[Response and pharmacokinetics of cisplatin instilled into the pleural cavity]

The response and pharmacokinetics of cisplatin instilled into the pleural cavity were studied in 11 patients with malignant pleural effusion; 10 patients had primary lung cancer and one had breast cancer. All of them were adenocarcinoma histologically. In five of the 11 patients effusion disappeared and its cytology became negative for malignancy after four weeks. In the other six patients effusion was reduced and its cytology became negative for malignancy after four weeks. Toxicity was almost similar to that in systemic administration of cisplatin but a few patients had chest pain and fever possibly due to local irritation. The pharmacokinetics showed that a high concentration of cisplatin (free-form, 48.9 micrograms/ml) was maintained over a long period (free from (t 1/2) beta = 33.6 hours) in the pleural cavity. This was regarded as the reason for the high response to this therapy. The intrapleural instillation of cisplatin into the pleural cavity therefore seems to be an effective modality for malignant pleural effusion.

[Preoperative combination therapy involving local administration of a non-specific immunoactivated preparation (OK-432) and chemotherapeutic preparations for patients with stomach cancer]

OMF therapy, which is a combination therapy consisting of OK-432 administered locally, Mitomycin C and 5-Fluorouracil, was administered to 50 cases of stomach cancer (52 episodes) preoperatively. Judging the criterion for a positive (+) effect as being the existence of degeneration or necrosis in 1/3-1/2 of carcinomas visible within whole fields, the ratio of histological effectiveness shown by this therapy was 75%. As for its effect on metastatic foci of lymph nodes, when 70 case from an n1 group and 8 from an n2 group with metastatic positive lymph nodes, including 17 cases (4 in Stage II and 13 in Stage III) ablated for curing were studied, a greater than positive (+) effect was shown in 51 out of the total of 78. Consequently the effective ratio was 65%. The survival ratio of 16 cases in Stage III on the 48th month calculated by the Kaplan Meier method was 78.6%. The survival time of 50% of 9 cases in Stage IV (absolute non-curing ablation) was 15 months. Tissue samples were examined constantly after local administration of OK-432. Exudation of neutrocytes was shown on the 1st day, and that of histiocytes, lymphocytes and plasmacytes on the 4th day. At this stage, degeneration of the primary focus or necrotizing change was observed. Interstitial reaction peaked on the 14th day, but histiocytes tended to decrease.

[Phase II study of cis-dichlorodiammineplatinum (II) for non-small cell lung cancer]

A phase II study of cis-dichlorodiammineplatinum (II) (CDDP) was performed in 83 patients with inoperable non-small cell lung cancer (21 squamous cell carcinomas, 57 adenocarcinomas and 5 large cell carcinomas). CDDP was given by i.v. infusion at a dosage of 50 mg/m2 (low-dose regimen) or 80-100 mg/m2 (high-dose regimen) every 3 to 4 weeks. Seventy-nine out of 83 patients were evaluable for tumor response. Sixteen of these evaluable patients achieved complete or partial response, and the overall response rate was 20.3%. The response rates were 27.8% in patients with squamous cell carcinoma and 19.6% in those with adenocarcinoma. None of the patients with large cell carcinoma responded. The high-dose regimen was superior to the low-dose regimen in response rate (25.6% versus 5.8%). The responders survived significantly longer than patients with NC (p = 0.02) or PD (p = 0.003). Leukopenia of less than 3000/mm3 occurred in 12.1% of cases, and thrombocytopenia of less than 7 X 10(4)/mm3 occurred in 7.6%. A transient elevation of serum creatinine value was observed in 9 patients (10.8%). Moderate to severe nausea and/or vomiting occurred in almost all patients. It was therefore considered that CDDP was one of the most effective agents for non-small cell lung cancer with tolerable toxic effects.

[Local application of anti-cancer drugs for the treatment of malignant pleural and pericardial effusion]

Pleural effusion is a common complication in patients with malignant neoplasm. A randomized controlled study of intrapleural instillation of Adriamycin (control group, 30 patients) and Adriamycin Nocardia rubra cell wall skeleton (N-CWS group, 26 patients) with tube thoracostomy was performed in 55 patients with malignant pleural effusion due to primary lung cancer. The response rates for control of pleural effusion were 73.4% in the N-CWS group and 46.1% in the N-CWS group. These results suggest that intrapleural instillation using a combination of anti-cancer agent and immunopotentiator is an effective treatment for malignant pleurisy. Cardiac tamponade secondary to cancer is a life-threatening complication requiring immediate treatment. Twenty-four patients with malignant pericardial effusion were treated by intrapericardial instillation of anti-cancer drugs, such as Carbazilquinone, Mitomycin-C or ACNU, with pericardial drainage. The range of survival time from the instillation of anti-cancer drug was 3-365 days (average days). In only 4 patients, reaccumulation of pericardial effusion was recognized. There were no serious complications with this procedure. It was considered that local instillation of anti-cancer agents with pericardial drainage was a useful therapeutic modality for malignant pericarditis.

The relation between visual sensitivity and intraocular pressure in normal eyes

Intraocular pressure and flicker modulation sensitivity at 25 and 40 Hz were measured in 22 normal observers, with an age range from 20-71 years. Significant correlations up to 0.67 were found between intraocular pressure and flicker sensitivity at several points in the visual field. There was no correlation between flicker sensitivity and age of the observers. Thus intraocular pressure may affect neuronal function in the normal eye.

[Conditions suitable for chemotherapy of lung cancer]

The influence of several factors for response to Chemotherapy and survival was analysed in 310 patients with inoperable lung cancer who were treated by single or combination chemotherapy. In small cell lung cancer, survival was strongly affected by the results of induction chemotherapy, and combination chemotherapy with three or four drugs was most effective. In non-small cell lung cancer, performance status and body weight loss on admission were important factors for response to chemotherapy and survival. Combinations did not improve the response rate in non-small cell lung cancer.

A newly devised speech accumulator

Voice therapy is often most effective for treating patients with vocal cord polyp, polypoid degeneration and singer's nodule. However, little is known about the total speaking times in 1 day, the ratio of speech per hour and the sound level during speech, in individual patients. If these parameters can be readily detected, it could be clarified as to how speaking times or patterns are related to a particular voice disorder and/or what instruction a doctor had given a patient. We devised a speech accumulator which records the vibration time of the vocal cords by a small contact microphone attached to the neck, but does not record the actual speech, thus monitoring the privacy of the individual. The time of speech, at any sound level can be read digitally, at any time. This system was clinically used for 11 patients and proved to be most useful. The longest speaking time in 1 day was 182 min, for a bus guide, and the shortest time was 33 min for an office clerk.

Biofeedback therapy for spastic dysphonia

Spastic dysphonia is a disorder of phonation which is characterized by a strained, creaking, and choked vocal attack, a tense and squeezed voice sound. Spastic dysphonia in a functional voice disorder can be classified into two types from the viewpoint of activities of the extrinsic and intrinsic laryngeal muscle groups. A functional voice disorder pertaining to abnormal activities of the intrinsic and extrinsic laryngeal muscles results in spastic dysphonia. The adductor spastic dysphonia may be due to abnormal actions of the intrinsic laryngeal muscles as such is relieved by sectioning of the recurrent nerve, while spastic dysphonia mainly dealing with the extrinsic laryngeal muscles is relieved by relaxation on monitoring an electromyographic feedback system. Within 3 months we encountered two patients whose extrinsic laryngeal muscles were hyperactive on phonation. A trial on injection of lidocaine into extrinsic laryngeal muscles made their muscles relax. So, biofeedback therapy of relaxation was began using a monitoring system of EMG burst regarding to hypertonicity of the extrinsic laryngeal muscles. Normal vocal abilities were recovered using a biotrainer as a monitoring device of electromyographic feedback.

Evaluation of tumor angiogenesis factor with the rabbit cornea model

Sequential histopathological observations were made of the rabbit corneas after an implantation of viable and nonviable tumor cells in the corneal stroma. They showed a nonspecific localized interstitial keratitis accompanied by inflammatory cells and new capillaries. We could not observe any significant clinical or histopathological differences between the corneas containing live or dead tumor implants, or between those with different tumor types (i.e., retinoblastoma and melanoma). Some variation in the severity of the inflammatory response was observed in different animals with the same tumor. In all cases, the extent of the corneal neovascularization correlated with the degree of inflammation. However, in rabbits made immune-deficient by radiation, there was negligible inflammation and vascularization when tumor was implanted.

The effects of microinjection of carbachol or hemicholinium into the amygdala on the levels of plasma and adrenal corticosterone in rats

Microinjections of 0.4 microgram of carbachol into the amygdala caused a rise of corticosterone (CS) in the morning when the prestimulating level of CS was lower. But the same procedure with a larger dose had no effect in the afternoon, when the prestimulating level of CS was higher.

Synergistic combination therapy of 5-fluorouracil, vitamin A and cobalt-60 radiation upon head and neck tumors

We have applied a triple combination of 5-fluorouracil (5FU), vitamin A and cobalt-60 radiation (FAR therapy) to clinical treatment of head and neck tumors since 1972. The treatment of 33 patients with cancer of larynx and 15 patients with hypopharyngeal or cervical esophageal cancer with FAR therapy during three years from 1972 to 1974 resulted in highly effective synergism in vivo, and the improved points of this therapy were presented.

T-cell regulation of T-cell responses to antigen

Parental thymocytes, inoculated into F₁ mice which have been depleted of lymphoid cells by lethal irradiation, react to the host antigens which are contributed by the reciprocal parent in the F₁ cross, by synthesizing DNA. The amount of DNA the parental thymocytes synthesize can be regulated by the addition of F₁ thymocytes to the lethally irradiated F₁ recipient. F₁ thymocytes suppress the response of a highly responding inoculum of parental thymocytes and boost the response of an inoculum responding less well. These regulatory effects of F₁ thymocytes are not abolished by 900 R of irradiation. 900 R-irradiated parental cells which are themselves incapable of DNA synthesis can also affect the response of DNA synthesizing cells. As with F₁ thymocytes, the effect that 900 R-irradiated parental thymocytes has depends on the activity of the DNA synthesizing population; when it is high the effect is suppressive, when it is low there is augmentation. These results indicate that during the course of their response to antigen, T cells may transmit signals to other T cells which in turn transmit feedback signals to the primarily responding cells and in so doing alter their response. Such circular interactions between T cells may play an important role in immunological homeostasis.