[Pelvic hyperthermochemotherapy combined with surgery for rectal cancer]

In an attempt to prevent local recurrence, intraoperative pelvic hyperthermochemotherapy (IOPHC) was performed in combination with curative surgery for rectal cancer. One hundred twenty-three patients were divided into four groups: A, 8 patients without nodal involvement (n0) and given IOPHC; B, 22 with nodal involvement (n+) and given IOPHC; C, 47 n0 and no IOPHC; D, 46 n (+) and no IOPHC. Local recurrence developed in one patient in group A (12.5%), 3 in group B (13.6%), 5 in Group C (10.6%), and 16 in Group D (34.8%), respectively. Thus, the rate of local recurrence in group B was low compared to that of Group D, even through there was no statistical difference (p = 0.11). IOPHC may be one option for limiting local recurrence after surgical resection of rectal cancer.

[Evaluation of prophylactic intra-hepatic-arterial infusion chemotherapy after resection of hepatic metastases from colorectal primaries]

To prevent recurrence in the residual liver after surgical treatment for colorectal metastases, the efficacy of intermittent or continuous intra-hepatic-arterial chemotherapy was analyzed. The three- and five-year survival rate of patients with intermittent infusion of ADM or MMC (n = 11) was 36.4% and 36.4%, respectively, while the survival rate of the patients without the regional chemotherapy (n = 32) was 41.9% and 23.3%, respectively, indicating no statistical significance. On the other hand, one patient out of 8 with continuous infusion of 5-FU and 2 patients out of 6 without local chemotherapy developed recurrent disease during the median follow-up time of 12 months. No serious complication such as sclerotic cholangitis or hepatic necrosis was observed. Although the follow-up was not long enough to accurately evaluate the efficacy, local chemotherapy with continuous infusion of 5-FU could be a promising method as an adjuvant chemotherapy after hepatic resection for colorectal metastases.

[Neoadjuvant intra-arterial infusion chemotherapy for the treatment of locally advanced breast cancer with remote metastases]

Intra-arterial infusion chemotherapy (I.A.) before the operation was performed in 7 advanced breast cancers with remote metastases. The locations of remote metastases were bone (6 cases), lung (one case), and brain (one case). The response rate of primary lesions to I.A. was 71% and the responders of remote metastases were two cases, of which one was CR (lung). After the chemotherapy, all cases underwent standard radical mastectomy, and five of seven cases are alive at this writing without local recurrence. We have performed I.A. for locally advanced breast cancer with remote metastases on the grounds that the effect of this treatment is "semi-local and semisystemic," I.A. bring down-staging to the primary lesions and can control local recurrence. The effect of the drug which leaks from I.A. is expected to the metastatic lesions. I.A. was considered to be useful too for the treatment of locally advanced breast cancer with remote metastases in terms of the excellent control effect of the local lesions and the effect on the metastatic lesions.

[Combination with intra-hepatic arterial infusion of low-dose cisplatin and oral administration of high-dose doxyfluridine in patients with liver metastases of gastric cancer]

Two cases of gastric cancer with multiple liver metastases were treated with 5'-DFUR and CDDP after the surgery. The first case, a 79-year-old male, was administered 1,200 mg/day of 5'-DFUR orally, 6 mg/day of CDDP continuously for 2 weeks, then 20 mg once a week for 5 months by intra-hepatic arterial infusion. This case showed 95% tumor reduction by CT. The other case, a 78-year-old female, was administered 1,200 mg/day of 5'-DFUR orally and 20 mg of CDDP once a week through the hepatic artery. Following several intra-hepatic arterial infusions, it was changed to intra-venous infusion of 20 mg of CDDP twice a week because of trouble with the vascular access system. Two months after, CT showed a 46% tumor reduction in her liver. Neither complained of diarrhea nor nausea, but there was a mild degree of appetite loss. Combination with high-dose 5'-DFUR and low-dose intra-hepatic arterial infusion of CDDP is considered a very effective chemotherapy which can be performed ambulatorily while maintaining the quality of life of patients with liver metastases of gastric cancer.

[Intra-arterial infusion chemotherapy for recurrent breast cancer via an implantable system--the second report]

Intra-arterial infusion chemotherapy via an implantable port catheter has been applied in 16 patients with locally recurrent breast cancer. The regimen consisted of induction and subsequent maintenance: intra-arterial infusion of epirubicin (EPI). Non-responders were entered into the second-line regimen consisting of Methotrexate and 5-FU (MF). The results were as follows: 1) The response rate (CR+PR) of EPI to locoregional lesions was 50%, and the median duration of response was 5.7 months. 2) The response rate and the duration of response of MF were 25% and 3 months, respectively. 3) Patients with ER-rith, no previous therapy and a long disease-free interval tended to have a high rate of response to intra-arterial infusion therapy. 4) Improvements of QOL, such as intractable pain, infection and severe lymphedema were recognized in 68.6% of the cases. In more than half of the cases, these treatments were carried out in an outpatient clinic. 5) Leucopenia and catheter or portal problems were encountered in 68.6% and 25.0%, respectively. We conclude that intra-arterial infusion chemotherapy via implantable system is a promising modality with regard to therapeutic effect and improvement of quality of life.

[Late phase II clinical study of KW-2307 in previously untreated patients with non-small cell lung cancer. KW-2307 Study Group (Lung Cancer Group)]

A late Phase II clinical study of KW-2307, a new vinca alkaloid derivative, in previously untreated patients with non-small cell lung cancer was jointly carried out in 26 medical institutions. Of 80 enrolled cases, 75 cases were eligible, and PR was attained in 23 cases (30.7%). The main adverse effect of this drug, leukopenia (neutropenia), was observed in 62.7% (83.3%) of Grade 3 and 4 cases, but they recovered rapidly. In addition to decreased hemoglobin in 67% (Grade 3 in 5.7%) of the cases, adverse effects included slight disorder of hepatic function, anorexia, nausea and vomiting, fever, general fatigue, phlebitis, paresthesia and interstitial pneumonia. Peripheral neuropathy such as paresthesia occurred rarely and was slight, if any.

[Clinical evaluation of measuring system of occlusal force]

An occlusal diagnostic system was evaluated for clinical applications. This system consists of pressure sensitive sheets (DENTAL PRESCALE, Fuji Photo Film Co.) and analyzing computer (OCCLUZER FPD703, Fuji Photo Film Co.). The clinical efficiency of this system was evaluated in aged dentates, aged complete denture wearers and an aged patient suffered from periodontitis. The results were as follows: 1. There was a positive correlation between the masticatory efficiency and maximum occlusal force. 2. In the complete denture wearers, the distances from the medial line to the center of the occlusal load were statistically greater in the adjustment needed cases than in the control group. 3. In a case of periodontitis, the full arch fixed splint was adjusted using this system. After adjustment, the maximum occlusal force and contact area increased, and the maximum and medial pressure of the occlusal contact force decreased. 4. It was suggested that this system would be available for the examination of masticatory efficiency and diagnosis of various types of occlusions.

Effect of natural sleep on auditory steady state responses in adult subjects with normal hearing

Auditory 40-Hz steady state response (SSR), auditory brainstem response (ABR), and middle-latency response (MLR) were recorded in 12 healthy adult females with normal hearing while awake and asleep. The responses were recorded with 500-Hz tone pips at 55 dBnHL. Synthesized SSR were made by superimposing the recorded ABR and MLR waveforms (ABR-MLR), and their amplitudes were compared with those of the actually recorded SSR. In the waking state, the ratio of the mean amplitude of recorded SSR to that of synthesized SSR was 0.819, whereas in the sleeping state it decreased to 0.522, a statistically significant difference. The results indicate that the SSR can be predicted from the linear superimposition of ABR and MLR in the waking state, but not in the sleeping state.

Prevention of proteinuria by the administration of anti-interleukin 8 antibody in experimental acute immune complex-induced glomerulonephritis

Glomerular infiltration by neutrophils is a hallmark of acute glomerulonephritis. The pathophysiological role of interleukin 8 (IL-8), a potent neutrophil chemotactic cytokine (chemokine), was explored in an animal model of acute immune complex-mediated glomerulonephritis by administering a neutralizing antibody against IL-8. Repeated injection of bovine serum albumin (BSA) into rabbits caused the deposition of immune complexes consisting of BSA and rabbit IgG in glomeruli. Histological analyses revealed a small but significant number of neutrophils in glomeruli and the fusion of epithelial cell foot processes. Concomitantly, urinary levels of protein and albumin increased markedly (3.20 +/- 0.97 and 1.39 +/- 0.53 mg/h, respectively) compared with those of untreated animals (0.77 +/- 0.21 and 0.01 +/- 0.01 mg/h, respectively). Anti-IL-8 antibody treatment decreased the number of neutrophils in glomeruli by 40% and dramatically prevented the fusion of epithelial cell foot process. Furthermore, treatment with anti-IL-8 antibody completely normalized the urinary levels of protein and albumin (0.89 +/- 0.15 and 0.02 +/- 0.01 mg/h, respectively). These results indicated that IL-8 participated in the impairment of renal functions in experimental acute immune complex-mediated glomerulonephritis through activating as well as recruiting neutrophils.

[A case of Gardner's syndrome associated with thyroid carcinoma]

We report a 22-year-old female who was diagnosed as familial adenomatous polyposis (FAP) associated with thyroid carcinoma. Total thyroidectomy and bilateral neck lymph nodes dissection were performed. Gardner's syndrome was pointed out after an investigation of her family. Total colectomy and ileo-rectal anastomosis were carried out. Colon cancer was not found pathologically. We reviewed 10 cases of FAP with thyroid carcinoma in Japan. Ten out of 11 cases including this patient were female. Thus it is important to pay careful attention to the presence of thyroid carcinoma in the case of FAP or Gardner's syndrome.

Epilepsy with electrical status epilepticus during slow sleep and secondary bilateral synchrony

In 3 children with "epilepsy with electrical status epilepticus during slow sleep" (ESES), we estimated interhemispheric small time differences (TDs) during spike-wave activity in EEG by coherence and phase analysis by the two-dimensional autoregressive model to differentiate their continuous diffuse spike-waves during slow-wave sleep (CSWS) between primary bilateral synchrony and secondary bilateral synchrony (SBS). Maximal TDs at onset of apparently bilateral synchronous spike-wave bursts (BSSWs) during slow-wave sleep were 12.0-26.5 ms (mean 20.3 ms) with consistent leading hemispheres in eight bursts of the 3 patients, indicating SBS as pathophysiology of their CSWS. This suggestion was supported by their clinico-EEG findings, including the effect of a single oral dose of clobazam (CLB) on EEG. Three ictal BSSWs of atypical absence seizures in 2 patients were also analyzed to obtain maximal TDs of 17.9-41.7 ms (mean 26.3 ms) at onset, with the same leading sides as in sleep, also indicating SBS. Examination of intraburst TD variations showed no consistent disappearance of TDs during the latter part of the bursts, in either sleep or the ictal EEGs of atypical absences, and a role of the corpus callosum was suggested in the generation of SBS in ESES.

Disorder in ultrastructure of basement membrane and mechanical junction in human esophageal cancer

The ultrastructure and clinical significance of the basement membrane (BM) are still unclear in esophageal cancer. In this report, we examined the ultrastructure of the BM and microstructures related intercellular adhesion in squamous cell carcinoma of human esophagus using a transmission electron microscope, and investigated their clinical significance. BM was absent in 38% of the examined cases and the frequency or the presence of the microstructures of cancer cells of the infiltrating margin (CCIM) was negatively related to the presence of BM (BM-P); CCIM of BM-P tumors often had smaller number per cell of desmosomes and cytoplasmic processes. These results indicate that CCIM of BM-P tumor are in an 'inconvenient status' for tumor cells to form a firm group. In the intercellular space between CCIM and BM or surrounding stromal cells, all of the CCIM of BM-P tumors had hemidesmosomes, but not those of BM absent (BM-A) tumors. Though no statistical significant difference was found in our clinical observation between BM-P and BM-A tumors, the present study suggested that a considerable proportion of cancer cells have abnormal intercellular adhesiveness via a mechanical mechanism related to the presence or absence of BM.

Effects of a new oral hypoglycaemic agent (CS-045) on metabolic abnormalities and insulin resistance in type 2 diabetes

The effects of a thiazolidinedione antidiabetic agent (CS-045) on diabetic metabolic abnormalities were studied in a double-blind clinical trial. Fourteen patients with Type 2 diabetes were selected according to study criteria. Eight were treated with oral CS-045 at 400 mg daily, and six were given placebo. A multi-step, hyperinsulinaemic, euglycaemic clamp study, with simultaneous plasma free fatty acid study, and glucagon tolerance test were performed before and after administration of drug. Following 3 months of treatment with CS-045, there were significant decreases in the mean levels of fasting plasma glucose (from 9.18 +/- 0.95 to 7.78 +/- 0.44 mmol l-1), postprandial plasma glucose (from 11.8 +/- 1.23 to 10.36 +/- 1.06 mmol l-1), and haemoglobin A1c (from 9.3 +/- 0.4 to 6.8 +/- 0.4%). Insulin sensitivity also improved (1st step: from 3.12 +/- 0.33 to 4.70 +/- 0.47 mg kg-1 min-1 (p < 0.01); 2nd step: from 5.61 +/- 0.63 to 7.54 +/- 0.58 mg kg-1 min-1 (p < 0.01); 3rd step: from 9.21 +/- 0.67 to 11.10 +/- 0.87 mg kg-1 min-1). The fasting free fatty acid level decreased significantly from 0.28 +/- 0.04 to 0.22 +/- 0.02 g l-1. The residual free fatty acid level (%) under insulin infusion clamp conditions decreased significantly from 63.7 +/- 9.7 to 45.0 +/- 9.2%. CS-045 treatment was associated with decrease in total cholesterol, total triglycerides, and increase in HDL cholesterol. Basal C-peptide immunoreactivity level decreased, but there was no change in the peak C-peptide immunoreactivity value.(ABSTRACT TRUNCATED AT 250 WORDS)

Nuclear accumulation of p53 protein correlates with mutations in the p53 gene on archival paraffin-embedded tissues of human breast cancer

Fifty invasive ductal carcinomas of the breast were analyzed by immunohistochemistry, polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and direct sequencing after microdissection of conventional formalin-fixed, paraffin-embedded tissues. A highly significant association between the presence of p53 gene mutation and nuclear accumulation of p53 protein was found (P < 0.0001). Of 13 tumors that demonstrated p53 gene mutations, 11 (84.6%) showed nuclear accumulation of p53 protein. However, of 37 tumors in which gene mutations were not detected, only 5 (13.5%) showed nuclear accumulation of p53 protein. There was a statistically significant association between the nuclear accumulation of p53 protein and a higher histological grade (P < 0.001) or mitotic index (P < 0.01). In addition, gene mutations had a statistically significant association with a higher histological grade (P < 0.05) or mitotic index (P < 0.0001). Therefore, p53 abnormalities might be associated with an aggressive phenotype in breast cancer. We conclude that the immunohistochemical detection of nuclear p53 protein accumulation is highly associated with p53 gene mutations in archival paraffin-embedded tissues, and that this method is useful for rapid screening of p53 abnormalities.

Detection of urinary interleukin-8 in glomerular diseases

To clarify the mechanism of neutrophil infiltration in glomerulonephritis, both urinary and plasma levels of a potent neutrophil chemotactic cytokine, interleukin-8 (IL-8), were measured in 40 healthy volunteers and 96 patients with various renal diseases. The plasma IL-8 levels were less than 16 pg/ml. The urinary IL-8 levels were elevated in several renal diseases including IgA nephropathy (17 of 43), acute glomerulonephritis (4 of 6), lupus nephritis (11 of 15), purpura nephritis (2 of 4), membranoproliferative glomerulonephritis (1 of 1), and cryoglobulinemia (2 of 2). IL-8 was detected immunohistochemically in diseased glomeruli, suggesting its local production. Elevated urinary IL-8 levels during the acute phase or exacerbations were found to be decreased during spontaneous or steroid pulse therapy-induced convalescence in all patients examined. The urinary IL-8 levels were higher in patients with glomerular leukocyte infiltration than in those without infiltration. Collectively, local production of IL-8 in diseased glomeruli might be involved in the pathogenesis of the glomerular diseases and measurement of IL-8 in the urine might be useful for monitoring the glomerular diseases.

A nine-year chronic toxicity study of cadmium in monkeys. II. Effects of dietary cadmium on circulatory function, plasma cholesterol and triglyceride

The effects of long-term (9 y) po administration of daily low doses of cadmium on blood pressure, heart rate, electrocardiogram and plasma cholesterol and triglyceride concentrations were examined in rhesus monkeys. Thirty-five male rhesus monkeys were divided into 5 groups and fed pelleted food containing cadmium chloride at dosages of 0, 3, 10, 30 or 100 micrograms cadmium/g food (= ppm). The 100 ppm group had increased blood pressure during the initial 1 1/2 y. Thereafter, the expected increase in blood pressure that occurred due to aging in the control and 3 ppm groups was not evident in the 100 ppm group. No changes attributable to cadmium were detected in pulse rates or in electrocardiograms. Plasma cholesterol in the 2 highest dosage groups and triglyceride in the 100 ppm group were slightly lower than in controls after 2 1/2 y. Long-term exposure to cadmium contributed to the development of elevated blood pressure during the first and second years and then inhibited the hypertension expected due to aging.

Sympathetic ganglion blockade for the management of hyperhidrosis

We present three patients with severe primary hyperhidrosis, refractory to conservative medical treatment, who were successfully managed with sympathetic ganglion blockade with ethanol. We also summarize 10 patients with hyperhidrosis who underwent sympathetic ganglion blockade in the past 2 years. This closed percutaneous method offers the patients considerably less discomfort and less stress with minimal morbidity and has a efficacy similar to that of surgical sympathectomy, which has previously been the only effective and permanent therapy for severe primary hyperhidrosis. It is concluded that chemical sympathectomy is an effective and useful method for treating severe hyperhidrosis which has advantages over surgical sympathectomy.

Monoclonal antibodies specific for 18-hydroxycortisol and their use in an enzyme immunoassay for human urinary 18-hydroxycortisol for diagnosis of primary aldosteronism

We report the development of a monoclonal antibody-based enzyme immunoassay (EIA) specific for human urinary 18-hydroxycortisol, a biological marker of primary aldosteronism. Hybrid cell lines (hybridomas) were isolated after fusion between myeloma cells and spleen cells prepared from mice immunized with 18-hydroxycortisol conjugate. A competitive EIA suitable for the measurement of urinary 18-hydroxycortisol was developed using the mouse monoclonal antibody, KTM-41, which showed no practical cross-reaction with related endogenous steroids and synthetic steroids. This EIA meets all the requirements of routine clinical assay in terms of sensitivity (detection limit: 20 nmol/L), reproducibility (total CV: 8-15%), accuracy (recovery: 88-115%), simplicity and rapidity (< 3 h). Urinary 18-hydroxycortisol measured by the present assay was 153 +/- 119 nmol/L (mean +/- SD, range, 28-485) and 1787 +/- 1180 (range, 810-4264) in normal subjects (n = 20) and in patients with primary aldosteronism (n = 7), respectively. Clinical validation of the assay was confirmed by an appropriate decrease in urinary 18-hydroxycortisol level in patients with primary aldosteronism subsequent to adrenalectomy: 171 +/- 141 nmol/L (range, 41-466).

Induction of cytochrome P-450s and expression of liver-specific genes in rat primary hepatocytes cultured on different extracellular matrices

Freshly isolated hepatocytes were cultured on an EHS-gel prepared from EHS-tumor, poly-N-p-vinylbenzyl-D-lactonamide (PVLA), and type I collagen (TIC). Hepatocytes on EHS-gel showed a spherical shape and much more strongly maintained the inducible expression of cytochrome P-450 genes which were lost on PVLA and TIC. Further, the expression of liver-specific genes were maintained on EHS gel at the highest level, and then higher on PVLA than TIC.