Aggressive pulmonary metastasectomies for synovial sarcoma

A 51-year-old woman underwent a bilateral wedge resection of lung metastases through a median sternotomy 10 months after an initial operation for synovial sarcoma of the left lower extremity. Since then, five right and two left posterolateral thoracotomies have been performed over a 6-year period. The patient is presently doing well 7 years after the initial operation of the left lower extremity without any evidence of recurrence.

K-ras and p53 mutations are an independent unfavourable prognostic indicator in patients with non-small-cell lung cancer

We examined 159 consecutive cases of non-small-cell lung cancer (NSCLC) for a mutation at codon 12 of the K-ras gene and for a mutation of the p53 gene occurring in exons 5-8. Eleven (6.9%) had mutations of the K-ras (ras+) and 57 (35.8%) had mutations of the p53 (p53+). There were 95 cases (59.7%) with ras- p53-, seven cases (4.4%) with ras+/p53-, 53 cases (33.3%) with ras-/p53+ and four cases (2.5%) with ras+/p53+. The ras+ group had a worse prognosis than the ras group in all cases and in 107 early-stage cases (stage I-II, P<0.05). The p53+ group had a worse prognosis in 107 early-stage cases (P<0.01), but there was no statistically significant difference when 52 advanced-stage cases (stage III-IV) or all patients were considered. Both ras and p53 mutations were unfavourable prognostic factors in 94 cases with adenocarcinoma, but there was no statistical significance in 57 cases with squamous cell carcinoma. According to Cox's model, the pathological stage, ras mutation and p53 mutation were found to be independent prognostic factors. Our results suggest that ras and p53 mutations were independent unfavourable prognostic markers especially in the early stage of NSCLC or in adenocarcinoma.

Prenatal diagnosis of Fukuyama type congenital muscular dystrophy by polymorphism analysis

Fukuyama type congenital muscular dystrophy (FCMD) is an autosomal recessive disorder characterized by a combination of primary muscular dystrophy of early infantile onset and brain malformation (lissencephaly type II). The identification of the FCMD gene locus at 9q31 opened the theoretical possibility of prenatal diagnosis. The authors conducted prenatal diagnosis in two unrelated FCMD families by analysis using nine microsatellite CA-repeat polymorphic markers flanking the FCMD locus, and calculated phenotype probabilities in fetuses with a computer program, LINKAGE. The fetus in family 1 showed a 99% probability of being healthy either as a normal homozygote or a heterozygote carrier and was born without signs of FCMD. In family 2, the fetus was diagnosed to have FCMD with at least 86% probability. The parents of this family decided to terminate the pregnancy and an abortus showed brain malformations characteristic of an FCMD fetus.

Interleukin-2 receptors in pulmonary adenocarcinoma tissue

We previously reported that the serum soluble interleukin-2 receptor (sIL-2R) level increased with the advance of disease stage in non-small cell lung cancer. The present study was thus conducted to investigate the origin of serum sIL-2R in patients with pulmonary adenocarcinoma. Fresh tumor cell suspensions were prepared from surgically resected specimens of pulmonary adenocarcinoma. They were adjusted to a cell density of 5 x 10(5)/ml and then cultured for 24 h at 37 degrees C. The culture supernatants were collected and assayed to determine the sIL-2R levels using an enzyme immunoassay. The resultant cells were thereafter cytocentrifuged onto glass slides and immunochemically stained with anti-human IL-2R alpha (CD25) monoclonal antibody. In three of six cases examined, a substantial level of sIL-2R was identified in the culture supernatants. In four cases, including those three cases with the presence of sIL-2R in the culture supernatants, various proportions of tumor cells were positively stained with the anti-IL-2R alpha antibody. Further examinations revealed that tumor cells expressed IL-2R alpha (CD25) in seven of 16 cases with pulmonary adenocarcinoma. These results thus suggested that the tumor cells did express IL-2R alpha and release sIL-2R in some cases with pulmonary adenocarcinoma.

Tumor-induced hypercalcemia and parathyroid hormone-related protein in lung carcinoma

BACKGROUND

Although lung carcinoma is the most common cause of tumor-induced hypercalcemia (TIH), the precise incidence of TIH remains obscure. Furthermore, the role of parathyroid hormone-related protein (PTHrP) has not been clearly elucidated.

METHODS

This study included 690 consecutive patients who were newly diagnosed as having lung carcinoma between 1989 and 1994 (379 adenocarcinomas, 207 squamous cell carcinomas, 75 small cell carcinomas, and 29 large cell carcinomas). All patients were treated for lung carcinoma and were also periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dL. The serum levels of PTHrP (109-141) were measured by a C-terminal-region-specific radioimmunoassay.

RESULTS

TIH was observed in 17 of 690 patients (2.5%). All 17 patients demonstrated an advanced stage of lung carcinoma (Stage III or IV), 10 squamous cell carcinomas, 5 adenocarcinomas, 1 small cell carcinoma, and 1 large cell carcinoma. In 15 patients, the serum level of C-PTHrP (109-141) was substantially high, ranging from 99 pmol/L to 890 pmol/L (normal range, 21-50.7 pmol/L). There was no significant difference in the serum PTHrP level between patients with or without bone metastasis. The reduction of tumor burden decreased both the serum level of PTHrP and that of Ca in parallel. The median survival time after diagnosis of TIH was only 27 days.

CONCLUSIONS

TIH in lung carcinoma was most likely attributable to PTHrP, and its occurrence appears to be an ominous prognostic sign.

[Pulmonary metastatic carcinoma of the rectum growing extensively in the bronchial lumen--a case report]

A 75-year-old man secondly developed a solitary pulmonary metastatic carcinoma of the rectum, who had undergone an operation for the first pulmonary metastatic disease in the left upper division segment before three years. The second tumor was about 2.0 cm in diameter, and located in the central area of the left lower lobe. At the time of operation, the tumor was found at the roots of both the B8 and the B9 bronchi, and thus removed by the basal segmentectomy. The resected specimen showed an endobronchial growth of metastatic adenocarcinoma in both the B8 and the B9 bronchi. Especially in the lumen of the B9 bronchus, the tumor dendritically extended from the central portion to the peripheral portion. The growing pattern of the tumor was very unique, and gave us attention to the extension of resection for metastatic lung carcinoma.

Kinetic analysis of recurrence and survival after potentially curative resection of nonsmall cell lung cancer

BACKGROUND

About two-thirds of the patients with nonsmall cell lung cancer (NSCLC) who undergo a potentially curative resection eventually suffer from recurrent disease. However, it has yet to be elucidated as to how survival after recurrence is influenced by different variables, including timing, type of recurrence, or other clinicopathological features. There have been few studies concentrating on the kinetics of growth of occult micrometastatic tumor cells that eventually manifest as tumor recurrence.

METHODS

We retrospectively reviewed the charts of 197 patients who developed recurrence after a potentially curative resection for NSCLC.

RESULTS

The median disease-free interval was a little over 1 year (395 days), as was the median postrecurrence survival-383 days. We created a model for the kinetics of recurrence by assuming that: (1) a tumor of 10(9) cells is the usual limit of detection, (2) patients generally die before the tumor reaches 10(12) cells, and (3) it takes 1 year for average lung cancer cells to show a 10-fold increase. The model indicated that as much as 10(9) tumor cells should have been present immediately after the operation. Alternatively, the residual tumor cells should have an accelerated growth after the surgery.

CONCLUSIONS

These models indicate the importance of developing a sensitive detection method for occult metastatic cells and to understand the tumor dormancy mechanism.

Practical guidelines for physicians in the management of febrile seizures

Recent studies have shown that adequate medication can prevent the recurrence of febrile seizures (FS). It has also been clarified that the vast majority of, though not all, FS patients follow a benign course. Then, questions arise as to whether or not FS should be prevented, particularly in light of the risks of side effects from drugs. Which kinds of FS can be prevented, if necessary? The guidelines presented here are aimed primarily at helping general practitioners in considering how to manage FS most appropriately. The guidelines stress that judgements should be individualized, while referring to a few specific 'warning factors'. The guidelines follow a 'laissez-faire' principle for the majority of FS cases, whereas intermittent therapy with diazepam and continuous medication with either phenobarbital or valproate are indicated in other limited cases meeting respective definite criteria.

Tumor-induced hypercalcemia and parathyroid hormone-related protein in lung carcinoma

BACKGROUND

Although lung carcinoma is the most common cause of tumor-induced hypercalcemia (TIH), the precise incidence of TIH remains obscure. Furthermore, the role of parathyroid hormone-related protein (PTHrP) has not been clearly elucidated.

METHODS

This study included 690 consecutive patients who were newly diagnosed as having lung carcinoma between 1989 and 1994 (379 adenocarcinomas, 207 squamous cell carcinomas, 75 small cell carcinomas, and 29 large cell carcinomas). All patients were treated for lung carcinoma and were also periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dL. The serum levels of PTHrP (109-141) were measured by a C-terminal-region-specific radioimmunoassay.

RESULTS

TIH was observed in 17 of 690 patients (2.5%). All 17 patients demonstrated an advanced stage of lung carcinoma (Stage III or IV), 10 squamous cell carcinomas, 5 adenocarcinomas, 1 small cell carcinoma, and 1 large cell carcinoma. In 15 patients, the serum level of C-PTHrP (109-141) was substantially high, ranging from 99 pmol/L to 890 pmol/L (normal range, 21-50.7 pmol/L). There was no significant difference in the serum PTHrP level between patients with or without bone metastasis. The reduction of tumor burden decreased both the serum level of PTHrP and that of Ca in parallel. The median survival time after diagnosis of TIH was only 27 days.

CONCLUSIONS

TIH in lung carcinoma was most likely attributable to PTHrP, and its occurrence appears to be an ominous prognostic sign.

Analysis of nonlinear properties of immune network reactions

On the basis of biochemical reaction dynamics, the temporal behavior of the immune network system was analyzed theoretically to promote the analysis of quantitative changes in the reactions of immune disorders and organ substitution. The idiotype immune network reaction system was expressed by 64 nonlinear differential equations that comprised four kinds of antibodies and B-cell subpopulations. All four kinds of antibodies decreased rapidly. With the progress of the reactions, they have increased gradually. The single and double bound antibodies increased rapidly from the onset of the reaction. The single-bound antibodies did not show a definite increase after the rapid increasing phase. The antibody-antibody complex increased parallel with the double bound antibodies. The effects of rate constant expand to all the immune complexes in the network system. The double bound antibodies and antibody-antibody complexes were oscillatory functions of a given antibody. Therefore, the idiotypic immune network system must be a chaotic one. The present theoretical method is available to evaluate the total ability of immune reaction system that operates as a network system.

The clinical significance of serum soluble interleukin-2 receptors in lung cancer

It has been recently reported that the soluble interleukin-2 receptor (IL-2R) levels in the sera of cancer patients were higher than those of normal controls. The present study was conducted in order to clarify the clinical significance of serum soluble IL-2R in patients with lung cancer. Using commercially available EIA kits, we measured the serum levels of soluble IL-2R in 102 lung cancer patients and 18 normal controls. The serum level of IL-2R was higher than 100 pM (mean +3 S.D. in the normal controls) in 14 of 58 patients with adenocarcinoma and in 13 of 32 patients with squamous cell carcinoma. In both adenocarcinoma and squamous cell carcinoma, the mean level of soluble IL-2R was higher in advanced stages (Stages IIIA, IIIB and IV) than in early stages (Stages I and II). In contrast, no patients with small cell carcinoma exhibited a serum level of soluble IL-2R higher than 100 pM, whereas almost all of those patients were in advanced-stage diseases. These results first demonstrated that the serum level of soluble IL-2R increased in association with both the disease stage and the histological type in lung cancer.

The role of vasopressin, somatostatin and GABA in febrile convulsion in rat pups

In order to further elucidate a possible role of neuropeptides and GABA in the pathogenesis of febrile convulsions, we studied changes of immunoreactive-arginine vasopressin (IR-AVP), IR-somatostatin (IR-SRIF) and gamma-aminobutyric acid (GABA) in the rat brain after febrile convulsions induced by ultra-red light (UR). Male Wistar rats at 16 days of age irradiated with UR developed generalized convulsions after 4.9 +/- 0.5 min irradiation. Six rats were killed by microwave irradiation 3 min after UR irradiation prior to convulsion development, and 29 rats were killed either 0 min, 2 h, 6 h, 24 h or 48 h after febrile convulsions. Non-irradiated rats served as controls. The rat brain was dissected into 4 regions; amygdala, hypothalamus, cortex and hippocampus, and subjected to radioimmunoassays. IR-AVP levels in hypothalamus were increased 3 min after UR and decreased at 2 h and 6 h after the convulsions. IR-SRIF levels were increased in cortex and hippocampus at 3 min after UR and 0 min after the convulsions. The GABA content increased in all regions tested at 2 h and 6 h after the convulsions. These results suggest that AVP, SRIF and GABA may be involved in the pathogenesis of febrile convulsions in different ways.

Peak oxygen uptake and respiratory function in persons with spinal cord injury

This study investigated the association between peak oxygen uptake (peak VO2) during arm cranking exercise and respiratory function in paraplegics. Fourteen male paraplegics were recruited for the present study. The subjects were grouped according to the level of injury into the HL (Th3-Th8) and LL (Th11-L3) group. Prior to the maximal test, pulmonary function, including vital capacity (VC) and residual volume (RV), was measured in the sitting position. Mean peak VO2 in the LL group (1662 ml.min-1) was significantly greater than that in the HL group (1357 ml.min-1), corresponding to 82% of that in the LL group (P < or = 0.05). In respiratory function, the HL group showed marked restrictive impairment of ventilatory function. That is, VC and RV were significantly lower in the HL group than in the LL group (P < or = 0.05). The reduction in VC and RV is related to the degree of loss of control in respiratory functioning muscle mass. However, there was no clear-cut correlation between respiratory function and peak VO2 expressed as a function of body mass (ml.kg-1.min-1). In addition, a multiple linear regression analysis revealed that RV and VC were not associated with peak VO2 (ml.min-1) in contrast to the importance of body mass. It seems reasonable to conclude from these results that respiratory function is not an important factor in determining peak VO2 in the paraplegic.

Linear systems analysis of activating processes of complement system as a defense mechanism

The complement system is an important element of the host defense mechanism, although its kinetics and characteristics as a system are still unclear. We have investigated its temporal changes and system properties from the view point of system engineering. The temporal changes of sequential activating processes of the system were expressed by 26 non-linear differential equations using reported values of rate constants and serum concentration for each component. The intermediate products in the activating processes increased parabolically while the membrane attack component as the final product, increased linearly. The little change in inactive precursors afforded validity for system linearization. Linear systems analysis revealed that the system which was insensitive to the changes in rate constants was unstable. The system became stable when the feed-back input from the final product was set to operate on the first step of the activating processes. Seven uncontrollable variables were insensitive to changes in rate constants or system optimization that minimized the changes in concentrations of components in the complement system. The singular values of the complement system were reduced and the impulse responses of the system were improved when the system was optimized. When stronger minimization was imposed on the changes of concentration of the components in the complement system, the singular values were reduced more, the magnitude of the impulse responses was depressed further and the responses terminated earlier than those when the elements in the weighting matrix of concentration of the components were set to be unity. By this potent minimization, the influences of changes in rate constants on the singular values were diminished. The present theoretical analysis is presented to evaluate the ability of defense mechanism of complement system.

[Improved quality of life (QOL) in terminal renal carcinoma patients through home nurse visitation: some considerations]

Ours is a general hospital administered directly by the government. There are 585 beds and some 1,200 outpatients on average per day. Visits by home nurses began in September of 1990, and beginning in April of 1994 a home nursing department has been in place at the Community Medical Center. There are 5 persons in charge of the visits. Home visits are paid to 40 patients at present on an ongoing basis. In recent years, malignant diseases have been increasing, and there has been much discussion devoted to the quality of life (QOL) of the patients. In 1994, 15 of the 60 patients visited had malignant diseases. Presently, a 63-year-old female patient with terminal kidney cancer is receiving HPN. Thanks to home nursing visits, she has been able to be discharged. This patient had been receiving home nursing visits from December 21, 1993 until June 20 of 1994 at the rate of 2 visits per month. The person in charge gave guidance for HPN management, and the patient began to regain her pre-hospitalization life and a sense of her role in her family and society. As a result, though she had not actively fought the disease while in the hospital, she gained confidence with the HPN, and with her husband's help, she became a Culture School teacher, resumed her role in society and found her life meaningful. Since there were limits to her husband's ability to care for her, she agreed to enter the hospital again, but was able to continue meaningful life at home for 6 months with assistance from a caregiver, and thus achieved a high QOL.

Tricycloillicinone, a novel prenylated c6-c3 compound increasing choline acetyltransferase (ChAT) activity, isolated from Illicium tashiroi

Tricycloillicinone (1), a novel tricyclic prenylated C6-C3 compound, has been isolated as a neurotrophic substance from the woods of Illicium tashiroi and its structure has been elucidated by spectroscopic analyses. Compound 1 could increase ChAT activity in culture of P10 rat septal neurons.

[Hydrostatic weighing, skinfold thickness, body mass index relationships in high school girls]

A study was conducted to evaluate body composition by hydrostatic weighing, skinfold thickness, and body mass index (BMI) in 102 senior high school girls, aged 15 to 18 in Nagasaki City. Body density measured by the underwater weighing method, was used to determine the fat weight (Fat) and lean body mass (LBM. or fat free weight: FFW) utilizing the formulas by Brozek et al. The results were as follows; 1. Mean values of body density were 1.04428 in the first grade girls, 1.04182 in the second grade, and 1.04185 in the third grade. 2. Mean values of percentage body fat (%Fat) were 23.5% in the first grade, 24.5% in the second and 24.5% in the third. 3. Percentage body fat (%Fat), lean body mass (LBM) and LBM/Height were not significantly with different advance of grade from the first to the third. 4. The correlation coefficients between percent body fat and the sum of two skinfold thicknesses, the sum of three skinfold thicknesses and the sum of seven skinfold thicknesses was 0.78, 0.79, and 0.80 respectively and were all statistically significant (p < 0.001). 5. The correlation coefficients between BMI and the sum of two skinfold thicknesses, the sum of three skinfold thicknesses and the sum of seven skinfold thicknesses was 0.74, 0.74, and 0.74 respectively and were all statistically significant (p < 0.001). 6. Mean values of BMI, Rohrer index and waist-hip ratio (WHR) in all subjects (n = 102) were 20.3, 128.2 and 0.72 respectively.

[A clinical study of sudden death in the severely handicapped persons]

A clinical study was performed on 8 cases of sudden death (9.0%) selected from a series of 89 patients with severe handicaps who died at the Metropolitan Medical Center of Severely Handicapped during the period from 1968 through 1986. 1) All suffered from profound mental retardation with motor disturbance, but were able to react to environmental stimuli. 2) Most had mixed quadriplegia showing athetosis-related hypertonus. 3) Severe physical deformation and chronic respiratory symptoms were present in 6 of 8 patients. 4) Most of them were adolescent. 5) Autopsy revealed no particular findings to which the expected death could be attributed except for the right cardiac enlargement in 5 cases. Four of the 8 patients were recovering from respiratory infection or were in the process of having their anticonvulsant doses tapered. These four cases had shown recent improvement in their general systemic condition. Sudden death occurred mainly during limited time periods in the early morning or in the evening and was not related to sleep. The authors suggest that the changes in the autonomic nervous system may precipitate them into sudden death.

[Body density assessment utilizing skinfold thickness and age in Japanese men]

A study was conducted to investigate the validity of skinfold-based prediction equations for body density (g/ml) by Nagamine and Suzuki (1964), and to formulate more convenient and more useful equations for predicting body density from skinfold and age in men. Subjects of the study were 257 healthy men aged 19-60 years in or near Nagasaki City. The regression equation for the dependent variable, body density, was determined by hydrostatic weighing. Independent variables included eight skinfolds, the sum of two skinfolds (triceps, subscapular), the sum of three skinfolds (triceps, subscapular, and abdominal), age, and body surface area. Skinfolds were measured with an Eiken-model skinfold caliper. Age (mean 33.1, range 19-60 yrs.), weight (mean 65.3, range 46.6-107.7 kg), height (mean 168.8, range 152.3-185.4 cm), and body density (mean 1.05874, range 1.00860-1.09020 g/ml) were also recorded. Percent body fat was calculated using the formula by Brozek et al. and ranged from 6.1% to 38.9%. Multiple correlation coefficients (MR) and standard error (SE) of 10 regression equations (A-J) for predicting body density in men were obtained. The best-fitting and the most convenient prediction equation for body density was equation-E.: body density = 1.09556-0.00062 x sum of three skinfolds (mm)-0.00028 x age (MR = 0.815 and SE = 0.0087 g/ml). The equation was cross-validated on a different sample of 45 men. The correlation coefficient between predicted and hydrostatically determined body density was 0.781 (p < 0.001). Equation-E (Tahara's equation) appears to be useful in body density analysis particularly when the subjects are Japanese men, aged 18-50 yrs, with percent body fat 10 to 30%.

Video-assisted thoracoscopic surgery of bullous and bleb disorders of the lung using endoscopic stapling device

The video-assisted thoracic surgical (VATS) approach appears to be a viable alternative to thoracotomy when surgical management of bullous and bleb disorders of the lung is required. Fifty patients with giant bullae (n = 6) and spontaneous pneumothoraces (n = 44) were recently treated by our group using the VATS approach and endoscopic stapling devices. Of the 50 patients, 47 were managed completely by the VATS approach, including six giant bullae that were asymptomatic in five and infectious in one and 41 pneumothoraces, of which 16 were first episode and 25 with recurrent pneumothorax. Median operating times for the bullous and bleb excisions were 147.8 and 45.9 min, respectively (p < 0.01), and median chest tube durations were 5.2 and 1.2 days, respectively (p < 0.05). There was no mortality, and significant morbidity was limited to prolonged air leak in more than 5 days in three patients and postoperative atelectasis in two patients. Median hospital stays of patients with bullous excision was 11.3 days compared with 4.7 days of those with bleb excision. We conclude that the VATS treatment is a safe, effective procedure in patients with bullous and bleb disorders of the lung even in asymptomatic giant bullae or spontaneous pneumothoraces with the first episode. The advantages of the VATS approach for these diseases are ease of operation, less pain, early mobility, and superior cosmetic results.

[Long-term changes in body mass index in rural inhabitants: Takasu study]

Based on community health examination data (1975-1992) of Takasu, a rural town in Hokkaido Prefecture, long-term changes in body mass index (BMI) were studied and contour maps were developed. The results were as follows: 1) A high median BMI, 23 or more, appeared in female age groups from 50's to 70's during the observation period, whereas the high median BMI appeared in male age groups 30's and 40's after 1981. 2) Median BMI in age groups 30's and 40's at the time of the initial observation increased gradually with age in both sexes.

[Combination chemotherapy with tegafur-uracil (UFT) and cisplatin (CDDP) for advanced gastric cancer. UFTP Study Group]

An early phase II study of tegafur-uracil (UFT) combined with cisplatin (CDDP) was conducted in patients with advanced gastric cancer. UFT was administered orally for 28 consecutive days at a dose of 400 mg/m2 and CDDP was injected intravenously for 3 day at a dose of 30 mg/m2 over 8 hours every 4 weeks. This treatment cycle was repeated every 4 weeks. Sixteen patients were enrolled in this study and 14 patients could be evaluated for clinical response and toxicity. Based on the results of extramural review, 6 of 14 patients achieved a partial response and the response rate was 42.9%. High grade toxicities (WHO grade 3 or 4), specifically anorexia, nausea and vomiting, diarrhea, and leukocytopenia, were seen in 5, 2, 3 and 2 patients, respectively. The overall median survival time was 347 days (11.4 months) for evaluated patients. Although these results are preliminary, this regimen does appear to be effective in terms of tumor response and survival. Larger patient numbers in a Phase II study and further studies to evaluate survival are awaited.

Characteristics of non-small cell lung cancer 3 cm or less in diameter

We retrospectively investigated 308 cases of non-small cell lung cancer of < or = 3 cm diameter. There were 204 adenocarcinomas, 78 squamous cell carcinomas, 15 large cell carcinomas, and 11 other carcinomas. According to TNM staging, there were one case stage 0, 208 stage I, 22 stage II, 49 stage IIIA, 15 stage IIIB, and 13 cases stage IV. T1 disease was seen in 262 cases, T2 in 19, T3 in 10, T4 in 16, and Tis in 1. N0 disease was seen in 217 cases, N1 in 30, N2 in 60, and N3 in 1. The 5-year survival rate of all cases was 63%. There were statistically significant differences among T status (T1 vs. T3, T4), N status (N0 vs. N1, N2), and M status (M0 vs. M1) (P < 0.01). The 5-year survival rates of cases with adenocarcinoma and squamous cell carcinoma were 60% and 64%, respectively. In 204 cases of adenocarcinoma, T3 disease was found in one case, T4 disease in 15 (7%), and nodal involvement (N1 + N2) was present in 69 (34%). In 78 cases of squamous cell carcinoma T3 was seen in 6 (8%), T4 in 1, and nodal involvement in 14 (18%). The incidence of T3 disease, T4, and N(+) varied significantly according to histology (P < 0.05). Our investigation suggested that cases of small-sized lung cancer were often at an advanced stage at detection, and that the spread of disease differed according to histology. The patient with small-sized lung cancer should be offered a standard operation regardless of histology.

Naturally occurring 5-lipoxygenase inhibitors. VI. Structures of ardisiaquinones D, E, and F from Ardisia sieboldii

New 1,4-benzoquinone derivatives, ardisiaquinones D(2), E(4), and F(5) along with the known ardisiaquinones A(1) and B(3) have been isolated from the leaves of Ardisia sieboldii (Myrsinaceae) and shown to be 5-lipoxygenase inhibitors. Their structures have been elucidated by spectroscopic analysis and chemical degradation. The degree of inhibition of 5-lipoxygenase activity by the ardisiaquinones and some derivatives of ardisiaquinone A is reported.

The close relationship between growth factors and the nucleolar organizer regions in adenocarcinoma of the lung

We examined immunohistochemically 111 cases of primary adenocarcinoma of the lung, for transforming growth factor alpha (TGF alpha) or epidermal growth factor (EGF), and argyrophilic nucleolar organizer regions (AgNORs). The presence of more than 75% positive cells for both growth factors was designated as a high-GF, while all others were considered to be a low-GF. If AgNORs counts were more than 5.00, it was considered to be a high-AgNORs group, while less than 5.00 was designated as a low-AgNORs group. In our 111 examined specimens, there were 51 (46%) cases of high-GF, and 64 (58%) with high AgNORs. The 5-year survival rates of the patients with a high-GF and low-GF were 34% and 57% (P < 0.05) respectively, while those with high-AgNORs and low-AgNORs were 21% and 81% (P < 0.001), respectively. In the cases of high-AgNORs, the 5-year survival rates of the patients with high-GF and low-GF were 0% and 36% (P < 0.05), respectively. However, in the cases of low-AgNORs, the 5-year survival rates of the patients with high-GF and low-GF were 83% and 79%, respectively. These data suggest that growth factors might be related to the biological malignancy of tumours with a high cell proliferation.