Effective timing of hyaluronate gel injection in image-guided adaptive brachytherapy for uterine cervical cancer: a proposal of the 'adjusted dose score'

Hyaluronate gel injection (HGI) in the rectovaginal septum and vesicovaginal septum is effective in the setting of high-dose-rate image-guided adaptive brachytherapy (IGABT) for cervical cancer. We aimed to retrospectively investigate optimal conditions for HGI to achieve optimal dose distribution with a minimum number of HGI. We classified 50 IGABT plans of 13 patients with cervical cancer who received IGABT both with and without HGI in the rectovaginal septum and vesicovaginal septum into the following two groups: plan with (number of plans = 32) and plan without (number of plans = 18) HGI. The irradiation dose parameters of high-risk clinical target volume (CTVHR) and organs at risk per fraction were compared between these groups. We also developed the adjusted dose score (ADS), reflecting the overall irradiation dose status for four organs at risk and CTVHR in one IGABT plan and investigated its utility in determining the application of HGI. HGI reduced the maximum dose to the most exposed 2.0 cm3 (D2.0 cm3) of the bladder while increasing the minimum dose covering 90% of CTVHR and the percentage of CTVHR receiving 100% of the prescription dose in one IGABT plan without causing any associated complications. An ADS of ≥2.60 was the optimum cut-off value to decide whether to perform HGI. In conclusion, HGI is a useful procedure for improving target dose distribution while reducing D2.0 cm3 in the bladder in a single IGABT plan. The ADS can serve as a useful indicator for the implementation of HGI.

Prostate brachytherapy seed migration to the right renal artery due to right-to-left shunting across a patent foramen ovale

Introduction

The seeds used in brachytherapy for prostate cancer may migrate through the surrounding venous plexus to other sites in the body, most commonly to the pulmonary vasculature.

Case presentation

A 78-year-old Japanese man received iodine-125 low-dose-rate prostate brachytherapy. Computed tomography revealed that one seed had migrated to the right kidney. No seed was observed in the ureter upon ureteroscopy. Transesophageal echocardiography confirmed a right-to-left shunt due to a patent foramen ovale, suggesting that the seed had migrated into the right renal artery. Three years after treatment, no recurrence of prostate cancer and no adverse events due to seed migration or due to the patent foramen ovale occurred.

Conclusion

Arteriovenous malformations and a right-to-left shunt should be suspected if a brachytherapy seed has migrated to an artery of the systemic circulatory system.

Seed lost to perineum from hydrogel spacer after brachytherapy for prostate cancer

Introduction

We describe a rare case of brachytherapy for prostate cancer in which a seed was lost from the perineum after a hydrogel injection.

Case presentation

A 71-year-old Japanese man was diagnosed with localized high-risk prostate cancer. Trimodality therapy with I-125 brachytherapy was selected, and combined androgen blockade therapy was initiated. Brachytherapy and hydrogel injection were performed 7 months after combined androgen blockade initiation; 6 months later, the patient visited our hospital with complaints of redness and bleeding in the perineum. Serous effusion and loss of a seed on the right side of the perineal anus were observed. Pelvic magnetic resonance imaging showed a tunnel like discharge of hydrogel from the dorsal prostate to the perineum. The fistula was incised, the seed was removed, and drainage was performed.

Conclusion

Appropriate diagnosis and treatment with careful follow-up are required in patients at high risk of infection after brachytherapy with hydrogel injection.

Sarcopenia and excess visceral fat accumulation negatively affect early urinary function after I‐125 low‐dose‐rate brachytherapy for localized prostate cancer

OBJECTIVES

To evaluate the effects of sarcopenia and excess visceral fat accumulation on early urinary function after I-125 low-dose-rate brachytherapy for prostate cancer.

METHODS

We retrospectively reviewed consecutive patients who underwent brachytherapy for prostate cancer. Pre-treatment computed tomography was used to measure skeletal muscle index at the L3 level to assess sarcopenia and visceral fat area at the umbilical level. The International Prostate Symptom Score and the University of California Los Angeles Prostate Cancer Index were used to assess quality of life during the 24 months after brachytherapy. Logistic regression analysis was used to examine whether sarcopenia and excess visceral fat accumulation had clinically significant effects on post-treatment quality of life.

RESULTS

Among 246 patients, 92 (37.4%) were stratified into the sarcopenia group and 141 (57.3%) into the excess visceral fat accumulation group. The sarcopenia group had significantly lower University of California Los Angeles Prostate Cancer Index urinary function than the non-sarcopenia group 24 months post-brachytherapy. The excess visceral fat accumulation group had significantly poorer International Prostate Symptom Score total, storage, and voiding scores than the non-excess accumulation group 12 months post-brachytherapy. In the multivariate analysis, sarcopenia had a clinically significant adverse effect on the University of California Los Angeles Prostate Cancer Index urinary function at 12 months. Excess visceral fat accumulation had a clinically significant adverse effect on the International Prostate Symptom Score voiding and storage scores at 12 months.

CONCLUSIONS

Sarcopenia and excess visceral fat accumulation negatively affect urinary function early after I-125 low-dose-rate brachytherapy for prostate cancer.

Tri‐modality therapy with i‐125 brachytherapy, external beam radiation therapy, and short‐term hormone therapy for high‐risk prostate cancer after holmium laser enucleation of the prostate

Introduction

We present tri‐modality therapy with i‐125 brachytherapy for high‐risk prostate cancer after holmium laser enucleation of the prostate.

Case presentation

A 75‐year‐old man had visited our hospital with complaints of dysuria. Holmium laser enucleation of the prostate was performed for benign prostatic hyperplasia. The resected histopathological prostate tissue showed malignancy (Gleason score: 3 + 3 = 6). Two years thereafter, Gleason score progressed (4 + 5 = 9) concomitantly with increased prostate‐specific antigen levels. Therefore, tri‐modality therapy, including brachytherapy, was applied. Combined androgen blockade therapy was conducted over a 9‐month period. One month after brachytherapy, external beam radiation was performed.

Conclusion

Brachytherapy following transurethral prostate surgery is relatively contraindicated because of increased adverse urethral event frequency and seed placement difficulties. A tri‐modality therapy, including brachytherapy, was implemented without any major problems in this patient with high‐risk prostate cancer after holmium laser enucleation of the prostate, following which he had a favorable prognosis without recurrence for 6 years.

Radiation-Induced Olfactory Neuroblastoma Following Treatment for NK/T-cell Lymphoma, Nasal Type

Radiation-induced olfactory neuroblastoma (ONB) is an uncommon neoplasm that is generally associated with a poor prognosis. We experienced an unusual case of ONB in a patient who had received previous radiation therapy for extranodal NK/T-cell lymphoma 15 years previously. To our knowledge, this is the first report of a patient with radiation-induced ONB obtaining a complete response (CR) with radical re-irradiation alone. The purpose of this report is to discuss therapeutic strategies for radiation-induced ONB. We report an unusual case of ONB suspected to be a radiation-induced neoplasm in a 33-year-old female who had received 30 Gy of irradiation for extranodal NK/T-cell lymphoma, nasal type (NTCL) 15 years earlier. In this case, the patient presented with nasal obstruction and frequent epistaxis. The patient was diagnosed with ONB based on left nasal biopsy findings. The surrounding normal tissues tolerance of nasal ONB radiation had to be limited, because the previously radiated NTCL was located adjacent to critical organs. We performed intensity modulated radiation therapy (IMRT), which could offer precise irradiation (60 Gy in 2 Gy daily fractions) while sparing critical tissues. The present case was treated with radiation therapy alone, whereas previously reported cases were treated with a combination of chemotherapy and radiation therapy. We treated radiation-induced OBN successfully with radical re-irradiation using IMRT alone and the patient has had no recurrence for 3 years.

Comparative Treatment Outcome in T3N0 Glottic Cancer With and Without Vocal Fold Fixation Receiving Radiation Therapy and Concurrent Low-Dose Intra-Arterial Cisplatin Infusion

OBJECTIVES

Selective radiotherapy and concomitant intra-arterial cisplatin infusion (m-RADPLAT) with a lower cisplatin dosage have been performed for organ and function preservation in patients with locally advanced squamous cell carcinoma of the larynx (SCC-L), and results showing a lower rate of adverse events have been reported. This study evaluated the treatment outcomes of patients with T3N0 glottic SCC-L with or without vocal fold fixation (VFF) who were treated with m-RADPLAT.

METHODS

We retrospectively reviewed the data of 33 patients with T3N0 SCC-L who received m-RADPLAT.

RESULTS

The vocal fold in patients with VFF 3 months after completing m-RADPLAT resumed normal movement in 15 patients (83%) and persisted fixation in 3 (17%). The 3-year local control, laryngeal cancer-specific survival, and overall survival rates of patients with or without VFF were 88.9% and 86.7%, 94.1% and 93.3%, and 88.9% and 86.7%, respectively. Additionally, the 3-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates of patients with or without VFF were 94.4% and 86.7%, 88.9% and 73.3%, and 83.3% and 73.3%, respectively. Grade 3 or higher toxicities were observed in all patients: leukopenia in 4 patients (12%), neutropenia in 5 (15%), anemia in 2 (6%), thrombocytopenia in 3 (9%), and mucositis in 2 (6%).

CONCLUSIONS

This study demonstrated that m-RADPLAT yielded VFF improvement and a favorable survival while maintaining laryngeal function not only in patients with T3N0 glottic SCC-L without VFF but also in patients with VFF.

Longitudinal Changes in Health-related Quality of Life After 125I Low-dose-rate Brachytherapy for Localized Prostate Cancer

BACKGROUND/AIM

The factors associated with longitudinal changes in health-related quality of life (HRQOL) are unclear. In this study we aimed to evaluate the longitudinal changes and predictors of HRQOL after ¹²⁵I low-dose-rate brachytherapy (LDB) for localised prostate cancer (PCA).

PATIENTS AND METHODS

We evaluated 180 patients with localised PCA treated with LDB. The HRQOL was evaluated at 3 weeks before LDB and at 1, 3, 6, 12, 18, 24, 36, and 48 months after LDB using the International Prostate Symptom Score, Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and University of California Los Angeles Prostate Cancer Index (UCLA-PCI).

RESULTS

All HRQOL scores, except for UCLA-PCI sexual function and SF-8 mental component summary (MCS), were improved to baseline after an early transient deterioration. In contrast, the sexual function did not return to baseline after early deterioration. Meanwhile, the MCS scores showed no significant decline after implantation and trended upward. The prostate V100 and baseline UCLA-PCI sexual function scores predicted a clinically significant decrease in sexual function in the late post-implantation period.

CONCLUSION

Most aspects of the HRQOL of PCA patients who underwent LDB improved to baseline. The results that V100 and baseline sexual function were predictors of late post-LDB may provide more accurate information for patients with preserved sexual function before treatment and for their partners.

Organ preservation following radiation therapy and concurrent intra-arterial low dose cisplatin infusion for advanced T2 and T3 laryngeal cancer: Long-term clinical results from a pilot study

BACKGROUND

This pilot study evaluated the long-term outcomes of patients with advanced T2 or T3 squamous cell carcinoma of the larynx (SCC-L) who were treated with selective intra-arterial cisplatin and concomitant radiotherapy (RADPLAT).

METHODS

We retrospectively investigated the data of 49 patients with advanced T2 or T3 SCC-L who received a RADPLAT regimen with low-dose cisplatin.

RESULTS

The 5-year locoregional control, disease-specific survival, and overall survival rates were 83.3%, 88.1%, and 82.6%, respectively, while the 5-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates were 89.6%, 79.4%, and 77.1%, respectively. The incidences of grade 3-4 hematologic and nonhematologic toxicities were 18% and 6%, respectively. Although two patients (4%) developed late toxicities within 5 years following RADPLAT, no other events were noted beyond 5 years.

CONCLUSION

This pilot study demonstrated that RADPLAT is feasible and safe and yielded favorable survival outcomes and functional laryngeal preservation in patients with advanced T2 or T3 SCC-L.

LEVEL OF EVIDENCE

3.

Tumoricidal effect and pain relief after concurrent therapy by strontium-89 chloride and zoledronic acid for bone metastases

OBJECTIVE

The purpose of this study was to investigate the palliative and tumoricidal effects of concurrent therapy of strontium-89 chloride (⁸⁹SrCl₂) and zoledronic acid (ZA) for painful bone metastases.

SUBJECTS AND METHODS

Fifty-one patients with painful bone metastases prostate cancer (n=17), lung cancer (n=13), breast cancer (n=12), other cancers (n=9) were treated. Bone metastases was confirmed in all patients by technetium-99m hydroxymethylene diphosphonate (^99mTc-HMDP) bone scintigraphy. The numeric rating scale (NRS) and performance status (PS) were used to assess the degree of pain and patients' physical condition. The extent of bone metastases was assessed with imaging modalities including CT, MRI and/or ^99mTc bone scintigraphy before treatment and 2 or 3 months after.

RESULTS

The pain relief response of ⁸⁹SrCl₂ with ZA for bone metastases was 94% (48/51) from 1 to 3 months after treatment. The tumoricidal effect of concurrent therapy by ⁸⁹SrCl₂ with ZA for painful bone metastases was 8/22 as shown by imaging modalities and the rate of non-progressive disease (non-PD) was 19/22. Pain due to bone metastases assessed with the NRS was significantly improved (P<0.001) in many types of primary cancer, including prostate, breast and lung cancers.

CONCLUSION

Concurrent therapy of ⁸⁹SrCl₂ with ZA may offer not only pain relief, but also a tumoricidal effect for painful bone metastases.

Predisposing factors for larynx preservation strategies with non-surgical multimodality treatment for locally advanced (T3-4) larynx, hypopharynx and cervical esophageal disease

AIM

To identify predisposing factors for larynx preservation strategies using non-surgical multimodality approaches.

PATIENTS AND METHODS

We retrospectively reviewed the records of 48 patients with T3-4 diseases (14 larynx, 19 hypopharynx, 15 cervical esophagus). Out of 48 patients, 33 refused surgery, and 15 were deemed inoperable, and a total of 25 were graded as T3 and 23 as T4. A total of 24 patients received induction chemotherapy. Radiotherapy was administered at a median dose of 61 Gy (range, 30-71 Gy). Concurrent chemotherapy was administered to all patients: intra-arterial infusion in 21, systemic infusion in 24, or both in 3.

RESULTS

Thirty-seven cases (77%) achieved a complete response. The 3-year local control, progression-free survival (PFS), overall survival (OS), and laryngeal preservation rates were 56%, 48%, 56%, and 73%, respectively. Tumor location, nodal involvement, and pre-treatment serum hemoglobin values were identified as predisposing factors for local control, PFS, and OS. Multivariate analysis revealed that the pre-treatment serum hemoglobin levels and tumor location were significant prognostic factors for PFS.

CONCLUSION

Tumor location and pre-treatment hemoglobin levels are important prognostic factors for PFS for non-surgical multimodal organ preservation treatment.

Multimodal approach for cervical esophageal carcinoma: role of neoadjuvant chemotherapy

AIM

To examine the outcome of patients with cervical esophageal cancer treated by a multimodal protocol.

PATIENTS AND METHODS

We retrospectively analyzed the outcome and prognostic factors for 20 patients with cervical esophageal cancer who received multimodal treatment at the Kurume University Hospital between 2003 and 2009. One case of stage I, seven of stage II and 12 of stage III disease (2 T1, 3 T2, 4 T3, 11 T4 and 14 N1) were included. Radiotherapy was administered at a median dose of 60 Gy (range=30-70 Gy). The median follow-up time was 32 months for surviving patients (14-94 months). Platinum-based neoadjuvant chemotherapy (NAC) was performed in 14 cases and all received chemoradiotherapy.

RESULTS

median survival was 20 months and overall survival rates at 1, 2, and 5-years were 70%, 60% and 30%, respectively. T-Category, length of the primary lesion, N-category, stage, hemoglobin levels and response to induction chemotherapy were statistically significant predisposing factors for overall survival rate. According to NAC response, 10 good responders (complete response or partial response) showed 2-year survival rates of 80% (5 survivors), whereas that for poor responder (stable disease and progressive disease) was 0% (p=0.006), respectively. Response to NAC was the only statistically significant predisposing factor for increased progression-free survival (p=0.03). Severe acute toxicities of grade 3 or more appeared in 5 patients; two grade 5 (esophageal perforations and lung fistula), one grade 4 (bilateral recurrent nerve palsy), and two grade three (pneumonitis and mucositis).

CONCLUSION

Although severe prognosis was identified for cervical esophageal cancer, good response to NAC indicates a good prognosis with organ preservation even for those with T4 tumor.

Relationship between sexual function and prostate-specific antigen bounce after iodine-125 permanent implant brachytherapy for localized prostate cancer

OBJECTIVE

To analyze clinical and dosimetric factors involved in prostate-specific antigen bounce in patients who underwent permanent implant brachytherapy for localized prostate cancer, and to study the relationships among prostate-specific antigen bounce, age and sexual function.

METHODS

Between March 2007 and April 2012, 116 patients with localized prostate cancer underwent permanent implant, iodine-125 brachytherapy. Patients receiving external-beam radiotherapy or who used phosphodiesterase-5 inhibitor pre- or post-treatment were excluded. Prostate-specific antigen bounce was defined as an increase of ≥0.2 ng/mL and ≥0.4 ng/mL above an initial prostate-specific antigen nadir followed by a subsequent decline to or below the initial nadir without treatment. Clinical and dosimetric factors involved in prostate-specific antigen bounce were analyzed using multivariate logistic regression analysis with the forced entry method.

RESULTS

The median age was 66 years (range 51-80 years), and prostate-specific antigen bounce on a prostate-specific antigen rise of ≥0.2 ng/mL occurred in 47 of the 116 participants (40.5%). The median period before the prostate-specific antigen bounce was 17.5 months (range 8-36 months). Patients with prostate-specific antigen bounce were younger and had higher sexual function before treatment (P = 0.003) than those who not show prostate-specific antigen bounce. Regression analysis results showed that young age and a high level of pretreatment sexual function were significant predictive factors for prostate-specific antigen bounce (P = 0.028 and P = 0.048).

CONCLUSION

Sexual function seems to be associated with a prostate-specific antigen bounce in patients undergoing permanent implant brachytherapy for localized prostate cancer, and it can be preserved after treatment if it is well present before treatment. Highly maintained sexual function after treatment might influence prostate-specific antigen bounce.

[Treatment with low-dose cyclophosphamide and radiation therapy for advanced non-small lung cancer in elderly patient]

The patient was a 70-year-old man who had unresectable locally advanced large-cell lung cancer with aorta and mediastimun invasion(T4N2M0). He had left shoulder pain and obstructive pneumonitis caused by lung cancer.We performed 60 Gy/ 35 Fr radiotherapy with concurrent low-dose cyclophosphamide(5mg/body/day). After chemoradiotherapy, the main tumor has been decreasing gradually. Seven years and six months after chemoradiotherapy, we detected the soft tissue mass lesion on his chest CT, but could not find abnormal accumulation on his 18F-FDG-PET. The local control was improved gradually and he had no respiratory symptoms or pain for a long period. There has been no recurrence for 10 years now. We recommend radiation and/or low-dose chemotherapy as useful treatments for the advanced non-small lung cancer in elderly patients.

Towards the genetic architecture of seed lipid biosynthesis and accumulation in Arabidopsis thaliana

We report the quantitative genetic analysis of seed oil quality and quantity in six Arabidopsis thaliana recombinant inbred populations, in which the parent accessions were from diverse geographical origins, and were selected on the basis of variation for seed oil content and lipid composition. Although most of the biochemical steps involved in lipid biosynthesis are known and the key genes have been identified, the regulation of the processes that results in the final oil composition and total amount is not understood. By using physically anchored markers it was possible to compare results across populations. A total of 219 quantitative trait loci (QTLs) were identified, of which 81 were significant at P<0.001. Some of these colocalise with QTLs identified previously, but many novel QTLs were also identified. The results highlight the importance of studying traits in multiple populations, which will lead to a better understanding of the contribution that natural variation makes to the genetic architecture of a phenotype.

The clinical characteristics and non-steroidal treatment for radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

PURPOSE

A rare and unique occurrence of radiation-induced pulmonary injury was observed outside the tangential field for early breast cancer treatment. The findings appeared to be idiopathic and were termed radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome. The goal of this study was to report and determine the incidence, analyze the characteristics of the pulmonary lesions on the images and also investigate the treatment methods.

MATERIALS AND METHODS

A retrospective analysis was conducted of 616 consecutive patients that underwent breast-conserving therapy (BCT) from January 1992 to December 2008. The patients were observed at least one year after radiotherapy for BCT. Radiotherapy was administered by 4 MV photons in all patients. The patients underwent chest X-rays periodically. If the BOOP syndrome was found, chest computed tomography (CT) were conducted to identify the characteristics of the pulmonary lesion outside the radiation field.

RESULTS

The incidence of the radiation-induced BOOP syndrome was 12 patients (1.9%). Six of them had fever and cough, 6 had no symptoms. The pulmonary lesions were classified into four patterns on chest CT. Progression of the pulmonary lesions observed on chest X-ray were classified into three patterns. BOOP syndrome appeared within 5.6 months after radiotherapy and completely disappeared within 12 months after its onset. Their clinical conditions were not severe and these pulmonary lesions disappeared gradually without use of steroids in our institution. There was no death caused by BOOP syndrome.

CONCLUSIONS

Although the incidence of BOOP syndrome and its associated prognosis are not significant, this clinical condition must be carefully followed using diagnositic imaging in order to not over administer steroids.

[A 23-year delayed locoregional recurrence of breast carcinoma following mastectomy]

A 77-year-old woman who underwent a right modified radical mastectomy 23 years ago with no further adjuvant treatment presented with a right chest wall mass (3 x 4 x 2 cm) at the scar. She had no symptoms nor metastasis. The laboratory data were normal including tumor marker. The mass was diagnosed as compatible with a local recurrence tumor from the previous breast cancer on the ultrasonography and chest CT. After obtaining her informed consent for the therapy, we performed 60 Gy/30 fr radiotherapy on the recurrent tumor on her right chest wall with concurrent oral chemo-endocrine therapy. The first regimens were tamoxifen 20 mg/day and 5'-DFUR 600 mg/day, followed by toremifene 80 mg/day and 5'-DFUR 600 mg/day, and then the tumor disappeared. But three years later, we found tumor regrowth. We changed the regimen, giving 5'-DFUR 1,200 mg/day and cyclophosphamide 100 mg/day for 2 weeks followed by a 1-week drug-free period, then added 10 Gy/5 fr radiotherapy and hyperthermia twice a week. Final regimens were anastrozole 1 mg/day and capecitabine 900 mg/day. The recurrent tumor decreased and the disease stabilized. After these therapies, she had very good quality of life. We recommend radiation and/or hyperthermia with concurrent oral chemo-endocrine therapy as useful for the delayed recurrence of elderly breast cancer after a modified radical mastectomy.

Tumorigenicity depends on angiogenic potential of tumor cells: dominant role of vascular endothelial growth factor and/or fibroblast growth factors produced by tumor cells

The aim of this study was to determine the role of tumor-derived angiogenic factors in solid tumor formation. We compared the angiogenic potential of tumorigenic and non-tumorigenic human tumor cell lines. All tumorigenic cell lines induced angiogenesis in vivo and their angiogenesis-inducing abilities were higher than those of the other non-tumorigenic cell lines. This in vivo angiogenic potential was well correlated with the in vitro endothelial cell growth-stimulating activity contained in the cell extract or conditioned medium of each cell line. The endothelial cell growth-stimulating activities of these cell lines were completely inhibited by neutralizing antibodies to basic fibroblast growth factor (bFGF), acidic FGF (aFGF) or vascular endothelial growth factor (VEGF). Furthermore, the levels of tumor-derived endothelial cell growth-stimulating activities depended on the amounts of angiogenic factors such as VEGF and bFGF produced by tumor cells. Although VEGF transcripts were detected in all of the cell lines by RT-PCR assay, the non-tumorigenic cell lines showed poor productivity of VEGF as well as FGFs and had less or non-potency for endothelial cell growth stimulation. These findings suggest that the increase in production of angiogenic factors by tumor cells is necessary for their in vivo angiogenic and tumorigenic potentials, and that VEGF and FGFs are the major mediators of tumor-induced angiogenesis.

Diffuse intrasinusoidal liver metastasis of small cell lung cancer causing fulminant hepatic failure: CT findings-a case report

A 65-year-old man with small cell lung cancer treated with two courses of chemotherapy manifested appetite loss and abdominal distention 10 days before admission. Helical CT scanning of the abdomen and pelvis disclosed marked hepatomegaly without any visible nodular lesion in the hepatic parenchyma. He died of severe liver dysfunction with multiorgan failure on the 20th hospital day. Autopsy revealed diffuse invasion of tumor cells into the sinusoid throughout the liver.

[Comparison of combined operation and nasal CPAP treatments for sleep disorders]

Uvulopalatopharyngoplasty (UPPP) and nasal CPAP are used for the treatment of obstructive sleep apnea syndrome (OSAS) in different institutions. Although OSAS results from an abnormality in the soft-palate, almost no reports have been made on the selection of UPPP or nasal CPAP procedures according to the type of abnormality. The most probable reason for this is that a comparison of treatment methods in individuals cases is difficult. We performed CPAP titration before and after operations, and compared the treatment methods, and evaluated the medical therapy.

METHOD

A sleep polygraph was performed on the first night, and cases diagnosed as OSAS received CPAP titration on the second night. The blocked region was identified by endoscopic examination. The results of the operation were evaluated after 1-2 months, and apnea hypopnea index (AHI) improvements of less than 50% received a second CPAP titration.

RESULTS

The operation results were poor for cases where endoscopic examination showed full-circumference palatal type, and good for soft palate and tonsillar type abnormalities. When endoscopic examinations were performed in conjunction with nasal CPAP, the treatment was observed to act on the soft palate and expand the air way in all cases. Nasal CPAP was effective in cases with full-circumference palatal abnormalities because in these cases, the pressure was caused by inflamma. Combined medical treatments were effective in cases where CPAP alone was ineffective because the pressure was too high.

Vascular endothelial growth factor overproduced by tumour cells acts predominantly as a potent angiogenic factor contributing to malignant progression

To elucidate the role of vascular endothelial growth factor (VEGF), an endothelial cell-specific mitogen, in tumour angiogenesis and malignant progression, an expression vector harboring human VEGF cDNA was stably transfected into three human cancer cell lines with poor VEGF productivity. Though their in vitro growth rate and intrinsic productivity of another angiogenic factor, basic fibroblast growth factor (bFGF), were not changed by transfection, those clones with higher VEGF production were endowed with tumorigenic and angiogenic potentials as follows: firstly, nontumorigenic, lung carcinoma QG90 cells having lower bFGF productivity acquired tumorigenicity as well as significant in vivo angiogenesis-inducing ability, secondly, tumorigenic colorectal carcinoma RPMI4788 cells having higher potency for bFGF production could form more vascularized solid tumour with faster growth rate and thirdly, oestrogen-dependent breast carcinoma MCF-7 cells, which did not produce detectable bFGF, acquired tumorigenicity even in the absence of oestrogen and the solid tumour growth rate was remarkably enhanced, accompanied with increased vascularization, in the presence of oestrogen. These results suggest that tumour progression closely depends on angiogenesis, and VEGF significantly contributes to malignant progression of a variety of tumour cells through its potent angiogenic activity, independent on the bFGF productivity of tumour cells.

Structural elucidation of aculeximycin. III. Planar structure of aculeximycin, belonging to a new class of macrolide antibiotics

The planar structure of aculeximycin (1) produced by Streptosporangium albidum has been determined by spectral methods and chemical degradations such as 1,8-diazabicyclo[5,4,0]undec-7-ene (DBU)-methanol reaction, ozonolysis, and periodative oxidation. The antibiotic consists of a 30-membered polyhydroxy lactone ring, an alpha, beta-unsaturated ester group, an intramolecular hemiketal, an oligosaccharide (aculexitriose), a neutral sugar and an amino sugar. The structure of aculeximycin is closely related to those of sporaviridins produced by Streptosporangium viridogriseum. We consider that aculeximycin and sporaviridins belong to a new class of macrolide antibiotics, which is different from the polyol macrolides produced by Streptomyces.

Mutagenicity study of the new cognition-enhancing agent nefiracetam

A new cognition-enhancing agent, nefiracetam (N-(2,6-dimethylphenyl)-2- (2-oxo-1-pyrrolidinyl) acetamide, DM-9384, CAS 77191-36-7) was studied for mutagenicity by using the following short-term in vitro and in vivo tests: 1. reverse mutation test (Ames method) on S. typhimurium and E. coli, 2. cytogenetic test on Chinese hamster cells, and 3. mouse micronucleus test. In the cytogenetic study, nefiracetam caused a slight but significant increase of chromosomal aberration at the highest dose in the 48 h treatment group, but no mutagenicity was observed with the same indicator in the in vivo micronucleus test. Furthermore, nefiracetam did not show any positive response in the reverse mutation test. These results suggest that nefiracetam has no biologically significant respectively relevant mutagenic potential.

Mutagenicity of the new quinolone antibacterial agent levofloxacin

A new quinolone antibacterial agent (-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10- (4-methyl-1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de][1,4]benzoxazine-6- carboxylic acid hemihydrate (levofloxacin, DR-3355, CAS 100986-85-4), was studied for mutagenicity using the following short-term in vitro and in vivo tests. 1.

IN VITRO STUDIES

reverse mutation test (Ames method) on S. typhimurium and E. coli; and HGPRT forward mutation test, cytogenetic test, and sister chromatid exchange (SCE) test, all on Chinese hamster cells. 2. In vivo studies: mouse micronucleus test, SCE test on mouse bone marrow cell, in vivo-in vitro unscheduled DNA synthesis (UDS) test on rat primary hepatocytes, and dominant lethal test in BDF1 mice. In the in vitro tests for SCE and for chromosomal aberration, DR-3355 gave dose-dependent positive responses, but no mutagenicity was observed in the same indicators of the in vivo studies, even at the maximum tolerated doses. This strongly suggested that DR-3355 would have no mutagenic effects when used in the treatment of infectious diseases. DR-3355 did not show any positive response in the reverse mutation test, the HGPRT mutation test, the in vivo-in vitro UDS test or the dominant lethal test. These results suggest that chemotherapy with DR-3355 should have no mutagenic effect in man.

The micronucleus test of benzo[a]pyrene with mouse and rat peripheral blood reticulocytes

The micronucleus test using peripheral blood reticulocytes (RETs) was evaluated in CD-1 and BDF1 mice and Sprague-Dawley rats treated with benzo[a]pyrene at two independent laboratories. The maximum incidence of micronucleated reticulocytes (MNRETs) appeared in both strains of mice 48 h after the treatment; interlaboratory differences were small. The incidence of MNRETs in BDF1 mice was higher than in CD-1 mice. In rats, significant increases of MNRETs with the maximum response at 72 h were detected when B[a]P was administered i.p.; slight but significant increases were observed at 24 h or later, with the maximum at 24-48 h, when it was administered p.o. These results suggest that the new method for the micronucleus test using circulating RETs will be useful in the detection of the clastogenicity of chemicals.

Multiple-dosing effects of benzo[a]pyrene in the mouse bone marrow micronucleus test

Multiple-dosing effects of benzo[a]pyrene (B[a]P) in the micronucleus test were studied using CD-1 male mice. Mice were treated orally once, twice or 3 times with 250, 500, 1000 or 2000 mg/kg, at 24-h intervals. Bone marrow cells were sampled 24 h after the last administration. The present study indicated that the incidence of polychromatic erythrocytes with micronuclei significantly increased more in the group of animals that received B[a]P twice than in those receiving it one or 3 times. The dose of 500 mg/kg B[a]P yielded the greatest response of any dose regimen.

Binding sites of interleukin-3-mimetic monoclonal autoantibodies derived from a MRL/lpr mouse

MRL/lpr mouse-derived interleukin-3 (IL-3)-mimetic monoclonal antibodies were examined for their binding sites. One of these five antibodies (B10, F8, F9, F12, H11), F9 interacted with the IL-3 receptor, as if it were an anti-idiotypic antibody; the IL-3-mimetic activity of F9 was blocked by a neutralizing rat monoclonal anti-IL-3 antibody. IL-3 mRNA was not detected in hybridoma F9, as analyzed by the S1 protection assay, Thus, the activity neutralized by the rat antibody is of the F9 antibody itself but not the IL-3 type. Such blocking was not observed with the IL-3-mimetic activity of the other MRL/lpr-derived monoclonal antibodies. On the other hand, the binding of all these monoclonal antibodies to IL-3-dependent cells was inhibited by each other and vice versa, as analyzed by two-color flow cytometry. This indicates that the binding sites of the five monoclonal antibodies are located so close to each other that the binding of one would interfere with the binding of any one of the others (since the binding experiment was done on ice, it is unlikely that the inhibition is due to down-modulation of the receptors). Taken together the results obtained by the enzyme digestion study, we discussed that all five IL-3-mimetic monoclonal antibodies are directed to the IL-3 receptor, but only F9 binds to the portion directly responsible for the binding of IL-3 and the other antibodies (B10, F8, F12, H11) bind to different portions, respectively, which are adjacent or overlapping to the binding site of F9.

Micronucleus test with potassium chromate(VI) administered intraperitoneally and orally to mice

The effect of route of administration, intraperitoneal (i.p.) or oral gavage (p.o.), in the mouse micronucleus test was studied with K2CrO4 in 2 mouse strains (MS/Ae and CD-1). A simplified acute toxicity test to estimate the toxic dose levels of K2CrO4 showed that the LD50S were 50 mg/kg i.p. and 300 mg/kg p.o. for MS/Ae and 32 mg/kg i.p. and 180 mg/kg p.o. for CD-1. Based on results of a pilot micronucleus test to determine appropriate dose levels and the optimal sampling time, it was decided to sample bone marrow cells of both strains of mice 24 h after i.p. doses of 10-80 mg/kg and p.o. doses ranging from 20 to 320 mg/kg. K2CrO4 administered i.p. induced micronucleated polychromatic erythrocytes (MNPCEs) dose-dependently in both strains. In contrast, when administered p.o. the chemical failed to induce MNPCEs. These results suggest that this difference between i.p. and p.o. routes is related to a difference of absorption or metabolic fate of chromate in vivo.

Mutagenicity studies of muroctasin

A synthetic muramyl dipeptide derivative N2-[(N-acetylmuramoyl)-L-alanyl-D-isoglutaminyl]-N6-stearoyl-L-lysine (MDP-Lys(L18), muroctasin) was studied for mutagenicity using the Ames method, in vitro cytogenetics and micronucleus test. MDP-Lys(L18) had no mutagenic effect on S. typhimurium (TA1535, TA1537, TA1538, TA98 and TA100) or E. coli (WP2 uvrA) in the reverse mutation assay. In the cytogenetic study, MDP-Lys(L18) had no effect on the chromosomes of the Chinese hamster cells at cytotoxic doses. Single subcutaneous treatment of MDP-Lys(L18) at dose levels of 3.5, 35 or 350 mg/kg in the mouse micronucleus test did not increase the incidence of micronucleated polychromatic erythrocytes. These results show that MDP-Lys(L18) has no demonstrable mutagenic potential.

Monoclonal autoantibodies with interleukin 3-like activity derived from a MRL/lpr mouse

Hybridomas that secrete monoclonal antibodies with interleukin 3 (IL-3)-like activity were established from spleen cells of a nonimmunized autoimmune MRL/lpr mouse. Five of the monoclonal antibodies thus obtained bound selectively to IL-3-dependent cells and supported their growth. These monoclonal antibodies inhibited the binding of IL-3 to FDC-P2 cells and vice versa. Thus, these antibodies were probably directed to IL-3 receptor sites, or at least to some cell surface proteins related to the growth of the IL-3-dependent cells. These MRL/lpr-derived monoclonal antibodies reacted strongly with cells from bone marrow, spleen, and lymph node of MRL/lpr mice, but minimally with such cells of MRL/+ or BALB/c mice. The findings were consistent with our earlier suggestion that the IL-3-like activity in MRL/lpr sera is not caused by IL-3 itself but is associated with IgG that is probably an autoantibody directed to the IL-3 receptor.

Monoclonal autoantibodies with interleukin 3-like activity derived from a MRL/lpr mouse

Hybridomas that secrete monoclonal antibodies with interleukin 3 (IL-3)-like activity were established from spleen cells of a nonimmunized autoimmune MRL/lpr mouse. Five of the monoclonal antibodies thus obtained bound selectively to IL-3-dependent cells and supported their growth. These monoclonal antibodies inhibited the binding of IL-3 to FDC-P2 cells and vice versa. Thus, these antibodies were probably directed to IL-3 receptor sites, or at least to some cell surface proteins related to the growth of the IL-3-dependent cells. These MRL/lpr-derived monoclonal antibodies reacted strongly with cells from bone marrow, spleen, and lymph node of MRL/lpr mice, but minimally with such cells of MRL/+ or BALB/c mice. The findings were consistent with our earlier suggestion that the IL-3-like activity in MRL/lpr sera is not caused by IL-3 itself but is associated with IgG that is probably an autoantibody directed to the IL-3 receptor.