Clinical and magnetic resonance imaging findings in temporomandibular joint disc displacement

OBJECTIVES

To describe the clinical and MRI findings in patients with disc displacement of the temporomandibular joint.

METHODS

Eighty-eight joints in 51 patients referred for suspected TMJ disc displacement were examined by MRI. Two oral radiologists assessed the images. The clinical findings were obtained by retrospective review of the patients' records.

RESULTS

Clicking was the most common clinical finding, present in 47 joints. Pain was reported for only 30 joints. Anterior disc displacement with reduction was found in 39 joints, anterior disc displacement without reduction in 31 joints, compound dislocations (anterolateral or anteromedial) in 13 joints and sideways displacement in 5 joints respectively. In about one-fourth of the joints, MRI revealed abnormal configuration of both disc and condyle. The osseous changes were subtle. Only 9% of the joints exhibited an osteophyte. Joint effusion in either the upper or the lower joint compartment was found in 19 joints. Out of 14 patients with joint effusion, six patients complained of pain from the TMJ region.

CONCLUSION

The most extensive soft and hard tissue changes were found in patients with anterior disc displacement without reduction. Pain was not a characteristic symptom for any type of disc displacement.

Developmentally regulated expression of APG-1, a member of heat shock protein 110 family in murine male germ cells

Apg-1 encodes a heat shock protein belonging to the heat shock protein 110 family, and is inducible by a 32 degrees C to 39 degrees C heat shock. Northern blot analysis of the testis from immature and adult mice, and of the purified germ cells revealed the quantitative change of the apg-1 transcripts during germ cell development. By in situ hybridization histochemistry the expressions of the apg-1 transcripts were detected in germ cells at specific stages of development including spermatocytes and spermatids. Although heat-induction of the apg-1 transcripts was observed in W/Wv mutant testis lacking germ cells, it was not detected in wild-type testis nor in the purified germ cells. Thus, the apg-1 expression is not heat-regulated but developmentally regulated in germ cells, suggesting that APG-1 plays a role in normal development of germ cells.

A case of sarcomatoid carcinoma of the thymus

A 57-year-old woman presented with a 10 x 10 cm anterior mediastinal mass. The tumor had invaded the pericardium, both lungs and the left brachiocephalic vein, and was treated by partial resection and postoperative radiation therapy. Pathological examination of the tumor revealed squamous cell carcinoma with a spindle cell sarcomatous component. Immunohistochemically, keratin and epithelial membrane antigen were positive in both the spindle cell sarcomatous areas and the squamous cell carcinomatous area and thus, a diagnosis of thymic carcinoma of sarcomatoid type was made. The patient died of recurrent disease 1 year after surgery. This case is the seventh reported in the English literature. Because of the poor outcome, adjuvant therapy is recommended.

Role of nitric oxide in the development of vascular alpha 1-adrenoreceptor desensitization and pressure diuresis in conscious rats

We evaluated whether a minor impairment of the L-arginine-nitric oxide pathway would affect the desensitization of vascular alpha-adrenoreceptor and pressure diuresis induced by prolonged intravenous infusion of phenylephrine (an alpha-adrenoreceptor agonist) in conscious Wistar-Kyoto rats. We examined dose-pressor-response curves to phenylephrine after an intravenous infusion of phenylephrine (2.5 micrograms.kg-1.min-1) or saline for 9 hours with and without concomitant infusion of N omega-L-arginine methyl ester (L-NAME) given to partially inhibit the L-arginine-nitric oxide pathway. In addition, to evaluate the effect of plasma volume loss on the pressor response to phenylephrine, we evaluated the dose-pressor-response curves to phenylephrine after intravenous injection of furosemide (5 mg/kg) or infusion of phenylephrine (5 micrograms.kg-1.min-1) for 9 hours. The renin-angiotensin, vasopressin and autonomic nervous systems were blocked before the examination of dose-pressor responses. Prolonged infusion of phenylephrine (2.5 micrograms.kg-1.min-1) shifted the dose pressor-response curve to this agent rightward, with significantly increased log ED50 (the dose needed to reach 50% of the maximal response) to a similar extent in both L-NAME-treated (0.51 +/- 0.05 versus 0.93 +/- 0.07 microgram/kg) and -untreated (0.79 +/- 0.06 versus 1.08 +/- 0.03 micrograms/kg) rats. The log ED50 value after phenylephrine infusion (5 micrograms.kg-1.min-1) was significantly higher than that after furosemide injection (1.28 +/- 0.06 versus 1.02 +/- 0.01 micrograms/kg, respectively, P < .01), although the two treatments induced a similar loss of plasma volume. The slope in the linear relationship between the average change in mean arterial pressure during the 9-hour infusion period and the rate of urine excretion was significantly depressed in L-NAME-treated versus control rats (L-NAME: 0.057 mL.kg-1.h-1.mm Hg-1, control: 0.146 mL.kg-1.h-1.mm Hg-1, P < .05). In conclusion, a minor impairment of the L-arginine-nitric oxide pathway does not appear to interfere with the desensitization of vascular alpha-adrenoreceptor but does inhibit the pressure-diuresis response in conscious normotensive rats.

Sequential cis/trans autophosphorylation in TrkB tyrosine kinase

TrkB, a member of the tyrosine kinase family of growth factor receptors, is activated by binding of brain-derived neurotrophic factor or neurotrophin 4/5. The intracellular kinase domain of TrkB (ICD-TrkB) was prepared by an insect cell expression system and characterized to identify the mechanism of autophosphorylation. The time course of autophosphorylation, which shows a biphasic progression with a slow nonlinear phase followed by a fast linear phase, indicates the existence of autophosphorylation-induced activation in ICD-TrkB. This is also supported by the finding that phosphorylated ICD-TrkB shows significantly higher activity than control naive ICD-TrkB. Interestingly, the autophosphorylation rate in the linear phase clearly depends on the ICD-TrkB concentration, whereas the rate of initial autophosphorylation is independent of the concentration of ICD-TrkB in the reaction mixture. This observation suggests a two-step autophosphorylation, first an intramolecular activating step and then an intermolecular step. This mechanism is confirmed by the result that only the later phase of autophos-phorylation is inhibited by addition of glycerol which interferes with intermolecular interactions. Therefore, we propose the mechanism of ICD-TrkB autophosphorylation as a sequential cis/trans phosphorylation.

Expression of a novel isoform of Vav, Vav-T, containing a single Src homology 3 domain in murine testicular germ cells

Vav is a signal transducing molecule containing C-terminal Src homology 3 (SH3)-SH2-SH3 domains, and has been thought to be expressed exclusively in hematopoietic and trophoblastic cells. By Northern blot analysis, vav transcripts of unique sizes, 4.8 kb and 1.0 kb, were detected in the testis among various tissues examined. From a mouse spermatocyte cDNA library, a novel isoform of vav (vav-T) was cloned, which corresponded to a part of the 4.8 kb transcript. Vav-T had an alternative 5' sequence up to the middle of SH2-coding region, and encoded 163 amino acids with a single SH3 domain. Northern blot analysis of fractionated testicular cells and in situ hybridization histochemistry demonstrated that vav-T transcripts were expressed in the differentiating germ cells, especially spermatocytes. A 24 kD protein was detected by anti-Vav antibodies in the testis, but not in the spleen or bone marrow. Transcripts of heterogeneous nuclear ribonucleoprotein K, known to associate with the most C-terminal SH3 domain of Vav, were also detected in the differentiating male germ cells. These results demonstrate expression of previously nondescribed Vav-isoform in the testicular germ cells, and suggest that it interacts with RNA-binding proteins and plays an important role in spermatogenesis.

A novel hsp110-related gene, apg-1, that is abundantly expressed in the testis responds to a low temperature heat shock rather than the traditional elevated temperatures

We isolated a novel hsp110-related gene, apg-1, from a testis cDNA library. The apg-1 transcripts were constitutively expressed in the testicular germ cells and, in some degree, most tissues examined. In a mouse TAMA26 Sertoli cell line, apg-1 transcripts were induced in 2 h by a temperature shift from 32 to 39 degrees C, but not by a shift from 37 to 42 degrees C, the traditional heat stress, or a shift from 32 to 42 degrees C. The heat response pattern of hsp110 expression was similar to that of apg-1. Although induction of a hsp70 transcript was observed in 2 h by a shift from 32 to 39 degrees C, the induction was more apparent by a shift from 37 to 42 degrees C or from 32 to 42 degrees C. Essentially similar differential response patterns were observed among these genes in NIH/3T3 fibroblasts as well. The nuclear run-on assay and the native gel mobility shift assay demonstrated that, by the 32 to 39 degrees C temperature shift, the apg-1 gene was transcriptionally activated, and heat shock factor 1 bound to the heat shock elements in the 5'-flanking region of the apg-1 gene. These results demonstrated that expressions of apg-1, hsp110, and hsp70 could be heat-induced at a temperature lower than the traditional elevated temperatures in somatic cells of both testis and nontestis origin and suggest that the mechanisms regulating the transcript levels of apg-1 and hsp110 are different from those of hsp70. Furthermore, the constitutive expression in germ cells suggests that APG-1 plays a specific role in spermatogenesis as well as in stress response.

[Airway hyperresponsiveness and airway mucosal permeability]

The relationship between airway mucosal permeability and airway hyperresponsiveness was examined with tachykinins, their selective antagonists, and superoxide dismutase in male Hartley guinea pigs. In animals with ozone-induced airway inflammation, airway hyperresponsiveness and mucosal permeability increased concurrently but there was a time lag before the increase in airway vascular permeability. To study the role of tachykinins in the increases in mucosal permeability and in hyperresponsiveness, we used a neurokinin-receptor antagonist, CP-96345, and a neurokinin-2 receptor antagonist, SR-48968. CP-96345 had no significant effect, but SR-48968 reduced the increase in airway mucosal permeability; their effects on airway hyperresponsiveness were the opposite of their effects on airway permeability. Tachykinins themselves, both substance P and neurokinin A, significantly increased airway mucosal permeability. Superoxide dismutase, a scavenger enzyme of superoxide, reduced the ozone-induced airway hyperresponsiveness. These data suggest that the factors causing airway hyperresponsiveness differ from those that influence mucosal permeability, but it is possible that these pathophysiologic conditions are caused by the same substances or processes.

Inhibitory effect of a novel orally active GP IIb/IIIa inhibitor, SC-54684A on intimal thickening in the guinea pig femoral artery

The inhibitory effect of a novel orally active platelet membrane glycoprotein receptor complex IIb/IIIa (GP IIb/IIIa) inhibitor, SC-54684A is studied on intimal thickening in the guinea pig femoral artery. A segment of the femoral artery was occluded by a platelet-rich thrombus induced by photochemical reaction between systemically administered Rose Bengal and transluminal green light which causes endothelial injury followed by platelet adhesion and aggregation at the site of photochemical reaction. Three weeks after successful thrombolysis by tissue-type plasminogen activator, intimal thickening occurred at the irradiated site. SC-54684A (30 mg/kg), administered 2 h before photochemical reaction, significantly (P < 0.05) prolonged the time to occlusion of the femoral artery; in this respect aspirin (100 mg/kg) was ineffective. A combination of SC-54684A and recombinant tissue-type plasminogen activator (rt-PA) increased the frequency of reopening and significantly (P < 0.05) prolonged the duration of reflow compared with rt-PA alone. Further, SC-54684A administered orally twice a day for 3 weeks significantly (P < 0.05) inhibited intimal thickening but aspirin, administered orally once a day for 3 weeks, was ineffective. Scanning electron microscopy revealed extensive platelet adhesion and aggregation on the denuded vessel walls in the untreated group 24 h after successful thrombolysis. In separate experiments, SC-54684A markedly inhibited platelet aggregation ex-vivo. Inhibition of platelet adhesion and aggregation at the site of endothelial injury by SC-54684A (via GPIIb/IIIa inhibition) may account for its inhibitory effect on intimal thickening.

Altered prostaglandin metabolism induced by angiotensin-converting enzyme inhibitors in broncho-alveolar lavage fluid of the guinea pig

The aim of this study was to investigate if prostaglandin (PG) metabolism is altered by angiotensin-converting enzyme (ACE) inhibitors as determined in the broncho-alveolar lavage fluid (BALF) of the guinea pig. Enalapril or imidapril was orally administered once a day for 2 weeks to Hartley male guinea pigs. Twenty-four hours after the last treatment, BALF was collected and the concentrations of PGI2, thromboxane A2 (TXA2) and PGE2 were measured by enzyme immunoassay. Enalapril significanlty P < 0.05) increased the TXA2 content, which was inhibited by indomethacin treatment and significantly (P < 0.05) decreased the PGI2 content. Imidapril, however, did not affect TXA2 or PGI2 generation. These findings suggest that altered PG metabolism may be associated with coughing as a side effect of enalapril.

[Comparative study of mRNA expression of E-cadherin and collagenase IV in early and advanced cancers]

During the process of invasion, tumor cells must detach from the primary neoplasm and degrade host stroma. E-cadherin is responsible for the cell-cell adhesion and collagenase IV is the one of the matrix metalloproteinases. We determined whether the levels of mRNA for E-cadherin and collagenase IV were differently expressed within 12 cases of early and 13 cases of advanced gastric cancers using a rapid calorimetric in situ hybridization assay for mRNA. In 6 of 12 early cancers, we found a decreased expression of E-cadherin mRNA in the invasion edge compared to the main tumor. In advanced gastric cancers, 3 out of 13 cancers also exhibited this finding. Higher expression of the collagenase IV at the invasion edge of the tumor compared to the main tumor was observed in half of the early and advanced gastric cancer cases. Inverse expression levels of E-cadherin and collagenase IV mRNA were observed in 6 of 12 early cancers. However, only one of 13 advanced cancer cases expressed the same finding.

Midkine, a heparin-binding growth/differentiation factor, exhibits nerve cell adhesion and guidance activity for neurite outgrowth in vitro

By means of a baculovirus expression system, a large amount of mouse midkine (MK) was produced. The protein was purified to homogeneity by heparin-Sepharose column chromatography. The purified protein was of a mature type; the signal peptide was cleaved at the expected site. To examine the neurite-guiding activity of MK, rat embryonic brain cells (embryonic days 17-18) were cultured on plates coated with purified MK in a grid pattern. The cells attached to and extended their neurites along the substrate pattern. This interaction was strongly inhibited by heparin, but not by other glycosaminoglycans. Treatment of the cells with heparitinase was effective for inhibiting their adhesion to the substrate. These data suggest that the heparin-like domain on cell surface heparan sulfate proteoglycan is the primary site for MK binding upon interaction with nerve cells.

A chemiluminescent detection of superoxide radical produced by adherent leucocytes to the subendothelium following thrombolysis: studies with a photochemically induced thrombosis model in the guinea pig femoral artery

Reocclusion following thrombolysis is a major limitation of thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) because denuded vessel wall exposed to blood following thrombolysis is a favourable surface for platelet and leucocyte deposition. We have applied a chemiluminescence technique to detect superoxide radical (0(-2)) produced by leucocytes adherent to the femoral artery 24 h after photochemically induced thrombogenesis in the guinea pig in vivo and subsequent thrombolysis by rt-PA. Intravenous administration of MCLA, a specific chemiluminescence reagent for detecting O(-2), markedly increased photon emission. the photon emission was markedly potentiated by phorbol myristate acetate and was suppressed by superoxide dismutase. Reocclusion 24 h after rt-PA induced thrombolysis was observed in 10 of 16 animals. Histological observations revealed extensive polymorphonuclear leucocytes adherent to the vessel wall at the site of thrombogenesis and thrombolysis. A higher level of 0(-2) could be detected from the arteries in which thrombolysis was induced compared with those without thrombolysis. Further, the level 0(-2) detected was greater in reoccluded arteries compared with those in which reflow was established. These observations suggest that 0(-2) is produced by adherent leucocytes at the site of thrombolysis and that leucocytes are involved in reocclusion after thrombolysis.

[Intrapleural bleomycin for management of malignant pleural effusions]

We studied the efficacy of intrapleural administration of bleomycin for the management of malignant pleural effusions of non-small cell lung cancer in 24 cases. Bleomycin 60 mg was administered into the pleural space after tube drainage. If the effusion continued, one additional dose was given. The efficacy was seen in 18 cases (75%). The main adverse drug reaction was transient fever among others. There was little toxicity and no cases of pulmonary fibrosis. Intrapleural administration of bleomycin is useful in management of malignant pleural effusions.

[A recurrence of benign fibrous mesothelioma of the pleura: a case report]

A 64-year-old man who complained of the right chest pain was admitted in our hospital. A mass shadow which revealed the extrapleural sign was shown in the chest X-ray. This patient was performed thoracotomy and a tumor invading to the intercostal muscles was resected. Pathological diagnosis was benign fibrous mesothelioma. About 10 months after this operation, we suspected the local recurrence of the tumor on the chest X-ray. The re-operation was performed, and we resected the recurrent tumor and the 2nd and 3rd ribs. Pathologically the resected tumor was benign fibrous mesothelioma.

Platelet-activating factor mediates the ozone-induced increase in airway microvascular leakage in guinea pigs

In the present study, we asked whether platelet-activating factor (PAF) mediates the ozone-induced increase in airway microvascular leakage. To answer this question, we examined the effect of a PAF receptor antagonist on the ozone-induced increase in airway microvascular leakage quantified by the extravasation of Evans blue dye in the guinea pig trachea and main bronchi. Guinea pigs were pretreated with the PAF receptor antagonist, E6123 ((S)-(+)-6-(2-chlorophenyl)-3-cyclopropane-carbonyl-8,11-dimethyl-2,3,4, 5- tetrahydro-8H-pyrido[4',3':4,5]thieno[3,2- f][1,2,4]triazolo[4,3-a][1,4]diazepine) (0.01, 0.1 and 1.0 mg/kg i.v.) and then exposed to 3 ppm ozone for 30 min. The PAF receptor antagonist significantly reduced the ozone-induced increase in microvascular leakage in a dose-dependent manner in both the trachea and main bronchi. Our results indicate that PAF mediates the ozone-induced increase in airway microvascular leakage. We therefore suggest that PAF may be involved in ozone-induced airway inflammation.

Presence of alternative 5' untranslated sequences and identification of cells expressing ctk transcripts in the brain and testis

From a mouse brain cDNA library, two species of the Csk-type tyrosine kinase (ctk) gene containing different 5' untranslated sequences were cloned. Using the common as well as specific nucleotide sequences of the two clones as probes, we examined the expression of ctk in various mouse tissues by Northern blot analysis. The results indicated that both species of ctk were expressed in the brain, testis and bone marrow. By in situ histochemistry of the brain, ctk transcript was detected in neurons throughout the entire brain, especially those of the cortex, the hippocampus and the cerebellum. This distribution pattern is similar to that of the Src family kinases including Yes, Src, Fyn and Lyn. In the testis, the major transcript (0.7 kb) was shorter than that expressed in the brain and the bone marrow (2.0 kb). A subsequent Northern blot analysis of fractionated germ cell populations and in situ histochemistry revealed that the short and long transcripts were expressed in germ cells and somatic cells, respectively, and that the expression level was quantitatively regulated during germ cell development. These results suggest that Ctk is involved in the regulation of neural function and differentiation of male germ cells through interactions with member(s) of the Src family kinases.

[Concurrent chemoradiotherapy followed by surgery for advanced stage III non-small cell lung cancer (NSCLC)]

Forty-two patients with stage IIIA (bronchoscopically T3 and/or bulky N2) and stage IIIB NSCLC were treated with concurrent chemoradiotherapy (CRT). Treatment consisted of CDDP, 20 mg/m2 and etoposide, 40 mg/m2 by continuous infusion (day 1-5) of weeks 1 and 5 simultaneously with chest radiotherapy (RT), 50 Gy, 2 Gy/Fx, 5 Fx/week. Surgery was attempted 3-5 weeks after RT in pts clinically downstaged. Between 10/90 and 12/92, 43 previously untreated pts were enrolled and 42 were eligible. Pts characteristics were: male/female = 37/5; mean age, 61 yrs (range, 31-74 yrs); stage IIIA/IIIB = 10/32; 15 adenocarcinoma, 24 squamous cell, 2 large cell, 1 unclassified; PS 0/1/2 = 11/24/7. Excluding 1 ineligible pts, 42 pts were evaluated for CRT response. The response rate was 81% (1 CR, 33 PR, 5 NC, 1 PD, 2 NE). Clinical downstaging was achieved in 20 pts (48%). Twenty-one pts (50%) received surgery and 19 of them were completely resected. In 7 resection specimens, no tumor was observed. Toxicity of CRT was well tolerable (Grade 4 leukopenia, 15%; Grade 2-3 esophagitis, 15%). We conclude that this intensive combined modality therapy is acceptable and appears to increase the response rate as well as resectability. Prospective randomized studies should be conducted for further evaluation of this treatment modality.

Absent uptake on hepatobiliary scintigraphy in hepatic lobar infarction from portal vein occlusion in cholangiocarcinoma

Hepatic infarction is an uncommon entity because of the dual blood supply to the liver. We report a case in which multimodalities demonstrate infarction of the left lobe of the liver secondary to left portal vein occlusion by an invasive cholangiocarcinoma. A 99mTc-DISIDA hepatobiliary scan showed complete absence of activity to the left of the gallbladder fossa. The differential diagnosis of absent hepatic activity on a hepatobiliary scan must include hepatic infarction.

[Urinary erythrocyte morphology under optical microscopy: value in the urological outpatient clinic]

Urinary erythrocyte morphology was examined by optical microscopy 1,256 urological patients with hematuria, between 1990 and 1993. The patients were grouped according to whether their urinary red cells were glomerular origin or non-glomerular in origin or mixed form, or others. Of the 740 patients in the glomerular group 537 were examined urologically, and some urological disease was found in 78 (15%) patients. Urological disease was found in only 7 (2%) of the 316 patients in the glomerular group whose complaint was only asymptomatic microscopic hematuria. Examination of urinary erythrocyte morphology under optical microscopy is inexpensive and valuable in the urological outpatient clinic.

[Clinical and serological studies in six cases of chlamydial pneumonia]

Clinical and serological studies of chlamydial pneumonia were done in six patients (three men and three women). The other three patients had no avian contact and showed almost the same clinical symptom. Acute infection with Chlamydia psittaci and Chlamydia pneumoniae were diagnosed in two patients and in one patient, respectively, by MFA. Because in some cases Chlamydia psittaci pneumonia and Chlamydia pneumoniae pneumonia are difficult to differentiate, it is necessary to use a test that allows different chlamydia species to be distinguished.

Effect of long-term methotrexate-induced neutropenia on experimental periodontal lesion in rats

The effects of long-term methotrexate (MTX)-induced neutropenia on the periodontal lesion in rats were investigated histologically, histometrically and bacteriologically. A nylon thread was inserted into the interdental gingiva between the 1st and 2nd right maxillary molars of the animals 3 weeks before an application of MTX. The animals were then divided into Groups A and B. Group B were injected intraperitoneally with 1.0 mg/kg of MTX 3 times per week for 9 weeks. Group A received saline as a control. Five animals were killed at the 1st, 3rd, 5th, 7th, and 9th week. In Group A, the neutrophils did not decrease during these 9 weeks. In Group B, however, the neutrophils decreased during the 3rd to 9th week. Whereas the experimental side of Group A showed only moderate alveolar bone resorption between the 7th and 9th week, [in Group B] a marked alveolar bone resorption occurred in Group B occurred in the same period. Alveolar bone loss in the experimental side of Group B was significantly greater (p < 0.01) than in Group A in the 7th to 9th weeks. The percentage of gram-negative rods increased in both control and experimental sides of Group at the 9th week. The results of the present study indicate that neutropenia is induced by a long-term application of MTX in rats and that alveolar bone destruction increases as time goes by in the area where a nylon thread was inserted.

Enhancement of thrombolytic efficacy of tissue-type plasminogen activator by adjuvants in the guinea pig thrombosis model

Reocclusion following thrombolysis is a major limitation of thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA). We investigated the effects of vapiprost ((1R-(1 alpha(Z),2 beta,3 beta,5 alpha))-7-(5-((1,1'-biphenyl)-4-yl-methoxy)- 3-hydroxy-2-(1-piperidinyl)cyclopentyl)-4-heptenoic acid, a thromboxane A2 receptor antagonist); argatroban ((2R,4R)-4-methyl-1-[N2-(3-methyl-1,2,3,4-tetrahydro-8-quinolinyl)sulfon yl] - L-arginyl)]-2-piperidine-carboxylic acid, a specific thrombin inhibitor) and MK-886 (3-[1-(4-chlorobenzyl)-3-t-butyl-thio-5-isopropylindol-2-yl]-2,2- dimethylpropanoic acid, a specific leukotriene biosynthesis inhibitor) on the thrombolytic efficacy of rt-PA. The guinea pig femoral artery was thrombotically occluded by photochemical reaction between rose bengal and green light. Thirty min after the occlusion, rt-PA was administered and the time (T1) for reopening of the vessel and the frequency of reocclusion (Fro) 24 h after thrombolysis were monitored. With rt-PA alone, T1 was 28 +/- 7 min (n = 10) and Fro was 70%. T1 was reduced to 9 and 20 min by a combination of rt-PA with vapiprost and argatroban respectively. Fro was reduced by all three adjuvants. Histological observations revealed extensive adherence of polymorphonuclear leucocytes to the damaged endothelium at the site of thrombolysis. It is concluded that thromboxane A2, thrombin and leucocytes are involved in reocclusion after thrombolysis.

[Phase II study of a continuous five-day intravenous infusion of cisplatin and etoposide with concurrent chest radiation therapy in limited stage small cell lung cancer]

The efficacy of continuous five-day intravenous infusion of cisplatin (CDDP) and etoposide with concurrent chest radiation therapy was evaluated in patients with limited stage small cell lung cancer. The first group of patients registered from February 1989 to September 1990 received three courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 40 mg/m2/day x 5 days) and concurrent chest radiation therapy on the third course with dose reduction of etoposide. The second group of patients registered after February 1991 received four courses of chemotherapy (CDDP 20 mg/m2/day x 5 days, etoposide 50 mg/m2/day x 5 days) and concurrent chest radiation therapy on the first and second courses with dose reduction of etoposide. The response rates were 91.7% and 93.3%, respectively. The median duration of survival was 32.0 months and 20.1 months, respectively. Major toxicity was leukocytopenia and 64% and 80% of patients encountered leukocytopenia of Grade 3 or 4. In conclusion, these regimens show remarkable efficacy with acceptable toxicity.