Tumor doubling time and prognostic assessment of patients with primary lung cancer

BACKGROUND

Relationships between tumor doubling time (DT) and other prognostic factors and the risk of death related to these factors are not yet fully understood.

METHODS

Tumor doubling time of primary lung carcinomas of 174 patients, detected in a limited number of local municipalities during a limited period, was calculated using the Schwartz formula. Survival rate of the 174 patients was compared with reference to categories of prognostic factors (univariate analyses) and significant factors affecting survival were identified by multivariate analyses using the Cox proportional hazard model.

RESULTS

Tumor doubling time had a log normal distribution. There was a significant difference in mean DT in relation to sex, smoking history, presence of symptoms, cell type, primary tumor factor, and stage. Univariate analyses showed a significant difference in survival in relation to DT, age, sex, method of tumor detection, smoking history, symptoms, therapy, cell type, primary tumor (T) factor, regional lymph node (N) factor, distant metastasis (M) factor, and stage. Multivariate analyses using the Cox's proportional hazard model in a stepwise fashion identified a final set of five significant variables: N factor (P = 0.0001); therapy (P = 0.0016); M factor (P = 0.0017); T factor (P = 0.0018), and DT (P = 0.0152).

CONCLUSIONS

Tumor doubling time was an independent and significant prognostic factor for lung cancer patients.

Carbohydrate-mediated recognition of a circulating placental alkaline phosphatase-immunoglobulin M complex

We detected an abnormal alkaline phosphatase (AP) electrophoretically in the serum of a patient with rheumatoid arthritis, who had a macromolecular AP linked with immunoglobulin M (IgM) bearing a kappa light chain. The IgM isolated from the AP-IgM complex in the patient's serum reacted apparently with all of the AP isozymes tested, i.e. those originating in the liver, bone, intestine and placenta, but the alpha-mannosidase-treated IgM from the patient's serum bound to placental AP (PAP) alone. This suggests that untreated IgM recognizes multivalent epitopes of the AP and that the complex of AP with alpha-mannosidase-treated IgM is a specific antibody-antigen complex. In order to investigate further the multivalent binding capacity for the PAP-untreated IgM complex, we prepared a monoclonal antibody (MoAb) against PAP and identified it as an IgM with a kappa light chain. The binding affinities and their circulating half-lives of the synthetic complexes of PAP and respective MoAbs were examined with and without treatment with several glycosidases. The untreated MoAb bearing IgM had binding affinity for all of the AP isozymes tested, while alpha-mannosidase-treated IgM attached only to PAP, the same as the IgM isolated from the PAP-IgM complex in the patient's serum. The circulating clearance of the PAP-IgM complex in rabbits was faster than either component alone. In addition, the PAP-IgM complex treated with alpha-mannosidase was found to have the shortest half-life of all the complexes of PAP and Igs treated with the several glycosidases tested. These results suggest that the formation of the PAP-IgM complex as an enzyme-linked antibody and the clearance of the complex in vivo are dependent on the sugar moieties of the Igs.

[A case of mitral valve replacement with chronic idiopathic thrombocytopenic purpura after high-dose immunoglobulin infusion]

A 60-year-old female patient diagnosed as having mitral stenosis with chronic idiopathic thrombocytopenic purpura (ITP), with a platelet count of 6.8 x 10(4)/mm3, was scheduled to undergo mitral valve replacement. High-dose immunoglobulin infusion (400 mg/kg/day for five days) was begun four days before the operation and increased the platelet count to 9.1 x 10(4)/mm3 just before the operation. Intraoperative hemostasis was excellent, and the postoperative course was uneventful. High-dose immunoglobulin therapy appears to be a first choice for controlling hemorrhagic tendency in ITP patients undergoing heart surgery.

Relationship between thyroid functions and urinary growth hormone secretion in patients with hyper- and hypothyroidism

Thyroid hormone plays an important role in growth hormone (GH) synthesis and secretion. To study the relationship between thyroid function and urinary GH secretion in the hyperthyroid and hypothyroid states, we measured thyroid hormones, simultaneously with serum and urinary GH levels, in 54 patients with thyroid diseases. GH-releasing hormone (GRH) test was performed in 18 patients in order to evaluate serum and urinary GH responses to GRH in hyper- and hypothyroid states. Serum thyroid hormone levels were strongly correlated with the urinary GH levels in the patients, and the correlation was greater than that between serum thyroid hormone and serum GH levels. Urinary GH levels were significantly higher in the hyperthyroid patients than in the euthyroid and hypothyroid patients, although serum GH levels were not significantly different among these three groups. Serum GH response to GRH was significantly decreased in hyperthyroid patients as compared to euthyroid patients. However, urinary GH levels after GRH administration were not decreased in the hyperthyroid patients. These results suggest that hyperthyroid states increase GH in urine and may accelerate the urinary clearance of GH.

Anti-Candida activity of synthetic hydroxychalcones

The antifungal activity of different synthetic hydroxychalcones was determined against Candida species. It was revealed that the presence of hydroxyl groups at C-2, C-4, and C-2' in chalcone was essential to inhibit Candida growth. Among the chalcone derivatives examined, 2,4,2'-trihydroxy-5'-methylchalcone showed the most intensive anti-Candida activity, suggesting that it could be a potential therapeutic agent for candidosis.

Morphogenesis of normal human salivary gland cells in vitro

Primary cultured human salivary gland cells were transfected with ori-defective mutant DNA of SV40. Following 2-3 weeks of transfection, slowly expanding colonies consisting of small compact cells emerged, while mock-transfected cells did not grow any more and eventually entered crisis, followed by cell death. Using limited dilution technique, we isolated 4 cell clones with distinct morphology from a single colony. Morphological observation of cells cultured on plastic dishes precisely revealed the characteristics of the constituent cells of salivary gland; i.e., three cell clones showing cuboidal- (NS-SV-DC), spindle- (NS-SV-MC), and flattened morphology (NS-SV-SC) were similar to duct-, myoepithelial-, and squamous phenotype, respectively. A remaining cell clone, polygonal in shape and with numerous secretory granules (NS-SV-AC), resembled an acinar cell. Characterization of cell clones by ultrastructural examination and search for specific antigens showed the similarity of NS-SV-DC, NS-SV-MC, NS-SV-AC, and NS-SV-SC to duct, myoepithelial, acinar, and squamous cells, respectively. Anchorage-independent growth in soft agar and tumorigenicity in nude mice were not recognized in all cell clones. These results demonstrate that establishment of cell clones with duct-, myoepithelial-, acinar-, or squamous phenotype was accomplished in the in vitro system, and that based on the evaluation of colony-forming ability in soft agar and tumorigenicity in nude mice these cell clones can be considered to be non-tumorigenic. Using the above in vitro system, we examined the effect of a reconstituted basement membrane extract, Matrigel, on the morphogenesis of cultured normal human salivary gland cells. When NS-SV-DC or NS-SV-MC were seeded on Matrigel in serum-free culture conditions, they formed round or zonal clusters on day 1; failing however, to develop into a salivary gland morphogenesis. Semithin sections of cell clones cultured on Matrigel exhibited multicellular aggregates on day 1, while on days 2 and 3 these cells lost both cell-cell and cell-Matrigel interactions and eventually entered crisis. In an attempt to understand the mechanism involved in this phenomenon, we have investigated proteolytic enzymes and their inhibitors secreted by cell clones. Although cell clones produced almost identical levels of gelatinases, they released increased amounts of plasminogen activators (PAs) as compared with a neoplastic human salivary gland cell line (HSG), which had already been demonstrated to differentiate into acinar cells when cultured on Matrigel. Obvious difference of expression level of tissue inhibitor of metalloproteinases-1 (TIMP-1) was not observed in these cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Gustatory responsiveness of chorda tympani fibers in the cynomolgus monkey

Responses of chorda tympani (CT) fibers of cynomolgus monkeys to various gustatory stimuli were analysed to obtain quantitative data on their response properties and to reveal the coding of gustatory information. Based on responses of 66 fibers to the four basic gustatory stimuli, they were classified into 16 sucrose-best, 28 NaCl-best, 11 HCl-best and 11 QHCl (quinine hydrochloride)-best fibers. Sucrose-best fibers were narrowly tuned to sucrose, while HCl-best fibers were broadly tuned to the four stimuli. The average breadth of response measure. H for all the 66 fibers was 0.375. The average value of H for sucrose-, NaCl-, HCl- and QHCl-best fibers was 0.276, 0.348, 0.634 and 0.384, respectively. Hierarchical cluster analysis performed on responses of 25 fibers to 14 gustatory stimuli revealed that all the stimuli except for 0.3 M Na-saccharin were grouped into four clusters; sucrose and 0.01 M Na-saccharin, NaCl and LiCl, acids, and non-sodium and -lithium salts, and QHCl. It is concluded that in the monkey CT each of the four classes of fibers predominantly contributes to mediate gustatory information for sweet, salty, sour and bitter stimuli.

Visualization of renal microcirculation in isolated Munich-Wistar rat kidneys: effects of endothelin-1 on renal hemodynamic activity

The aim of the present study was to visualize the superficial glomeruli of the Munich-Wistar (MW) rat and to characterize the responses of the renal microvasculature to endothelin-1 (ET-1). We first examined the distribution of superficial glomeruli of the MW rat compared to that in a control strain (Wistar rat). Secondly, we examined the effects of ET-1 on the renal microcirculation of the MW rat. The right kidney was perfused with a Krebs-Ringer solution containing fluorescein isothiocyanate dextran (FITC-dextran) and was visualized under an epi-illuminated fluorescence microscope system. Changes in perfusion pressure and diameter of the microvessels accompanying the administration of ET-1 (10 fmole-300 pmole) were measured. The number of superficial glomeruli was greater in the MW rat than in the Wistar rat. ET-1 had long-lasting and dose-dependent pressor effects. Perfusion pressure showed a 3.5-fold increase compared with the control, and the afferent arterioles showed greater dose-dependent vasoconstriction than the efferent arterioles. These findings suggest that the MW rat is a useful animal model for the study of renal microcirculation and that the renal microcirculation is extremely sensitive to ET-1.

Far less frequent mutations in ras genes than in the p53 gene in skin tumors of xeroderma pigmentosum patients

Mutations in Ha-ras, Ki-ras, and N-ras genes in squamous and basal cell carcinomas in patients with xeroderma pigmentosum (XP) were examined by the polymerase chain reaction followed by single-strand conformation polymorphism analysis and direct base sequencing. No mutation was detected in codons 12, 13, and 61 of the ras genes in XP skin tumors. This was in contrast with previous findings of a high frequency of mutation in the p53 gene in skin tumors in XP patients. A novel mutation in codon 6 of the Ki-ras gene was detected in a squamous cell carcinoma. The mutation was a C-->T transition at a dipyrimidine (5'-CT) sequence and could have been produced by solar ultraviolet light. The mutated ras gene did not have the ability to transform NIH/3T3 cells. In three tumors, multiple base substitutions were detected in exon 1 of the Ki-ras and N-ras genes. These results and our previous work on p53 gene mutations suggest that mutations in ras genes are far less frequent than in the p53 gene in the skin tumors in XP patients and that ras genes are less important in skin tumorigenesis in XP patients than is the p53 gene.

Self-expanding metal stents for palliative treatment of malignant biliary and duodenal stenoses

Patients with malignant biliary stenosis due to pancreatic head cancer often have the associated problem of duodenal obstruction. We report here the case of a 78-year-old woman with this clinical situation, who was treated with self-expanding Gianturco metal stents placed in the distal common bile duct and, nine months later, placed in the descending duodenum. The patient's frequent vomiting resolved, and she was able to tolerate peroral solid food; jaundice also decreased (bilirubin pre-stenting: 7.8; post-stenting: 1.2). Self-expanding metal stents therefore appear to be effective for the palliative treatment of malignant duodenal stenosis as well as biliary stenosis.

A highly enhanced thrombopoietic activity by monomethoxy polyethylene glycol-modified recombinant human interleukin-6

Interleukin-6 (IL-6) is a novel cytokine with activities that can affect hematopoietic cells including those of the megakaryocytic lineage. We have examined the effects of monomethoxy polyethylene glycol-modified recombinant human interleukin-6 (Peg-IL-6) on thrombopoiesis in vivo. To compare the thrombopoietic activity between Peg-IL-6 and unmodified IL-6, each was administered subcutaneously to mice every 24 hours at various doses. A dose-response experiment showed that Peg-IL-6 and IL-6 increased platelet counts in a dose-dependent fashion at a plateau stimulation level of 0.5 micrograms/day and 10 micrograms/day, respectively. This dose of Peg-IL-6 and IL-6 induced the elevated platelet counts by approximately 140% to 160% and 50% to 60%, respectively. Peg-IL-6 treatment (0.5 micrograms/day) for x-ray (6.0 Gy) irradiated mice induced an increase in the rate of platelet recovery, and a higher dosage (5 micrograms/day) completely blocked the induction of thrombocytopenia in this model. In contrast, IL-6 (10 micrograms/day) could not protect the animals from platelet nadir but reduced the period of thrombocytopenia after x-ray irradiation. Furthermore, when administered to 5-fluorouracil-treated mice, 5 micrograms/day of Peg-IL-6 diminished the platelet nadir and increased platelet counts on individual days during the recovery phase. The potent thrombopoietic activity of Peg-IL-6 were due to prolongation of circulating IL-6 levels that were reverted from Peg-IL-6 in vivo. These findings indicate that reduction of total body clearance of IL-6 induces potent thrombopoiesis and that Peg-IL-6 may be a useful thrombopoietic agent.

[Effect of mesalazine microgranules on experimental colitis]

Mesalazine microgranules are an ethylcellulose-coated formulation from which mesalazine is released throughout the intestinal tract and are expected to be effective for idiopathic inflammatory bowel disease, ulcerative colitis and Crohn's disease. Mesalazine microgranules were administered orally to investigate the distribution of mesalazine throughout the intestinal tract in rats. Mesalazine microgranules distributed sufficient amounts of mesalazine and its metabolite, N-acetyl-mesalazine, to the intestinal tissues, while pure mesalazine delivered lower amounts of both. In acetic acid-induced colitis in rats, mesalazine microgranules administered orally reduced the damage score significantly (P < 0.05) at a dose of 50 mg/kg as assessed by macroscopic observation and at 100 mg/kg as assessed by histological evaluation. The number of ulcers in carrageenan-induced colitis in guinea pigs was inhibited at doses of 50, 100, 200 mg/kg, p.o. The colonic wet weight of rats in 2,4,6-trinitrobenzenesulfonic acid (TNB)-induced colitis was reduced significantly (P < 0.05) at a dose of 50 mg/kg, p.o. Mesalazine microgranules showed the ability to distribute mesalazine efficiently throughout the intestinal tract and showed effectiveness against acetic acid-, carrageenan- and TNB-induced colitis. These studies strongly suggest that mesalazine microgranules are effective for idiopathic inflammatory bowel disease.

[A case of surgical treatment of sever constrictive pericarditis with biventricular failure]

A 68-year-old woman had been pointed out a calcification of pericardium on chest X-ray ten years ago. She admitted to our hospital associated with generalized edema. RA pressure.pulmonary capillary wedge pressure.RVEDP.LVEDP increased markedly and low cardiac output coexisted (C.I. = 1.77 l/min/m2). On September 9, 1992, she underwent a total pericardiectomy through mediansternotomy without cardiopulmonary bypass. She complicated a prolonged biventricular heart failure despite total pericardiectomy postoperatively. It was considered that delayed clinical improvement had based on myocardial degeneration or atrophy in long-term morbidity. We recommend a early operative intervention at the clinical hemodynamic deterioration.

Action of a diffusible target-derived chemoattractant on cortical axon branch induction and directed growth

Cortical axons innervate their brainstem target, the basilar pons, by the initiation and extension of collateral branches interstitially along their length. To address whether a diffusible pons-derived chemoattractant controls these events, we used cocultures in collagen matrices and time-lapse microscopy. Pontine explants enhanced by 5-fold the de novo initiation of transient branches along cortical axons; most branches were directed toward pons. Of the branches extended toward pons, 2%-3% were stabilized; those extended away were not. Pontine explants also enhanced the stable bifurcation of growth cones and prompted directional changes by growth cone turning and collateral extension. These effects were distance dependent and mimicked by pons-conditioned medium. This evidence indicates that the pons activity promotes branch initiation interstitially along cortical axons, a novel property for a chemoattractant, and provides a directional cue for their growth. These findings suggest that the pons chemoattractant serves as a diffusible target-recognition molecule.

Inhibition of the growth of cariogenic bacteria in vitro by plant flavanones

Phytoalexins, defensive compounds produced by plants against microbial infections, were purified from Sophora exigua (Leguminosae) and their growth inhibitory effects on oral cariogenic bacteria were determined in vitro. Among three isolated compounds, 5,7,2',4'-tetrahydroxy-8-lavandulylflavanone completely inhibited the growth of oral bacteria including primary cariogenic mutans streptococci, other oral streptococci, actinomycetes, and lactobacilli, at concentrations of 1.56 to 6.25 micrograms/ml.

Identification of a cis-acting element that is responsible for cadmium-mediated induction of the human heme oxygenase gene

Heme oxygenase is an essential enzyme in heme catabolism and is inducible by various environmental derangements such as cadmium. The activity and mRNA levels of heme oxygenase were remarkably increased in HeLa cells by the treatment with cadmium. As a first step in studying the molecular mechanisms of this induction, we performed transient expression assays in four human cell lines including HeLa to analyze the cadmium-mediated inducibility of the fusion genes, containing the firefly luciferase gene as a reporter under the human heme oxygenase gene promoter. By determining the luciferase activity expressed in the transfected cells, we found the region between about 4.5 and 4 kilobase pairs upstream from the transcriptional initiation site of the heme oxygenase gene which confers cadmium-mediated inducibility on the fusion gene. The region was then subjected to further functional analysis in HeLa cells, which allowed us to localize the cadmium-responsive element to 20 base pairs. Gel mobility shift assays demonstrated that this 20-base pair element is specifically bound by nuclear protein(s) of HeLa cells, the binding activities of which were however unchanged by the treatment with cadmium. Using the synthetic cadmium-responsive elements containing various base changes, we have identified a 10-base pair sequence, TGCTAGATTT, required for the cadmium-mediated inducibility and in vitro protein binding. We thus suggest that this binding protein(s) is involved in the cadmium-mediated activation of the heme oxygenase gene. Incidentally, the consensus sequence of AP-1 binding site, TGAGTCA, is present downstream of this cadmium-responsive element. However, we provide evidence that AP-1 is not directly involved in the cadmium-mediated induction of the human heme oxygenase gene.

Inhibition of DNA topoisomerase II by ICRF-193 induces polyploidization by uncoupling chromosome dynamics from other cell cycle events

ICRF-193, a novel noncleavable, complex-stabilizing type topoisomerase (topo) II inhibitor, has been shown to target topo II in mammalian cells (Ishida, R., T. Miki, T. Narita, R. Yui, S. Sato, K. R. Utsumi, K. Tanabe, and T. Andoh. 1991. Cancer Res. 51:4909-4916). With the aim of elucidating the roles of topo II in mammalian cells, we examined the effects of ICRF-193 on the transition through the S phase, when the genome is replicated, and through the M phase, when the replicated genome is condensed and segregated. Replication of the genome did not appear to be affected by the drug because the scheduled synthesis of DNA and activation of cdc2 kinase followed by increase in mitotic index occurred normally, while VP-16, a cleavable, complex-stabilizing type topo II inhibitor, inhibited all these processes. In the M phase, however, late stages of chromosome condensation and segregation were clearly blocked by ICRF-193. Inhibition at the stage of compaction of 300-nm diameter chromatin fibers to 600-nm diameter chromatids was demonstrated using the drug during premature chromosome condensation (PCC) induced in tsBN2 baby hamster kidney cells in early S and G2 phases. In spite of interference with M phase chromosome dynamics, other mitotic events such as activation of cdc2 kinase, spindle apparatus reorganization and disassembly and reassembly of nuclear envelopes occurred, and the cells traversed an unusual M phase termed "absence of chromosome segregation" (ACS)-M phase. Cells then continued through further cell cycle rounds, becoming polyploid and losing viability. This effect of ICRF-193 on the cell cycle was shown to parallel that of inactivation of topo II on the cell cycle of the ts top2 mutant yeast. The results strongly suggest that the essential roles of topo II are confined to the M phase, when the enzyme decatenates intertwined replicated chromosomes. In other phases of the cycle, including the S phase, topo II may thus play a complementary role with topo I in controlling the torsional strain accumulated in various genetic processes.

Pulmonary hypertension in systemic lupus erythematosus: a report of an autopsied case

An autopsied case of systemic lupus erythematosus with pulmonary hypertension is reported. A 29-year-old woman with a seven-year history of polyarthralgia, butterfly rash, nephrotic syndrome and Raynaud's phenomenon was admitted because of progressive dyspnea on exertion. Tests for antinuclear antibody, anti-cardiolipin antibody and lupus anticoagulant were positive. Echocardiographic examination revealed right ventricular hypertrophy and a moderate pericardial effusion. Estimated systolic pulmonary arterial pressure was 53 mmHg. Despite treatment with corticosteroids including pulse methylprednisolone therapy, lipo-PGE1 and warfarin, she died of progressive congestive heart failure. Postmortem examination of the pulmonary vasculature revealed findings consistent with plexogenic pulmonary arteriopathy, without evidence of vasculitis, fibrinoid necrosis, or thromboemboli.

Structure-activity studies of the s-echistatin inhibition of bone resorption

Synthetic Arg-Gly-Asp (RGD)-containing peptides were examined in bone resorption or attachment and detachment assays with isolated mammalian osteoclasts in an effort to elucidate the mechanistic and structural basis for the inhibition of bone resorption by s-echistatin. Bone resorption was the process most sensitive to inhibition by s-echistatin, with IC50 = 0.3 nM; inhibition of attachment to bone or detachment (lamellipodial retraction) was 30- to 70-fold less sensitive, with IC50 = 10 or 20 nM, respectively. Single amino acid substitutions within the 49-residue sequence of s-echistatin showed that although the efficacy of s-echistatin is dependent on the Arg24-Gly25-Asp26 sequence, additional residues, including Asp27, Met28, and Cys39, are also critical for potent inhibition of the resorbing activity of isolated rat osteoclasts. Because of the identification of the av beta 3 as the primary integrin on rat osteoclasts interacting the RGD peptides (Helfrich et al.), we examined the possibility of modeling bone resorption with other beta 3-mediated processes. Specifically, av beta 3 endothelial cell (human or rat) attachment to vitronectin and aIIb beta 3 platelet aggregation were compared with bone resorption for sensitivity to s-echistatin analogs, linear RGD peptides, and cyclic RGD peptides. Essentially no similarity in sensitivity to RGD peptides were observed between bone resorption, platelet aggregation, or endothelial cell attachment. Because rat osteoclasts and human giant cell tumors (osteoclastomas) shared similar sensitivity to s-echistatin and rat and human endothelial cells showed a similar sensitivity profile to RGD peptides, the dissimilarity of bone resorption to other beta 3-mediated processes cannot be explained in terms of species differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Remote subarachnoid haemorrhage in the posterior fossa following supratentorial surgery. Clinical observation of 6 cases

Haemorrhage in regions remote from the site of following intracranial operations is rare, but they do occur. We performed supratentorial craniotomy on 639 patients between the time of introduction of computed tomography (CT) for clinical use in 1983 and June 1992; subarachnoid haemorrhage (SAH) in the posterior fossa occurred postoperatively in six of these cases. These included four patients with tumours in the sellar region, one with an arteriovenous malformation (AVM) and one who underwent superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The ages of the six patients ranged from 17-72 years. Haemorrhage occurred on the day of operation in one case and was detected on CT examination on the day following surgery in the remaining five cases. Of three patients with disturbance of consciousness, two underwent suboccipital craniectomy for reduction of intracranial pressure, while one received barbiturate therapy and later underwent cerebrospinal fluid (CSF) shunt surgery. No special treatment was necessary for the remaining three patients with less serious lesions. Five of the six patients ultimately recovered their pre-operative neurological status apart from the primary diseases. Factors inducing such haemorrhages seem likely to include displacement of the cerebellum by reduced CSF pressure during and after operations, and stretching and tearing of the veins and venules in the sulci of the tentorial surface of the cerebellum. Consideration should therefore be given to the maintenance of an appropriate CSF pressure during operation; this is particularly important in elderly patients and those with an atrophied cerebral cortex.

Cerebrospinal fluid leakage from the nipple after ventriculoperitoneal shunt: case report

A case of ventriculoperitoneal shunt malfunction is presented, in which cerebrospinal fluid was discharged from the nipple. A pseudocyst was found at the end of peritoneal catheter in the right subphrenic abdominal cavity. In addition, a fibrous tract was formed around the peritoneal catheter and communicated with the lactiferous duct probably injured incidentally during the subcutaneous insertion of catheter. Consequently, cerebrospinal fluid accumulated in the pseudocyst in the abdominal cavity and then flowed backward in the fibrous tract to the lactiferous duct during the respiration to discharge from the nipple.