smoke exposure, and we confirmed that long-term smoke exposure had suppressive effects. In addition AM from smoked rabbits suppressed lymphoproliferative response to autologous spleen cells. It was concluded that in this experimental HP, smoking affects the functions of both AM and lymphocytes, and that it suppresses antibody production as long as the smoke exposure continues.