[Two cases of adrenal cysts]

Two cases of adrenal cysts are described. The first case is of bilateral adrenal cysts in a 44-year-old woman. It seems to be the first case of bilateral adrenal cysts in the Japanese literature. The second case is of a left adrenal cyst with sandy calcification in a 71-year-old woman presenting with asymptomatic gross hematuria. Several hormone levels in the cyst fluid were higher than in those in the plasma; cortisol and aldosterone in the first case, and cortisol in the latter. This finding suggests that the hormonal study of cyst fluid obtained by percutaneous needle aspiration under ultrasonic guidance is useful in the differential diagnosis of adrenal cyst from those arising from other organs.

[Thoracoabdominal approach for adrenal pheochromocytoma]

In the case of surgical approaches for adrenal pheochromocytoma, successful ligation and severance of the adrenal vein at the start can make intraoperative circulatory kinetics stable and subsequent operative procedures very easy. Recently, we adopted a thoracoabdominal approach in 5 cases of pheochromocytoma instead of transabdominal or translumbar approach which has so far been adopted for such tumors. The results revealed that the thoracoabdominal approach was very advantageous compared with these conventional approaches. Its main advantages include a wide and shallow operative field, early ligation and severance of the adrenal vein before mobilization of the tumor, easy operative procedure and short operation time, etc. The essential point is to carry out an operation not in a torqued flank-position but in a correct flank-position.

[Primary localized amyloidosis of the urinary bladder: a case report]

A case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively.

[A case of adult renal hamartoma resembling congenital mesoblastic nephroma]

A 35-year old man was hospitalized for left flank pain. IVP showed left non-visualizing kidney with multiple renal calculi. Selective renal arteriogram revealed avascular mass in the left upper pole. The upper calyx was irregularly distorted. Left nephrectomy was carried out. Grossly, the upper pole was replaced by whitish, firm and homogeneous tumor, which was 7 X 7 cm in diameter and protruded into the upper calyx. Histologically, the tumor was composed of both epithelial and mesenchymal components. The epithelial elements consisted of cysts and tubules, and the mesenchymal elements of loosely textured fibroblasts and smooth muscle cells. Other elements could not be identified. This case was diagnosed as renal hamartoma histologically resembling congenital mesoblastic nephroma of infancy. Congenital mesoblastic nephroma is rare in adults. Continued maturation may finally transform it either to benign mixed tumor as in our case or fibromatous tumor if stroma matures dominantly.

[A case of recurrent yolk sac tumor of the testis in childhood: bulky retroperitoneal metastatic tumors cured by tumor resection and chemotherapy]

We carried out only high orchiectomy for a 1-year and 7-month-old boy with stage 1 yolk sac tumor of the testis, after 13-months a bulky retroperitoneal metastatic tumor was found. Following chemotherapy with CDDP, ACD, VBL, PLM and CTX two times after tumor resection, elevated serum AFP was normalized. He has been in continuous complete remission with no evidence of disease for 3 years and 2 months. Combination chemotherapy with CDDP has a dramatic effect on the yolk sac tumor of infantile testis. We believe that "watchful waiting" after high orchiectomy alone is the best modality for all cases of stage 1 yolk sac tumor of the infantile testis.

[Effects of combination chemotherapy of MCNU with various anti-cancer agents]

Combination chemotherapy using the water-soluble nitrosourea MCNU with various anti-cancer agents was studied using L1210 leukemia and P388 leukemia. In titration experiments MCNU showed remarkable antitumor effects at doses from 5 mg/kg to 80 mg/kg, producing numbers of 60-day survivors with L1210 leukemia. In L1210 leukemia, respective combinations of MCNU with the antimetabolites, MTX, 6-MP, 6-TG, MCNU, 5-FU and Cyclo-C showed enhanced antitumor effects. MCNU combined with each of ADR, MMC and CPM also showed marked anti-tumor effects with 60-day survivors. In P388 leukemia MCNU combined with each of ADR, MMC, VDS and CPM produced strong anti-tumor effects with numbers of 60-day survivors. In the results of these combinations, especially the combinations of MCNU + 5-FU in L1210 leukemia and MCNU + CPM in both L1210 and P388 leukemia, a significant increase in mean survival time was achieved. These combinations also produced many 60-day survivors which were considered to be due to the synergistic antitumor effects of the combined drugs.

Molluscum contagiosum occurring in an epidermal cyst on the eyelid. Light and electron-microscopic studies with literature review

We hereby report light and electron-microscopic (EM) studies on an unusual case of molluscum contagiosum occurring in an epidermal cyst. It was considered that the pre-existing cyst was inoculated with molluscum contagiosum viruses, which were confirmed electron-microscopically. We also would like to re-emphasize the usefulness of formalin fixed tissue for EM confirmation of viruses.

[Ureteroceles in adult women: report of two cases]

Two cases of ureteroceles are reported. Case 1: Transurethral prolapse of a simple ureterocele was seen in a 27-year-old woman. Bilateral vesicoureteral neostomy was carried out, and she has been living with no vesicoureteral reflux or complaints. Case 2: An ectopic ureterocele was seen in a 51-year-old woman. She had right complete double renal systems, neither of which was dilated. There were three stones in the ureterocele and several stones in the upper renal system. Ureterocelectomy and plasty of the ureteral orifices were performed, and a complete cure was achieved.

Existence of eigen polarization modes in anisotropic single-mode optical fibers

The existence of eigen polarization modes in a twisted single-mode fiber with an elliptical core is verified theoretically and experimentally. The eigen polarization modes are transmitted without degradation in the degree of polarization. Ellipticity and the principal axis orientation of the eigen polarizations are determined by fiber-core ellipticity and fiber twist. The ellipticity of the eigen polarization modes remains unchanged for a fixed core ellipticity and twist effect, even after long-distance transmission, whereas the orientation of the principal axis varies according to the fiber twist angle. For a sufficiently large twist rate, all the incident polarizations maintain their ellipticity of polarization.

Immunoreactive dog C-peptide level in the pancreatic vein

C-peptide immunoreactivity (CPR) levels were measured in dog superior pancreaticoduodenal vein using synthetic dog C-peptide and its antiserum. The basal CPR level was approximately twice as high as the basal immunoreactive insulin (IRI) level on a molar basis. Glucose (10 mg/kg/min) or arginine (250 mg/kg/min) infusion for 5 min into the superior pancreaticoduodenal artery caused a prompt, parallel increase in IRI and CPR. IRI and CPR were closely equimolar at peak secretions. One bolus administration of synthetic neurotensin (10 microgram/kg) into the same artery produced a mild hyperglycemic response and biphasic IRI and CPR responses at 30 min in the vein. The IRI and CPR increases were closely equimolar during the first phase of secretion, but during the second peak a larger increase was found in CPR than IRI. Upon infusion of synthetic substance P (50 ng/kg/min) for 30 min, IRI and CPR concentrations showed a parallel and closely equimolar fall. These results indicate that insulin and C-peptide were released from beta cells in equimolar concentrations.

An evaluation of leucocyte adherence inhibition microassay using colorectal cancer cell lines

The leucocyte adherence inhibition (LAI) microassay using crude extracts from colorectal cancer cell lines (M-7609 and S-7512) was evaluated as a test of immunological antitumor reactivity in colorectal cancer patients. The optimal antigen concentration for differentiating cancer patients from control subjects was 0.05 mg/ml protein. The cut-off values of LAI index for determining reactive and nonreactive cases was -0.20. The numbers of colorectal cancer patients reactive against antigens M (derived from M-7609), S (derived from S-7512) and M + S were 9 of 19, 9 of 12 of 18, respectively, whereas against control antigens K (derived from K-7610, pulmonary cancer), SF (derived from cultured fibroblastic cells) and T (derived from fresh colorectal cancer tissue), they were only 1 of 18, 1 of 17, and 3 of 15, respectively. The mean LA indices of the Dukes A and B group, and of the Dukes C and recurrent cancer group were -0.28 and -0.24, but that of a tumor-free postoperative group, another malignant disease group and a group of healthy individuals were -0.04, -0.05, and -0.03, respectively. Judging from these results, LAI microassay using cultured human cancer cell lines as tumor antigen sources is suitable as a test for evaluating the antitumor immunmoreactivity of colorectal cancer patients.

Specific immunotherapy for non-curatively resected gastric cancer

The prognosis of patients with advanced gastric cancer treated with non-curative resection is very poor. In order to improve patient prognosis, we have tried specific immunotherapy as an adjunct to surgery since January 1968. Sixty-two patients with gastric cancer underwent non-curative resection during the period of this study. Twenty-eight of these patients were treated with specific immunotherapy after surgery, and 34 patients received no additional therapy. The five year survival rate was 35 per cent in the former group, and zero in the latter. No significant difference in the degree of tumor extension and invasion was noted between the two patient groups. We concluded that specific immunotherapy as an adjunct to non-curative resection for advanced cancer is worthy of further study.

Experimental and clinical studies on toxicity of xenogeneic tumor-specific immune ribonucleic acid

To learn the toxicity of xenogeneic tumor-specific immune ribonucleic acid (I-RNA), experimental and clinical studies were carried out. Experimentally, doses of 30 mg/kg, 15 mg/kg, 7.5 mg/kg or 3.75 mg/kg of xenogeneic I-RNA extracted from lymphoid tissues of rabbits sensitized with 105,000 Xg sediments of human gastric carcinoma tissue were injected intraperitoneally into Wistar rats once a day for 30 days. During the period of the study, changes of physiological and biochemical values were examined. In addition, pathological study was made for each organ after the I-RNA administration. There was no death during the study. In the groups of high dose administration, there were poor increase in the body weight, elevation of GOT, GPT and LDH, findings of vacuolar degeneration of hepatic cells, and increase of mesangial matrix and polynuclear glomerulus. Throughout the experiment, the groups given 7.5 mg/kg and 3.75 mg/kg of I-RNA showed no significant difference from control groups. Clinically, 31 cases treated with passive immunotherapy with allogeneic lymphocytes, preincubated with xenogeneic I-RNA, were examined retrospectively for the difference in hematological and biochemical data before and after the therapy. One case showed a transient mild febrile reaction after the therapy. There was no significant difference in hematological and biochemical data. Pathological findings in 3 autopsies after the treatment were reported.

Immunological responsiveness and adjunct immunotherapy in lung cancer

Immunocompetency was assessed before and after the operation in 40 patients with lung cancer by skin reaction against tuberculin (PPD) and dinitrochlorobenzene (DNCB), lymphocyte response to PHA, proportion of T-cells, macrophage migration inhibition test (MIT) and the presence of blocking factor. MIT was positive in 27 per cent and blocking factor was positive in 42 per cent. Immune response paralleled the clinical stage of the lesion. In curative resection cases, the immune response rose postoperatively, but declined in non-resectable or recurrent cases. The influence of postoperative radiation therapy, cancer chemotherapy and host mediated agents on the patients was observed. The feasibility of adjuvant specific immunotherapy is discussed.

Bladder carcinoma associated with ectopic production of gonadotropin

A rare incidence of a primary gonadotropin-producing bladder carcinoma in which gynecomastia appeared in the terminal stage was encountered in a 76-year-old Japanese male. There was a good probability that the symptoms of hormonal activity were due to chorionic gonadotropin (hCG), since its whole molecule, beta- and alpha-subunits were detected by radioimmunoassay in the blood, urine, and the tissue from the malignant neoplasm, and the plasma and urine estrogens were elevated. Recent papers concerning the synthesis of hCG-like material by neoplastic cells are reviewed and the implication of the measurement of beta- and alpha-subunits of hCG in various neoplastic diseases are discussed. Other characteristic profiles of plasma hormonal levels are also discussed in this case.

Potential endocrine effects of hypothalamic peptide "neurotensin" on pancreas in dogs

Effects of synthetic neurotensin on the endocrine pancreas were studied in nine normal and six hypophysectomized (10th to 14th day post-hypophysectomy) dogs. Synthetic neurotensin was administered into the superior pancreaticoduodenal artery, and plasma insulin and glucagon concentrations were measured radioimmunologically. In normal dogs, ten microgram/kg neurotensin administration brought about a mild hyperglycemic response and sharp and rapid increase of plasma insulin and glucagon concentrations in the superior pancreaticoduodenal vein. A biphasic insulin response was noted in the pancreatic vein. The results suggest that a large dose of neurotensin acts directly on the endocrine pancreas causing secretion of these hormones. In hypophysectomized dogs, basal levels of plasma insulin and glucagon were decreased and neurotensin had little effect on the endocrine pancreas even with the administration of a large dose.

The effects of xenopsin of endocrine pancreas and gastric antrum in dogs

Effects of synthetic xenopsin on endocrine pancreas and gastric antrum in anesthetized dogs were studied. Synthetic xenopsin was administered into the superior pancreaticoduodenal artery and plasma insulin, glucagon and gastrin in the superior pancreaticoduodenal vein and gastrin in the right gastroepiploic vein were measured radioimmunologically. Administration of 10 microgram of xenopsin per kg of body weight brought about a hyperglycemic response and rapid and sharp elevations of the hormones in the pancreatic vein. Plasma gastrin level in the gastric vein also showed an immediate and sharp increase following xenopsin administration. Xenopsin appeared more potent inducer of the glucagon. It is concluded that xenopsin acts directly on endocrine pancreas and gastric antrum to secrete their hormones.

Specific cancer immunotherapy adjunctive to surgery for advanced gastric cancer: a report of six long term survivors

In order to improve the results with non-curatively resected advanced gastric cancer, we have tried specific cancer immunotherapy adjunctive to surgery. In this article, six long term survivors (median 6.2 years) are reported.

Establishment of a human rectal cancer cell line producing carcinoembryonic antigen

A permanent cell line (S-7512) was established by cell culture from the subcutaneous metastatic tumor of a human rectal cancer and has been maintained for 18 months. Cultured cells grew as isolated and piled-up colonies of epithelial cells, each with a scanty cytoplasm and a large nucleus containing several nucleoli. The average doubling time of this cell line was 57 hr and plating efficiency was 30.1 approximately 45.2% in a liquid medium. The modal chromosome number was 115 but a marker chromosome was not evident. Electron microscopic examination revealed many microvilli, free ribosomes, and abundant glycogen granules. Heterotransplantation of the cultured cells produced a large tumor and its microscopic examination showed the same histological appearance as the original tumor (carcinoma simplex). Carcinoembryonic antigen level of the spent medium of the confluent culture was 235.50 ng/3.2 X 10(6) cells.

Isolation of a new polyether antibiotic, lonomycin

A new polyether antibiotic, lonomycin, was isolated from the culture of Streptomyces ribosidifcus strain TM-481. The antibiotic obtained as a sodium salt is a colorless prism having a molecular formula of C44H75O14Na(M.W. 850), m.p. 188 approximately 189 degrees C, and has no absorption maxima in the ultraviolet region. The infrared and NMR spectra of the antibiotic suggest the presence of a carboxyl and four methoxyl groups. Lonomycin shows antimicrobial activity against gram-positive bacteria.