[A quantitative analysis of pulmonary arterioles in 402 cases of cor pulmonale]

A quantitative analysis of pulmonary arterioles were made in 402 cases of cor pulmonale. The results showed that arteriole muscularization and medial hypertrophy, intimal fibrosis of pulmonary small arteries were important lesions. The authors found that right ventricular hypertrophy was bound to follow intimal fibrosis of pulmonary small arteries but was not along with medial hypertrophy and arteriole muscularization, and that the lesion of pulmonary arteries was not balanced with the course of disease. The authors considered that these results were related to vessel dilatation and medial atrophy because of intimal pressure in late stage of the disease.

Intrapleural cisplatin and mitomycin for malignant mesothelioma following pleurectomy: pharmacokinetic studies

PURPOSE

Intrapleural cisplatin-based chemotherapy has been used in the treatment of patients with malignant pleural mesothelioma and malignant pleural effusions, but the pharmacokinetics of this form of chemotherapy have not been previously evaluated. We performed pharmacokinetic studies on 12 patients who received both intrapleural cisplatin and mitomycin immediately following pleurectomy/decortication for malignant pleural mesothelioma.

PATIENTS AND METHODS

Simultaneous pleural fluid and plasma samples were collected at 15 and 30 minutes, and at 1, 2, 3, 4, and 24 hours after administration of the intrapleural chemotherapy (cisplatin 100 mg/m2 and mitomycin 8 mg/m2), and after cisplatin (total and free) and mitomycin levels were measured. The mean peak levels, the areas under the concentration-time curve (AUC) and the drug half-lives (t1/2s) in plasma and pleural fluid were compared using the paired t test. Differences were considered significant if P less than or equal to .05.

RESULTS

Systemic absorption was rapid, with peak plasma levels being reached within 1 hour of administration of the intrapleural chemotherapy. Peak plasma levels measured after intrapleural chemotherapy approximated those reportedly attained during systemic administration of these drugs at similar doses. However, the mean peak cisplatin and mitomycin levels, and their mean AUCs, were significantly higher in the pleural fluid than in the plasma. There was a three- to fivefold advantage (on a logarithmic scale) for pleural to plasma AUCs for both cisplatin and mitomycin. The mean t1/2s for cisplatin and mitomycin were significantly longer in the plasma than in the pleural fluid.

CONCLUSIONS

The pharmacokinetics of intrapleural cisplatin-based chemotherapy are analogous to those of intraperitoneal chemotherapy. Our findings show that intrapleural cisplatin-based chemotherapy has a distinct local pharmacologic advantage, but also produces significant and sustained drug plasma levels.

Cytogenetic analysis of 434 consecutively ascertained specimens of non-Hodgkin's lymphoma: clinical correlations

Cytogenetic and histopathologic data were correlated with clinical parameters from 423 patients with non-Hodgkin's lymphoma (NHL). Clinical correlations were performed on subgroups of 149 patients with low-grade lymphoma (LG) and 205 patients with diffuse lymphoma with a large cell component (DLLC). Correlations were made between clinical outcome and individual recurring cytogenetic aberrations, each of which was noted in greater than 5% of cases belonging to LG NHL and DLLC, and derived measures of karyotypic complexity, comprising modal chromosome number, number of marker chromosomes, and number of translocation breakpoints. No correlations with survival were noted in LG NHL, although median follow-up was only 2 years. Seven patients with t(8;14) LG NHL had an indolent course. Among 104 patients with DLLC and abnormal karyotypes at diagnosis, breaks at 1q21-23 or more than 4 marker chromosomes was associated with a shortened median survival. Using these variables we constructed a proportional hazards model with a good fit to observed data. Breaks at 6q21-25 predicted a decreased probability of achieving remission. Patients with DLLC and breaks at 1q21-23 or 1p32-36 had a shorter duration of complete remission. Of 41 DLLC studied at relapse, the only long-term survivors had t(14;18).

[Common tumors of the fourth ventricle and cerebellum in childhood: evaluation of CT differential diagnosis]

Forty pediatric patients with infratentorial cerebellar astrocytomas, medulloblastomas and ependymomas were evaluated. In most cases it was possible to predict the histological type of these tumors by CT. The search for the residual fourth ventricle cavity and defining its location were the first step in differential diagnosis. The density of tumor on plain scans was of value to distinguish medulloblastomas from astrocytomas. Cerebellar astrocytomas had an obvious tendency to develop cystic change. Especially, the configuration of "Cyst-with-mural nodule" was the most specific characteristic in diagnosis. Just like medulloblastomas and ependymomas, cerebellar astrocytomas may have also the tendency to arise at the midline in childhood. The incidence of calcification was rather high in ependymomas.

Experimental lung injury induced by trimellitic anhydride inhalation on guinea pigs

Trimellitic anhydride (TMA) causes lung injury by inhalation exposure in humans. In order to investigate more precisely the mechanism of lung injury by TMA, an experimental animal model of TMA-induced lung injury was established. Guinea pigs were intramuscularly injected with trimellitylated bovine serum albumin (TM BSA) with complete Freund's adjuvant (CFA). Appreciable amounts of antibodies against TM epitopes were detected in the sera of these animals. Guinea pigs that were passively sensitized with anti-TM antisera as well as the actively immunized animals developed hemorrhagic pneumonitis after TMA inhalation. It is well recognized that hyperimmune antisera of guinea pigs contain two subclasses of IgG antibodies, IgG1 and IgG2, which are known as homocytotropic and heterocytotropic antibodies, respectively. To determine the role of these antibodies in the airway injury with alveolar hemorrhages, they were isolated by gel filtration and by ion exchange column chromatography, and the guinea pigs that were sensitized with each of these antibodies were exposed to TMA inhalation. The extent of lung injury in these animals was quantitatively determined by the measurements of lung extravasation of Evans blue dye injected intravenously after TMA inhalation. Significant increases in the extravasation of dye were observed in both animal groups sensitized with IgG1 and IgG2 antibodies. In addition, results obtained with heat-treated antisera and IgG1 antibody did not significantly differ from those obtained with untreated samples. These results suggest that the lung injury resulting from TMA inhalation exposure can be induced with humoral antibodies, not only IgG1 but also IgG2, and that at least two types of allergic reactions are involved in the pathogenesis of lung injury.

Basis for natural resistance to methotrexate in human acute non-lymphocytic leukemia

The basis of intrinsic resistance of blasts from patients with acute non-lymphocytic leukemia (ANLL) to methotrexate was studied. MTX polyglutamate formation was measured in blast cells from 19 patients with ANLL and in 7 pediatric patients with acute lymphocytic leukemia (ALL), after in vitro incubation for 24 h with 3H-methotrexate. There was no significant differences seen in the total amount of MTX plus polyglutamates measured between ANLL and ALL blasts, indicating that transport defects do not account for intrinsic MTX resistance in ANLL. However, there were significant differences between the amounts of long chain MTX polyglutamates found in ANLL cells as compared to ALL cells. Most, but not all, ANLL blasts were unable to form long chain polyglutamates. In as much as the level of MTX polyglutamates found in blast cells after MTX administration allows for retention of this drug, this property may explain, at least in part, the refractoriness of most patients with ANLL to methotrexate.

[The marrow granulocyte reserve in lung cancer patients]

The marrow granulocyte reserve (MGR) of patients with lung cancer have been estimated by measuring the maximum neutrophil increment after administration of hydrocortisone. The MGR was found to have decreased in four of 19 untreated patients, but the reason for this decrement was not clear. Further, there were no differences in the MGR between the cell types or cancer stages. The MGR in patients 70 years old or older tended to be decreased. After chemotherapy or radiation therapy, the MGR depressed significantly. However, on administration of OK 432, the MGR significantly increased in two patients who had received radiation therapy and whose MGR had been deficient initially.

[Post-transfusion hepatitis in operated uterine cancer patients]

We examined the incidence of non-A, non-B hepatitis (NANB) in post-transfusion hepatitis in uterine cancer patients treated by surgery at our hospital. The diagnosis of NANB was based on the diagnostic standards for post-transfusion hepatitis of the Japanese Society of Gastroenterology 1985. In 587 patients with blood transfusions from 1978 to 1988, 80 patients (13.6%) were diagnosed as NANB. The proportions of blood components were, preserved whole blood 44.1%, concentrated red blood cells (CRBC)+ fresh frozen plasma 31.2%, and CRBC 12.8%. The proportions of blood components changed over the years, but since 1987 those of blood components in blood transfusion have been greatly decreased. No difference in the incidence of NANB was seen in patients with up to 10 units of blood transfused, but a high incidence was observed to patients who had received over 10 units. The number of patients treated by radical hysterectomy was five hundred and sixty-two (95.7%) out of a total of five hundred and eighty seven. The average blood loss in the operation was 1,392 ml.

[Purification and characterization of beta-N-acetyl hexosaminidase from Aspergillus tamarii]

A beta-N-acetylhexosaminidase from mycelium-free culture filtrate of Asp tamarii S215 was purified to PAGE homogenous by ammonium sulfate and polyethylene glycol fractionation precipitation followed by Sephadex G-50 desalt, DEAE-Sephadex A-25 chromatography, hydroxyapatite chromatography and DEAE-Sephadex A-25 rechromatography with 170-fold purification and 24.7% recovery. The ratio of the beta-GlcNAcase and beta-GalNAcase was 2.5 and remained constant throughout the purification. The Mr estimated with concentration gradient PAGE was 140,000 and subunit Mr determined with SDS-PAGE was 72,000, the number of subunit were 2. The pI was 4.2 determined by PAGIEF. The optimum pH was 5.5-6.5 and 5.0-6.0 for beta-GlcNAcase and beta-GalNAcase respectively with stable pH range 5.5-8.3 for both. The optimum temperature was 60 degrees C for beta-GlcNAcase and beta-GalNAcase. The residual activity of beta-GlcNAcase was 52.7% after treated at 50 degrees C for 8 h and it was 44.9% for beta-GalNAcase. The residual activities of both were down to 1% after treated at 62 degrees C for 10 min. The activity was slightly activated by Mn2+ or Fe2+, while strongly inhibited by Hg2+ and slightly by Ag+, Cu2+, Pb2+, Cd2+ or Zn2+. Analyses of amino acids composition showed that the beta-HexNAcase contained about 24.2% acidic amino acids and 14.9% basic amino acids and only 0.6% methionine.

[Screening of beta-N-acetylhexosaminidase forming strains and conditions for enzyme production]

About 1200 strains of microorganisms were screened including fungi, actinomyces, and bacteria, in which 237 strains producing the enzyme desired. The results showed that the beta-GlcNAcase and beta-GalNAcase always co-existed in one strain, though may be in different ratio. From strains mentioned above the authors screened out a potent beta-N-acetylhexosaminidase producing strain, Aspergillus tamarii S215, from the soil sample. The optimal conditions for enzyme production were as follows: the microorganisms was inoculated in a 5% wheat bran suspension, cultured at 28-30 degrees C on shaker for 5-6 days. The productivity can be moderately enhanced by the addition of cellobiose or glucosamine or galactosamine or by the extra supplement of (NH4)2SO4 and NH4NO3 as N sources. In the culture filtrate of Asp. tamarii, the alpha, (beta)-galactosidase, beta-glucosidase, alpha-mannosidase and beta-fucosidase were also found.

[A case of ovarian germ cell tumor]

PVP (CDDP, VBL, PEP) regimens were administered to a case of ovarian embryonal carcinoma (Higuchi-Kato) Group C, which had metastatic lesions of liver, lumbar bones, and paraaortic lymph nodes soon after operation, with good results.

[Preparation and preliminary identification of the monoclonal antibody against esophageal carcinoma]

A series of monoclonal antibody against esophageal carcinoma was prepared by ECa109 cells immunizing Balb/c mice. Hybrids secreting antibodies reacting to ECa109 were isolated and further cloned. One monoclonal antibody, 4C3, reacted only to an esophageal cancer cell line, gastric cancer and hepatocellular carcinoma cell lines. Purified 4C3 was used in ELISA test to detect tumor cells in the esophageal epithelial cells obtained by friction balloon. The result showed that the concordance rate to the result of balloon cytosmear was 62.4% (73/117). Patients, diagnosed cytologically as dyskaryosis, were often positive in ELISA test. It is proposed that 4C3 be useful in detecting pre-cancerous lesions.

Fractionation and quantitation of egg antigens from Schistosoma japonicum by the single-tube kinetic-dependent enzyme-linked immunosorbent assay (k-ELISA): higher antigenic activity in urea-soluble than in aqueous-soluble fractions

To identify sources of high potency antigens for use in serodiagnosis, aqueous-soluble egg antigens from Schistosoma japonicum were extracted with Dulbecco's phosphate-buffered saline. Residual particulates were solubilized with Tris-buffered 8 M urea, yielding a urea-soluble egg antigen fraction. The urea-soluble fraction was further fractionated with Bio Gel A50m and QAE-Sephadex. All fractions were quantitatively assayed for their specific antigenic activities against serum specimens from infected rabbits by the single-tube enzyme-linked immunosorbent assay (k-ELISA). In antigen rate-limiting conditions, the urea-soluble particulate fractions were more antigenically active than the aqueous-soluble fraction. In antigen-excess and antibody-limiting assay conditions, the ideal conditions for serologic assays, the urea-derived antigens also showed superior activities against sera from infected humans. Analysis by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) on gradient gels revealed numerous low molecular weight protein bands in the aqueous-soluble fraction, whereas the urea-soluble fractions appeared to be much simpler with the majority of their proteins concentrated in one or two high molecular weight bands (greater than or equal to 200 kdaltons). Electro-transfer blots of the SDS-PAGE onto nitrocellulose papers and subsequent visualization of antigens by enzyme-linked immunoabsorbence confirmed these findings. The above data suggest that the urea-soluble fraction of S. japonicum eggs is antigenically active and has potential use in the development of a diagnostic reagent.

A tracheal culture model of respiratory tract infection with Pseudomonas aeruginosa

The pathogenesis of Pseudomonas aeruginosa for the respiratory tract has been examined using hamster tracheal organ cultures. Tracheal rings prepared from male Syrian hamsters, strain LSH/LAK, were infected with P. aeruginosa for 4 h and processed at 4-h intervals for 24 h for examination by light- and electron microscopy. Tissue destruction was observed within 8 h after infection with 10(8) colony-forming units (cfu)/ml and within 12 h after infection with 10(4) or 10(6) cfu/ml. Ciliated cells that contained abnormal subcellular organelles were expelled from the epithelium. By 20 h the epithelial borders were composed primarily of nonciliated cells. Transmission- and scanning electron microscopy revealed details of the cellular destruction and attachment of P. aeruginosa to the ciliated epithelium. Pseudomonas aeruginosa causes a rapid destruction of the epithelium of hamster trachea in cultures. Hamster tracheal organ cultures have been shown to be useful in studying the pathogenesis of P. aeruginosa for the respiratory tract.

Systematic fractionation of Schistosoma mansoni urea-soluble egg antigens and their evaluation by the single-tube, kinetic-dependent, enzyme-linked, immunosorbent assay (K-ELISA)

The application of a single-tube, kinetic-dependent, enzyme-linked, immunosorbent assay (k-ELISA) is described. The k-ELISA is simple, highly sensitive, and quantitative. With this test, the antigenic activities and cross-reactivities of several fractions from Schistosoma mansoni eggs were quantitated and compared. Particulate egg components were solubilized readily by 8 M urea, yielding antigenic fractions of high specific activities and low corss-reactivities. SDS-PAGE and activity profiles of these antigens clearly showed that they were separate and distinct form the soluble egg antigens (SEA) group. The urea-solubilized antigens appeared to be composed of two major protein bands of high molecular weights. The yield for these antigens was significantly greater than the SEA group, thus making them worthwhile candidates for serological antigens. The systematic and quantitative nature of the present study allows for the critical comparison of every antigenic fraction from S. mansoni eggs. From data of this type, a diagnostic antigen of high efficacy can be selected.

The management of extratesticular seminoma without gonadal involvement

Diagnosis, treatment and follow-up of 8 patients from 1955 to 1975 with extratesticular seminoma are presented. In 5 patients, the neoplasm developed in the mediastinum and in 3 in the retroperitoneum. All the patients were treated by radiation therapy after resection or biopsy. In the entire group, no tumor was diagnosed in the testes. Two patients expired with disease, one after 2 months due to pneumonia, and the other 5 years after diagnosis (10 months after treatment) due to cerebral metastases. Two patients died 12 and 16 years after diagnosis and treatment. At death, they were free of seminoma and the cause of death was a second malignancy. Four patients are alive and healthy, free of disease, 5, 10, 13, and 17 years after diagnosis and treatment. In essence, of the 8 patients, only one actually died of disease, and he was not adequately treated. We feel that this is an entity with an excellent prognosis if adequately and appropriately treated with radiation. We recommend not to perform an orchiectomy when the testes are clinically normal, and to follow the patient closely after treatment.