[Assessment of response to therapy based on the application of the guideline of reporting treatment results of head and neck cancer]

It seems difficult to compare the treatment results to each other, without "common language" to describe cancer therapy and its results. In this paper, guideline of reporting treatment results of head and neck cancer was applied to carcinoma of the pharynx and larynx. There were some problems in reporting of response, such as the measurability and assessment of the response. However, there were small discrepancies between assessment of response to therapy and end-point evaluation, i.e., long-term control, survival and disease-free survival, according to the prospective department-based and retrospective hospital-based studies.

[Acinic cell tumor of the epipharynx--a patient treated with surgery and high-dose intracavitary radiation therapy]

A case of acinic cell tumor of the epipharynx is reported. The patient was a 41-year-old man. The tumor was surgically removed by the transpalatal approach. Light microscopically, the lesion was composed of serous acinic cells with eosinophilic granules, clear cells with water-clear cytoplasm and their intermediate type, vacuolated cells. The serous acinic cells were PAS (periodic acid-Schiff)- and DPAS (PAS with diastase predigestion)-positive. The clear and vacuolated cells were PAS- and DPAS-negative. The patient underwent early postoperative radiation therapy; high-dose intracavitary radiation therapy using remote-controlled afterloading equipment was given subsequent to the external radiation therapy. The patient has been free of recurrence and abnormal findings for one year after treatment.

Whole brain irradiation for metastases from lung carcinoma. A clinical investigation

Sixty-nine consecutive patients with brain metastases from lung carcinoma were randomly allocated to one of two radiation therapy schedules: 30 Gy/10 fractions/2 weeks or 50 Gy/20 fractions/4 weeks. The improvement rate for neurologic function was similar in the two groups. The median survival times for patients receiving the short course and the long course were 4 months and 3 months, respectively. The half-year survival rate was 42 per cent after the short course and 14 per cent after the long course (p less than 0.05). Performance status and lactate dehydrogenase were other factors which significantly influenced the half-year survival rate.

Rectal complication after remote afterloading intracavitary therapy for carcinoma of the uterine cervix

From August 1978 through December 1980, 119 patients of previously untreated carcinoma of the uterine cervix were treated using RALS, remote afterloading high dose rate intracavitary therapy at our department. The data from 92 out of 119 patients were available for analysis of rectal complication. The incidence of major rectal complications was only 2% (2/92). Uni- and multivariate analyses were used based on the external criterion variable of rectal complication which included even minor injuries. By using these methods, it was clearly indicated that these factors such as TDF of rectum, Z-coordinate of weighted geometric center (WGC-Z), the dose of whole pelvic irradiation, history of chemotherapy and Treponema pallidum hemoagglutination test (TPHA) were important for occurrence of rectal complication. According to discriminant score, 71 out of 92 cases (77%) could be correctly discriminated.

[Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck]

Thirty-seven previously untreated cases of primary non-Hodgkin's lymphoma in the head and neck were treated at our department from September 1977 through January 1983. The survival rate at three years by stage was 84% in stage I, 44% in stage II and 0% in stage III and IV. Stage, T- and B-cell markers, initial primary site, the level of lymph node involvement (UICC, 1978) and number were important prognostic factors. Chemotherapy in the pre- or post-radiation period was essential, especially in stage II. It was proved that adequacy of radiation portals with special reference to anatomical considerations was necessary.

Stereochemical studies of a selenium-containing hydrogenase from Methanococcus vannielii: determination of the absolute configuration of C-5 chirally labeled dihydro-8-hydroxy-5-deazaflavin cofactor

Reduction of 7,8-didemethyl-8-hydroxy-[5-2H]-5-deazariboflavin by the selenium-containing hydrogenase from Methanococcus vannielii gave a C-5 chirally labeled 1,5-dihydro derivative. The absolute configuration of the chiral label was shown to be (R) by comparison of the chemically degraded product with authentic samples of known absolute configurations. Therefore, the steric course of the enzymic reactions involving the 8-hydroxy-5-deazaflavin cofactor can be defined as follows: (a) reduction occurs on the si face of the 5-deazaflavin molecule; (b) oxidation proceeds by the abstraction of the pro-S hydrogen at C-5 of the 1,5-dihydro-5-deazaflavin. Thus, the selenium-containing hydrogenase and 8-hydroxy-5-deazaflavin-dependent NADP+ reductase from M. vannielii are si face specific.

Estimation of alveolar deposition ratio of inhaled radioaerosol

The lung retention ratio (LRR) and the alveolar deposition ratio (ALDR) are mandatory to calculate the other three indices for quantitatively evaluating mucociliary clearance function of the ciliated airways; the airway deposition ratio (ADR), the airway retention ratio (ARR) and the airway clearance efficiency (ACE). According to our original method, the LRR required 2-hr continuous measurement of radioactivity in the thorax and the ALDR a repeat measurement at 24-hr after radioaerosol inhalation. The 2-hr continuous measurement is, however, too long for a clinical examination and the 24-hr repeat measurement cumbersome. The purpose of the study was to find a way to get the ALDR by calculation without repeating the 24-hr measurement and by counting radioactivity for the shortest possible period and yet without sacrificing the visual evaluation by compiling radioaerosol inhalation lung cine-scintigraphy. By using the derived formulae listed in Table 1, the ALDR was calculable. Forced expiratory volume (FEV) in one sec divided by FEV in per cent (FEV1.0%), the initial 60 min measurement of radioactivity without repeating 24-hr measurement, and smoking history were the minimum requirements to calculate the ALDR. The calculated ALDR appeared reliable enough to estimate the other indices.

tRNA binding to programmed ribosomes increases the ribosomal affinity for tuberactinomycin O

The binding of 14C-labelled tuberactinomycin O was analysed in equilibrium dialysis cells. The ionic conditions and the concentration of the labelled drug used in the binding assays allowed the binding of just one drug molecule per non-programmed ribosome. Under these conditions, the occupation of the ribosomal P-site by deacylated tRNAPhe in the presence of poly(U) increased the amount of [14C]tuberactinomycin O bound by a factor of two. Kanamycin, gentamicin and neomycin reduced the binding of tuberactinomycin O, whereas chloramphenicol, tetracycline, streptomycin and puromycin had no effect. A stimulation of the binding of tuberactinomycin O was found upon addition of erythromycin.

[Investigation of rectal and bladder complications after RALS therapy for carcinoma of the uterine cervix]

From August 1978 through December, 1980, 119 patients with previously untreated carcinoma of the uterine cervix were treated using RALS, (remote-controlled) high dose rate intracavitary radiotherapy. The data from 92 out of the 119 cases were available for multivariate analysis for rectovesical complications. By using this method, it was clearly indicated that factors such as TDF of the rectum, weighted geometric center (WGC)-Z, the dose of whole pelvic irradiation, chemotherapy and TPHA were important in the occurrence of rectal complications. However, there was no definite physical or physiological factor to predict the occurrence of bladder complications.

[Evaluation of the accuracy in radiotherapy for carcinomas of the hypopharynx and larynx]

Immobility and reproducibility were investigated to evaluate the accuracy in radiotherapy for carcinomas of the hypopharynx and larynx. Based on our comparative study using a semi-conductor detector, a light-cast shell is sufficient to maintain immobility during radiotherapy. In most cases, the range of reproducibility was within 5 mm throughout the course of radiotherapy.

[Prophylactic central nervous system irradiation for childhood acute lymphoblastic leukemia]

Documentation on 324 children with leukemia who underwent cranial irradiation between 1972 and 1981 was collected from 15 participating hospitals in the Kansai Cancer therapy Group. Among 182 children with acute lymphoblastic leukemia, records on 90 children treated with prophylactic cranial irradiation (2,400 rads) plus intrathecal methotrexate in 12 hospitals were available for analysis. There was no significant difference in survival between the two prognostic groups based on age and initial WBC count at diagnosis, i.e., overall, relapse-free and CNS relapse-free 5-year survivals in the good and intermediate prognostic groups were 57% vs. 51%, 55%, vs. 49%, and 83% vs. 95%, respectively.

Lung clearance mechanisms in obstructive airways disease

Using radioaerosol inhalation lung cinescintigraphy, pulmonary clearance mechanisms were studied in 21 patients with obstructive airways disease. In none of them did we find homogeneous deposition of inhaled radioaerosol in the lungs, or a steady, constant, axial, and cephalad transport of radioactivity in the major airways. Of the 21 patients, 14 showed temporary but frequent stopping and starting of radioactivity in the airways in the course of lung clearance; in ten there was reversal of flow; in five migration of radioactivity from one bronchus into the opposite, bypassing the trachea and often followed by shuttling between right and left bronchi; and in four there was spiral or zigzag transport of radioactivity. The overall lung retention ratio in the first 2 hr was not abnormal, but the airway deposition ratio was significantly above normal, and airway clearance efficiency was below. The alveolar deposition ratio was also significantly smaller in these patients.

Mucociliary clearance mechanism in smoking and nonsmoking normal subjects

Mucociliary clearance mechanisms were evaluated in 17 normal subjects visually and qualitatively by radioaerosol inhalation cinescintigraphy of the lung, and quantitatively by calculating the following indices: (a) overall or regional lung retention ratio; (b) airway deposition ratio; (c) airway retention ratio; (d) airway clearance efficiency; and (e) alveolar deposition ratio. The inhaled aerosol deposited homogeneously throughout the lungs, and mucus transport was always cephalad in direction and constant in velocity, although a temporary stasis of mucus was seen in smokers. Overall lung retention ratio was significantly smaller and airway deposition ratio was significantly larger in the smokers than in nonsmokers, but there was no difference between the groups in airway retention ratio or airway clearance efficiency. There was an inverse relationship between alveolar deposition ratio and cigarette consumption. Mucociliary clearance mechanisms were well maintained in the normal subjects, but in the smokers inhaled aerosol tended to deposit more proximally.

Antibacterial activity of palmitoyltuberactinamine N and di-beta-lysylcapreomycin IIA

Palmitoyltuberactinamine N (Pal-Tua N) and di-beta-lysylcapreomycin IIA (di-beta-Lys-Cpm IIA), which are synthetic derivatives of the antituberculous agent tuberactinomycin (Tum) and capreomycin (Cpm) respectively, were tested for anti-bacterial activity. Pal-Tua N inhibited not only tuberactinomycin-resistant Mycobacterium smegmatis but also Escherichia coli, Corynebacterium diphtheriae, Staphylococcus aureus, Streptococcus pyogenes, although it has lost activity against Mycobacterium tuberculosis. Di-beta-Lys-Cpm IIA inhibited the growth of laboratory-derived Tum-resistant M. smegmatis and M. tuberculosis as well as Tum-resistant M. tuberculosis from patients with one exceptional case.

[Effects of head movements on sound localization in pseudo-phonically reversed hearing]

Measurements of sound localization in the lateral dimension were taken with or without head movements when the observer wore the electronic pseudophone in an anechoic chamber. Tones of various frequencies as stimuli were presented from the loudspeakers located on the horizontal plane of the observer's head and on the circle, 2 m in diameter, around the observer, who pointed with his hand the position from which he thought the sound originated. The results of three subjects showed that: when the inter-aural axis of the pseudophone was 180 degrees reversed, real and apparent locations of the sound were symmetrical with respect to the median of the observer's head under the head-fixed condition, but were symmetrical with respect to the position of the observer's head as a center under the head-free condition. The implication of the results obtained was discussed.

A new class of heterocyclic serine protease inhibitors. Inhibition of human leukocyte elastase, porcine pancreatic elastase, cathepsin G, and bovine chymotrypsin A alpha with substituted benzoxazinones, quinazolines, and anthranilates

The serine proteases human leukocyte (HL) elastase, porcine pancreatic elastase, cathepsin G, and bovine chymotrypsin A alpha are inhibited competitively at pH 7.5 by heterocyclic compounds such as 2-substituted 4H-3,1-benzoxazin-4-ones, 4-quinazolines, and 4-chloroquinazolines, N-substituted phthalimides, and by thioesters of N-acylanthranilic acids. The most potent inhibitors have KI values in the 10(-7)--10(-8) M range. The inhibitors with fluoroalkyl or fluoroacyl substituents are much more potent than the alkyl or acyl derivatives. The quinazolinones, chloroquinazolines, and N-substituted phthalimides are quite specific for HL elastase. With HL elastase, an excellent correlation is observed between pKI and the infrared carbonyl-stretching frequency of the inhibitor. It is proposed that the partially polarized carbonyl group of the inhibitor interacts with a partially polarized charge relay system of the serine protease. The substituents on the inhibitors are proposed to interact with the primary substrate binding site of the serine proteases. The results indicate that it is possible to develop non-peptide small molecules which are specific inhibitors for HL elastase.

Trypsin-catalyzed synthesis of peptide bond in human hemoglobin. Oxygen binding characteristics of Gly-NH2(142 alpha) Hb

Incubation of human hemoglobin (Hb) A with glycineamide (Gly-NH2) in the presence of trypsin gives rise to two bands of approximately equal amount on the isoelectric focusing gel. Structural analyses, including digestion with trypsin and carboxypeptidases A and B, have shown that one is unmodified Hb A and the other is Gly-NH2(142 alpha) Hb in which Gly-NH2 is bound to the COOH-terminal residue of the alpha subunit (Arg 141 alpha) via peptide bond. Gly-NH2(142 alpha) Hb exhibits slightly increased affinity for oxygen and slightly reduced heme-heme interaction as compared with normal Hb A. Although Gly-NH2(142 alpha) Hb exhibits normal 2,3-diphosphoglycerate effect, the alkaline Bohr effect and chloride effect are diminished. These oxygen binding properties are attributable to abolished binding of chloride to the anion binding site positioned between the alpha-amino group of Val 1 alpha and the guanidinium group of Arg 141 alpha. Gly-NH2(142 alpha) Hb restores normal oxygen binding properties upon trypsin digestion which removes Gly-NH2 from the COOH terminus of the alpha subunit.

Activity of di-beta-lysyl-capreomycin IIA and palmitoyl tuberactinamine N against drug-resistant mutants with altered ribosomes

The effects of 61 synthetic tuberactinomycin derivatives on polypeptide synthesis were tested in bacterial cell-free systems. Di-beta-lys-capreomycin IIA was more effective than the natural product. Palmitoyl tuberactinamine N inhibited the growth of tuberactinomycin-resistant mutants and was not a ribosome inhibitor.

Radioaerosol inhalation lung cine-scintigraphy: a preliminary report

"Radioaerosol inhalation lung cine-scintigraphy", a cinematographic display of the lungs following radioaerosol inhalation has been found to be extremely helpful not only to the visual assessment of mucociliary clearance in the lungs but also to the setting of regions of interest and to the interpretation and analysis of clearance curves over the regions of interest in the lungs. It is expected that this procedure offers an important means to the study of mucociliary clearance in health and disease in man.

Effect of isoproterenol on regional pulmonary perfusion and its blockade by propranolol

Effects of isoproterenol and propranolol on regional pulmonary perfusion were assessed in the dog. In each experiment the right upper lobe was isolated in vivo by a balloon catheter and artificially ventilated with nitrogen, air or 60% oxygen in nitrogen before and after administration of the medicaments listed above. The rest of the lungs kept breathing air spontaneously. Following administration of isoproterenol regional pulmonary perfusion increased in the hypoxic right upper lobe induced by artificial ventilation with nitrogen, but the increase was not observed when isoproterenol was administered following pretreatment with propranolol. Administration of propranolol alone did not induce any change in regional pulmonary perfusion distribution. When artificial ventilation was done in the right upper lobe either with air or 60% oxygen in nitrogen, thus inducing regional less hypoxia or hyperoxia, no change in regional perfusion was observed with any of the medication. Thus isoproterenol reversed regional hypoxic pulmonary vasoconstriction, but its action was blocked by pretreatment with propranolol. Propranolol per se, however, showed no effect on pulmonary vascular responses to the different alveolar oxygen tensions.

Effect of dopamine on regional pulmonary perfusion

Dopamine effect on regional pulmonary perfusion in the right upper lobe was studied in 6 dogs in which the lobe was isolated by a balloon catheter and artificially ventilated with nitrogen, air or 60% oxygen in nitrogen, while the rest of the lungs was allowed spontaneous air respiration. Dopamine was administered at the rate of 20 micrograms/kg/min. Each dog served as its own control. There was no change in the regional vascular responses to the different alveolar oxygen tensions in the right upper lobe before and after dopamine administration.

The translocation inhibitor tuberactinomycin binds to nucleic acids and blocks the in vitro assembly of 50S subunits

Binding studies were performed with a [14C]-labelled derivative of viomycin, tuberactinomycin 0 (TUM O). TUM O bound to 30S and 50S subunits. The binding component was the RNA, since ribosomal proteins did not bind the drug. Other RNAs such as tRNA, phage RNA (MS2), and homopolynucleotides also bound the drug. Striking differences in the binding capacity of the various homopolynucleotides were found. Poly(U) bound strongly, poly(G) and poly(C) bound intermediately, whereas poly(A) showed a very low binding. DNA also bound TUM O, although with native DNA the binding was only weak. Finally the effects of viomycin on the assembly in vitro of the 50S subunit from E. coli were tested. A very strong inhibition was found: when the reconstitution was performed at 0.5 x 10(-6) M viomycin the particles formed sedimented at about 50S, but showed a residual activity of less than 10%. The inhibitory power of viomycin with respect to the in vitro assembly is more pronounced than that found in in vitro systems for protein synthesis.

Effect of alveolar hypercapnia on regional pulmonary perfusion

The effect of alveolar hypercapnia under a wide range of alveolar oxygen tensions was assessed in the right upper lobe of the normal dogs and the dogs with the reimplanted right lung. To induce alveolar hypercapnia by artificial ventilation of the right upper lobe, gas mixtures of differing oxygen fractions containing 10% or 20% CO2 were used as exchange gases for the right upper lobe. The concurrent alveolar hypercapnia had little superimposed effect on the regional vascular responses to a wide range of alveolar oxygen tensions in the normal and the reimplanted denervated lung lobe. Under an extreme alveolar hyperoxia, however, the concurrent alveolar hypercapnia somewhat suppressed regional hyperoxic vasodilation and/or recruitment of the pulmonary vascular beds, whereas in the reimplanted lung lobe it potentiated the hyperoxic pulmonary vascular response. The alveolar oxygen tension seems to be the main factor in the regulation of regional perfusion in the lungs.

Effect of non-filtered and filtered cigarette smoke on mucociliary clearance mechanism

Acute effect of a short-term exposure to cigarette smoke on mucociliary clearance mechanism was studied in 69 anesthetized dogs. A tracer material, 99mTc-MAA (macroaggregated albumin), was placed in the right main bronchus near the carina 2 min after completion of exposure and its migration distance on the tracheal mucosa with time was assessed by a scintillation camera, and the mean migrating velocity (MMV) was calculated. The average MMV values were 12.0 +/- 1.0 (mean +/- S.E.) mm/min in the control dogs, while the values were 11.6 +/- 1.5, 8.3 +/- 2.2, 3.3 +/- 0.8, and 4.2 +/- 2.3 mm/min in the dogs which smoked 1, 3, 5 and 8 cigarettes, indicating that there was an inverse correlationship between the number of cigarettes smoked and the MMV values. When cigarette smoke was filtered through a glass fiber filter, the average MMV values were 7.0 +/- 0.5 and 1.3 +/- 0.9 mm/min in the dogs which smoked 5 and 8 cigarettes respectively, suggesting that once the number of cigarettes amounted to eight, even cigarette smoke filtered through a glass fiber filter was as detrimental to the mucociliary clearance mechanism as the non-filtered cigarette smoke.

Effect of aminophylline on regional perfusion distribution in the lungs

Using ten normal dogs, the right upper lobe of the lung was isolated in vivo by a balloon catheter and was artificially ventilated with nitrogen, air, 60% oxygen in nitrogen, and 60% oxygen and 20% carbon dioxide in nitrogen, while the rest of the lungs maintained a spontaneous breathing of ambient air. Aminophylline did not show a vasodilating action under severe alveolar hypoxia (PAO2: ca. 40 mmHg); on the contrary, it seemed to potentiate hypoxic pulmonary vasoconstriction. When the regional alveolar oxygen tension became less hypoxic (PAO2: ca. 70 mmHg) or higher than that in the rest of the lungs which spontaneously breathed ambient air, aminophylline showed a definite vasodilating action. Aminophylline also showed a vasodilating action in alveolar hypercapnia in the presence of alveolar hyperoxia.

Regulation of regional perfusion distribution in the lungs. Experimental model and effect of alveolar pressure

An experimental model for studying changes in regional perfusion distribution in the lungs of a dog was described. The right upper lobe was separated in vivo from the rest of the lungs by a balloon catheter and gas exchange of the lobe was artificially done asynchronously with the rest of the lungs by using a gas of interest at a prescheduled aveolar pressure. 99mTc-albumin microsphere was the agent of choice for multiple sequential studies in one dog. Alveolar gas composition reached a plateau after the 4th inflation of the right upper lobe. Effect of alveolar pressure on regional perfusion distribution was studied by using nitrogen and air as exchange gases. Perfusion distribution in the right upper lobe was the least at the maximal alveolar pressure of 14 to 19 cm H2O, while it was the greatest at the tidal maximal alveolar pressure of 1 to-1cm H2O with either gas. Alveolar hyperinflation in a localized lung region due to the increase in regional alveolar pressure reduced regional perfusion distribution.

Chemical studies on tuberactinomycin. XV. Total synthesis of tuberactinomycin O

Tuberactinomycin O, one of the four congeners of the antituberculous peptide tuberactinomycin, was totally synthesized. The beta-ureidodehydroalanine moiety was constructed from beta,beta-diethoxyalanine with excess urea in acidic medium after a cyclization reaction of a pentapeptide was finished. Cyclization was carried out by means of the 1-succinimidyl ester method. To the cyclic pentapeptide, beta-lysine was introduced as the branched moiety and then deprotected to afford tuberactinomycin O which was completely identified with the natural form of the antibiotic.

The revised structure of capreomycin

The total structures of capreomycins IA and IB were determined mainly from the results of the comparative study on the NMR spectra of capreomycins and tuberactinomycins, resulting in a revision of the formerly proposed structure. The beta-lysine residue as a branched part was revealed to be linked with the beta-amino group of the alpha, beta-diaminopropionic acid residue in the cyclic pentapeptide moiety in a different manner than in tuberactinomycins.