Effects of an elemental diet to reduce adverse events in patients with esophageal cancer receiving docetaxel/cisplatin/5-fluorouracil: a phase III randomized controlled trial-EPOC 2 (JFMC49-1601-C5)

Background

Oral mucositis (OM) is an unpleasant adverse event in patients receiving chemotherapy. A prospective feasibility study showed that elemental diet (ED), an oral supplement that does not require digestion, may prevent OM. Based on this, we established a central review system for oral cavity assessment by dental oncology specialists blinded to background data. We used this system to elucidate the preventive effect of an ED against OM in patients with esophageal cancer receiving docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy.

Patients and methods

In this phase III, multicenter, parallel-group, controlled trial, patients consuming a normal diet orally were randomly assigned (1 : 1) to receive two cycles of DCF with (group A) or without (group B) an ED (Elental® 160 g/day). We assessed the incidence of grade ≥2 OM evaluated by two reviewers, changes in body weight, prealbumin, C-reactive protein, and DCF completion rate based on ED compliance.

Results

Of the 117 patients randomly assigned to treatment, four failed to start treatment and were excluded from the primary analysis; thus, groups A and B comprised 55 and 58 patients, respectively. There were no significant differences in background characteristics. Grade ≥2 OM was observed in eight (15%) and 20 (34%) patients in groups A and B, respectively (P = 0.0141). Changes in body weight and prealbumin during the two DCF cycles were significantly higher in group A than B (P = 0.0022 and 0.0203, respectively). During the first cycle, changes in C-reactive protein were significantly lower in group A than B (P = 0.0338). In group A (receiving ED), the DCF completion rate was 100% in patients with 100% ED compliance and 70% in patients failing ED completion (P = 0.0046).

Conclusions

The study findings demonstrate that an ED can prevent OM in patients with esophageal cancer receiving chemotherapy.

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Patients receiving docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy commonly develop oral mucositis (OM).

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An elemental diet (ED) was able to prevent OM in patients with esophageal cancer receiving DCF.

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Grade ≥2 OM was observed in 15% of patients receiving the ED versus 34% of those not receiving the ED (P = 0.0141).

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Body weight was maintained in the ED group, and hematologic toxicities were lower, compared with the non-ED group.

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The DCF completion rate significantly correlated with ED compliance (P = 0.0046).

Role of definitive chemoradiotherapy using docetaxel and 5-fluorouracil in patients with unresectable locally advanced esophageal squamous cell carcinoma: a phase II study

Definitive chemoradiotherapy (CRT) with docetaxel (DOC) and 5-fluorouracil (5-FU) is a unique regimen for esophageal cancer. In this prospective phase II study, antitumor effect and safety of CRT using DOC and 5-FU for inoperable locally advanced esophageal cancer were evaluated. DOC 7.5 mg/m² was infused on days 1, 8, 22, and 29. 5-FU 250 mg/m² /day was infused continuously on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, and 43-45. Radiotherapy was given to 66 Gy in 33 fractions. Eleven patients with thoracic and five with cervical esophageal cancer were eligible. All patients had esophageal squamous cell carcinoma (ESCC). The response rate was 94%, with complete response in five patients (31%) and partial response in 10 (63%). Hematologic toxicity was mild; only one patient (6%) had Grade 1 leukopenia. Nonhematologic Grade 3 or higher adverse events were esophagitis (31%), anorexia (6%), and esophago-bronchial fistula (6%). No treatment-related deaths occurred. The median time to progression was 20 months and overall 3-year and 5-year survival were 44% and 31%, respectively. Definitive CRT using DOC and 5-FU could be performed safely, and it demonstrated a favorable antitumor effect for ESCC. This regimen might be indicated in patients in whom it is desirable to avoid myelosuppression and progression of renal impairment.

Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

We compared the surgical outcomes between 114 patients who did not receive neoadjuvant therapy (group 1) and 92 others who received neoadjuvant chemoradiotherapy (nCRT) (group 2), and assessed the preoperative and surgical factors that influence postoperative morbidity to determine the impact of nCRT on morbidity and mortality after esophagectomy via cervical, right transthoracic, and abdominal approaches. The overall postoperative morbidity rates were 44.7% and 55.4% in groups 1 and 2, respectively (P = 0.13). Rates of anastomotic leak (8.8% vs. 16.3%; P = 0.10), pneumonia (9.6% vs. 13.0%; P = 0.44), recurrent nerve palsy (15.8% vs. 10.9%; P = 0.31), and all other complications did not significantly differ between the groups. Multivariable analysis revealed cervical lymph node dissection (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01-3.84; P = 0.047) as the sole independent covariate for overall morbidity. Furthermore, a history of cardiovascular disease (OR, 2.90; 95% CI, 1.03-8.24; P = 0.045), the retrosternal reconstruction route (OR, 15.15; 95% CI, 3.56-62.50; P = 0.0002), and a longer surgical duration (OR, 1.01; 95% CI, 1.002-1.02; P = 0.01) were independent covariates for anastomotic leakage, and advanced age (OR, 1.08; 95% CI, 1.01-1.15; P = 0.02) and lower body mass index (OR, 1.16; 95% CI, 1.01-1.33; P = 0.04) were independent covariates for pneumonia. However, whether or not patients received nCRT was irrelevant. We found that nCRT is safe for three-incision esophagectomy and it does not increase the incidence of postoperative morbidity and mortality relative to esophagectomy alone.

[Intrabronchial leiomyoma treated with endoscopic resection; report of a case]

A 63-year-old female presented with an abnormal shadow on a chest X-ray. A serial chest computed tomography (CT) showed ground-glass attenuation, which measured 2 cm on S1+2 of the left lung. When bronchofiberscopy was performed to make a diagnosis, a tumor with a smooth surface was revealed which obstructed the right middle bronchus. Leiomyoma was thus diagnosed. At first, a wide wedge resection of left lung tumor was performed. Secondly, a bronchus tumor was successively removed using a high frequency snare and a laser by a bronchofiberscopy. Her postoperative course was uneventful. Leiomyoma of the bronchus is rare benign tumor. This report describes the performance of a resection using bronchofiberscopy with good results.

Human leukocyte antigen-G-expressing cells differently modulate the release of cytokines from mononuclear cells present in the decidua versus peripheral blood

PROBLEM

To better understand the role of human leukocyte antigen (HLA)-G in regulating the T helper (Th)1/Th2 cytokine balance, one of key conditions in determining the fate of pregnancy, we asked whether the presence of HLA-G protein altered the release of cytokines from both decidual mononuclear cells and peripheral blood mononuclear cells (PBMCs).

METHOD OF STUDY

The amounts of cytokines released from decidual mononuclear cells and PBMCs were compared in the presence or absence of HLA-G-expressing cells.

RESULTS

When cocultured with HLA-G-expressing cells, the amounts of tumor necrosis factor-alpha and interferon-gamma released from decidual mononuclear cells and PBMCs were decreased, while the amounts of interleukin (IL)-4 from PBMCs was increased, with IL-4 release from decidual mononuclear cells being unchanged.

CONCLUSIONS

Upon contact with HLA-G, decidual mononuclear cells, and PBMCs as well, modulate their ability to release cytokines in a way that may shift the Th1/Th2 balance towards relative Th2 dominance, suggesting a role for HLA-G in maintaining pregnancy.

Generation of periventricular leukomalacia by repeated umbilical cord occlusion in near-term fetal sheep and its possible pathogenetical mechanisms

Periventricular leukomalacia (PVL) is a major cause of cerebral palsy. However, pathogenetic mechanisms of PVL have not been fully understood. Although it has been postulated that umbilical cord compression is related to the development of PVL, no animal experiments clearly demonstrated an association of umbilical cord occlusion with 'periventricular' white matter lesions. The purpose of this study is to determine whether umbilical cord occlusions could produce periventricular white matter lesions in fetal sheep and to examine how changes in fetal cardiovascular and metabolic variables are related to the induction of brain damage. Fourteen near-term fetal sheep underwent umbilical cord occlusion (3-min total cord occlusions 5 times at 5-min intervals). Dissections performed 24 h after cord occlusion revealed that periventricular white matter lesions were produced in 7 out of 14 sheep fetuses. According to the pattern of brain damage, we classified the fetal sheep into three groups: 5 fetuses with dominant lesions in the periventricular white matter (group I), 4 fetuses with brain lesions in the cerebral cortex and thalamus (group II) and 5 fetuses with no or minimal brain lesions (group III). Group I showed higher blood pressure and higher plasma lipid peroxide levels before cord occlusion compared to the other groups, while group II showed systemic hypotension during cord occlusion. No significant differences in changes in pH, PaCO2, PaO2 and heart rate were found between the three groups. It is speculated that PVL might be produced by an association of preexisting chronic circulatory instability with an acute episode of severe repetitive cord occlusion.

Theoretical basis for herbal medicines, Tokishakuyaku-san and Sairei-to, in the treatment of autoimmunity-related recurrent abortion by correcting T helper-1/T helper-2 balance

PROBLEM AND METHOD OF STUDY

To get insight into the basis for the empirical usage of herbal medicines in the treatment of recurrent abortion, we examined whether Tokishakuyaku-san (Toki) and Sairei-to (Sai) modulate T helper-1 (Th1) and T helper-2 (Th2) cytokine release from peripheral blood mononuclear cells (PBMCs). The effects of these medicines were investigated as related to human leukocyte antigen (HLA)-G, a non-classical HLA class I antigen expressed on trophoblasts and a putative crucial player involved in fetomaternal immune interplay.

RESULTS

Toki and Sai increased the release of Th1 group cytokines, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma while preserving the inhibitory effect of HLA-G on the release of these cytokines. As for Th2 group cytokine release, Toki was without effect in modulating interleukin (IL)-4 release, regardless of the presence of HLA-G, whereas Sai nullified the effect of the presence of HLA-G to stimulate the release of IL-4 without affecting its release in the absence of HLA-G.

CONCLUSION

Toki and Sai may have therapeutic potential, particularly in autoimmunity-related recurrent abortion where Th2 response is pathologically enhanced, but not in recurrent abortion involving alloimmune fetomaternal derangement, a condition of, rather, an enhanced Thl response.

Immunotherapy prevents recurrent abortion without influencing natural killer receptor status

PROBLEM

We assessed the expression of natural killer (NK) receptors in recurrent aborters before and after immunotherapy using their husbands' peripheral blood mononuclear cells (PBMCs).

METHOD OF STUDY

Using stored PBMCs from recurrent aborters before and after the immunotherapy, the expression of NK receptors, CD158a, CD158b, CD159 and CD94, were analyzed using monoclonal antibodies for respective receptors. The diversity of killer activatory receptors (KARs) and killer inhibitory receptors (KIRs) was also examined using reverse transcriptase-polymerase chain reaction (RT-PCR)-single strand conformation polymorphism (SSCP) method.

RESULTS

In recurrent aborters, no apparent changes in NK receptor expression and the balance between KARs and KIRs were found before and after the immunotherapy.

CONCLUSION

The allo-human leukocyte antigen (HLA)-stimulation caused by the immunotherapy for recurrent aborters did not affect the expression of NK receptors and the ratio of KARs to KIRs regardless of the outcome of subsequent pregnancies, suggesting that recurrent aborters may benefit from the immunotherapy through mechanisms unrelated to alteration in NK receptor status.

Proposition for assessment of quantitative whole-body autoradiography

To assess recent improvements in quantitative whole-body autoradioluminography (QWBA), the entire QWBA procedure was divided into five processes. Each process was then investigated carefully to determine whether there were any problems in defining a clear standard operating procedure. Results show that use of two instruments, Macro-Cut, Leica, Germany, and the Bioimaging Analyzer with IP, Fuji Photo Film, was essential to produce macroautoradiographs for QWBA data. The remaining problems include the process for freezing the animal carcass and the process for freeze-drying or lyophilizing the frozen sections of the biomaterials. In addition, a desirable standard operating procedure (SOP) must be developed for assessing QWBA. This article proposes satisfactory SOPs with sufficient clarification and experimental proofs to ensure regulatory compliance for the QWBA technique.

Early axonal and glial pathology in fetal sheep brains with leukomalacia induced by repeated umbilical cord occlusion

We conducted a chronic preparation experiment involving near term fetal sheep to evaluate the contribution of umbilical cord occlusion to fetal brain injury. In experimental groups (n = 11), complete cord occlusion for 3 min followed by 5 min release, repeated 5 times were performed at 3 days after initial surgery. Instrumental cases without cord occlusion (n = 3) and uninstrumental twins (n = 6) were also examined as controls. Multiple necrotic foci predominantly in the periventricular white matter were found in the fetal brains examined at 1-3 days after cord occlusion. To estimate the contribution of early axonal and glial reaction to brain injury the following immunohistochemical study was performed. In the lesions, coagulation necrosis, axonal swelling and microglial activation were demonstrated with amyloid precursor protein or ionized calcium binding adapter molecule 1 immunohistochemistry. The induction of tumor necrosis factor alpha and inducible nitric oxide synthase were also detected immunohistochemically in the microglia at 1 and 3 days after cord occlusion. In contrast, the reaction of glial fibrillary acidic protein positive astrocytes was faint at 1 day after occlusion, but the induction of cyclooxygenase-2 was observed. These findings suggest the glial reaction of cytokines and free radicals induced by fetal hypoxia may contribute to the occurrence of brain injury.

Effects of sairei-to and tokishakuyaku-san on cytokine release from peripheral blood mononuclear cells upon recognition of HLA-G protein in the treatment of recurrent abortion

Human leukocyte antigen (HLA)-G has been shown to play a role in establishing pregnancy through the mechanism of modulating cytokine secretion from maternal lymphocytes. To elucidate the mechanisms of actions of the herbal medicines, Sairei-to and Tokishakuyaku-san, in the treatment of recurrent abortion, we investigated whether these medicines modulate cytokine secretion from peripheral blood mononuclear cells (PBMCs) upon recognition of HLA-G protein on trophoblasts. Sairei-to and Tokishakuyaku-san increased the interleukin (IL)-1 beta and tumor necrosis factor (TNF)-alpha secretion and decreased the IL-3 secretion from PBMCs regardless of whether these cells recognized HLA-G protein or not. Accordingly, Sairei-to nullified the effects of HLA-G to reduce the secretion of IL-1 beta and TNF-alpha and to enhance the secretion of IL-3. Tokishakuyaku-san also abolished the effect of HLA-G to reduce IL-1 beta and TNF-alpha secretion but did not affect the increase in IL-3 secretion. Thus, it is conceivable that Sairei-to may normalize Th1/Th2 balance by enhancing Th1 polarization in autoimmunity-related recurrent abortion in which Th1/Th2 balance might be shifted towards Th2 polarization. However, the mechanisms of action of Tokishakuyaku-san when used in treating unexplained recurrent abortion, cannot be explained only by the Th1/Th2.

Quantitative assessment of human leukocyte antigen-G protein in amniotic fluid by a double-determinant enzyme-linked immunosorbent assay using anti-human leukocyte antigen-G-specific antibody '87G'

PROBLEM

The objective of this study was to establish an enzyme-linked immunosorbent assay (ELISA) system, in an attempt to quantify the amount of human leukocyte antigen (HLA)-G protein in amniotic fluid.

METHOD OF STUDY

We established a double-determinant ELISA system using the anti-HLA-G specific mouse monoclonal antibody '87G' as a capture antibody and the horseradish-peroxidase labeled rabbit anti-human beta2-microglobulin antibody as a detection antibody. We then measured the concentration of HLA-G protein in amniotic fluid samples from nine normal second-trimester pregnant women and in serum samples from eight normal males.

RESULTS AND CONCLUSION

HLA-G protein was detected in amniotic fluid at a concentration of 275 ng/ml (197-343 ng/ml) (median value and 95% confident range), whereas the concentration of HLA-G protein in male serum was below the minimum detection level.

The expression of human leukocyte antigen-G on trophoblasts abolishes the growth-suppressing effect of interleukin-2 towards them

PROBLEM

We have shown the attenuated human leukocyte antigen (HLA)-G expression on trophoblasts and an aberrant expression of interleukin (IL)-2, a cytotoxic cytokine, in decidual tissue in preeclampsia, where deteriorated trophoblastic invasion into decidual layers may constitute a crucial pathogenesis. We hypothesized that the absence of HLA-G might make trophoblasts susceptible to compromise by IL-2.

METHOD OF STUDY

We analyzed the growth of HLA-G-negative and positive cell lines, all of which possessed IL-2 receptors, in the culture with or without IL-2 supplementation.

RESULTS

The proliferation of HLA-G positive trophoblastic cell lines (BeWo and JEG-3) was not influenced by the addition of IL-2, whereas a HLA-G-negative trophoblastic cell line (JAR) exhibited significantly decreased proliferation when cultured with IL-2. Interestingly, the transfection of JAR cells with HLA-G completely eliminates the growth-inhibitory effect of IL-2.

CONCLUSION

The expression of HLA-G may commit trophoblasts to evade cell damage by IL-2, which may be relevant to maternal tolerance of the fetus during pregnancy and its derangement as exemplified by preeclampsia.

Analysis of human leukocyte antigen-G polymorphism including intron 4 in Japanese couples with habitual abortion

PROBLEM

The purpose of this study was to clarify whether there is a difference between the allele frequency of human leukocyte antigen (HLA)-G in healthy Japanese people and that of Japanese couples with habitual abortion.

METHOD OF STUDY

Exons 2, 3, 4, and intron 4 of the HLA-G gene were analyzed in 20 couples with habitual abortion, using polymerase chain reaction (PCR)-single-strand conformation polymorphism (SSCP) analysis. Intron 4 of the HLA-G gene was also analyzed in 54 healthy individuals. The nucleotide sequence of the PCR product of intron 4 was further determined by direct sequencing.

RESULTS

Two kinds of nucleotide sequence were identified in intron 4 of the HLA-G gene, one of which was identical to that of HLA-G*01011, and the other was identical to that of HLA-G*01012, G*01013, and G*0104. The frequency of each allele in affected women and their husbands did not significantly differ from that of healthy individuals, and no mutation was found in any affected couple.

CONCLUSION

HLA-G allelic abnormality seemed to have little, if any, implication in the pathogenesis of habitual abortion.

Peripheral blood mononuclear cells from women with recurrent abortion exhibit an aberrant reaction to release cytokines upon the direct contact of human leukocyte antigen-G-expressing cells

PROBLEM

In search for pathogenesis of recurrent abortion, we examined whether lymphocytes/macrophages from women with recurrent abortion exhibited an aberrant ability to release cytokines upon the direct contact of human leukocyte antigen (HLA)-G.

METHOD OF STUDY

The amounts of cytokines released from peripheral blood mononuclear cells (PBMCs) from women with recurrent abortion were compared with those from normal multiparous women or normal nulligravidous women when cocultured with or without HLA-G-expressing target cells.

RESULTS

When cocultured with HLA-G-expressing target cells, the amount of interleukin-1 beta released from PBMCs was increased in recurrent aborters whereas it decreased in both normal multiparous and nulligravidous women. The amount of interleukin-3 released from PBMCs did not differ with or without HLA-G-expressing cells in recurrent aborters, whereas it increased in the presence of HLA-G-expressing cells in normal controls. The amount of tumor necrosis factor-alpha released from PBMCs was decreased in the presence of HLA-G-expressing cells in both recurrent aborters and normal controls.

CONCLUSION

The aberrant reaction of maternal lymphocytes/macrophages in releasing cytokines upon the contact of HLA-G expressed on trophoblasts may impact negatively on trophoblastic growth, which may be pathogenic in recurrent abortion.

Secretion of interleukin-2 from unstimulated peripheral blood mononuclear cells is a possible pathogenic mechanism in recurrent abortion

PROBLEM

The objective of this study was to evaluate the activated status of helper T cells in women with recurrent abortion.

METHOD OF STUDY

The spontaneous secretion of interleukin (IL)-2 from peripheral blood mononuclear cells (PBMCs) obtained from 12 women with primary partner-specific recurrent abortion and 7 normal females and 10 normal males was measured.

RESULTS

IL-2 concentrations in medium conditioned with PBMCs from the recurrent abortion group were 1.44 +/- 0.32 (mean +/- standard deviation) U/ml, whereas those from the normal female and male groups were below the minimum detectable concentration.

CONCLUSION

The fact that PBMCs from recurrent aborters spontaneously secrete IL-2 suggests that helper T cells are activated in recurrent aborters.

Evidence for basic fibroblast growth factor as a crucial angiogenic growth factor, released from human trophoblasts during early gestation

The objective of this study was to clarify the possible angiogenesis-promoting factors from human trophoblasts in early stage gestation. The existence of angiogenic growth factors such as basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in the condition medium from human villous trophoblasts was determined. Biological activity of angiogenic growth factors released by trophoblasts was examined using vascular endothelial cell lines. The condition medium from trophoblasts enhanced the growth of endothelial cells. Although cultured trophoblasts exhibited immunoreactive products for both bFGF and VEGF in the cytoplasm, only bFGF was detected in the condition medium by ELISA. The growth-enhancing activity of the condition medium was eliminated completely by the addition of anti-bFGF antibody but not with anti-VEGF antibody. Thus, trophoblastic cells seem to play an important role in extensive angiogenesis occurring in early gestation, mainly by releasing bFGF but not VEGF.

Immunotherapy before and during pregnancy improves pregnancy outcome in women who suffer from recurrent abortion and did not benefit from immunotherapy before pregnancy

PROBLEM

The appropriate modality of immunotherapy with the husband's mononuclear cells in women with a history of recurrent abortion who aborted despite the immunotherapy performed before pregnancy was explored.

METHOD OF STUDY

Nineteen patients who had suffered from recurrent abortion who had received the immunotherapy only before pregnancy and had aborted were treated with further immunotherapy performed either only before pregnancy or twice: before and during pregnancy.

RESULTS

In 9 out of the 19 women who received further immunotherapy before pregnancy, 2 had healthy babies and 7 aborted again. In the remaining 10 patients who received further immunotherapy twice, before and during pregnancy, 8 had healthy babies and 2 aborted again.

CONCLUSION

Our results indicate that immunotherapy performed before and during pregnancy produces a better outcome compared with that performed only before pregnancy, especially in patients who showed no benefit from the immunotherapy performed only before pregnancy.

Evidence for an elevation in serum interleukin-2 and tumor necrosis factor-alpha levels before the clinical manifestations of preeclampsia

PROBLEM

The purpose of this study is to clarify whether the disruption of immune regulation occurs in early pregnancy before the clinical manifestations of preeclampsia.

METHOD OF STUDY

The serum concentrations of interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) were determined by using enzyme-linked immunoadsorbent assay (ELISA) in the first trimester of pregnancy in women who had preeclampsia develop after 28 weeks of pregnancy (preeclamptic group) and in women who completed pregnancy uneventfully (control group).

RESULTS

Serum concentrations of both IL-2 and TNF-alpha in the first trimester of the preeclamptic group were significantly higher than those of the control group.

CONCLUSIONS

That the perturbation of feto-maternal immune regulation may precede the clinical manifestations of preeclampsia, which may be of relevance in the development of preeclampsia, is suggested.

Pathogenetic implication of interleukin-2 expressed in preeclamptic decidual tissues: a possible mechanism of deranged vasculature of the placenta associated with preeclampsia

PROBLEM

The purpose of this study is to clarify whether IL-2 expressed in the decidua in preeclampsia affects the angiogenesis of the placenta.

METHOD OF STUDY

We investigated the angiogenic substances released from human trophoblasts obtained from early pregnancy that had been pretreated with either IL-2, non-activated lymphocytes from peripheral blood mononuclear cells (PBMCs), decidual lymphocytes, or these lymphocytes activated by lymphokine (LAK cells). Angiogenic activity was determined by evaluating the ability of growth-promotion of cultured human microvascular endothelial cells (HMvECs) using MTT assay.

RESULTS

Trophoblasts pretreated with IL-2 or non-activated lymphocytes, irrespective of their origin, released angiogenic factor similar to those without pretreatment. However, trophoblasts pretreated with LAK cells released less angiogenic factor compared with those without pretreatment.

CONCLUSIONS

Interleukin-2 (IL-2) expressed in preeclamptic decidua might reduce the angiogenic substances arising from trophoblasts by inducing LAK-cells from decidual lymphocytes, which might be relevant to deranged vasculature of the placenta, a characteristic histology in preeclampsia.

Differential clinical courses of pregnancies complicated by diabetes insipidus which does, or does not, pre-date the pregnancy

We present six cases of diabetes insipidus (DI) complicating pregnancy. In three cases, DI was manifested during pregnancy and required the administration of desmopressin acetate (1-desamino-8-D-arginine vasopressin, DDAVP). All these cases exhibited abnormal laboratory data such as an elevation of liver enzymes or a decrease in serum antithrombin III. The remaining three cases had suffered from DI before pregnancy which was well controlled on DDAVP. The clinical courses of these pregnancies were all uneventful subsequent to therapy. If DI is first recognized during pregnancy, attention should be paid to the possibility of abnormal liver function and eclampsia.

A case of pregnancy in a woman with cloacal dysgenesis and a rudimentary uterine horn

Cloacal dysgenesis is frequently associated with uterine anomalies. We report a case of pregnancy which resulted in an abortion in a woman with a persistent cloaca. Presumptive diagnosis before operation was ectopic pregnancy of the left tube. Postoperatively, the site of implantation of the conceptus was found to be the cavity of a unicornuate uterus in association with a rudimentary horn, the presence of which misled us to diagnose an ectopic pregnancy.

Studies on the quantitative autoradiography. III. Quantitative comparison of a novel tissue-mold measurement technique "paste-mold method," to the semiquantitative whole body autoradiography (WBA), using the same animals

A novel preparation technique, so called "Paste Mold," was devised for organ and tissue distribution studies. This is the most powerful by joining with autoradioluminography (ARLG), which was established and validated recently in the working group of Forum '93 of Japanese Society for study of xenobiotics. A small piece (10-50 mg) of each organ or tissue was available for measuring its radioactive concentration and it was sampled from the remains of frozen carcass used for macroautoradiography (MARG). The solubilization of the frozen pieces was performed with mixing a suitable volume of gelatine and strong alkaline solution prior to mild heating kept at 40 degrees C for a few hours. After that, the tissue paste was molded in template pattern to form the small plates. The molded plates were contacted with Imaging plate (IP) for recording their radioactive concentration. The recorded IP was processed by BAS2000. The molded plate was formed in thickness of 200 microns, so called infinit thickness against soft beta rays, and therefore the resulting relative intensities, represented by (PSL-BG)/S values, indicated practically responsible ratio of the radioactive concentration in organs and tissues, without any calibulation for beta-self absorption coefficiency. On the other hand, the left half body of the frozen carcass was used for making whole body autoradiography (WBA) before the Paste-Mold preparation. Comparison was performed for difference in (PSL-BG)/S values of organs and tissues between frozen and dried sections. A good concordance in relative intensities, (PSL-BG)/S by the Paste-Mold preparation was given with those by the frozen sections rather than dried sections.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electron microscopic observation on intracellular connective structures during healing of the tracheal mucous epithelia of guinea pigs--by means of tissue culture]

Healing processes of the tracheal epithelia after minor mechanical injury in vitro were morphologically investigated by electron microscopy. Actin filaments in the epithelia, at the injured site, were observed by phalliodin. The results are as follows: 1) The injured area was covered with one layer of epithelium within 48 hours and there were no mitotic figures. 2) The epithelial cells at the healing site were squamous and well developed. 3) Actin-filaments could be observed with well developed interdigitation. In conclusion these findings suggest that areas of minor injury heal by sliding of cells surrounding the injured area. The development of interdigitation is considered to play an important role in this process. It seems that actin observed at the site of interdigitation development plays some role in this healing process.

[BrdU immunohistochemical observation on regeneration of tracheal epithelia using tissue culture method]

The growth process of tracheal epithelia was observed by primary cell culture method using BrdU. Cells stained with BrdU, that showed mitotic activity, were nonciliary cells and BrdU was not found in ciliated (differentiated) cells. The dividing cells and the mature cells could be distinguished by BrdU. Thus, it was demonstrated that BrdU could be used as an index for investigating the growth process of basal cells. Tissue culture of the tracheal rings after mucosal injury was performed. On the third day post-injury, the cells stained with BrdU and the migrating epithelia were observed in the border region between the non-injury and injury site. On the seventh day post-injury, healing was completed. The tissue culture method using BrdU is useful for observing the healing process of the tracheal mucous membrane.

Localization of nitric oxide synthase-immunoreactive neurons in the solitary nucleus and ventrolateral medulla oblongata of the rat: their relation to catecholaminergic neurons

The morphological relationship between nitric oxide (NO) and catecholamines in the solitary nucleus (SOL) and ventrolateral medulla oblongata (VLM) was studied by a double immunostaining method with antibodies against NO synthase (NOS), an NO-synthesizing enzyme, and tyrosine hydroxylase (TH), a catecholamine-synthesizing enzyme. Although NOS- and TH-immunoreactive neurons were widely distributed in the SOL and VLM, these immunoreactivities did not coexist in any single neurons. NOS-immunoreactive neurons formed clusters in some restricted regions, i.e. in the medial subnucleus of the SOL, where both NOS- and TH-immunoreactive neurons showed a complementary distribution. These findings suggest that NO-producing neurons constitute a subclass that is distinct from that of catecholaminergic neurons.

[Tissue culture of guinea pig middle ear epithelium--morphological characterization and proliferative activities of cultured cells on fibroblast-reorganized collagen gels]

Long-term culture of the middle ear epithelium of guinea pigs was carried out on reconstituted floating collagen matrix. Fibroblasts established from the abdominal skin dermis of allogenic animals were used to reorganize hydrated collagen gels into a dermal-like matrix. The explants placed on the surface of these matrices were composed of pseudostratified columnar cells with polygonal flat outgrowth sheets, which could be maintained for up to one month. In contrast, with simple hydrated collagen gel, no lysis of the substrate was observed regarding this reorganized collagen gel. In order to examine the growth pattern of these culture cells, 5-bromodeoxyuridine (BrdU) was added to the medium during the entire culture period. The specimens were immunohistologically stained using monoclonal antibodies. Noticeable changes were observed in the marginal portion of the explant where the cell shape changed from cuboidal to squamous. In this transitional area, most cells showed positive staining and consequently high proliferative activity. In the central area of the explants, however, the number of positive cells decreased and the main observation was a few labeled basal cell nuclei. It was suggested that the same regenerative process which usually occurs in normal respiratory epithelia after mechanical injury or other insults, was replayed in this culture system.

Asymptomatic hyperbromidaemia detected as pseudohyperchloridaemia measured with an ion selective electrode meter

Six patients were found to have increased serum chloride concentrations when these concentrations were determined with an ion-selective electrode, but not when determined by continuous flow mercuric thiocyanate colorimetry or amperometric-coulometric titration. Their serum bromide levels of 1.8-8.0 mmol/l were much higher than those of 0.07-0.13 mmol/l in normal controls. The urinary bromide excretion, measured in two of these patients, was higher than that in normal subjects. No common symptoms or abnormalities in laboratory findings except hyperbromidaemia were found in these patients, who claimed not to have taken any drugs containing bromide. For determination of the incidence of subclinical hyperbromidaemia, the serum bromide concentrations were measured in sera of 1,323 outpatients sent to Tokushima University Hospital for routine measurements of blood chemistry over a one-month period. Five samples showed abnormally high bromide levels. It is concluded that subclinical hyperbromidaemia is not as rare as generally thought, though the aetiology of this state is unknown. Chloride determination with an ion-selective electrode can be used to screen for hyperbromidaemia, since increased levels of bromide ion result in apparently high chloride values.

[Percutaneous subacute toxicity study of 10% nitroglycerin (NT-1 ointment) in rabbits]

NT-1 ointment is a compound containing 10% nitroglycerin which is topically applied to the skin for angina pectoris. The subacute toxicity of this compound was examined by the continuous application for 5 weeks to the shaven skin of rabbit back at dose levels of 240, 120 and 60 mg/kg, and the recovery was examined 3 weeks after withdrawal of the drug. No special skin response to the NT-1 ointment was observed other than an erythema of the grading 2-3 Draize points, while the control ointment, which was the base ointment without nitroglycerin, showed a higher grade of erythema equivalent to 4 Draize point with crusta formation. No relationship between the dose level of NT-1 ointment and the skin response was observed, and skin response was thought to be caused mainly by the base ointment. The skin response gradually reduced even during the application period, and the skin response disappeared within a few days after withdrawal of the ointment. Histological examination of the treated skin at the respective ends of the application and recovery periods showed thickening of the corneum and epithelial layer, round cell infiltration and fibrosis in the corium, and development of hair folliculi in the subdermis. No systemic effect of the topically applied NT-1 ointment was observed in the majority of the animals, either in behavior, hematologic and electrocardiographic examination, food consumption, body weight change or urinalysis.

Novel aspect of cyclic 3',5'-adenosine monophosphate synthesis in Escherichia coli 3000A1

A kinetic analysis of cyclic 3',5'-adenosine monophosphate (cAMP) synthesis in an adenine auxotroph of Escherichia coli 3000 was made by assaying the incorporation of [3H]adenine into cAMP during exponential growth. The rate of increase in intracellular [3H]cAMP was very slow (0.1-0.2 pmol/min/DU660). The steady state level was attained at about 40-min incubation after the addition of [3H]adenine, and was estimated to be 5 to 7 pmol/DU660. The rate and level of intracellular cAMP were scarcely affected by growth conditions, such as change of carbon source, whereas the excretion of cAMP into the medium began immediately after the addition of [3H]adenine, and continued at a rate of 5 to 7 pmol/min/DU660 in the glycerol medium. The excretion rate decreased to 1.4 pmol/min/DU660 in the presence of glucose. These results are inconsistent with the view that the excretion rate is dependent on the intracellular concentration of cAMP. Although the decreased rate of cAMP synthesis in the presence of glucose accounts for the permanent catabolite repression of inducible enzyme systems, no immediate depression in cAMP synthesis, which might account for the transient repression, was found after the addition of glucose.

Survival time of tumor-bearing rats as related to operative stress and immunopotentiators

To investigate the mechanism of tumor growth enhancement induced by operative stress in rats, laparo-thoracotomy was performed on day 2 after tumor cell inoculation associated with administrations of various kinds of immunopotentiators. OK-432 (Streptococcal preparation), PS-K (extract from mycelium of Coriolus Versicolor), Lentinan (extract from Lentinus Edodus) and C. parvum were administered intravenously or intraperitoneally in the fractionated form prior to or after inoculation. In general, administration of each immunopotentiator, except for Lentinan, resulted in a recovery from the reduction in survival days after laparo-thoracotomy. In particular, OK-432 administration prior to inoculation showed a significant improvement.

Inhibitory effects of immunopotentiators on the enhancement of lung metastases induced by operative stress in rats

To investigate the mechanism of tumor growth enhancement induced by operative stress, laparothoracotomy was performed on day 2 after tumor cell inoculation in rats associated with administration of various kinds of immunopotentiators. OK-432 (streptococcal preparation), PS-K (extract from mycelium of Coriolous versicolor), lentinan (extract from Lentinus edodus), levamisole and Corynebacterium parvum were administered intravenously or intraperitoneally in the fractionated form prior to or after inoculation. In general, administration of each immunopotentiator showed an inhibitory effect on the increase of lung metastases induced by laparothoracotomy. In particular, administration of lentinan prior to inoculation and that of levamisole after inoculation caused significant inhibition in the number of metastatic nodules on the lungs. The significance of the inhibitory effects is discussed.

Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis using a by-pass method obviating thoracotomy

Transabdominal resection of esophagocardial cancer and reestablishment of alimentary continuity using a by-pass method with gastric tube or colonic segment have been performed in 40 patients including 5 with squamous cell carcinoma. Of 40, 4 cases were at stage II, 8 cases at stage III and 28 cases at stage IV. Major factors which determined the stage were peritoneal dissemination and serosal invasion in the stage IV patients. The removal of the lesion was performed curatively in 13 (33%). Major complications in the post-operative course were the leakage of anastomosis and respiratory failure. Nine of 40 cases (23%) were combined with minor leakage at the cervical anastomosis, but such did not interfere with the resumption of oral ingestion of food. The 3 year survival rate was 46% in the cases of stages (II + III) and 16% in the cases of stage IV, indicating moderately high rates as compared with that in cases of cancer located in the upper third of the stomach with the limited proximal extension within the esophagocardial junction.

Enhancing effect of thoracotomy on tumor growth in rats with special reference to the duration and timing of the operation

To investigate the influence of operative stress on tumor growth, laparotomy and/or thoracotomy were performed in association with intraperitoneal and intravenous inoculation of Sato lung cancer cells into Donryu rats. Survival time and the number of metastatic nodules on both lungs were examined. Five-hour laparotomy and/or one-hour thoracotomy were performed on day 2 after inoculation. The enhancing effects on tumor growth of a five-hour laparotomy and of a one-hour thoracotomy were similar as regards survival time, the rate of 50-day survivors and the number of metastatic nodules on the lungs. Thoracotomy seems to enhance tumor growth several times more effectively than laparotomy. The addition of a bleeding procedure (4 ml) to these operations had little effect on the tumor growth. As for the operation timing, it was found that the operative stress of thoracotomy or laparo-thoracotomy enhanced tumor growth most markedly when the operation was performed on day -1. The enhancing effects were almost the same, and the difference from the control was still highly significant, when the operation was performed on days -2, 0 or +2.

Combined treatment with by-pass operation, irradiation and immunochemotherapy for advanced thoracic esophageal cancer

Based on the experimental results that operative stress of thoracotomy or laparothoracotomy has enhanced tumor growth remarkably in rats compared with laparotomy, a new combined treatment with by-pass operation, irradiation and immunochemotherapy was investigated in 39 advanced thoracic esophageal cancer patients. At by-pass operation, abdominal esophagus was divided and its proximal stump was closed immediately. Cervical esophagus was then divided and its distal stump was pulled out to the right supraclavicular region to make outer fistula. Thus, anticancer drug was poured into the esophagus through outer fistula very easily just before irradiation and then irradiation was performed under the condition that the lesion was immersed in the drugs. As anticancer agent, Mitomycin-C, 5-Fluorouracil or Bleomycin was given alternately. Lately, the combination of 5-Fluorouracil and Vitamin A was preferably used. The changes of immunological parameters and the survival after the onset of treatment was reported.

On the findings of stroke-prone SHR

The fundus of 82 SHRSP were observed and all of them showed the narrowing caliber irregularity of retinal arterioles and optic disc edema. Moreover, tortuosity of retinal arterioles was characteristic.

Fluorescein fundus angiography of stroke-prone SHR

The fluorescein fundus angiography was performed on SHRSP, SHR, and NR. The following results were obtained. 1. No expravasation of fluorescein from retinal vessels of SHR and NR was observed at any phase of circulation. 2. The extravasation of fluorescein from retinal arterioles and peripapillary capillary of SHRSP of post-hypertensive stage was seen at arterial phase of circulation. These extravasation of fluorescein coincided with the initial stage of stroke incidence.

Enhancing effect of thoracotomy on tumor growth in rats

To indicate the influence of operative stress on tumor growth, thoracotomy and/or laparotomy were performed 48 hr after intraperitoneal or intravenous inoculation of Sato lung cancer into Donryu rats. Survival period, number of metastatic nodules on the surface of the lungs, and the percentage-area of metastases in the frontal section through pulmonary hilus were examined. By thoracotomy and laparothoracotomy the survival period of the tumor-inoculated rats was reduced significantly compared with that of the control but difference between these two test groups was not significant. Also there was no significant difference between the laparotomy group and the control. The results obtained in the number and percentage-area of metastatic nodules were quite similar to that observed in the survival period. Correlation between the number and the percentage-area of metastatic nodules was highly significant. The meaning of the stress of thoracotomy in cancer treatment is discussed.

Enhancing effect of thoracotomy and/or laparotomy on the growth of ascitic tumor in rats

To evaluate the effect of operative stress on a tumor growth, thoracotomy and/or laparotomy were performed 48 hours after the intraperitoneal inoculation of Sato lung cancer cells in Donryu rats. The survival time and the spread of the tumor were examined. Thoracotomy and laparothoracotomy reduced significantly the survival time of the inoculated rats as compared with the control but no significant difference was observed between the two test groups subjected to operative stress. No difference was observed in the spread of the tumor between the test groups and the control. These results indicated that the operative stress increased only the number of metastatic foci and did not change the characteristics of the tumor cells.