A Rare Tumor of Intravascular Myopericytoma in the Right Renal Vein

Myopericytoma, a perivascular myoid neoplasm, is commonly found in the dermis or subcutaneous tissues; however, its occurrence in visceral organs is unusual. Here, we present an extremely rare tumor of intravascular myopericytoma of the right renal vein. A 44-year-old man was incidentally diagnosed with a mass in the right kidney during a routine checkup. A nephrectomy was performed because the urologist suspected renal cancer. A gross examination of the resected specimen revealed a well-circumscribed brown mass in the renal hilum. Histologically, the tumor showed a concentric multilayered proliferation of spindle cells surrounding blood vessels. Immunohistochemical staining showed that the spindle-shaped tumor cells were negative for desmin but positive for α-smooth muscle actin and h-caldesmon, indicating their myoid nature. We confirmed that the tumor was located in the right renal vein because it was encased within a thick wall that was desmin-positive and contained elastic fibers, as shown by Elastica van Gieson staining. The patient was diagnosed with an intravascular myopericytoma of the right renal vein. There are several differential diagnoses for renal mesenchymal tumors, including angiomyolipoma. This emphasizes the importance of considering these uncommon tumors when examining nephrectomy specimens.

Transcriptional repressor GATA binding 1 (TRPS1) immunoexpression in normal skin tissues and various cutaneous tumors

BACKGROUND

Transcriptional repressor GATA binding 1 (TRPS1) is a transcription factor recently shown to play a role in the development of breast and liver cancer. Here, we evaluate TRPS1 immunoexpression in normal skin tissues and various cutaneous tumors.

METHODS

TRPS1 immunohistochemistry was performed in 109 cases of primary cutaneous tumors and 19 cases of metastatic carcinomas. TRPS1 expression was also evaluated in the normal skin tissues.

RESULTS

The normal epidermis was TRPS1-. In contrast, the eccrine apparatus, epithelial compartment of the hair follicles, hair papilla, sebaceous glands, and anogenital mammary-like glands were TRPS1+. In primary cutaneous tumors, TRPS1 positivity varied in poroma (2/3), nodular hidradenoma (4/5), spiradenoma (4/4), cutaneous mixed tumor (5/5), trichilemmal cyst (7/8), proliferating trichilemmal tumor (1/3), pilomatricoma (9/9), sebaceoma (2/5), extramammary Paget disease (13/13), sebaceous carcinoma (2/2), actinic keratosis (3/10), Bowen disease (7/12), and squamous cell carcinoma (1/5) cases. All cases of seborrheic keratosis, basal cell carcinoma, Merkel cell carcinoma, and malignant melanoma were TRPS1-. All metastatic breast carcinoma cases (8/8) were highly positive for TRPS1, while all but one of the other metastatic tumor cases were TRPS1-.

CONCLUSIONS

TRPS1 immunoexpression was observed in several skin appendages and cutaneous tumors.

Plastic bronchitis of human bocavirus 1 detected by comprehensive polymerase chain reaction of mucus casts

Plastic bronchitis (PB) is a rare and severe respiratory disease characterized by the formation of branching mucus casts, resulting in airway obstruction. PB can be divided into two types. Type 1 PB is primarily caused by inflammatory casts that result from allergic diseases. In type 2 PB, mucinous casts are produced in association with congenital heart disease. PB is also associated with viral respiratory infections, particularly the influenza A (H1N1) pdm09 virus, which is the most common pathogen affecting pediatric patients. Herein, we report a case of severe type 1 PB caused by human bocavirus (HBoV)1 in a child. Multiplex polymerase chain reaction (PCR) of a nasopharyngeal swab revealed the presence of respiratory syncytial virus and human parainfluenza virus 3. However, no viruses other than HBoV1 were detected in mucus casts by real-time PCR. Consequently, we suggest that HBoV can cause PB in pediatric patients, and direct and comprehensive PCR of bronchial casts may be useful for identifying the etiologic agents.

Congenital cerebellar dysplasia in White Leghorn chickens (Gallus gallus domesticus)

Congenital cerebellar anomalies have been rarely reported in birds. We examined cerebellums with disorganized folia from seven specific-pathogen-free White Leghorn chickens (Gallus gallus domesticus). Islands of heterotopic cortex were distributed from the deeper cortices to the medulla in the cerebellum. The characteristic lesions were composed of randomly admixed components of the cerebellar cortex, including Purkinje cells, a molecular layer and granular cells. Immunofluorescent analysis revealed Purkinje cells with haphazardly extended dendrites and a lack of Bergmann's glial fibres in the foci. Chicken parvovirus, Aino virus and avian retrovirus were not detected in the affected birds by polymerase chain reaction. This is the first report of cerebellar dysplasia in chickens possibly caused by a genetic abnormality.

Distribution of dioxins in surface soils and river-mouth sediments and their relevance to watershed properties

The dioxins toxic equivalent (TEQ) concentration in surface soils, river sediments and river-mouth sediments was measured by the CALUX assay in the Yasu and Ado River basins around Lake Biwa, Japan. In order to examine the distribution of dioxins in each watershed, we evaluated and compared the correlation between the dioxins TEQ concentration and the solid characteristics (i.e. organic carbon content and particle size distribution) of all samples. In both basins, the dioxins TEQ concentration in forest soil correspondingly showed a very good linear relationship to organic carbon content. On the other hand, the dioxins TEQ concentration in paddy field was significantly high, although organic carbon content was relatively low. Generally, the smaller particles have the higher dioxins TEQ concentrations in surface soils, and river sediments were composed of very coarse particles and had relatively low dioxins TEQ concentration. Therefore, we expected high dioxins TEQ concentration in river-mouth sediment, which was, however, not the case. Although the dioxins TEQ concentration in river-mouth sediments is low, the degree of dioxins pollution was different in each basin. The difference was considered to come from the difference of watershed properties including land use, river-slope, dam construction as well as the surface soil pollution.

Evaluation of intracoronary stenting by intravascular optical coherence tomography

BACKGROUND

Conventional contrast cineangiography and intravascular ultrasound (IVUS) provide a limited definition of vessel microstructure and are unable to evaluate dissection, tissue prolapse, and stent apposition on a size scale less than 100 micro m.

OBJECTIVE

To evaluate the use of intravascular optical coherence tomography (OCT) to assess the coronary arteries in patients undergoing coronary stenting.

METHODS

OCT was employed in patients having percutaneous coronary interventions. Images were obtained before initial balloon dilatation and following stent deployment, and were evaluated for vessel dissection, tissue prolapse, stent apposition, and stent asymmetry. IVUS images were obtained before OCT, using an automatic pull back device.

RESULTS

42 stents were imaged in 39 patients without complications. Dissection, prolapse, and incomplete stent apposition were observed more often with OCT than with IVUS. Vessel dissection was identified in eight stents by OCT and two by IVUS. Tissue prolapse was identified in 29 stents by OCT and 12 by IVUS; the extent of the prolapse (mean (SD)) was 242 (156) microm by OCT and 400 (100) microm by IVUS. Incomplete stent apposition was observed in seven stents by OCT and three by IVUS. Irregular strut separation was identified in 18 stents by both OCT and IVUS.

CONCLUSIONS

Intracoronary OCT for monitoring stent deployment is feasible and provides superior contrast and resolution of arterial pathology than IVUS.

Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer

OBJECTIVE

Even after curative resection of early endometrial cancer, some patients die as a result of recurrence. We believe that these patients likely had occult lymph node metastases at the time of diagnosis. In an attempt to identify the responsible occult metastases, the clinicopathological significance of cytokeratin expression in lymph nodes with unconfirmed metastasis was evaluated retrospectively in patients with endometrial carcinoma.

METHODS

We examined 304 pelvic lymph nodes and 46 primary tumors excised from 46 patients with endometrial cancer, including 36 with Stage I disease and 10 with Stage IIIc disease. Formalin-fixed paraffin-embedded tissue sections were stained immunohistochemically using antibodies against cytokeratin, CA125, and macrophage-related antigen. Sections were also stained with hematoxylin and eosin.

RESULTS

In 10 patients with Stage IIIc disease, cytokeratin expression was detected in cells other than the tumor cells in all 13 lymph nodes with metastasis and also in 20 (30.3%) of 66 lymph nodes without metastasis. Cytokeratin expression was observed in 37 (16.4%) of 225 lymph nodes with unconfirmed metastasis, which were obtained from 14 of 36 patients with Stage I disease. Five of fourteen patients with lymph nodes expressing cytokeratin had recurrent disease in the pelvic cavity, while all 22 patients with unconfirmed cytokeratin expression in their lymph nodes showed no recurrence. Cytokeratin and CA125 were detected simultaneously on macrophages in lymph nodes. Cytokeratin expression in lymph nodes was closely related to lymph-vascular space involvement of the primary tumor, but was not related to either histological grade or depth of myometrial invasion. Multivariate analysis identified cytokeratin expression as an independent risk factor for recurrence in Stage I endometrial cancer.

CONCLUSIONS

The immunohistochemical expression of cytokeratin in lymph nodes with undetected metastases predicts occult metastasis to these nodes and is a risk factor for recurrence in early-stage endometrial cancer.

Intermittent nitrate therapy for prior myocardial infaraction does not induce rebound angina nor reduce cardiac events

OBJECTIVE

Long-term nitrate therapy for ischemic heart disease may cause drug tolerance which diminishes its beneficial effects; consequently, intermittent administration of nitrates is recommended. With this regimen, however, the potential occurrence of rebound angina during the nitrate-free intervals is a source of concern.

SUBJECTS AND METHODS

We carried out a retrospective study of 606 patients to determine whether rebound angina occurred when conventional continuous nitrate administration was replaced by intermittent administration as part of a long-term therapy protocol for prior myocardial infarction. The subjects were receiving treatment for myocardial infarction and included 293 patients treated with nitrates (Nitrate group) and 313 patients who were not (No-nitrate group). The former included 186 patients who received intermittent nitrate administration (Intermittent group) and 107 patients who received continuous administration (Continuous group). The mean period of observation was 4.3 +/- 1.6 months.

RESULTS

There were no cases of rebound angina in the Intermittent group. Cardiac events occurred in one case in the No-nitrate group (0.3%), in 4 cases in the Continuous group (3.7%) and in 2 cases in the Intermittent group (1.1%). The incidence of cardiac events was thus significantly increased in the Continuous group compared to the No-nitrate group (p < 0.05; odds ratio 9.06; 95% CI 1.41-58.28). The Intermittent group did not significantly differ from the No-nitrate group in the incidence of cardiac events.

CONCLUSION

It is concluded that intermittent administration of nitrates does not cause rebound angina and is therefore safe. A randomized controlled trial is needed to find the long-term effect on cardiac events.

The association of transforming growth factor-beta 1 with myometrial invasion of endometrial carcinomas through effects on matrix metalloproteinase

OBJECTIVE

The association of transforming growth factor-beta 1 (TGF-beta 1) with a matrix metalloproteinase (MMP) and a tissue inhibitor of metalloproteinase (TIMP), as well as myometrial invasion of endometrial cancer was studied.

METHODS

The effects of TGF-beta 1 on cellular invasiveness, gelatinase activity, and expression of TIMP-1 were examined in 2 endometrial adenocarcinoma cell lines, KLE and Ishikawa. Plasma was obtained from 8 endometrial cancer patients with Stage-Ia disease, from 6 with Stage-Ib disease, and from 4 with Stage-Ic disease, and the levels of TGF-beta 1 were measured by enzyme immunoassays. The immunohistochemical expression of MMP-9, TIMP-1, TGF-beta 1, and TGF-beta receptor Type I in tumor tissue from the same patients also was detected.

RESULTS

Invasiveness, gelatinase activity, and the expression of TIMP-1 were higher in KLE cells than in Ishikawa cells, and they were increased by treatment with rTGF-beta 1. The expression of TGF-beta receptor Type I was higher in KLE cells than in Ishikawa cells, which were unresponsive to exogenous TGF-beta 1. The plasma levels of TGF-beta 1 were greater in Stage-Ib and Stage-Ic patients than in Stage-Ia patients. MMP-9 and TGF-beta receptor Type I were expressed mainly in tumor cells, while TIMP-1 and TGF-beta 1 were localized in both tumor epithelial cells and stromal cells. MMP-9 and TIMP-1 were expressed only in Stage-Ib and Stage-Ic patients, although TGF-beta 1 and TGF-beta receptor Type I were ubiquitous.

CONCLUSIONS

Myometrial invasion of endometrial cancers involves an increase in gelatinase activity, regulated to some extent by TGF-beta 1 in an autocrine or paracrine fashion.

[Drug treatment for secondary prevention of myocardial infarction]

The effects of drug treatment on cardiac events for 11 years from January 1986 to December 1996 were investigated in 1,483 patients with myocardial infarction, 1,164 men and 319 women (mean age 60.1 +/- 11.2 years), followed up for 17.4 +/- 20.9 months. Seventy-one patients (4.8%, 33 cases per 1,000 person-year) had cardiac events (recurrent myocardial infarction, sudden death and death by congestive heart failure). Multivariate analysis showed treatment with cholesterol lowering agents and beta-blockers reduced cardiac events, whereas administration of antiarrhythmic agents increased cardiac events. Univariate analysis showed that the incidence of cardiac events was 2.2% in patients treated with cholesterol lowering agents but 6.2% in patients without treatment, showing a significant difference (p < 0.01). The incidence was 3.2% for patients treated with beta-blockers and 6.8% for those without (p < 0.01), showing that beta-blockers were also effective to reduce cardiac events. Antiplatelet agents were also effective (3.7% vs 7.1%, p < 0.01). Calcium antagonists, angiotensin converting enzyme inhibitors and warfarin were not effective. Nitrates (6.0% vs 3.1%, p < 0.01) and antiarrhythmic agents (13.7% vs 3.6%, p < 0.01) increased the incidence of cardiac events. A placebo-controlled, double blind, large clinical multicenter study is required to confirm these results.

Retrospective analysis showing less cardiac events in post-myocardial infarction patients treated with metoprolol. Secondary Prevention Group

This analysis was carried out to clarify the capacity of metoprolol to prevent cardiac events in Japanese post-myocardial infarction patients during a follow-up period of 16.3 months. Cardiac events occurred in 44 of 650 patients treated without beta-blockers (6.8%) and in 13 of 432 patients treated with metoprolol (3.0%), which represents a significant decline in the incidence of cardiac events among patients receiving metoprolol (p<0.01, odds ratio 0.43, 95% confidence interval 0.23-0.80). Because this was a retrospective analysis, there were unavoidable differences in the backgrounds of the patients in the 2 groups. Subgroup analyses, each focusing on a specific patient characteristic, were therefore performed. These showed that metoprolol effectively reduced cardiac events in many subgroups. Furthermore, multivariate analysis carried out to exclude any modification based on the differences in patient background confirmed metoprolol to be effective in reducing subsequent cardiac events in post-myocardial infarction patients. A large, randomized, placebo-controlled clinical trial needs to be performed in the Japanese population to confirm the present result.

beta-blockers reduce the incidence of cardiac events in post-myocardial infarction patients

The capacity of beta-blockers to prevent cardiac events in post-myocardial infarction (MI) patients was investigated. Among 1,483 study participants, a beta-blocker was included in the therapeutic regimens of 833 (beta-blocker group) and was omitted from the regimens of 650 (control group). The incidence of cardiac events (recurrent MI, sudden death and death by congestive heart failure) during a follow up period of 17.4 +/- 20.9 months was retrospectively compared between the two groups. Cardiac events occurred in 27 (3.2%) members of the beta-blocker group and in 44 (6.8%) controls, which represents a significant decline in the incidence of cardiac events among patients administered beta-blockers (p < 0.01, odds ratio 0.46, 95 % confidence intervals 0.28-0.75). Subgroup and multivariate analyses showed beta-blockers to be as efficacious in Japanese post-MI patients as was previously shown in Western patients. While these findings are compelling, it is clear that confirmation in a large, multicenter, placebo - controlled, randomized clinical trial, analogous to those that have been carried out in Western countries, is necessary.

Effective utilization of N2-ethyl-2'-deoxyguanosine triphosphate during DNA synthesis catalyzed by mammalian replicative DNA polymerases

Acetaldehyde is produced by metabolic oxidation of ethanol after drinking alcoholic beverages. This agent reacts with nucleosides and nucleotides, resulting in the formation of N2-ethyl-guanine residues. N2-ethyl-2'-deoxyguanosine (N2-ethyl-dG) adduct has been detected in the lymphocyte DNA of alcoholic patients [Fang, J. L., and Vaca, C. E. (1997) Carcinogenesis 18, 627-632]. Thus, the nucleotide pool is also expected to be modified by acetaldehyde. N2-Ethyl-2'-deoxyguanosine triphosphate (N2-ethyl-dGTP) was chemically synthesized. The utilization of N2-ethyl-dGTP during DNA synthesis was determined by steady-state kinetic studies. N2-Ethyl-dGTP was efficiently incorporated opposite template dC in reactions catalyzed by mammalian DNA polymerase alpha and delta. When pol alpha was used, the insertion frequency of N2-ethyl-dGTP was 400 times less than that of dGTP, but 320 times higher than that of 7,8-dihydro-8-oxo-2'-deoxyguanosine triphosphate (8-oxo-dGTP), an oxidative damaged nucleotide. Using pol delta, the insertion frequency of N2-ethyl-dGTP was only 37 times less than that of dGTP. The chain extension from dC:N2-ethyl-dG pair occurred much more rapidly: the extension frequencies for pol alpha and pol delta were only 3.8 times and 6.3 times, respectively, lower than that of dC:dG pair. We also found that N2-ethyl-dG can be detected in urine samples obtained from healthy volunteers who had abstained from drinking alcohol for 1 week before urine collection. This indicates that humans are exposed constantly to acetaldehyde even without drinking alcoholic beverages. Incorporation of N2-ethyl-dG adducts into DNA may cause mutations and may be related to the development of alcohol- and acetaldehyde-induced human cancers.

[Clinical studies of oral antiemetic drugs on delayed emesis induced by cancer chemotherapy]

The effects of oral antiemetic drugs on delayed emesis induced by emetogenic chemotherapy were studied in seventeen patients (43 courses) with gynecological malignancies. On day 1, all patients received intravenous granisetron (40 micrograms/kg) and methylprednisolone (250 mg/body) for the control of acute emesis 0-24 hrs after receiving CDDP or CBDCA. Then they received each oral maintenance drug (dexamethasone 4 mg/day, ondansetron 4 mg/day and metoclopramide 40 mg/day) for the control of delayed emesis from day 2 to day 5. Efficacy rates for delayed emesis were 82.4% in dexamethasone, 75.0% in metoclopramide and 50.0% in ondansetron. The complete response for delayed nausea was 88.5% in metoclopram ide, and the complete response for delayed anorexia of 64.7% in dexamethasone was higher than for other oral drugs. The results suggest the usefulness of oral antiemetic therapy of dexamethasone plus metoclopramide or ondansetron for delayed emesis induced by cancer therapy.

Emergence of an irreversible differentiated subclone from the poorly differentiated ovarian adenocarcinoma cell line AMOC-2 treated with sodium butyrate

OBJECTIVE

To cast light on the capacity of an ovarian adenocarcinoma to undergo irreversible cellular differentiation, we established clonal cell lines from cultured ovarian carcinoma cells treated with sodium butyrate and examined their phenotypic changes.

METHODS

The poorly differentiated ovarian carcinoma cell line AMOC-2 was exposed to 2 mM sodium butyrate for 30 days, and clonal cell lines were established by a dilution plating technique.

RESULTS

Five clonal cell lines were established. One of them had a longer doubling time and lower plating efficiency than the parental clone, also demonstrating stronger expression of vimentin and 56 kD cytokeratin. This clone became columnar with pronounced polarity, formed gland-like structures when cultured in collagen gels, and exhibited no tumorigenicity, in contrast to the parental clone.

CONCLUSION

Sodium butyrate treatment of AMOC-2 cells can cause phenotypic changes reminiscent of maturation in the Müllerian duct, endocervix, and/or endometrium.

Short-acting nifedipine and diltiazem do not reduce the incidence of cardiac events in patients with healed myocardial infarction. Secondary Prevention Group

BACKGROUND

The administration of calcium antagonists to patients with healed myocardial infarction is a controversial treatment. This study was conducted to elucidate the effect of short-acting nifedipine and diltiazem on cardiac events in patients with healed myocardial infarction.

METHODS AND RESULTS

A controlled clinical open trial of 1115 patients with healed myocardial infarction was carried out between 1986 and 1994. The patients included 595 who received no calcium antagonist, 341 who received short-acting nifedipine 30 mg/d, and 179 who received short-acting diltiazem 90 mg/d. The primary end points were cardiac events, which were defined as fatal or nonfatal recurrent myocardial infarction; death from congestive heart failure; sudden death; and hospitalization because of worsening angina, congestive heart failure, or premature ventricular contractions. Cardiac events occurred in 51 patients (8.6%) in the no-calcium-antagonist group and 54 (10.4%) in the calcium-antagonist group (odds ratio, 1.24; 95% CI, 0.83 to 1.85), demonstrating that the calcium antagonists did not reduce the incidence of cardiac events. Subgroup analysis revealed no beneficial effects of these drugs for reducing cardiac events in patients with such complications as hypertension or angina pectoris.

CONCLUSIONS

This study showed that use of short-acting nifedipine and diltiazem in this postmyocardial infarction population was associated with a 24% higher cardiac event rate, but this strong adverse trend did not reach statistical significance.

Effects of electrochemotherapy on CaSki cells derived from a cervical squamous cell carcinoma

Electrochemotherapy is a new approach to the treatment of tumors that takes advantage of the permeabilization of the cell membranes by electric pulses to facilitate the intracellular delivery of chemotherapeutic drugs into cells. Using the female genital squamous cell carcinoma cell line, CaSki, the antitumor effectiveness of electrochemotherapy was tested. In vitro studies showed that the cytotoxicity of some anticancer drugs, especially bleomycin, can be greatly enhanced by exposing cells to noncytotoxic electric pulses. This enhancement was significantly greater when the electric treatment was given after exposure to the drug than when applied preexposure. Treatment of nude mice bearing subcutaneous transplanted tumors with noneffective intraperitoneal doses of bleomycin followed by local delivery of electric pulses similar to those performed in vitro resulted in tumor reduction and complete disappearance after 12 days this electrochemotherapy. Histological changes in tumor tissue such as necrosis and degeneration were extensive even 6 hr after the electrochemotherapy. Thus the antitumor effects of bleomycin in mice can be considerably potentiated by local electric pulses, suggesting that electrochemotherapy with bleomycin may have promise for treatment of vulvar or ectocervical squamous cell carcinomas with early invasion.

Vitamin D receptor in endometrial carcinoma and the differentiation-inducing effect of 1,25-dihydroxyvitamin D3 on endometrial carcinoma cell lines

In view of the potential of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] as a cell-differentiation-inducing agent in endometrial cancer, the localization of the vitamin D receptor (VDR) was examined immunohistochemically in 21 endometrial adenocarcinoma specimens, and the effect of 1,25(OH)2D3 on cell growth, as well as the phenotypic changes for cell maturation after treatment with 1,25(OH)2D3, was investigated in 2 endometrial carcinoma cell lines (AMEC-1, RL95-2). The VDR was detected in 14 of the 21 endometrial carcinoma specimens. The growth of RL95-2 cells expressing VDR was inhibited to 44% when cultured with 50 nM 1,25(OH)2D3 for 6 days. In contrast, the growth of AMEC-1 cells not expressing VDR was completely uninhibited even when cultured with 100 nM 1,25(OH)2D3 for 6 days. The RL95-2 cells exposed to 50 nM 1,25(OH)2D3 for 6 days had an increasing expression for 52.5 kD or 45 kD cytokeratin polypeptide, and they became columnar with pronounced polarity and formed gland-like structures when cultured in collagen gel. These results suggest that endometrial adenocarcinoma is a target for 1,25(OH)2D3, which appears to function as a cell-differentiation-inducing agent for the treatment of endometrial cancer.

Long-term nitrate treatment increases cardiac events in patients with healed myocardial infarction. Secondary Prevention Group

BACKGROUND

Nitrates dilate coronary arteries, ameliorate myocardial ischemia, minimize left ventricular remodeling, and reduce mortality in patients with acute myocardial infarction. However, the effects of long-term treatment with nitrates on cardiac events in patients with healed myocardial infarction are not known.

METHODS AND RESULTS

A total of 1,002 patients with healed myocardial infarction (789 male and 213 female) were randomly divided into 2 groups: treatment with nitrates or nontreatment. The mean observation period was 18.0 +/- 19.9 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics of the 2 groups were also compared to determine any effects on outcome. Among the 621 cases treated with nitrates, 41 cases (6.6%) experienced cardiac events during the observation period, whereas only 12 of the 381 cases that were not treated with nitrates (3.1%) had cardiac events. This difference was statistically significant (p < 0.05; odds ratio 2.17; 95% confidence interval 1.13-4.19). There were no differences in the incidence of noncardiac death or being lost to follow-up between the 2 groups. Although the precise mechanism of this increase in the occurrence of cardiac events by long-term treatment with nitrates is not clear, nitrate tolerance with possible rebound and neurohormonal effects may be involved.

CONCLUSION

Long-term treatment with nitrates increased cardiac events in patients with healed myocardial infarction.

[Apoptosis and cell growth fraction in normal, dysplastic and neoplastic squamous epithelium of uterine cervix]

The populations of cells in apoptosis as well as proliferating cycle were examined in normal cervical epithelium, dysplastic change, carcinoma in situ and invasive carcinoma. The percentage of apoptotic cells (% Apo) decreased with the neoplastic change and was significantly lower in carcinoma in situ group than in the dysplasia group. Conversely, the percentage of cells in proliferating cycle (% GF) increased with the neoplastic change and was significantly higher in the dysplasia group than in the normal group. In the dysplasia group, the % Apo was lower in cases with HPV 16 infection or with bcl-2 expression, and the % GF was higher in cases with p53 expression. In conclusions, the decrease in apoptosis may reflect the atypical change in cervical epithelial cells during their neoplastic change, and the proliferative activity in neoplastic lesion was found when the cervical epithelium with dysplastic change was transformed to the carcinoma in situ. Furthermore, these events were related to the p53 accumulation and bcl-2 expression following the HPV 16 infection.

[Apoptosis and cell growth fraction in normal, dysplastic and neoplastic squamous epithelium of uterine cervix]

To assess the transformation of cellular characteristics during a neoplastic change in uterine cervical epithelium, the populations of cells in apoptosis as well as proliferating cycle were examined in normal cervical epithelium, dysplastic change, carcinoma in situ and invasive carcinoma. The percentage of apoptotic cells (%DNA Fr.) decreased with the neoplastic change and was significantly lower in the carcinoma in situ group than in the dysplasia group. Conversely, the percentage of cells in the proliferating cycle (%GF) increased with the neoplastic change and was significantly higher in the dysplasia group than in the normal group. The ratio of %DNA Fr. to % GF was more than 1.0 in the normal group and dysplasia group, but it was less than 1.0 in the carcinoma in situ group and invasive carcinoma group. No significant correlation between %DNA Fr. and %GF was found. These results suggested to us that the decrease in apoptosis may reflect the atypical change in cervical epithelial cells during their neoplastic change, and the proliferative activity in neoplastic lesion was found when the cervical epithelium with dysplastic change was transformed to the carcinoma in situ.

[Comparative trial of granisetron versus granisetron plus methylprednisolone for the prevention of nausea and vomiting induced by cancer chemotherapy]

Preclinical and clinical studies have demonstrated the effectiveness of granisetron in preventing emesis induced by antineoplastic chemotherapy. This comparative study was undertaken to investigate the efficacy and safety of granisetron (40 micrograms/kg) and granisetron plus methylprednisolone (MPL; 10 mg/kg). Sixty-eight patients were given granisetron 170 times and thirty-nine patients were given a combination of granisetron and MPL 81 times. Sixty-one patients received the treatment in crossover fashion during the same chemotherapy regimens. The emetic and nausea episodes were counted during the 24 hours following each chemotherapy treatment. Complete response, no emesis or less than two episodes, were obtained in 75.3% (128/170 times) of patients receiving granisetron alone compared to 85.2% (69/81 times) of patients receiving the combination of granisetron plus MPL. There were no significant differences in complete responses between the two groups, male and female, and each age group. However, 11 of eighteen patients receiving granisetron alone who responded mildly, if at all, with respect to nausea and vomiting, showed a complete or major response when MPL was added to granisetron. There were two patients who developed temporal paresthesia of the both hands as an adverse effect, but there was spontaneous recovery after 3 hours. Our data suggested that granisetron plus MPL was slightly more effective than granisetron alone and a safe antiemetic drug.

Immunohistochemical assessment of the growth fraction in cervical cancers using the monoclonal antibody Ki-67; relationship to the clinical stage, histologic type and DNA content

To assess the growth potential of cervical cancer, cell populations in proliferating cycle (%PC) were examined by an immunohistochemical technique using the monoclonal antibody Ki-67. The %PC was 31.63 +/- 16.61% in 36 cervical cancers and was significantly higher when compared to the 7.8 +/- 3.81% found in 24 samples of normal ectocervical tissues. In cervical cancer tissues, the %PC increased in accordance with progression of the clinical stage of the disease, however, the %PC was not different among the various histologic types of invasive cervical cancers. The DNA index also increased in accordance with progression of the clinical stage of cervical cancer, however, there was no correlation between the %PC and the DNA index. These results suggest that the value of %PC obtained using the monoclonal antibody Ki-67 can be used as a parameter for evaluating the growth activity of cervical cancer and for predicting biological heterogeneity in a tumor.

Growth potential of endometrial cancers assessed by a Ki-67 Ag/DNA dual-color flow-cytometric assay

Ki-67 is a monoclonal antibody directed against a nuclear antigen present only in proliferating cells. To assess the growth potential of uterine endometrial cancer, the population of cells in proliferating cycle (%PC) was examined with Ki-67, using flow cytometry. The %PC of 27.18 +/- 12.00% in 22 endometrial cancers was significantly higher than the 14.5 +/- 5.94% found in 28 normal endometrial tissues. In premenopausal endometrial tissue, the %PC in the proliferatory phase was significantly higher than the %PC found in the secretory phase. In endometrial cancers, an increase of %PC was found in cases with deep myometrial invasion, and the %PC was elevated in groups containing histologically poorly differentiated types when compared to groups of well-differentiated and moderately differentiated types. Sorted cells reactive with Ki-67 antibody were large and had a high nuclear/cytoplasmic ratio. On the bases of these results, it was concluded that a Ki-67 Ag/DNA dual-color assay would be useful to examine the growth fraction in endometrial carcinoma and that an increased growth fraction was related to deep myometrial invasion or poorly differentiated types.

[The clinical significance of thrombin-antithrombin III complex (TAT) and fibrinogen and fibrin degradation products (FDP) levels in ovarian cancer]

We measured the levels of thrombin-antithrombin III complex (TAT) and fibrinogen and fibrin degradation products (FDP) in 115 patients with gynecological malignancies (ovarian cancer 34, cervical cancer 34, endometrial cancer 47). These concentrations were compared to those in control groups of 15 patients with benign ovarian tumor. The levels of TAT and FDP were significantly higher in patients with ovarian cancer compared to the control group (both: p less than 0.01), and these levels were higher than in other gynecological malignancies. In stages I and II the positive rate of TAT and FDP (TAT greater than 3.0 ng/ml, FDP greater than 1.40 microgram/ml) in patients with ovarian cancer was higher than that in other gynecological malignancies. TAT and FDP were increased following cancer dissemination, and the recovery of coagulative and fibrinolytic factors (TAT, FDP) with effective treatment was correlated to the prognosis for patients with ovarian cancer. These levels had no correlation with the levels of CA125 and histological classification in patients with ovarian cancer. Accordingly, these results suggest that these changes in TAT and FDP may be useful, together with other clinical signs, in detecting early stage ovarian cancer.

[Relation between blood coagulability and prognosis in patients with ovarian cancer]

In 13 patients with ovarian cancer who had been treated with remission induction chemotherapy, we measured the levels of platelet PT, APTT, Hepa T, ATIII, alpha 2PI and FDP, and we also measured such molecular markers as fibrinopeptide A(FPA), fibrinopeptide B beta 1-42(FPB beta 1-42), and fibrinopeptide B beta 15-42 (FPB beta 15-42) before and after chemotherapy. Then the relation between the post chemotherapeutic trends of these substances and the prognosis for patient with ovarian cancer were investigated. 1) After chemotherapy, the levels of fibrinogen were increased, ATIII was decreased significantly in cases in the NC.PD group compared with the PR.CR group (p less than 0.05). The alpha 2PI concentrations were also slightly low, and the levels of FDP were within the normal range in cases in the PR.CR group, but in many cases in the NC.PD group were increased. 2) After chemotherapy, the concentrations of molecular markers (FPA, FPB beta 1-42 and FPB beta 15-42) were increased significantly in cases in the NC.PD group compared with the PR.CR group (p less than 0.05). 3) In cases in the recurrent group, the levels of ATIII and alpha 2PI were decreased significantly compared with the after therapy group, FDP, FPB beta 1-42 and FPB beta 15-42 were increased. Accordingly, the recovery of hemostatic balance with effective chemotherapy is related to the prognosis for patients with ovarian cancer, and the levels of fibrinogen, PT, alpha 2PI, ATIII, FDP, FPA, FPB beta 1-42 and FPB beta 15-42 may be able to be used in the prognosis for patients after chemotherapy.

Establishment and characterization of a new human cell-line (AMOC-2) derived from a serous adenocarcinoma of ovary

A new cell line, designated as AMOC-2, was established from a mouse graft of human ovarian serous adenocarcinoma, and has grown well without interruption for over 12 months. The cultured cells of the AMOC-2 line were spindle or polygonal in shape and showed a monolayer growth with a pavement-like arrangement and a slight tendency to pile up, thus lacking contact inhibition. This cell line has a doubling time of 17.4h, a saturation density of 9.17 X 10(4) cells/cm2, a plating efficiency of 36.2% and a mitotic coefficient of 6.2%. The chromosomal number of this cell line is distributed in the diploid range and three of the specific marker chromosomes were identified in the cells with 49 chromosomes. This cell line was able to be transplanted into the subcutis of nude mice and produced a poorly differentiated serous adenocarcinoma resembling the original tumor. These cells have maintained their tumorigenic capacity despite prolonged maintenance in culture and are now in the 60th passage.

[Effect of remission induction chemotherapy on blood coagulability in patients with gynecological malignancies]

In 12 patients (38 courses) with gynecological malignancies who had been treated with remission induction chemotherapy, we measured the levels of ESR, Platelet, PT, APTT, Hepa T, AT III, alpha 2 PI, FDP and D-dimer, and we also measured such molecular markers as Fibrinopeptide A (FPA), Fibrinopeptide B beta 1-42 (FPB beta 1-42), and Fibrinopeptide B beta 15-42 (FPB beta 15-42) before and after chemotherapy. Then the relation between the post chemotherapeutic trends and prognosis for patient with gynecological malignancies were investigated. 1) Before chemotherapy, the levels of ESR, FDP, D-dimer and FPB beta 1-42 were increased, PT and APTT were shortened significantly in cases on groups IIIrd and IVth stage compared with in cases on groups Ist and IInd stage (p less than 0.05). The levels of FPA were also high, but there was no significant differences. The levels of FPB beta 15-42 were almost same in both groups. However, the each markers indicated the existence of chronic DIC in cases of group IIIrd and IVth stage. 2) One week after chemotherapy, the levels of ESR, fibrinogen, FDP and FPA were decreased, while FPB beta 1-42 and FPB beta 15-42 were increased, suggesting elevated fibrinolytic activity. Two weeks after chemotherapy, there was stronger tendency to coagulation dominant again, but it was only temporary. Three weeks after chemotherapy, the hemostatic balance was regained. 3) In patient with complete remission after effective chemotherapy, their coagulability data were showed within normal range, however, some cases with poor prognosis were not able to obtain the recovery of hemostatic balance, and the levels of molecular markers were significantly elevated. Coagulative activity was more enhanced than fibrinolytic activity in patients with progressive gynecological malignancies, but hemostatic balance was maintained clinically. The hemostatic balance was disrupted by the chemotherapy, but this balance was regained for the IIIrd week. Accordingly, the recovery of hemostatic balance with effective chemotherapy is related to the prognosis for patients with gynecological malignancies, and the levels of molecular markers may be able to expect the prognosis for patients.

Clinical usefulness of sialyl SSEA-1 antigen as tumor marker for ovarian cancer as compared with CA125, CA19-9, TPA, IAP, CEA and ferritin

In order to determine the clinical significance of sialyl SSEA-1 antigen, we compared its usefulness as a tumor marker for ovarian cancer with simultaneously measured CA125, CA19-9, TPA, IAP, CEA and ferritin. The sialyl SSEA-1 antigen in serum was measured by radioimmunoassay with an "FH-6" Otsuka Kit. The immunohistochemical localization of sialyl SSEA-1 antigen in ovarian carcinoma tissues was determined by an immunoperoxidase method using FH-6 monoclonal antibody. Among fifty-one patients with ovarian cancer, the incidence of elevated serum levels was 54.9% with sialyl SSEA-1 antigen, 90.2% with CA125, 48.8% with CA19-9, 78.0% with TPA, 73.1% with IAP, 17.1% with CEA and 63.4% with ferritin. On the other hand, among the patients with uterine malignancies and gynecologic benign tumors, the incidence of elevated sialyl SSEA-1 antigen levels in serum was lower than that of other tumour markers. In the patients with ovarian cancer, the serum levels of sialyl SSEA-1 antigen increased in accordance with the advance of the clinical stage and were also correlated with the effect of therapy. In the examination of immunohistochemical localization of sialyl SSEA-1 antigen, a positive reaction occurred in 10 out of 30 ovarian carcinoma specimens. Intense staining appeared in the secretory materials, in the luminal surface of the glands, and in the cytoplasm of cells. Thus, sialyl SSEA-1 antigen appears to be a useful tumor marker for the diagnosis of ovarian cancer, especially when measured simultaneously with CA125, CA19-9, TPA, ferritin and IAP.

[Experimental study on the effect of UFT with concomitant radiotherapy of uterine cervical cancer]

In order to examine effectiveness of the chemotherapy with concomitant radiotherapy, an experimental study was designed using AMCC-1 cell line established from a human uterine cervical carcinoma in our laboratory. The growth of AMCC-1 cells cultured in plastic flask was inhibited significantly in the group treated with a half of minimal effective doses of 60Co and 5-FU in comparison with the control group. The 5-FU treatment after radiation inhibited the AMCC-1 cell growth more effectively than that before radiation. The growth of AMCC-1 tumor transplanted into nude mice was inhibited significantly in the group given a combination chemoradiotherapy, consisted of oral administration of three quarters of minimal effective dose of UFT for fourteen consecutive days and radiation of a half of minimal effective dose of 60Co. The oral administration of UFT after radiation inhibited the AMCC-1 tumor growth more effectively than that before radiation. These results suggest that the radiotherapy with administration of UFT was more effective against uterine cervical cancer than radiation alone and it is important to administer UFT orally after radiation as well as before radiation.

[Intra-arterial cis-platinum in the treatment of squamous cell carcinoma of the cervix]

Three patients with advanced cervical carcinoma were treated with two courses of cis-platinum (CDDP) intra-arterial administration. Histology of all patients revealed squamous cell carcinoma, keratinizing type, and all patients had stage IIIb diseases. CDDP at a dose of 50 mg was infused through each catheter of which tips were fixed in the bilateral internal iliac arteries via the opposite femoral arteries. The course of therapy was repeated at an interval of three to four weeks, so the total dose of CDDP in each patient was 200 mg. The bleeding from lesions, which occurred intermittently before therapy in all patients, was reduced after the primary course of therapy and completely stopped after the second one. Marked reduction of lesion on computed tomograph (CT) was confirmed in all patients. The reduction in the product of perpendicular diameters of measurable lesions on CT ranged from 40 to 50%. Adverse effects such as nephrotoxicity, myelosuppression and gastrointestinal toxicity were mild as compared with patients receiving intravenous administration of CDDP. The excellent clinical effects and tolerance observed in this study indicated that an intra-arterial administration of CDDP has a highly therapeutic efficacy in the treatment of squamous cell carcinoma of the cervix.

Combination assay of CA125, TPA, IAP, CEA, and ferritin in serum for ovarian cancer

The levels of CA125, TPA, IAP, CEA, and ferritin in the serum were measured simultaneously in 68 healthy nonpregnant females and 133 patients with various gynecological diseases, and were subjected to statistical discriminant analysis for the diagnosis of ovarian cancer. The usefulness and the limits for diagnosis of various gynecological diseases were investigated for each tumor marker. Also, the diagnostic usefulness of the stepwise discriminant analysis employing the values of these five tumor markers in the serum in cases of ovarian cancer was compared with that of CA125 measurements alone. Because the frequency of cases with an elevated serum CA125 level increased more specifically in the ovarian cancer group than those of other tumor makers in the serum, this parameter was considered to be more useful for the diagnosis of ovarian cancer than the levels of the other tumor markers. The frequencies of cases with the elevated serum CA125 levels, however, also increased in the groups of patients with endometriosis and at an early stage of normal pregnancy more than in the group of healthy nonpregnant females. In the ovarian cancer patients, the discriminant analysis employing the values of CA125 and four other tumor markers in sera was more useful for early diagnosis, differential diagnosis, early detection of recurrences, and the determination of complete remission after therapy than the measurement of the serum CA125 level alone.

Clinical significance of statistical discrimination employing serum TA-4, TPA, and CEA levels in uterine cervical cancer

The serum levels of TA-4, TPA, and CEA were measured simultaneously in 52 patients with uterine cervical cancer and 99 healthy females. The findings were examined statistically by discriminant analysis method. The diagnostic usefulness of discriminant analysis employing the serum values for these three tumor markers was studied for uterine cervical cancer and compared with the diagnostic efficacy using each tumor marker alone. The following results were obtained: In the uterine cervical cancer patients, the frequencies of cases with the elevated serum levels were 55.8% for TA-4, 46.2% for TPA, and 36.5% for CEA. The functional formula, Z = 1.8395 log TA-4 + 3.5314 log TPA + 1.0130 log CEA-7.7352, was obtained by the stepwise discriminant analysis method. With the values obtained from this formula, 71.2% of patients with uterine cervical cancer were correctly classified in the uterine cervical cancer group. In the uterine cervical cancer patients, the values obtained from this formula increased according to the progression of the clinical stage and reflected the disappearance or persistence of tumor lesions after several therapies. From the above results, it was concluded that the discriminant analysis employing the serum values for three tumor markers was extremely useful in determining complete remission of uterine cervical cancers after several therapies, as well as for early diagnosis of the recurrences in uterine cervical cancer which were not detected by the cytologic smear examinations, compared with the measurement for each tumor marker alone. This discriminant analysis, however, was less effective for early diagnosis of uterine cervical cancer than the cervical cytologic smear test.

Effect of adriamycin entrapped by sulfatide-containing liposomes on ovarian tumor-bearing nude mice

Sulfatide-containing liposomes showed the highest degree of adriamycin entrapment of all the liposomes tested. Adriamycin was bound to the sulfatide anions on the liposomal membrane, inserted into the membrane, and incorporated into the aqueous compartment of the vesicle. Liposome-entrapped adriamycin was maintained at a much higher blood level than free adriamycin, and reached a lower concentration in the heart than did the free drug, which might lead to lower cardiotoxicity of the drug. Incorporation of adriamycin into ovarian tumor transplanted into nude mice was increased when entrapped by the sulfatide-containing liposomes. Liposome-entrapped adriamycin did not induce the drastic loss of body weight which occurred with the free drug. The growth of ovarian tumor was inhibited by liposome-entrapped adriamycin to the same degree as free adriamycin. Having these advantages, sulfatide-containing liposomes could be useful carriers of adriamycin for cancer chemotherapy.

[Diagnostic usefulness of stepwise discriminant analysis employing the values of CA125, TPA, IAP, CEA and ferritin in sera measured simultaneously for gynecological malignant neoplasms]

The values for CA125, TPA, IAP, CEA, and ferritin in sera were measured simultaneously in 68 healthy nonpregnant females and 133 patients with various gynecological diseases, and examined by stepwise discriminant analysis. The usefulness and the limits for diagnosis of various gynecological diseases were investigated for each tumor marker. Also, the diagnostic usefulness of stepwise discriminant analysis employing the values for five tumor markers in sera was studied for gynecological malignancies compared with that of measuring serum CA125 alone. Because the mean values for CA125 in sera were increased specifically in the ovarian cancer patient group compared with those of other tumor markers in sera, the measurement of serum CA125 was considered to be more useful in diagnosing ovarian cancer than that of the other tumor markers. The mean values for CA125 in sera, however, were also increased more significantly in the groups of patients with endometriosis and normal pregnancies than in the group of healthy nonpregnant females (p less than 0.005). In the stepwise discriminant analysis employing the values for CA125 and four other tumor markers in sera, the diagnostic usefulness of each tumor marker was demonstrated in the early diagnosis, the differential diagnosis, and the determination of complete remission after several therapies for ovarian cancers.