[Therapeutic effect of stage III breast cancer--comparative study of preoperative intra-arterial infusion chemotherapy and non-infusion therapy]

Between January 1977 and March 1988, 111 patients of stage III breast cancer were treated in Sapporo Medical College. The median age was 51.6 years (range, 26-83 years). Menopausal status was 47 cases of premenopausal, 19 cases of perimenopausal and 45 cases of postomenopausal. Fifty-seven of these patients received intra-arterial infusion chemotherapy. The anticancer drugs were mainly given by two routes, infusion into the internal mammary artery and the subclavian artery. Continuous infusion of 5-FU and intermittent injections of MMC, ADR or 4'-epi-ADR were jointly or individually made in each artery. Clinico-histological response was studied in 53 out of 57 patients. Clinical response, defined as CR + PR, was noted in 33 patients (62.3%). Histological response according to Shimosato Criteria, defined as grade IIb or better, appeared in 31 patients (58.5%). Non-infusion group contained 27.7% of stage IIIb, against 72.2% in infusion group. The 5-year overall survival rates were; non-infusion group 62%, 5-FU infusion group 34.1%, and ADR MMC group 66.2%. A significant difference was seen between 5-FU infusion group and ADR-MMC group (p = 0.03). The median disease-free interval was 22.0 months (range, 1-77 months) in infusion group and 28.2 months (range, 1-124 months) in non-infusion group. MMC + ADR combination group revealed the most excellent results in terms of the 5 year survival rate and clinicohistological effect.

Selective inhibition of cyclic AMP phosphodiesterase from various human tissues by milrinone, a potent cardiac bipyridine

We observed the effects of milrinone, an inotropic agent prescribed to treat congestive heart failure, on cyclic nucleotide messenger systems in various human tissues in vivo. Cyclic nucleotide phosphodiesterases (PDEs) from the human heart were separated into three isoforms, FI, FII and FIII, by DEAE-cellulose chromatography. Milrinone proved to be a potent and selective inhibitor of human cardiac FIII PDE, a "low Km" enzyme for cyclic AMP (cAMP-PDE). The IC50 value for the inhibition of FIII PDE was 0.42 microM, while those of FI and FII PDEs, "high Km" enzymes, were 38 and 19 microM, respectively. Kinetic studies showed that milrinone inhibited the activity of FIII PDE, competitively with respect to cAMP, and the Ki was 0.15 microM. Milrinone in doses to 100 microM had no effect on human cardiac cAMP-dependent protein kinase and adenylate cyclase. The activity of cAMP-PDEs from human platelets and the aorta, as well as that from heart, were potently inhibited by milrinone, with much the same IC50 values. Cyclic AMP-PDEs from human kidney, liver and lung were not readily inhibited by milrinone, and the IC50 values of cAMP-PDEs from these tissues were about 7-30-fold higher than that from heart. On the other hand, papaverine had a relatively lesser selectivity for any of the cAMP-PDEs. All these results suggest that milrinone exerts inotropic effects by inhibiting cAMP-PDE selectively in the human heart tissues and that this compound can be used to evaluate different forms of cAMP-PDEs present in human tissues.

[Pharmacokinetics of cis-dichlorodiammine platinum (II) in patients undergoing hemodialysis]

The pharmacokinetics of non-protein-bound platinum (free-Pt) and protein-bound platinum derived from cisplatin [cis-dichlorodiammine platinum (II), CDDP] were studied in five patients with chronic renal failure who developed gastric cancer during long-term hemodialysis. Plasma concentrations of CDDP were determined by atomic absorption spectrophotometry. CDDP at a dose of 25 mg/m2 was given i.v. over a 30-min period every one to two weeks. When CDDP was infused simultaneously with the start of hemodialysis, free-Pt at the blood inlet decreased rapidly and free-Pt at the blood outlet remained below the level for quantitative analysis. Furthermore, the total-Pt level declined in two exponential curves at the blood inlet simultaneously with the increased level of Pt at the blood outlet after the end of dialysis. In contrast, when CDDP was infused one hour earlier before dialysis, the pharmacokinetics revealed a higher concentration of free-Pt at the blood inlet which was maintained over a longer period as compared with that occurring when infused simultaneously with the start of dialysis. In conclusion it is considered that this method is feasible for the treatment of gastric cancer in patients with chronic renal failure under long-term hemodialysis.

Pseudoidiopathic hypoparathyroidism: report of a case and review of the literature in Japan

A case of pseudoidiopathic hypoparathyroidism is described. The patient, 47-year-old male, developed numbness and muscle spasms in the extremities in July 1980. Physical and laboratory examinations revealed positive Chvostek and Trousseau's signs, hypocalcemea, mild hyperphosphatemia, normal serum magnesium, prolongation of QTc on EKG, normal reaction to Ellsworth-Howard test and high levels of serum PTH. Treatment with calcium lactate and vitamin D was successful. The literature regarding 16 cases reported in Japan was reviewed.