Acute myeloid leukaemia with t(9;11)(p22;q23) in a patient treated for adult T cell leukaemia

A 37-year-old male patient with adult T cell leukaemia (ATL) began receiving chemotherapy in March 1992. He achieved complete remission in May 1992, but developed acute myeloid leukaemia (AML, FAB subtype M2) with t(9;11)(p22;q23) in May 1993. The presence of chromosome 11 abnormality at band 11q23 in this patient suggests that the AML was related to the chemotherapy with etoposide for ATL. Furthermore, the combination of etoposide with two cytostatic drugs, cyclophosphamide and carboplatin, possibly induced the leukaemia early (14 months) after the start of chemotherapy. To our knowledge, this is the first report of therapy-related AML after chemotherapy for ATL.

[Difference of cerebral arteriolosclerosis between the deep and subcortical white matter in normal aging and vascular dementia of Binswanger type]

A comparative pathological study of arteriosclerosis was conducted between the deep white matter (M1) and the subcortical white matter (M2) to investigate the difference in the arteriolar changes in normally-aging individuals and those presenting vascular dementia. The arterioles (20-100 microns in outer diameter) of 95 autopsied brains were examined (56 control cases; C group, 24 hypertensive cases; HT group, and 15 Binswanger type vascular dementia cases; VD group). In C group, the primary pathological change was adventitial proliferation (AP), which was significantly more pronounced in M1 than in M2. AP in M1 was found to have advanced promptly with aging, while AP in M2 advanced mildly. AP in M1 was much more pronounced in HT group than in the age-matched C group, but little difference in M2 was observed between the two groups. AP in VD group was more pronounced in M2 than in M1 compared with HT group. These findings indicate that AP in M1 occurs prior to that in M2 in the process of normal aging, and that AP, in M2 as well as in M1, may play an important role in the pathogenesis of Binswanger type vascular dementia.

Morphometry of structural preservation of tunica media in aged and hypertensive human intracerebral arteries

BACKGROUND AND PURPOSE

Medial smooth muscle cell necrosis has been reported as a lesion that may precede angionecrosis, which is a major cause of not only hypertensive brain hemorrhage but also lacunar infarct. We morphometrically studied a loss of smooth muscle cells in the media of cerebral arteries in relation to clinical risk factors.

METHODS

The lateral striate, ie, perforating arteries and the medullary arteries in the subcortical white matter of the temporal lobe (100 to 400 microns in diameter) were histologically investigated in 121 autopsied brains. Medial area was measured quantitatively, and the number of nuclei of smooth muscle cells in the area was calculated in 1210 cross-sectional arteries of histological sections. The influence on the structural (ie, smooth muscle cell) preservation of the tunica media (ratio of number of smooth muscle cell nuclei to medial area [N-MA ratio]) of age, blood pressure, serum lipids, and presence of absence of extracerebral severe atherosclerosis was investigated.

RESULTS

The N-MA ratio decreased slightly with age in both arteries. A reverse correlation between N-MA ratio and age was seen in groups both with and without hypertension. The mean N-MA ratio in the hypertensive group was significantly lower than that of the nonhypertensive group (P < .001) in all decades of life. The mean N-MA ratio of the perforating arteries was slightly lower than that of the medullary arteries in both groups. Severe atherosclerosis of the internal carotid arteries, even with hypertension, mitigated a decrease of the N-MA ratio, which was as slight as that in the nonhypertensive group. Serum cholesterol in this group was higher than in both the conventional hypertensive group (P < .005) and the nonhypertensive group (P < .001).

CONCLUSIONS

Although both hypertension and age were significant risk factors for medial smooth muscle cell necrosis, hypertension was relatively more significant. Medial smooth muscle cells of the perforating arteries in the basal ganglia were more vulnerable than those of the medullary arteries. Cerebral small arteries in subjects with severe atherosclerosis of the carotid and major cerebral arteries (hypertension in eight of nine subjects) may have been protected from extensive loss of medial smooth muscles presumably because of both high serum cholesterol and decreased wall tensile stress associated with reduced blood perfusion due to severe atherosclerotic stenosis.

Clinical study of biological response modifiers as maintenance therapy for hepatocellular carcinoma

We conducted a randomized, controlled trial comparing 5-fluorouracil (5-FU) with or without biological response modifiers (BRMs) as a maintenance therapy for hepatocellular carcinoma (HCC) after treatment with percutaneous ethanol injection (PEI), transcatheter arterial embolization (TAE) or arterial infusion of antitumor agents (AI). A total of 58 cases of HCC were classified into 4 groups as follows: group I, PSK with 5-FU (n = 15); group II, lentinan with 5-FU (n = 15); group III, OK-432 with 5-FU (n = 12); and group IV, 5-FU alone as the control (n = 16). The mean survival time, mortality rate, time to progression, and T4/T8 ratio of lymphocytes in the peripheral blood were compared among the four groups. There was no significant difference in the background factors among the groups. In group I, the T4/T8 ratio of lymphocytes was reduced after the therapy. No significant difference was found among the groups in terms of the mean survival time, mortality rate, or time to progression. PEI for initial therapy was superior to the other therapies in terms of the mean survival time and mortality rate. These results suggest that the addition of BRM to maintenance therapy with 5-FU exerts no prognostic benefit on HCC patients treated with PEI, TAE, or AI.

Effects of combined treatment with phenolic compounds and sodium nitrite on two-stage carcinogenesis and cell proliferation in the rat stomach

The effects of combined treatment with NaNO2 and phenolic compounds on N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) stomach carcinogenesis were investigated in F344 rats. In the first experiment, groups of 15-20 male rats were treated with an intragastric dose of 150 mg/kg body weight of MNNG, and starting 1 wk later, were given 2.0% butylated hydroxyanisole, 0.8% catechol, 2.0% 3-methoxycatechol or basal diet either alone or in combination with 0.2% NaNO2 in the drinking water until they were killed at week 52. All three antioxidants significantly enhanced forestomach carcinogenesis without any effect of additional NaNO2 treatment. However, in the absence of MNNG pretreatment, the grade of forestomach hyperplasia in the catechol and 3-methoxycatechol groups was significantly increased by the combined treatment with NaNO2. In a second experiment, the combined effects of various phenolic compounds and NaNO2 on cell proliferation in the upper digestive tract were examined. Groups of 5 rats were given one of 24 phenolic compounds or basal diet either alone or in combination with 0.3% NaNO2 for 4 weeks and then killed. Particularly strong enhancing effects in terms of thickness of the forestomach mucosa were seen with t-butylhydroquinone (TBHQ), catechol, gallic acid, 1,2,4-benzenetriol, dl-3-(3,4-dihydroxyphenyl)-alanine and hydroquinone in combination with NaNO2. In the glandular stomach, similar enhancing effects were evident in 11 cases, and in the esophagus with phenol, TBHQ and gallic acid. These results demonstrate that NaNO2 can augment cell proliferation induced in the stomach epithelium by various phenolic compounds.

[An early phase II study of CPT-11 (irinotecan hydrochloride) in patients with advanced breast cancer]

An early phase II study of irinotecan (CPT-11) in patients with advanced or recurrent breast cancer was undertaken by a cooperative study group of 15 institutes in Japan. CPT-11 was administered by intravenous drip-infusion. The administration schedules were 100 mg/m2 weekly (regimen A), 150 mg/m2 biweekly (regimen B), and 200 mg/m2 every 3-4 weeks (regimen C). There were 4 partial responses (PRs), 12 cases with no changes (1 minor response) and 9 cases of progressive diseases with a response rate of 16% (4/25). One out of 7 patients on regimen A and 3 patients out of 15 patients on regimen C achieved PR with a response rate of 14% and 20%, respectively. In three out of 4 PRs, prior chemotherapy, endocrinotherapy or radiotherapy had failed. Major adverse reactions were leukopenia 28/33 (85%), neutropenia 19/25 (76%), anemia 15/33 (46%), nausea/vomiting 28/33 (85%), anorexia 25/33 (76%), diarrhea 22/33 (67%) and alopecia 20/33 (61%). The incidence of leukopenia and thrombocytopenia seemed to be higher in regimen C than regimen A, and diarrhea was also more severe in regimen C than regimen A. The recovery of leukopenia was delayed in some patients on regimen C. The results suggested that CPT-11 was effective against advanced or recurrent breast cancer. The recommended administration schedule for a late phase II study was thought to be 100 mg/m2 weekly, considering efficacy and safety.

Influx of leukocytes and platelets in an evolving brain infarct (Wistar rat)

The results of several experimental studies of focal ischemia and anecdotal observations suggest that leukocytes may contribute to the injury initiated by an arterial occlusion. The timing and the nature of leukocyte responses in evolving brain infarcts (either human or experimental) are incompletely characterized. This is a study of experimental brain lesions in 96 Wistar rats that underwent occlusion of a large intracranial artery for variable intervals ranging between 30 minutes and 7 days. The experimental model, based on the occlusion of a middle cerebral artery ostium via the insertion of a nylon monofilament through the external carotid artery, does not require opening the skull; therefore, the inflammatory response is not influenced by the effects of craniotomy and changes in intracranial pressure are only those induced by the ischemic lesion. All 96 animals having the same type of arterial occlusion developed an ischemic brain lesion (limited to the territory of the corresponding artery) that evolved into an area of extensive neuronal necrosis over a period of 6 to 12 hours followed by pan-necrosis (infarct) approximately 60 hours later. In this study, leukocytes (in particular polymorphonuclear cells) were detected in the microvessels (capillaries and venules) of the ischemic hemisphere as early as 30 minutes after the arterial occlusion. Numbers of intravascular neutrophils peaked at 12 hours, whereas intraparenchymal granulocytes were most numerous at 24 hours; a few granulocytes were visible in the brain infarct as late as day 7. Circulating monocytes were first detected within the capillaries/venules of the ischemic area after 4 to 6 hours. Platelet aggregates were more abundant in the arterial than the venous side of the circulation, and luminal obstruction of arteries by platelet aggregates became noticeable only 48 hours after the arterial occlusion. Fibrin thrombi were conspicuous for their absence. These observations provide the background for studies that will attempt to unravel the relationship between the biological responses of leukocytes and neuronal necrosis secondary to focal ischemia.

Enzyme release from mitochondria during reoxygenation of rat liver

Reoxygenation-induced release of mitochondrial aspartate aminotransferase (mAST) into the cytosol was studied using perfused rat liver. As the absolute activity of mAST in the perfusate did not indicate the degree of mitochondrial enzyme release, the following 3 methods were applied: measurement of the mAST to total AST ratio in the efferent perfusate, the digitonin infusion method, and measurement of mAST activity in the cytosolic compartment isolated from perfused livers. The results by all 3 methods were consistent and showed that mitochondrial injury occurs on reoxygenation. The mitochondrial Ca2+ content was proportional to the extent of mAST release during reoxygenation, indicating involvement of Ca2+ in the enzyme release. CsA, a potent inhibitor of Ca(2+)-induced increase in permeability of the mitochondrial membrane, completely prevented mAST release on reoxygenation. We conclude that during reoxygenation of hypoxic liver, mAST leaks into the cytosol in a Ca(2+)-dependent, CsA-sensitive manner.

[An early phase II study of CPT-11 (irinotecan hydrochloride) in patients with hematological malignancies]

An early phase II study of CPT-11 (irinotecan hydrochloride) was conducted in patients with hematological malignancies by 4 administration regimens in a cooperative study involving 13 institutes in Japan. The overall response rate was 23% (7/30) for non-Hodgkin's lymphoma, 33% (1/3) for Hodgkin's disease, 18% (2/11) for acute lymphoblastic leukemia and 7% (1/15) for acute myelogenous leukemia. One PR was also obtained in a patient with chronic myelogenous leukemia. Among responders, 6 relapsed and refractory malignant lymphomas (ML) and 2 relapsed and refractory acute leukemias (AL) were involved. The response rates in ML with the regimens B (40 mg/m2 for 5 days every 3-4 weeks) and C (40 mg/m2 for 3 days every weeks) were 31% (5/16) and 33% (3/9), respectively. The other regimens (regimen A, 200 mg/m2 once a day every 3-4 weeks and regimen D) resulted in no response. Responses in AL were only observed in regimen D (20 mg/m2 twice a day for 7 days every 3-4 weeks). Major toxicities were leukopenia (91%), nausea/vomiting (74%), diarrhea (73%) and anorexia (64%). The incidence of severe gastrointestinal symptoms was higher in regimen B than regimen C. Further studies are warranted to confirm the effectiveness and safety of CPT-11 against ML and AL. The recommended administration schedule was regimen C for ML and regimen D for AL.

Effects of metal chelating agents on the oxidation of lipids induced by copper and iron

The non-enzymatic oxidations of soybean phosphatidylcholine liposomes, methyl linoleate micelles and low-density lipoprotein in aqueous dispersions induced by copper and iron have been studied aiming specifically at elucidating the action of the metal chelating agents such as ethylenediaminetetraacetic acid disodium salt (EDTA), nitrilotriacetic acid (NTA), adenosine-5'-diphosphate disodium salt (ADP), desferrioxamine (DFO), penicillamine (PCM), and triethylene tetramine (TTM). The effects of chelators on chemiluminescence emitted from its probe luminol in the decomposition of tert-butyl hydroperoxide by metal ion were also studied. The effects of chelators on the oxidations depended both on the metal ion and the substrate. Namely, in the oxidations of both liposomes and micelles, EDTA and NTA suppressed the copper-induced oxidations, whereas they enhanced the oxidations induced by iron. ADP had little effect, while PCM and TTM had accelerating effect for both metal ions. On the other hand, in the oxidation of LDL, none of these chelators enhanced the oxidation. Especially, TTM and PCM suppressed the copper-induced oxidation of LDL, suggesting that the chelating agents blocked the access of the metal ion to the hydroperoxide within LDL. The effects of chelators on chemiluminescence emission were similar to those on the oxidations of liposomes and micelles. The cyclic voltammograms of metal complexes were also measured. The multiple effects of chelators on the rate of non-enzymatic, metal-catalyzed oxidations of lipids were interpreted by their influence on redox-potential and accessibility to hydroperoxide of the metal-chelator complex.

[ELISA tests for detection of Helicobacter pylori antibodies]

The efficacy of commercial ELISA tests for detection of Helicobacter pylori antibodies was investigated. Some investigators reported that six commercial ELISA tests had sensitivities of 81-96%, and had specificities of 29-96%. It is possible that some of false-negative results by ELISA may occur for patients who are in the acute phase of infection. When ELISA tests gave false-positive results, it should be taken into account that there might be some false negative diagnoses for the gastric H. pylori status, arising from sampling errors. Some of the false-positive results by ELISA might indicate the previous infection only.

[The effect of the eradication of H. pylori on the intractable ulcer]

On 25 cases (gastric ulcer 14 cases and duodenal ulcer 11 cases) of the intractable ulcer which was H. pylori-positive, we eradicated H. pylori. The eradication was done during 14 days by a triple therapy: bismuth subnitrate 2.0 g, metronidazole 0.75 g, AMPC 0.75 g/day). All cases were confirmed to be eradicated by culture and microscopic examination. 24 cases (gastric ulcer 13/14 and duodenal ulcer 11/11) were confirmed to be completely cured. After the eradication, we ceased the maintenance therapy by H2RA and followed them up, however, no ulcer relapses were found up to 9 months. It was considered that the eradication against H. pylori was a very effective method to the intractable ulcer.

Age-related changes in the microvessels of the human stomach: an ultrastructural study

The ultrastructure of microvessels in the gastric mucosa of patients with atrophic gastritis was investigated. In the gastric mucosa of atrophic gastritis, the endothelial cells of microvessels were irregularly swollen and subendothelial spaces were enlarged. The basement membrane underlying the endothelium was thickened. Degeneration of smooth-muscle cells was also evident in the media. These changes appear to correspond to sclerosis or aging of the microvessels. Such sclerotic changes in microvessels may initiate deterioration of the microenvironment in the gastric mucosa and may consequently affect metabolic activity of the gastric mucosal cells. Those sequences might induce degeneration or abnormal differentiation of mucosal cells. Such vascular changes may advance slowly and increase in intensity with advancing age. The final result would be the histologic changes associated with atrophic gastritis.

Depolymerization of hyaluronan by sonication

High molecular weight hyaluronan (M(r) 400,000) obtained from human umbilical cord was depolymerized by sonication for 10 h into small molecules and finally into molecules of constant size (M(r) 11,000). The molecular size of the depolymerized hyaluronan was unaltered even under different conditions of sonication. After sonication, the main sugar residues at the reducing and non-reducing termini of depolymerized hyaluronan were N-acetylglucosamine (86%) and glucuronic acid (98%), respectively. Hyaluronans derived from rooster comb (M(r) 1 x 10(6)) and Streptococcus zooepidemicus (M(r) 1.2 x 10(6)) were depolymerized into molecules of different but characteristic sizes by sonication. On the other hand, neither chondroitin sulfate nor glycogen was depolymerized by sonication. These results suggest that high molecular weight hyaluronan may have some weak linkages related to N-acetylglucosamine in the chain, which are extremely sensitive to sonication. At present, however, the nature of these linkages is still unclear.

Histologic differentiation and motility of rat stomach

An ultrastructural and immunohistochemical study was done to investigate the normal developmental process of rat gastric wall. Neuronal processes were observed on the external side of immature muscle cells on gestational day 15, and Auerbach's plexus was found on gestational day 18, after which neuronal elements extended just under the subepithelial area. Myofilaments appeared in undifferentiated mesenchyme cells on gestational day 15. On day 17, stomach was responsive to Ach stimulation. On the day after the initiation of gastric motility, gastric glands started to form on the mucosal surface. At the same developmental stage, some parts of the mucosal epithelium and the submucosal connective tissues were stained with antiserum against tenascin. Endocrine and parietal cells appeared in the mucosal epithelium on gestational day 19. Dense secretory granules on the apical surface of mucosal epithelium were increased between day 20 and 21. The cytoplasmic organelles gradually developed with advancing fetal age. We suggest that tenascin may play a role in gastric gland formation and that there are some relationships between gastric gland formation and gastric motility. We believe that the development of subepithelial tissues may be closely associated with epithelial growth.

Nucleolar organizer regions are independently associated with a shortened survival in patients with non-small cell lung cancer

We examined nucleolar organizer regions (Ag-NOR) in 102 patients with non-small cell lung cancer (NSCLC). Ag-NOR counts were generally higher in tumours from more advanced stages, or in poorly differentiated adenocarcinomas. Six potential-prognostic indicators included sex, age, year of operation, histology, stage and Ag-NOR count. Stage and Ag-NOR counts had a significant prognostic value in the univariate analysis for 79 patients who died of their lung cancer. In the multivariate analysis, high Ag-NOR counts as well as disease stage were independently associated with a poor prognosis. Furthermore we divided patients into three groups according to their Ag-NOR counts and found that in patients with stage I and II disease higher Ag-NOR counts were associated with shortened survival. This trend did not continue in patients with stage III and IV disease.

[Relationship between Helicobacter pylori colonization in the gastric mucosa and the severity of atrophic gastritis]

We studied the relationship between Helicobacter pylori infection and atrophic gastritis. Eighty non-ulcer patients underwent endoscopy with biopsy. Detection and quantitative assessment of H. pylori was made based on smear, culture and tissue section (Gram stain). The extent of atrophic gastritis was assessed endoscopically according to the classification of Kimura and Takemoto. Severity of glandular atrophy and intestinal metaplasia was assessed histologically. H. pylori infection was accompanied by or preceded the extension of atrophic gastritis. In patients with severe atrophic gastritis H. pylori was not detected. In the advanced stage of atrophic gastritis H. pylori might be cleared from the gastric mucosa. Our results suggest that H. pylori may be one of the factors for the extension of atrophic gastritis.

[Dietary fiber intake among the general population in 25 prefectures]

The per capita daily intake of dietary fiber in 25 prefectures was calculated from measured values of dietary fiber in each food according to the modified Southgate method and the modified Prosky method. Results obtained were as follows; In the calculated values according to the modified Southgate method, mean per capita daily dietary fiber intake was highest in Gunma 20.5 g and lowest in Okinawa (13.5 g). On the other hand with Prosky method, dietary fiber intake was highest in Gunma (19.3 g) and lowest in Hyogo (12.4 g). Therefore, dietary fiber intake was higher in eastern Japan than in western Japan. In calculated values according to the modified Southgate method, the largest consumption was noted with rice at 30%. On the other hand, in Prosky method, vegetables were noted as the largest and rice ranked second. The mean per capita daily intake of hemicellulose was noted at 50% of the whole, cellulose at 30-35% and lignin at 15-20%.

The incidence of vertical transmission of hepatitis C virus

This study was undertaken to clarify the incidence of the vertical transmission of hepatitis C virus (HCV). During the third trimester, 2015 pregnant women were examined as to anti-HCV antibodies. Anti-HCV antibody seropositive women were examined for HCV-RNA in peripheral blood at labor and in breast milk. Their offspring were also examined for HCV-RNA in umbilical cord blood and peripheral blood one week after birth and during subsequent outpatient visits. The following results were obtained: (1) Twelve of the 2015 pregnant women (0.6%) were seropositive for anti-HCV antibodies; (2) Seven of the twelve women (58%) seropositive for anti-HCV antibodies were also seropositive for HCV-RNA; (3) Three newborns of the seven HCV-RNA seropositive women (43%) were found to have HCV-RNA in the cord blood; (4) In the three newborns HCV-RNA had disappeared from the peripheral blood within one month after birth; (5) Two of the seven HCV-RNA seropositive women (29%) had HCV-RNA positive breast milk; (6) The possibility of infection via breast milk was shown in one infant at ten months after birth. Based on these results, it is indicated that HCV vertical transmission is possible in more than half of the HCV-RNA seropositive mothers. However, because of the disappearance of HCV from the infants' peripheral blood, further following study is needed.

Frequency analysis of QRS complex with bundle branch block in patients with and without sustained ventricular tachycardia

To distinguish patients with bundle branch block (BBB) and sustained ventricular tachycardia (s-VT) from patients with BBB but without s-VT, a frequency analysis of the QRS complex was performed in 71 patients. Frequency analysis of the QRS complex of patients with left bundle branch block (LBBB) showed that patients with s-VT had significantly larger areas and area ratios between 50 and 100 Hz in the X lead than patients without s-VT (area: -0.905 +/- 0.231 vs -1.195 +/- 0.286. area ratio: -0.783 +/- 0.230 vs -1.125 +/- 0.310; P < 0.05). The area and area ratios from 100 to 200 Hz in the Z lead were also larger in patients with s-VT. The highest predictive accuracy using the area ratio from 50 to 100 Hz in the X lead was 86%, with a sensitivity and specificity of 83% and 88%, respectively. In cases with LBBB, time domain analysis showed no significant difference between patients with s-VT and those without s-VT. Frequency analysis of the QRS complex may be useful for distinguishing LBBB patients with s-VT from those without s-VT.