Expression of apoptosis regulatory proteins in the skeletal muscle of tumor-bearing rabbits

We reported finding that apoptosis occurred in skeletal muscle in the early stage after implantation. In the present study, we investigated expression of the apoptosis-related proteins Bax and Bcl-2 to determine the mechanism of the apoptosis. In the early stage of tumor bearing, 20 days after implantation, lean body mass (LBM) was reduced by 5.06 +/- 1.10% in the tumor-bearing group, compared with an increase of 4.96 +/- 1.26% in the control group. The apoptotic index (AI) of the skeletal muscle in the tumor-bearing group increased to 40.5 +/- 3.20% but was 0% in the control group, and Bax expression was strongly positive in 5 of the 10 rabbits in the tumor-bearing group, and significantly stronger than in the control group (P = 0.0002). In the late stage of tumor bearing, 40 days after implantation, the AI had declined to 0.93 +/- 0.96% in the tumor-bearing group, but was still 0% in the control group. Bax expression was rarely detected in either the tumor-bearing group or the control group, and there was no significant difference between the two groups (P = 0.706). No significant changes in Bcl-2 were observed in either group. The above results showed that apoptosis via Bax played a role in muscle wasting associated with progression of the malignant tumor. However, the apoptosis and expression of Bax were seen only in the early stage, within 20 days after implantation, not in the late stage. This suggested that the muscle wasting in the early stage might be caused by a different mechanism from that in the late stage.

Effects of cocaine and ethanol on mouse fetuses

In the presence of ethanol, cocaine is metabolized to its ethyl homolog, cocaethylene. To investigate the embryotoxic effects of cocaethylene, pregnant ICR mice receiving ethanol orally during pregnancy were treated with 50 mg/kg/day cocaine i.p. on days 7, 8 and 9 of gestation. Treatment with either cocaine or ethanol alone did not affect the fetal mortality rate or the mean fetal body weight. Concurrent cocaine and ethanol treatment increased the fetal mortality rate, and decreased the mean fetal body weight, although teratogenicity was not noted. These results suggest that concurrent use of cocaine and ethanol during pregnancy is more harmful to fetal body weight gain and their lives than the use of either drug alone, at least in the present experimental settings.

Association of the shrinkage of uterine leiomyoma treated with GnRH agonist and deletion of long arm of chromosome 7

Specific chromosomal abnormalities, such as del(7q), t(12;14), 12 trisomy, or the rearrangement of 6p, are seen in approximately 30% of uterine leiomyomas despite their benign status. We investigated the association between the shrinkage of uterine leiomyomas treated with a GnRH agonist and the interstitial deletion of chromosome 7q, which is one of the most common chromosomal abnormalities in uterine leiomyomas. This study covered 29 women with uterine leiomyomas who were treated with a GnRH agonist before surgery. The volume of the largest myoma nodule was measured by means of MRI before and at 12 weeks after the beginning of GnRH agonist treatment, and the percentage of the reduction in volume was calculated. Genomic DNA was extracted from leiomyoma tissue and peripheral blood, and amplified by PCR using fluorescently-tagged oligonucleotide primers of twelve microsatellite loci on chromosome 7. The PCR products were analyzed for loss of heterozygosity (LOH) using an automated fluorescent DNA sequencer. Of the 29 informative tumors, five (17%) showed LOH with deletion of the common region, D7S491. The mean percentages of the reduction in volume of the largest myomas with LOH or without LOH were 32+/-13 and 18+/-58%, respectively (not significant). One tumor showing interstitial deletion of both alleles (homo-deletion) reduced in volume by 19%. Another tumor showing an extraband increased in volume by 13%. Although tumor specific chromosomal deletion suggested the existence of tumor suppressor genes in this region, there was no significant association between the shrinkage of uterine leiomyomas treated with a GnRH agonist and the interstitial deletion of chromosome 7q.

Vesicovaginal fistula treated with fibrin glue

We report here a case of vesicovaginal fistula, following radiation therapy and intensive local chemotherapy for recurrent endometrial cancer of the vaginal stump, which was ameliorated with fibrin glue. The procedure temporarily postponed urinary diversion until the recurrence of irreparable fistula more than 4 years after the development of the first vesicovaginal fistula.

Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial

OBJECTIVE

To investigate the effects of the combination of pelvic floor muscle exercise (PFME) and estriol on postmenopausal stress incontinence (SI).

STUDY DESIGN

Sixty-six patients with postmenopausal SI were randomized to a group treated with a combination of estriol (1 mg/d) and PFME (group A, n = 32) and a group treated with PFME alone (group B, n = 34). Efficacy was evaluated every three months based on stress scores obtained from a urinary incontinence (UI) questionnaire.

RESULTS

A significant decrease in stress score was observed in mild and moderate UI patients in both groups three months after the commencement of therapy (A and B, P < .0001). The therapeutic effect in group A was more prominent for up to 18 months in mild UI and for up to 12 months in moderate UI (A vs. B, P < .05). Kaplan-Meier analysis showed that the cumulative morbidity rate in mild SI patients was significantly lower in group A (0%) than in group B (12%, P < .005).

CONCLUSION

Combination therapy with estriol plus PFME was effective and is capable of serving as first-line treatment for mild SI.

Neutropenia accompanying parvovirus B19 infection after gynecologic surgery

The hematologic data and symptoms of 7 patients seropositive for parvovirus B19 IgM antibody after gynecologic surgery were analysed. Parvovirus may have been transmitted by fibrin glue prepared from heat-treated human plasma and used for hemostasis during surgery. The peripheral blood neutrophil count decreased to below 1 x 10(9)/l between postoperative day (POD) 10 and 18, but recovered spontaneously to within the normal range. G-CSF injection was effective in preventing neutropenia or obtaining a prompt recovery. The reticulocyte count fell below 10 x 10(9)/l between POD 13 and 19, and also recovered spontaneously. A slapped-cheek rash was not observed in any of the 7 patients.

Metachromasia of the endocervical epithelium for delineating the internal os

OBJECTIVE

To study the metachromatic stainability of the endocervical epithelium.

STUDY DESIGN

Surgical specimens that included endocervical epithelium were deparaffinized and stained with toluidine blue at various pH levels and after enzyme digestion. Glycosaminoglycans were separated from endocervical tissue and analyzed by electrophoresis.

RESULTS

The endocervical epithelium stained metachromatically purple with toluidine blue in pH 4.1 buffer, but the staining disappeared after chondroitinase digestion. The electrophoretic mobility of the glycosaminoglycan fraction separated from the endocervical epithelium was compatible with nonsulfated chondroitin.

CONCLUSION

Endocervical epithelium was identifiable from metachromatic staining below the internal os, and the electrophoretic results of the tissue extract suggested that nonsulfated chondroitin is the main component of glycosaminoglycans in endocervical epithelium.

Ultrastructural comparison of uterine leiomyoma cells from the same myoma nodule before and after gonadotropin-releasing hormone agonist treatment

OBJECTIVE

To compare ultrastructural features of leiomyoma cells from the same uterine myoma nodule before and after GnRH agonist (GnRH-a) treatment and to examine the relation between these ultrastructural changes and the extent of myoma volume reduction with GnRH-a treatment.

DESIGN

Prospective clinical study.

SETTING

University teaching hospital.

PATIENT(S)

Twenty women with uterine leiomyomas who were scheduled for surgery.

INTERVENTION(S)

Transcervical needle biopsy of uterine myoma, s.c. leuprolide acetate injection (3.75 mg) at least three times every 4 weeks before surgery, and hysterectomy or myomectomy.

MAIN OUTCOME MEASURE(S)

The changes in ultrastructural features of uterine leiomyoma cells and the percentage decrease in the volume of the largest myoma at 12 weeks of GnRH-a treatment measured by magnetic resonance imaging.

RESULT(S)

A decrease in myofilaments, mitochondrial swelling, and emergence of the lysosomal body were observed in relation to GnRH-a treatment. Furthermore, a positive correlation was observed between the decrease in myofilaments and myoma shrinkage.

CONCLUSION(S)

Cellular atrophy due to a decrease in myofilaments plays a major role in the reversible myoma shrinkage resulting from GnRH-a treatment.

Diagnosis of metastasis of ovarian clear cell carcinoma to the peritoneum of the abdominal wall by positron emission tomography with (fluorine-18)-2-deoxyglucose

A 43-year old woman, operated on for ovarian clear cell carcinoma (stage IIc) four years previously was found to have a small mass under the abdominal wall in the right lower quadrant of the abdomen. Neither diagnostic imaging (ultrasonography and MRI) nor tumor markers showed any evidence of recurrence, but positron emission tomography revealed a hot spot area, and it was diagnosed as recurrence of the ovarian carcinoma. The postoperative histopathological diagnosis was metastasis of ovarian carcinoma to the peritoneal wall.

Platelet-derived endothelial cell growth factor in keratinizing-type squamous cell uterine cervical cancer

The purpose of this study was to determine whether intratumor expression of platelet-derived endothelial cell growth factor (PD-ECGF) is a prognostic factor. We examined specimens from 61 cases of carcinoma of uterine cervix (Ca-Cx). Specimens were stained with periodic acid-Schiff preparation with diastase (d-PAS) and alcian blue (pH 2.5) to identify the presence of intracellular mucin. PD-ECGF expression and microvessel count (MVC) were assessed by immunohistochemical staining. Twenty specimens stained positive for mucin. MVC correlated with clinical stage (p<0.01). There was a correlation between PD-ECGF expression and survival time (p<0.05), but no correlation was seen between mucin staining positivity, MVC, and PD-ECGF expression and survival time by the Cox proportional hazard model. Intratumor PD-ECGF expression was not a prognostic factor in keratinizing-type squamous cell carcinoma of the uterine cervix.

Apoptosis of muscle cells causes weight loss prior to impairment of DNA synthesis in tumor-bearing rabbits

The mechanism of weight loss induced by the growth of malignant tumors is still unknown. We investigated it by focusing on apoptosis of skeletal muscle. VX2-tumor was implanted into rabbits and the apoptotic index (AI) of skeletal muscle was measured by in situ end-labeling assay. Plasma of the tumor-bearing rabbits was perfused repeatedly through non-coated charcoal resin. The AI reached 54.6% early after tumor implantation, when weight loss amounted to an 18% decrease in lean body mass (LBM) without change in muscle DNA synthesis or urinary 3-methylhistidine / creatinine ratio (3-MH / Cr). When the decrease of LBM reached 30%, DNA synthesis was decreased by 48% and 3-MH / Cr was increased by 104%, whereas AI was only 4.7%. The plasma perfusion did not prevent apoptosis in muscle, but improved LBM, DNA synthesis, and 3-MH / Cr. There may be two mechanisms of muscle depletion during the tumor growth: apoptosis in the early stage and metabolic abnormalities in muscle in the late stage.

Bleomycin, actinomycin-D, and cisplatin treatment of ovarian germ-cell malignancies contributes to reducing adverse drug reactions

Sixteen ovarian germ-cell malignancy (OGCM) patients between 1983 and 1999 were randomly divided into the BEP group (n=6; bleomycin, etoposide and cisplatin) and the BAP group (n=10; bleomycin, actinomycin-D and cisplatin). The patients were evaluated for adverse drug reactions (ADRs) based on severity-grading of the National Cancer Institute Common Toxicity Criteria. The ADRs in the BAP group were milder than in the BEP group, as seen in regard to alopecia (p=0.0126), low hemoglobin (p=0.0147), and decreased neutrophil count (p=0.0197). The five-year survival rate was 87.5% in the BAP group and 83.3% in the BEP group, and the difference was not significant (p=0.5954). BAP therapy is likely to be more beneficial for OGCM patients than BEP therapy, because ADRs are reduced with no difference in outcome.

Kinetics of plasma platinum in a hemodialysis patient receiving repeated doses of cisplatin

The pharmacokinetics of cisplatin were studied in a 46-year-old hemodialysis patient treated for uterine cancer with weekly cisplatin. Hemodialysis was performed immediately before, one-hour after, and two-hours after cisplatin administration for two consecutive cycles each. The concentrations of total and free platinum were measured. The decay curve of both total platinum and free platinum showed a biphasic pattern characterized by an alpha-phase and a beta-phase, the same as in non-hemodialysis patients. There were no differences between the individual cycles in the peak platinum concentration or the decay pattern. The plasma platinum concentration decreased to below detection limit 3 months after the final dose.

Induction of estradiol synthesis by probucol in the adenocarcinoma cells of an ovarian clear cell tumor

BACKGROUND

Clear cell tumor of Müllerian organs have characteristic intracellular structures with numerous small mitochondria, free ribosomes, lamellae of granular endoplasmic reticulum and intracytoplasmic glycogen granules, but synthesize no estrogens under ordinary conditions.

MATERIALS AND METHODS

Cells from an ovarian clear cell tumor cultured with 10 micrograms/ml of the antioxidant probucol released more estradiol into the medium than cells cultured without probucol. Immunocytological analysis revealed the predominance of estradiol in the adenocarcinoma cells cultured with probucol.

RESULTS

There was no difference in the distribution of low-density lipoprotein receptors in adenocarcinoma cells according to whether they had been cultured with or without probucol. Cytochemical analysis showed that hydroxylation of estrone was accelerated in the adenocarcinoma cells cultured with probucol as compared to the cells cultured without probucol.

CONCLUSION

Probucol is thought to have an unknown function in the acceleration of hydroxylation of steroids in some types of cells with estrogen-producing potential.

New cervicoscopy with toluidine blue staining for superficial cervical invasion by endometrial carcinoma

We developed a method of endocervical staining with toluidine blue solution during cervicoscopy that clearly discriminates between the endocervical region and the endometrium and allows easy detection of superficial cervical invasion by endometrial carcinoma. Toluidine blue staining cervicoscopy was used for preoperative histological diagnosis in 10 cases of endometrial carcinoma. The staining permitted a correct diagnosis in 3 cases in which conventional diagnostic methods were practically useless. Endocervical staining with toluidine blue is highly useful for diagnosis of superficial cervical invasion by endometrial carcinoma.

Power Doppler findings of adenoma malignum of uterine cervix

Adenoma malignum (minimum deviation adenocarcinoma) is a rare neoplasma of the uterine cervix, the diagnosis of wich cannot be determined by cervical smear. Recently, magnetic resonance imaging (MRI) was reported as useful for its diagnosis, but differentiation of adenoma malignum from deep-seated nabothian cysts remains problematic. We report here a case of adenoma malignum of the uterine cervix, for which MRI findings could not neglect deep-seated nabothian cysts. However, transvaginal power Doppler ultrasonography clearly showed richness of small vessels, whose arterial flow had higher velocity in the diastolic phase, around the cystic lesion of the uterine cervix. These findings indicate that, at least in the case reported here, transvaginal power and pulsed Doppler ultrasonography is a useful tool for the diagnosis of adenoma malignum of the uterine cervix.

beta(2)-adrenergic agonists and pelvic floor exercises for female stress incontinence

OBJECTIVE

We compared beta(2)-adrenergic agonist therapy with clenbuterol (DT) and physiological therapy (PT) in a randomized study to establish the first line therapy for stress incontinence (SI).

METHOD

The clinical efficacy of DT (group A), PT (group B), and a combination of DT and PT (group C) was investigated in 61 patients with SI by means of a 12-week randomized controlled study. The frequency and volume of SI and the patients' own impressions were used as the basis for the assessment of efficacy.

RESULTS

The SI improvement rates in groups A, B, and C were 76.9, 52.6, and 89. 5%, respectively (P=0.0361). A significant therapeutic effect on the frequency of SI was observed in group B and group C at 2 weeks after the start of treatment (both P<0.05), and in all groups at 6 weeks (all P<0.01). The efficacy rates based on the patients' own impressions in groups A, B, and C were 84.6, 31.6, and 68.4%, respectively (P=0.0064).

CONCLUSION

The beta(2)-adrenergic agonist appeared to be clinically useful as a drug of choice for SI.

A novel technique for myomectomy. Intranodal surgery with an electromechanical tissue borer

OBJECTIVE

To investigate the possibility of clinical application of a new technique for myomectomy that involves morcellating the myoma within the myometrium with a new instrument that minimizes invasion of the myometrium and abdominal wall.

STUDY DESIGN

In a pilot clinical study, myomectomy was performed on five women with uterine myomas and a normal menstrual cycle using a microwave coagulator and electromechanical tissue borer of our invention. The length of the surgical incisions in the abdominal wall and myometrium, operating time and blood loss were measured.

RESULTS

The mean length of the surgical incisions was 6.3 cm in the abdominal wall and 3.5 cm in the myometrium. The mean operating time was 167 minutes, and the mean blood loss was 312 mL. The length of the incisions in the abdominal wall and myometrium per centimeter of the maximal diameter of the myoma was 0.78 and 0.42 cm, respectively. The incision tended to become smaller in successive operations.

CONCLUSION

This new technique of myomectomy significantly reduced invasion of the abdominal wall and uterus.

Case of hemorrhagic shock due to hypermenorrhea during anticoagulant therapy

We report the case of a patient with uterine myoma who developed uncontrollable massive hemorrhage from the uterus during anticoagulant therapy after cardiac valve replacement and required hysterectomy. There was a discrepancy between the laboratory findings regarding the blood coagulation system and the clinical manifestations, suggesting a combination of multiple factors, such as a hormonal imbalance. This was a case that demanded strict attention to the management of the uterine lesions during the conduct of anticoagulant treatment.

Angiogenesis in metastatic verrucous carcinoma of the uterine cervix

A 65-year old woman operated on for verrucous carcinoma of the uterine cervix 13 years previously was found to have multiple small recurrent tumors in the retroperitoneal space. Tumor cell expression of vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) was investigated at the second operation. Expression of VEGF was strongly positive in the tumor cells and expression of PD-ECGF was strongly positive in both the tumor cells and the interstitial cells.

Intermittent cisplatin therapy for stage-III ovarian cancer patients following clinical remission

Intermittent cisplatin (CDDP) administration as consolidation therapy for stage-III ovarian cancer was studied. No patients with residual disease at surgery or at second-look operation or patients with <8 U/ml of CA125 after remission induction chemotherapy were enrolled in this study. Fifteen subjects received intermittent chemotherapy, and 10 control patients did not. CDDP of 20 mg/m2 for 5 days was administered every 3-4 months for 5 years. A significant increase in 5-year survival rate was found in the intermittent chemotherapy group when compared with the control group. Side effects from the intermittent chemotherapy were controllable. Intermittent CDDP therapy seems to be an effective consolidation therapy for stage-III ovarian cancer patients.

Is measuring the posterior urethrovesical angle of clinical value for controlling pelvic organ Prolapse? Retrospective analysis of 107 postoperative cases

Vaginal total hysterectomy with vaginal plasty was performed in 107 patients with pelvic organ prolapse. The posterior urethrovesical angle (PUVA) was measured by chain urethrocystography. Bladder capacity, residual and incontinence urine volume were measured before and after surgery, and the data obtained were analyzed in relation to postoperative improvement and recurrence of urinary dysfunction. There were no significant differences between the background of patients with dysuria, incontinence, a mixture of dysuria and incontinence, and neither of these symptoms. Postoperative incontinence and residual urine volume decreased in all groups. However there was no correlation between the preoperative PUVA and either incontinence or residual urine volume. Measurement of PUVA was neither helpful in making the diagnosis nor predictive of the recurrence of urinary dysfunction.

Magnetic resonance imaging diagnosis of metastasis of chronic myelocytic leukemia to the uterus

We report a case of chronic myelocytic leukemia (CML) in which the initial manifestation of blastic crisis was massive genital bleeding. The bleeding was diagnosed as being caused by CML metastasis to the uterus on the basis of the magnetic resonance imaging findings.

Excellent results of postoperative radiotherapy for endometrial stromal sarcoma of low-grade malignancy

Endometrial stromal sarcoma of low-grade malignancy (ESSL) is a rare neoplasm, and neither preoperative diagnostic procedures nor standard therapy have yet been established. We treated 3 cases of ESSL in the past 27 years, and we report here one of these cases that was classified as stage III (according to the FIGO classification of endometrial carcinoma). Postoperative radiotherapy was used to treat a residual tumor, and the patient showed a complete response.

Estrogen-producing ovarian mucinous cystadenomas in postmenopausal women

Cells from benign and borderline malignant mucinous cystadenomas surgically resected from three postmenopausal women with elevated serum estradiol levels were found to have different abilities to synthesize estrogen from [14C]-cholesterol. Addition of gonadotropins to cultured cells with low levels of estrogen synthesis did not result in any significant increase in estrogen synthesis. Immunohistochemical studies of these mucinous cystadenomas showed that LDL receptors were distributed in the benign cystadenoma cells and in the stromal cells of borderline tumors, but not in the cystadenoma cells of borderline tumors. Sterol regulatory element binding protein was immunohistochemically shown to be distributed in the mucinous cystadenoma cells of borderline tumors, but not in the benign cystadenoma cells.

Clinical significance of mucin staining in keratinizing-type squamous cell carcinoma of the uterine cervix

Tumor tissue from 57 cases of keratinizing-type squamous cell carcinoma of the uterine cervix that had been stored in the archives of Osaka City University Hospital between May 1986 and October 1994 were stained with periodic acid-Schiff (PAS) reagent following amylase and alcian blue to identify the presence of intracellular mucin and to assess the value and significance of demonstrating the presence of mucin. Nineteen specimens (33.3%) stained positive for mucin with alcian blue or PAS following diastase. The results of mucin staining were not significant in terms of survival by Kaplan-Meier's analysis.

Tumor marker and MR imaging criteria for evaluating the efficacy of cyclic balloon-occluded arterial infusion for advanced cancer of the uterine cervix

We have already reported satisfactory therapeutic results of cisplatin-based cyclic balloon-occluded arterial infusion chemotherapy (BOAI) enabling treatment by simple total hysterectomy (STH) in patients with advanced cervical cancer of the uterus (cervical cancer), with 2- and 5-year survival rates of 88.9% and 66. 7%, respectively. Considering the fact that 3 to 4 months are needed to complete BOAI, the present study was a retrospective assessment of 18 cervical cancer patients to prepare criteria for the early determination of the efficacy of BOAI in patients who can be treated by STH. The results showed that STH could be performed after the first BOAI in patients with SCC value decreased to 34.3+/-8.2% of the pretreatment value (p=0.0001) and whose tumor size had decreased by 45.1+/-7.5% (p=0.0002).

Dimeric inhibin A as a fourth marker for Down's syndrome maternal serum screening in native Japanese women

OBJECTIVE

This study was conducted to assess the usefulness of dimeric inhibin A as a fourth marker for Down's syndrome screening in addition to AFP, hCG and uE3 markers for native Japanese women.

METHODS

Serum specimens from 367 native Japanese women in the second trimester were assayed for dimeric inhibin A levels. Day specific dimeric inhibin A medians were established for gestational ages 15.0-21.9. Weekly median values for the native Japanese were compared with those of a U.S. population. Selected Japanese specimens from 15 diagnosed Down's syndrome and 3 trisomy 18 cases were also assayed for dimeric inhibin A.

RESULTS

Dimeric inhibin A levels did not vary greatly over the gestational age range as expected. Median value comparison showed that native Japanese dimeric inhibin A medians are higher than the U.S. population medians by an average of 7.95%. Native Japanese dimeric inhibin A median values in this study are 1.77 times higher in Down's syndrome cases than in unaffected pregnancies. Trisomy 18 dimeric inhibin A levels show no significant difference from the unaffected pregnancies.

CONCLUSIONS

This report shows for the first time that dimeric inhibin A can be informative as a fourth marker for Down's syndrome screening in native Japanese women. We expect the addition of dimeric inhibin A to a triple marker protocol will increase the accuracy of predicted risk for all pregnancies screened and increase the detection rate of Down's syndrome affected pregnancies.

Classification of female urinary incontinence by the scored incontinence questionnaire

OBJECTIVES

Our purpose was to investigate whether urinary incontinence (UI) severity could be graded by UI scores.

METHODS

The study included 168 UI patients diagnosed by conventional procedures as stress incontinence (SI, n=108) or urge incontinence (URI, n=60). A questionnaire containing 15 items scored for stress-score (s-s) and urge-score (u-s) was administered to patients to assess the correlation between pad test values (PTVs) and s-s in SI and u-s in URI.

RESULTS

Significant correlations were found between log[PTVs] and both s-s and u-s: log[PTV(SI)]=0.051s-s-0.207 (r=0.830, P<0.0001) and log[PTV(URI)]=0.064u-s-0.459 (r=0.827, P<0. 0001). Based on theoretical PTVs obtained using these equations, s-s of 26-24, 23-18, and 17-10 in SI were equivalent to severe, moderate, and mild, respectively, and u-s of 22-19 and 18-12 in URI were equivalent to moderate and mild, respectively, according to the classification of the International Continence Society.

CONCLUSION

The UI score should be a simple and useful procedure for use by general gynecologists to grade UI severity clinically.

Clinical evaluation of mature teratomas containing malignant elements

We investigated the possibility of preoperative diagnosis and clinical features of mature ovarian teratoma containing malignant elements (MOTME). Between 1982 and 1998 in our hospital, MOTME accounted for 2.0% (5 cases) of the total of 251 patients with mature ovarian teratoma (ages, 37-72; mean age, 60.6). Serum CA19-9, CA125, SCC and CEA levels were high. All cases were strongly suspected malignancies, preoperatively diagnosed using serum tumor markers with diagnostic imaging. Two cases of stage I squamous cell carcinoma and one case of borderline malignancy survived, while the other two advanced cases died within 8 months.

Effects of cyclic plasma perfusion on adipocyte apoptosis and lipolytic activity in VX2 carcinoma-bearing rabbits

BACKGROUND

In an animal model we found that total body fat (TBF) decreased with progression of tumors, but that it rebounded after cyclic plasma perfusion (CPP). In this study, we investigated changes in adipocyte apoptosis and serum lipolytic activity (LA) after CPP.

MATERIALS AND METHODS

TBF, LA, and adipocyte apoptotic index (AAI) in VX2 carcinoma-bearing rabbits were measured every ten days after implantation. CPP was performed every 5 days from post-implantation day (PID) 14.

RESULTS

TBF decreased as the days passed and reached 43.2 +/- 10.0% on PID 50 in the non-CPP group, while it decreased 22.7 +/- 8.8% in the CPP group. LA on PID 50 was 17.8 +/- 14.0, 33.2 +/- 6.3 mumol glycerol/10(5) adipocytes in the non-CPP group, while LA did not increase in the CPP group. AAI was 28.8 +/- 16.4, 27.8 +/- 17.7, 10.3 +/- 9.9 and 0.4 +/- 1.1 on PID 10, 20, 30, and 40, respectively, in the non-CPP group. No change was noted in AAI after CPP.

CONCLUSIONS

CPP removed a humoral factor that possesses TBF-decreasing LA, but it did not suppress adipocyte apoptosis.

Angiogenesis in ovarian clear cell carcinoma and its relation to endometriosis

Twenty-five patients with ovarian clear cell carcinoma (CC-Ca) were enrolled in this study, and tumor cell expression of vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) was investigated, and correlated with the microvessel count (MVC) and the impact of complication endometriosis. Expression of VEGF was strongly positive in 16 cases, weakly positive in 6 cases, and negative in 3 cases. Expression of PD-ECGF was strongly positive in 11 cases, weakly positive in 6 cases, and negative in 8 cases. VEGF expression and the MVC were significantly correlated (p<0.01), and there were no correlations among complication by endometriosis, expression of VEGF, expression of PD-ECGF, and MVC.

Diagnostic accuracy of needle biopsy of uterine leiomyosarcoma

We previously reported on the efficacy of transcervical needle biopsy of a uterine muscle tumor. In this study, to examine diagnostic accuracy of our needle biopsy with small specimen size, previous slide preparations were used from 8 cases diagnosed with leiomyosarcoma and from 24 post-operative leiomyoma cases. Each tissue specimen was examined through needle biopsy-sized slit that had been randomly positioned over the slide. Three predictors: mitotic index, cytologic atypism, and tumor cell necrosis were evaluated on a 3-point scale (0, 1, or 2 points). When the diagnostic cut-off value was set to two, the sensitivity was 92.5% and the specificity was 100%.

Retrospective study of the prognostic factors of remission induction for single-agent chemotherapy with cisplatin in advanced epithelial ovarian cancer

A retrospective study to explore the prognostic factor was conducted in 39 patients with advanced epithelial ovarian cancer, FIGO stage III-IV, who underwent single-agent adjuvant chemotherapy with cisplatin following primary debulking surgery. The survival rate following the adjuvant chemotherapy was 50.9% after 3 years and 44. 7% after 5 years, with a median survival time of 40.4 months. The actual dose intensity of the cisplatin ranged from 14.38 to 46.30 mg/m2/week, and the total dose/m2 was 143.79 to 645.83 mg/m2. Under these therapeutic conditions, the actual dose intensity was found to correlate with survival time (p<0.05), but there was no correlation between the total dose/m2 and survival time.

The urinary incontinence score in the diagnosis of female urinary incontinence

OBJECTIVE

Our purpose was to determine whether the urinary incontinence (UI) score is significantly useful in evaluating the clinical status of UI.

METHOD

The questionnaire was administered to 198 UI patients (27-73 years of age) diagnosed by conventional procedures. It consisted of 15 questions, and the answers were assigned points divided into a stress score (s-s) and urge score (u-s) according to severity.

RESULTS

The patients were classified into a stress incontinence group (SI; 125 cases), urge incontinence group (URI; 29 cases), mixed incontinence group (MI; 41 cases), and overflow incontinence group (3 cases). Classification by questionnaire yielded 110 SI cases, 31 URI cases, and 46 MI cases, accuracy of 83.2%, 86.2%, and 61.0%, respectively. A significant correlation was observed with s-s of SI (r = 0.669, P < 0.001) and u-s of URI (r = 0.583, P < 0.005).

CONCLUSION

The UI score will be a simple, clinically effective diagnostic procedure for UI for use by general gynecologists.

Transmission of symptomatic parvovirus B19 infection by fibrin sealant used during surgery

Human parvovirus B19 infection has been shown to be transmissible by blood and blood products and to result in transient aplastic crisis in patients with rapid red cell turnover. We report three cases of iatrogenic parvovirus B19 infection resulting from the use of the same batch of fibrin sealant under operation. Fibrin sealant, which is a typical haemostatic agent produced from blood, has been used during surgery. Human parvovirus is resistant to existing virus-inactivating techniques, suggesting that infection may occur from blood products contaminated with it. Use of recombinant products for these proteins may thus be necessary.

Balloon-occluded arterial infusion chemotherapy, simple total hysterectomy, and radiotherapy as a useful combination-therapy for advanced cancer of the uterine cervix

We first performed 3 or 4 courses of balloon-occluded arterial infusion (BOAI) chemotherapy in 19 patients with advanced cancer of uterine cervix classified as stage III-IV according to the International Federation of Gynecology and Obstetrics. In the patients in whom the first BOAI resulted in insufficient drug accumulation in tumor tissue, the ovarian arteries and veins were ligated to improve the therapeutic effect. Ultimately simple total hysterectomy and radiotherapy were performed in 9 patients in whom the uterus was resectable (the combination group), and radiotherapy alone was conducted in the other 10 patients in whom hysterectomy was not practicable (the incomplete group). The survival rates were significantly higher in the combination group (2-year survival 88. 9%; 5-year survival 66.7%) than in the incomplete group (p=0.0013).

Leiomyomas in uterine remnants associated with vaginal agenesis

A premenopausal woman with vaginal agenesis underwent surgery for leiomyomas in rudimentary uterine horns. Immunohistochemical study of surgical specimens revealed that progesterone receptors are distributed in the nuclei of a majority of the leiomyoma cells and in the nuclei of a minority of the myometrial cells. Estrogen receptors are not detected in the surgical specimens.

Transient rapid growth of uterine leiomyoma in a postmenopausal woman

We report a case of transient rapid growth of uterine leiomyoma in a postmenopausal woman. A 58-year old woman presented with a rapidly enlarging pelvic tumor, from a 14-week to a 20-week gestational size in the one month. Transcervical needle biopsy revealed a smooth muscle tumor with 5 mitotic figures per 10 high power fields. However, surgical specimen obtained 1 month later revealed less than 1 mitotic figure per 100 high power fields. This variation may influence the final histopathological diagnosis because mitotic index is believed to be one of the most reliable histopathological parameters for differentiating between uterine leiomyoma and leiomyosarcoma.

Elimination of anemia-inducing substance by cyclic plasma perfusion of tumor-bearing rabbits

We carried out a fundamental study to search for a therapeutic modality that would remove the anemia-inducing substance (AIS) from the plasma of cancer patients because it is thought to be one of the substances responsible for anemia and immunodeficiency in advanced cancer patients. Using AIS isolated from the plasma of patients with advanced ovarian carcinoma, we confirmed that adsorption of AIS to noncoated charcoal was nonspecific and high. Moreover, it was verified that VX2 carcinoma-bearing rabbits are an optimal experimental model for plasma perfusion. The data obtained on day 40 after transplantation (hemoglobin, 9.1+/-2.1 g/dl; osmotic pressure inducing RBC lysis, 137+/-11 mosmol/kg; lymphocyte stimulation index, 8.8+/-8.6; and RBC fragility-inducing activity, 40+/-9 mosmol/kg) proved similar to the hematological findings in patients with cancer cachexia. A 1-h plasma perfusion (3 ml/min) through noncoated charcoal was performed in tumor-bearing rabbits, and it resulted in the restoration of RBC fragility-inducing activity and suppression of lymphocyte blast formation to pretransplantation values. When plasma perfusion was performed every 3 days, RBC fragility-inducing activity, which increased again 3 days after perfusion, was diminished, and RBC osmotic resistance was within the normal range from the fourth perfusion onward. These results showed that cyclic plasma perfusion is effective in sustained removal of RBC fragility-inducing factor from plasma, suggesting that it might have the potential for clinical application.

Lipolytic activity of anemia-inducing substance from tumor-bearing rabbits

Anemia-inducing substance (AIS) is a protein of approximately 50,000 molecular weight secreted by malignant tumor tissue that depresses erythrocyte and immuno-competent cell functions; in this study, its biological effects on adipocytes were examined. Changes in body weight, total body fat, and food intake were investigated in rabbits after VX2 carcinoma transplantation, and the results showed reductions of 11%, 24%, and 30%, respectively, at 40 days after transplantation compared with baseline values (before transplantation). The values were even more markedly reduced 70 days after transplantation. When cyclic plasma perfusion (2 times/wk) was started at 40 days after transplantation, the values at 70 days after transplantation (30 days after beginning plasma perfusion) recovered to 91%, 84%, and 87%, respectively, of the baseline values. AIS fractions were isolated from rabbit plasma by using a phenyl-Sepharose column before transplantation, 40 and 70 days after transplantation, and 30 days after start of plasma perfusion, and AIS activity and lipolytic activity were measured. The results showed enhancement of AIS activity and lipolytic activity as the tumors grew. Lipolytic activity also returned to baseline value as AIS was removed by adsorption by plasma perfusion, and there was a high correlation between lipolytic activity and AIS kinetics. These results strongly suggest that AIS might be one of the substances involved in the enhanced lipolytic activity in advanced tumor-bearing subjects.

Metabolic and morphologic characteristics of adipose tissue associated with the growth of malignant tumors

Changes in total body fat and the metabolic and morphologic characteristics of adipose tissue were sequentially investigated in individual rabbits implanted with VX2 tumors to elucidate the pathology of the fat reduction in animals with malignant tumors as compared with that of diet-restricted rabbits. Lipogenesis in normal, VX2-implanted, and diet-restricted rabbit groups on day 40 after the start of the experiments was 19.1 +/- 2.9, 13.3 +/- 3.5, and 41.7 +/- 6.0 x 10(5) cpm/g/h, respectively, and glycerol liberation by their adipose tissue was 199 +/- 21, 528 +/- 94, and 301 +/- 45 nmol/g/h, respectively. In addition, apoptotic cells were noted in the adipose tissue of VX2-implanted rabbits on days 20-30 after implantation, but not in diet-restricted rabbits. The results showed clear differences between the total body fat reduction profiles of VX2-implanted rabbits and diet-restricted rabbits, suggesting a characteristic lipid metabolism with enhanced lipolysis and diminished lipogenesis in VX2-implanted rabbits. The results strongly suggest that adipocyte apoptosis might be involved in these phenomena.

Muscle cell apoptosis is responsible for the body weight loss in tumor-bearing rabbits

In order to elucidate the cause of body weight loss in the early stage of tumor progression, morphological changes of striated muscle were investigated in rabbits every 10 days after VX2 carcinoma implantation. The lean body mass started to decrease in the tumor-bearing rabbits 10 days after implantation, and body fat ratio showed a significant decrease from 30 days, different from the starved rabbits, whose lean body mass and body fat ratio started to decrease from 10 days. Morphological hallmarks of apoptosis in muscle cells were detected in tumor-bearing animals prior to the tumor growth but not in starved animals. These findings suggest that muscle cell apoptosis may be responsible for the body weight loss in the early tumor-bearing.

Body composition analysis of cachectic rabbits by total body electrical conductivity

A simple formula (1.536 x TOBEC + 475.146 = LBM, where TOBEC is total body electrical conductivity and LBM is lean body mass) to estimate LBM in grams was developed on the basis of the total body fat data obtained by ether extraction and TOBEC in normal rabbits. The formula was also applicable to rabbits with cachexia induced by inoculation of VX2 carcinoma or by starvation. We were able to assess the losses of body fat in the rabbits with cachexia at 10-day intervals by using TOBEC.

Effects of plasmapheresis in a rabbit model of cancer cachexia

We developed a model of cancer cachexia by transplanting VX2 tumors into rabbits and investigated the effects of plasmapheresis in this model. AIS activity was identified in supernatants obtained from VX2 tumor by phenyl Sepharose chromatography. Fractions eluted with 0.5 M NaCl showed the ability to damage the red blood cell membrane and suppress immunity. Rabbits exhibited marked weight loss, anemia and immunodeficiency 40 days after transplantation of VX2 tumors. Plasmapheresis inhibited plasma-induced damage of the red blood cell membrane and suppression of immunity. Twice-weekly plasmapheresis resulted in gradual normalization of cellular immunity. Weight loss and survival were also improved. No side effects were observed.

Increased proliferation of myoblasts after cyclic plasma perfusion of tumor-bearing rabbits

Rabbits implanted with VX2 carcinoma and treated by cyclic plasma perfusion showed lower weight loss and longer survival than untreated rabbits. The urinary 3-methylhistidine/creatine ratio was less elevated in the treated rabbits than in the untreated rabbits. Myoblasts from untreated rabbits with VX2 carcinoma showed lower proliferation than those from normal rabbits, while those from rabbits treated by cyclic plasma perfusion showed intermediate proliferation. Furthermore, the DNA synthesis rate of myoblasts from treated rabbits was much better maintained than in the case of untreated rabbits.

Mechanism of depletion of liver glycogen in cancer cachexia

Mice transplanted with a cachexia-inducing colonic adenocarcinoma (MAC16) show a progressive decrease in liver glycogen in direct proportion to the loss of body weight. Such tumours elaborate a lipid mobilizing factor (LMF), which produces a dose-dependent stimulation, not only of adipocyte adenylate cyclase, but also of hepatocyte adenylate cyclase in a GTP-dependent manner. These results suggest that LMF has the capacity to initiate hepatic glycogenolysis through an increase in cyclic AMP.

Anemia-inducing substance from plasma of patients with advanced malignant neoplasms

Patients with advanced malignant neoplasms develop anemia and immunosuppression. During an attempt to identify the causes, we have found that plasma from such patients makes RBCs more fragile in hypotonic buffer, according to results obtained with a coil planet centrifuge. Plasma from these patients suppresses mitogen-stimulated lymphocyte proliferation. In this study, we identified the substance with these effects as a protein. During two-dimensional gel electrophoresis, two isomers with M(r) 50,000 and slightly different isoelectric points near 6.0 were found. Cell fractionation showed that these proteins were in both the cytosol and the nuclear fraction of cells in neoplasms. Another protein with the same antigenicity and a M(r) 100,000 found in the nuclear fraction of cells in neoplasms.