Bladder preservation by internal iliac arterial infusion chemotherapy and irradiation in T3 bladder carcinoma patients over the age of 70 years

Treatment by internal iliac arterial infusion chemotherapy (IA) combined with pelvic irradiation has proved to be effective for locally invasive bladder. Eight male patients, median age of 78 years (range 73-81) were enrolled. Pretreatment CT and whole layer core biopsy revealed T3a or T3b. Pelvic CT or fine needle aspiration biopsy following bipedal lymphography revealed N0 in 4 cases, N2 in 2 and N3 in 2, respectively. Three to 7 cycles of cisplatin (CDDP) 30-50 mg/m2, methotrexate 20 mg/m2 and tetrahydropymnyl-adriamycin 20 mg/m2 every 3 week was administered combined with 40-50 Gy. of whole pelvis irradiation. In 4 renal function impaired patients, 100 mg/m2 of carboplatin was administered instead of CDDP. All patients obtained complete response and the bladders were preserved. Observation periods were from 9 to 75 months (median 37 months). One N2 patient died with metastatic disease and two died without carcinoma. Two patients developed invasive bladder cancer on the side opposite to the primary tumors. Both were successfully treated by IA and irradiation. Bladders of all except one patient functioned for a long period. Side effects of IA and irradiation were not significant. IA combined with pelvic irradiation is effective and safe for elderly patients with bladder carcinoma.

Roles of mucosal bacteria and succinic acid in colitis caused by dextran sulfate sodium in mice

Intestines of mice with colitis caused by dextran sulfate sodium (DSS) contain more Bacteroidaceae cells than untreated controls. We investigated the roles of intestinal bacteria and succinic acid, a by-product of Bacteroidaceae metabolism, in this model of colitis. CBA/J mice were given 3% DSS in water for 14 days. After mice were anesthetized and killed, concentrations of organic acids in stools from the cecum and colon were measured. The resected rectum and colon were washed with sterile saline; some specimens were incubated with imipenem in saline for 1 h to kill bacteria on the surfaces and others were not. Their homogenates were cultured anaerobically and aerobically. Separately, 1 mL of 20 mM succinic acid was infused into the rectum of mice, whose anal verge was glued. Animals were anesthetized and killed the next day. The rectum and colon were examined histologically. Concentrations of succinate were higher everywhere in the colon of mice with colitis than in controls. Mice with colitis had more Bacteroidaceae cells, especially B. caccae, than controls. Mice given succinate enemas had focal erosions of the mucosa and edema of the submucosa. Succinic acid, produced abundantly by members of the family Bacteroidaceae, especially B. caccae, may be the ulcerogenic agent in DSS colitis.

Rathke's cleft cyst with large frontal extension: unusual shape and pathomechanism of its formation

The patient was a 62 year old woman who presented with a visual field defect. Magnetic resonance images showed an intra-and supra-sellar low intensity mass on T1 weighted images. The preoperative diagnosis was craniopharyngioma, Rathke's cleft cyst (RCC) or arachnoid cyst. The patient underwent transsphenoidal surgery & the pathological diagnosis was RCC. We conclude that although RCC has a round, ovoid or dumb-bell shaped configuration, it may present a unusual shape in cases with preconditions, as were seen in our patient.

Analysis of the immunoglobulin heavy chain gene of secondary diffuse large B-cell lymphoma that subsequently developed in four cases with B-cell chronic lymphocytic leukemia or lymphoplasmacytoid lymphoma (Richter syndrome)

The immunoglobulin heavy chain gene (IgH gene) was analysed in four cases of B-cell Richter syndrome, in order to determine whether a secondary diffuse large B-cell lymphoma (DLBCL) could arise from the same clone as the initial B-cell chronic lymphocytic leukemia (B-CLL) and lymphoplasmacytoid lymphoma (LPL) or be a de novo event, and whether secondary DLBCL shows an intraclonal microheterogeneity. Both the initial B-CLL and secondary DLBCL in two cases expressed CD5 antigen. Both samples of the initial B-CLL or LPL and the secondary DLBCL in three cases were examined for comparison. The polymerase chain reaction-amplified IgH gene of secondary DLBCL in two cases (CD5+ case and CD5- case) were different from those of the initial B-CLL, revealing a new malignant clone. The other case (CD5-) showed that secondary DLBCL had a sequence identical to the initial LPL, indicating the same clonal origin. The variable region of the IgH gene of secondary DLBCL (CD5+ two cases and CD5- two cases) exhibited a 0.5-9.0% somatic mutation range and no intraclonal microheterogeneity.

Significance of simultaneous determination of serum human chorionic gonadotropin (hCG) and hCG-beta in testicular tumor patients

BACKGROUND

Simultaneous determinations of human chorionic gonadotropin hormone (hCG) and hCG-beta frequently produce discrepancies, that is when hCG or hCG-beta is normal, the other is elevated. Accordingly, we examined the significance of simultaneous determination of serum hCG and hCG-beta in testicular tumors.

METHODS

Simultaneous determination of hCG and hCG-beta was performed in 54 patients with testicular seminoma and 74 with non-seminomatous testicular tumors.

RESULTS

For detection of seminoma patients, hCG-beta was more effective than hCG because hCG-beta was positive in 83% (45/54) of the patients and hCG was positive in 50% (27/54). In non-seminomatous testicular tumor cases, hCG-beta was positive in 74% (55/74) and hCG was positive in 82% (61/74). The cases of hCG<1.0 mIU/mL and HCG-beta>0.1 ng/mL were significantly more frequently seen in patients with seminoma than in those with non-seminomatous testicular tumor (P < 0.001). Fourteen patients had recurrent tumor. At recurrence, only hCG was elevated in nine cases, only hCG-beta was elevated in two cases and both in one case. For diagnosis of falsely positive hCG, testosterone administration was effective because after testosterone administration, serum hCG levels became undetectable (< 1.0 mIU/mL) within one week in three examined cases.

CONCLUSION

Human chorionic gonadotropin-beta was a better marker of seminoma than hCG. For earlier detection of recurrence, both markers should be examined. For diagnosis of falsely positive hCG, testosterone administration was effective.

Chronic unilateral ureteral obstruction represented as renin-dependent hypertension

A 50-year-old woman developed renin-dependent hypertension immediately after accidental unilateral ureteral ligation during hysterectomy, and the hypertension lasted for 5 months. Surgical release of the obstruction was carried out 157 days after the ligation. Then, her blood pressure was normalized. However, the obstructed kidney showed intensive tubulointerstitial fibrosis and functional recovery was not obtained. This case suggests that the renin-angiotensin system may be upregulated in human kidney during unilateral ureteral obstruction for a long duration.

Expression of the SART1 tumor rejection antigen in renal cell carcinoma

We have previously described the SART1 gene, which encodes both the SART1(259) antigen expressed in the cytosol of the majority of squamous cell carcinomas and some adenocarcinomas and the SART1(800) antigen expressed in the nucleus of the majority of proliferating cells. The SART1(259) antigen is recognized by HLA-A24 and A26-restricted cytotoxic T lymphocytes (CTLs). The present study investigated the expression of these two antigens in renal cell carcinomas (RCCs) in order to identify an appropriate molecule for use in specific immunotherapy for RCC patients. These two antigens were detected in all RCC cell lines and cells of the primary cultures of the RCCs tested. Further, they were detectable in cells of the primary cultures of non-tumorous kidney tissues. In contrast to these cultured cells, SART1(259) was detectable in only a few uncultured RCC tissues (5/20, 25%) and was undetectable in non-tumorous kidney tissues. SART1(800) was also scarcely detectable in uncultured RCC tissues (3/20, 15%) and non-tumorous kidney tissues (4/20, 20%). HLA-A2402-restricted and tumor-specific CTL (KE4-CTL) used for the cloning of the SART1 gene showed significant levels of cytotoxicity to both the cells from the RCC cell line and the cells from the primary cultures of RCC tissues, but did not lyse any normal cells, including cells from the primary cultures of non-tumorous kidney tissues. The SART1-derived peptide at positions 690-698 induced HLA-A24 restricted CTLs cytotoxic to RCC cells from peripheral blood mononuclear cells (PBMCs) of RCC patients. Therefore, the SART1 peptide could be an appropriate molecule for use in peptide-based specific immunotherapy for RCC patients.

[Anaplastic thyroid carcinoma with lung metastasis producing CA 19-9 and GM-CSF]

A 68-year-old Japanese woman was admitted to our hospital because of hoarseness, dysphagia and a mass on the right side of her neck. Chest radiographs showed multiple nodular shadows in both lung fields. Detailed investigations resulted in a diagnosis of multiple lung metastasis of anaplastic thyroid carcinoma transformed from papillary adenocarcinoma. Both serum CA 19-9 and GM-CSF levels were elevated, to 70.5 U/ml (normal range: 0-37 U/ml) and 343.4 pg/ml (normal range: 0-8 pg/ml), respectively. Immunostaining disclosed that the primary and metastatic tumors were positive for CA 19-9, but not for GM-CSF antigens. Serum levels of these two parameters slowly decreased after chemo-radiotherapy, suggesting that the tumor may have produced GM-CSF as well as CA 19-9. Recent studies have indicated that the prognosis is poor for non-small cell lung cancers that produce G-CSF or CA 19-9. To our knowledge, this is the first case report of anaplastic thyroid carcinoma characterized by high serum levels of both CA 19-9 and GM-CSF, with metastasis to the lung and other organs.

Growth hormone secreting adenoma with unusual extension: coexisting pituitary cyst and its clinical significance

A 58 year old man showed acromegalic features. The serum growth hormone (GH) level was 7.3 ng/ml and SMC (somatomedin-C) 637 U/ml. Triple stimulation test showed abnormal response compatible with a GH secreting tumour. The conventional enhanced MRI revealed a less enhanced hemisphere-shaped lesion at the right corner of the sella turcica. In addition, dynamic MRI demonstrated an elongated lesion extending to the left beyond the midline. The patient underwent transsphenoidal surgery. Besides the soft and suckable tumour at the right corner, we entered into a small cavity loosely filled with the tumour, which was subsequently also removed. The operative finding corresponded to the lesion shown in dynamic MRI. Postoperative GH and SMC levels became 2.3 ng/ml and 326 U/ml respectively. Incidental pituitary cystic lesions in autopsied cases have been reported to be 6-33%. This case had a GH secreting adenoma with coexisting pituitary cyst. The coexisting pituitary cyst supposedly influenced the unusual shape and extension of the pituitary adenoma. Coexistence of such lesion should be kept in mind for microadenoma on neuroradiological evaluation and on intraoperative inspection surrounding the tumour.

Histone deacetylase inhibitor but not arsenic trioxide differentiates acute promyelocytic leukaemia cells with t(11;17) in combination with all-trans retinoic acid

Acute promyelocytic leukaemia (APL) with t(11;17)/PLZF-RARalpha responds poorly to all-trans retinoic acid (ATRA) and arsenic trioxide (As2O3), in contrast to APL with t(15;17)/PML-RARalpha. Molecular studies have shown that histone deacetylase (HDAC) recruited by PLZF-RARalpha is associated with the ATRA resistance. Here, we analysed in vitro the differentiation of APL cells with t(11;17) using ATRA, As203, granulocyte colony-stimulating factor (G-CSF), HDAC inhibitor trichostatin A (TSA), or combinations of these. Although 1 microM ATRA, which stimulated the differentiation of APL cells with t(15;17), was insufficient to induce differentiation, 3 microM ATRA induced terminal differentiation into granulocytes. As203 alone or in combination with ATRA induced neither differentiation nor apoptosis. However, the combination of TSA and 1 microM ATRA had a potent differentiating effect, although TSA alone had little effect. The combination of 1 microM ATRA and G-CSF did not induce differentiation. These results indicate that APL cells with t(11;17) need a higher concentration of ATRA than those with t(15;17) to differentiate and suggest that HDAC inhibitor is a promising differentiation enhancer in APL with t(11;17).

Regulation of vascular smooth muscle cell proliferation by nuclear factor-kappaB and its inhibitor, I-kappaB

Proliferation of vascular smooth muscle cells (SMC) is a crucial event in the formation of atherosclerotic tissues and is regulated by nuclear transcriptional factors including nuclear factor-kappaB (NF-kappaB). We constructed a reporter gene assay to measure NF-kappaB-dependent transcriptional activity in SMC. Thrombin receptor-activating peptide (TRAP) and basic fibroblast growth factor (bFGF) stimulated SMC proliferation and rapidly enhanced the NF-kappaB transcriptional activity in a dose-dependent manner. 4-Cyano-5,5-bis-(methoxyphenyl)4-pentenoic acid (E5510) significantly inhibited SMC proliferation and also suppressed NF-kappaB transcription stimulated by TRAP and bFGF. In contrast, although tumor necrosis factor (TNF)-alpha activated NF-kappaB transcription, E5510 had no effect on TNF-alpha-induced activation. NF-kappaB was activated after the stimulation of TRAP, bFGF, and TNF-alpha in electrophoretic mobility shift assay, and E5510 suppressed the NF-kappaB activation induced by TRAP and bFGF but not the activation by TNF-alpha. Western blot analysis of I-kappaBalpha and I-kappaBbeta, inhibitors of NF-kappaB, indicated that I-kappaBalpha degradation, rather than I-kappaBbeta degradation, was important in NF-kappaB activation after the stimulation of TRAP and bFGF. PD98059, an inhibitor of extracellular signal-regulated kinase (ERK) kinase, suppressed NF-kappaB transcriptional activity and SMC proliferation. The phosphorylation of ERK1/2 was rapidly induced by TRAP and bFGF but not by TNF-alpha. These results indicate that TRAP and bFGF induced I-kappaB degradation and NF-kappaB activation through a distinct pathway from TNF-alpha and that ERK1/2 may play an important role in NF-kappaB activation induced by TRAP and bFGF.

[High-dose chemotherapy with peripheral blood stem cell autotransplantation for patients with poor-risk testicular germ cell tumors--pilot study of the Japan Blood Cell Transplantation Study Group]

The efficacy and toxicity of a single cycle of high-dose chemotherapy with peripheral blood stem cell autotransplantation (PBSCT) in patients with poor-risk testicular germ cell tumors (GCT) enrolled in the Japan Blood Cell Transplantation Study Group was investigated. Previously untreated poor-risk testicular GCT patients were treated with BEP therapy (cisplatin, etoposide and bleomycin) with or without high-dose chemotherapy (carboplatin, etoposide and ifosphamide) followed by PBSCT. Patients were qualified for a change to high-dose chemotherapy if elevated serum tumor markers (human chorionic gonadotropin-beta, alpha-fetoprotein and lactate dehydrogenase) was observed after 3 cycles of BEP therapy. Eighteen patients were treated with BEP therapy alone and 16 with BEP and high-dose chemotherapy. At the completion of high-dose chemotherapy, all tumor markers had returned to normal in 6 patients. Among them, 1 had only teratoma found at resection and 5 had carcinoma resected. Nine patients who had persistent elevation of any tumor marker were treated with high-dose chemotherapy or another anticancer drug. Thirteen are alive (81%) and 9 (56%) are continuously disease-free at a median follow up of 11 months. The median time from PBSCT to a granulocyte count > 500/microL was 9.5 days and to a platelet count > 50,000/microL was 13 days.

The study of PSA gene expression on urogenital cell lines

PURPOSE

Reverse transcriptase-polymerase chain reaction (RT-PCR) offers a potentially more sensitive assay for detecting cells expressing prostate-specific antigen (PSA) mRNA in peripheral circulation. But the sensitivity and specificity are variable depending on the position of the PSA amplification. To increase sensitivity and specificity, the whole PSA cDNA (1466 bp) was separated into eight different parts.

METHODS

We examined RT-PCR on 12 urogenital cell lines, including three prostate cancer (LNCaP, PC3, DU145), five human renal cell carcinoma (SMKT-R3, TOS-1, TOS-2, R4, ACHN), two urinary bladder cancer (YTS-1, KK-47) and two testicular cancer (NEC8, NEC14) cell lines. The sizes of the eight fragmented PSA used in the experiment were PSA-1 (1-257bp), PSA-2 (1-322bp), PSA-3 ( 172-507bp), PSA-4 (172-851 bp), PSA-5 (595-1347 bp), PSA-6 (682 967 bp), PSA-7 (682-1347 bp) and PSA-8 (863-1466 bp).

RESULTS

All cell lines had positive signals from PSA-6, PSA-7 and PSA-8. The positive signals from PSA-1, PSA-2 and PSA-3 were detected in some other cell lines in addition to the three prostate cancer cell lines. Only LNCaP which produces the PSA protein had a positive signal from PSA-5. PC3 and DU145 (which do not produce PSA) and LNCaP had a positive signal from PSA-4. Therefore, the inner primer PSA-4' (578-782 bp) used to increase sensitivity and specificity. Nested RT-PCR on the 12 cell lines, using the PSA-4 and 4' primers, detected more clear bands in the three prostate cancer cells.

CONCLUSION

Nested RT-PCR using PSA-4 (outer primer) and PSA-4' (inner primer) may be useful for detecting prostate cancer cells in the peripheral blood.

Uptake of orally administered polystyrene latex and poly(D,L-lactic/glycolic acid) microspheres into intestinal lymphoid tissues in chickens

Fluorescein-labeled microspheres were orally administered to chickens and their distribution in intestinal lymphoid tissues was investigated. Polystyrene latex microspheres were observed in Peyer's patches, and also in the Meckel's diverticulum and the jejunum. Their density, however, seemed to be lower than that in Peyer's patches. Microspheres were rarely observed in the other intestinal tissues examined, including the bursa of Fabricius. Of note is that, although microspheres were present in the lumen, few, if any, were observed in the lamina propria of the caecal tonsil and caecum. Polystyrene latex microspheres of diameter 2.0 microm or 4.5 microm were also observed in Peyer's patches, but their density seemed to be lower as compared with the 0.75 microm microspheres. Poly(D,L-lactic/glycolic acid) (PLGA) microspheres were prepared using PLGAs of various molecular weights (MW) and their uptake into Peyer's patches was compared. Microspheres prepared with PLGA of average MW of 20000 were not taken up into Peyer's patches, but those prepared with PLGA of average MW of 61000 or 99 800 were taken up into Peyer's patches.

Diagnosis and treatment of pelvic lymph node metastasis in bladder control

BACKGROUND AND METHODS

Bipedal lymphography and percutaneous fine needle aspiration biopsy (FNAB) of pelvic lymph node was done in 200 patients with bladder cancer.

RESULTS

A diagnosis of metastasis to the pelvic lymph node was obtained by this method in 34 patients. Of these 34 patients, only 12 (35%) were positive or suspected of having pelvic lymph node metastasis by computed tomography. Sixteen patients (47%) had unequivocally positive or highly suspicious lymphogram and 18 patients (53%) had normal lymphogram. Seventy-eight cases, including eight FNAB-positive cases, were treated by radical cystectomy and regional lymph node dissection. Sensitivity, specificity, positive predictive value and negative predictive value of FNAB were 57, 100, 100 and 91%, respectively. Thirteen FNAB-positive M0 patients could be treated by multimodality therapy and evaluated after neoadjuvant therapy by repeated lymphography and FNAB. All were changed to N0 by FNAB after neoadjuvant therapy. In eight patients treated by total cystectomy and lymph node dissection, four had down staged to pN0 but four had one positive node. In five follow-up cases without surgery, one had recurrent pelvic lymph node metastasis 35 months later. Cause-specific survival of these patients was 76% at 5 years and 57% at 8 years.

CONCLUSIONS

Pretreatment diagnosis of pelvic lymph node metastasis and multimodality therapy may improve the prognosis of regional lymph node-positive bladder cancer. Because it is difficult to diagnose pN1 using FNAB, radical operation should be performed even if neoadjuvant therapy is effective and down staging is obtained.

Bone window CT evaluation of the nasal cavity for the transsphenoidal approach

Bone window CT findings sliced parallel to the transsphenoidal surgical route were evaluated preoperatively in 104 patients with pituitary lesions in order to assess their clinical significance. (1) The width and depth of the transsphenoidal operative fields were measured. The piriform aperture was 26.3 mm (SD 2.5) in maximum width, the origin of inferior nasal concha 27.0 mm (SD 2.5) and the origin of the middle nasal concha 26.8 mm (SD 3.8), respectively. The distance between the piriform aperture and the sellar floor was 61.6 mm (SD 3.6). The operative field was cylindrical in shape, approximating 26-27 mm in width and 62 mm in depth. (2) The width and length of bony nasal cavity were different by 2-3 mm in patients with and without acromegaly. (3) In re-operated patients, the location of thinned or atrophic nasal mucosa, residual bony septum and narrow sellar floor opening, which needed further bony removal were demonstrated. Bone window CT provides direct visualization of the nasal anatomy for the approach, and is useful in screening for patients with a narrow nasal cavity. It helps to determine rhinological manoeuvres for providing wide operative fields at the nasal cavity and sellar floor.

The significance of resections for residual masses after chemotherapy in metastatic testicular tumors

BACKGROUND

After chemotherapy for metastatic testicular tumors, masses may remain, often in the metastatic sites. This study analyses the role of resections for the residual masses.

METHODS

Seventy-seven patients with advanced (stage II, III) testicular tumors were treated. Of these, 38 patients, including eight with seminoma and 30 patients with non-seminomatous germ cell tumors, underwent resection of residual masses after chemotherapy and have been followed for a median of 41.5 months (range 2-138) after the resection.

RESULTS

Residual masses were necrosis/fibrosis in 19 patients, mature teratoma in 11 and cancer in eight. The ratio of cancer in stage III (41.2%) was significantly higher than that in stage II (4.8%). Ten of 38 (26.3%) patients experienced recurrences in sites other than the resected sites, and five of 10 patients have died of cancer. Most recurrences (80%) occurred within two years. Recurrences after resection were detected in 4.8% of stage II patients, 52.9% of stage III, 16.7% of necrosis/fibrosis and mature teratoma, and 62.5% of cancer. The survival rate of patients with cancer was significantly lower in spite of adjuvant chemotherapy after surgery.

CONCLUSIONS

Resection for residual masses after chemotherapy in metastatic testicular tumors was useful in confirming the tissue and in controlling the metastatic sites. Recurrences were often found in patients with cancer in the residual mass and the prognosis of patients with cancer was poor, therefore the development of more effective therapy for patients with cancer is required to improve the prognosis.

Delayed postoperative CSF rhinorrhea of intrasellar arachnoid cyst

CSF rhinorrhea due to a transsphenoidal approach usually follows accidental or intentional arachnoid opening. We report a patient with an intrasellar arachnoid cyst, who developed delayed onset of CSF rhinorrhea. A sixty-two-year-old man presented with bitemporal type visual field defect for the last 3 years. With the diagnosis of arachnoid cyst or Rathke's cleft cyst, based on MRI findings of intra-and supra-sellar cyst with CSF intensity, he successfully underwent transsphenoidal surgery without evidence of intra-operative CSF leakage. He developed CSF rhinorrhea one week later. This needed another operation for sellar floor repair. The pathomechanism of this delayed onset is explained as follows. Incomplete or oneway communication of subarachnoid space to cyst cavity, unrecognized during surgery, might cause delayed onset of CSF rhinorrhea. By using MRI, identification of the residual gland, which was compressed posteriorly, is useful for differentiating an arachnoid cyst from other cystic lesions. In highly suspect cases, even without evidence of intra-operative CSF leakage, peri-operative measures to prevent occurrence of postoperative CSF rhinorrhea are required.

[Acute promyelocytic leukemia with t(11;17)(q23;q21)]

We report the first Japanese case of acute promyelocytic leukemia with t(11;17)(q23;q21) and CD56. A 41-year-old man with schizophrenia was hospitalized because of the appearance of blasts with Auer bodies in his peripheral blood. A bone marrow smear showed an abundance of abnormal cells with scanty azurophile granules in the cytoplasm and somewhat lobulated nuclei. Because the abnormal cells demonstrated strongly positive peroxidase reactivity with a few faggot bodies, the patient was given a diagnosis of acute promyelocytic leukemia (M3v according to the FAB classification). However, chromosome analysis revealed t(11;17)(23; q21). All-trans retinoic acid (ATRA) was not effective. Mitoxantrone was more effective than daunorubicin, and resulted in a complete remission with a normal karyotype. About 9 months later, the patient suffered a relapse. Surface marker analysis demonstrated blasts that were positive for CD56, CD13, and CD33. MEC (mitoxantrone, etoposide, cytarabine) therapy was ineffective. Although ATRA was administered at a dose of 80 mg/day for more than 2 months, the number of myelocytes and promyelocytes increased Finally CAG (cytarabine, aclarubicin, G-CSF) therapy was initiated, but the patient died due to intracranial invasion and hemorrhage accompanied by disseminated intravascular coagulation.

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

BACKGROUND

Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer.

METHODS

Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space.

RESULTS

Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux.

CONCLUSIONS

Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.

Comparison of adjuvants with respect to serum IgG antibody response in orally immunized chickens

We have previously shown that oral immunization with non-replicating antigens hardly induced serum IgG antibody response in chickens and addition of sodium fluoride (NaF) to the immunogen markedly improved their immunological states. In the present study, taurine, lithium and Quillaja saponin (Q-SAP) were compared with NaF with respect to their enhancement of serum IgG antibody response in chickens after oral immunization. The antibody titer of chickens which received Q-SAP as the mucosal adjuvant tended to be higher than that of chickens which received antigen plus NaF. Simultaneous administration of antigen with lithium or taurine elicited a higher antibody titer in chickens compared to those of chickens orally immunized with antigen alone, but the effect of these two adjuvants was less efficient compared with that of NaF. These results suggested that Q-SAP as well as NaF is useful as an oral adjuvant for chickens.

Enzyme-linked immunosorbent assay detection of prostate-specific antigen messenger ribonucleic acid in prostate cancer

OBJECTIVES

To develop a rapid, sensitive, reverse transcriptase-polymerase chain reaction (RT-PCR) prostate-specific antigen (PSA) messenger ribonucleic acid (mRNA) detection method by applying colorimetric enzyme-linked immunosorbent assay (ELISA).

METHODS

Total RNA was extracted from 16 urogenital cancer cells (including PSA-producing LNCaP cells) from pelvic and inguinal lymph node aspiration biopsy samples from patients with prostate, bladder, and penile cancer, as well as from blood samples of 500 patients with urogenital cancer. We used rTth polymerase for RT and PCR. The RNA target was amplified by RT-PCR with dinitrophenyl-labeled primer. The PCR product was denatured and hybridized on a PSA-specific probe-coated microwell plate.

RESULTS

In 1 6 cancer cell lines, only LNCaP cells expressed especially high PSA mRNA values, with an optical density (OD) greater than 3. In other cell lines, two testicular cells had relatively high ODs, 1.909 and 0.987, respectively. A high PSA mRNA value was obtained by fine needle aspiration from pelvic lymph node specimens of cytologically positive lymph nodes from patients with prostate cancer but not from patients with cytologically proved bladder or penile cancer. Sensitivity and specificity of fine needle aspiration samples were 70% and 100%, respectively. Blood tests obtained from patients with prostate cancer demonstrated high PSA mRNA values.

CONCLUSIONS

The PSA mRNA RT-PCR ELISA method provides a sensitive photometric enzyme immunoassay for the detection of PSA mRNA, using nonradioactive techniques.

Severe rhabdomyolysis as a complication of high-dose chemotherapy in a patient with advanced testicular cancer

BACKGROUND

A 38-year-old man was diagnosed with choriocarcinoma in the left testis, a 9 cm retroperitoneal tumor, left hydronephrosis, multiple lung metastasis and gynecomastia. His serum hCG level decreased but was still above the normal range after four courses of standard chemotherapy.

METHODS

High-dose chemotherapy was then given with ICE (ifosfamide, carboplatin, etoposide) from days -7 to-3.

RESULTS/DISCUSSION

On day -2 the patient became confused and hallucinated, so the sedatives haloperidol and flunitrazepam were administrated. His creatinine phosphokinase levels increased to 6150 IU/L (reference range <197 IU/L) on day 0. Myoglobinuria and myoglobinemia were noted and the renal dysfunction progressed. A peripheral blood stem cell transplantation was performed after hemodialysis on day 0. Although his bone marrow recovered, the patient died of respiratory failure on day 18. An autopsy revealed massive pulmonary bleeding. Pretreatment renal dysfunction, renal damage by high-dose chemotherapy, ifosfamide-induced hallucinations and the administration of sedatives, such as haloperidol and flunitrazepam, may have been causative factors for the rhabdomyolysis observed in this patient.

Underdevelopment of fetal thyroid follicular cells in athymic nude mouse (BALB/cAnNCrj-nu/nu) observed by electron microscopic morphometry

Fetal thyroid follicular cells of congenitally athymic nude mouse (BALB/cAnNCrj-nu/nu) were studied with an electron microscope. The area of the entire cell, nucleus and mitochondrion were measured and compared in athymic and euthymic fetal nude mice (BALB/cAnNCrj-nu/+) at 18 days of gestation. The mean area of cytoplasm was significantly smaller in homozygous athymic nude mice than in heterozygous euthymic ones. The mean area of the mitochondrion was also smaller in homozygous athymic nude mice, but the difference was not statistically significant. There was no significant difference between the two groups in the area of the nucleus. These findings suggest that the thyroid gland of athymic nude mice is still underdeveloped at the end of gestation as compared to that of their euthymic littermates.

Infrequent genetic alterations of the PTEN gene in Japanese patients with sporadic prostate cancer

Prostate cancer is a major cause of cancer death among elderly men in America, Europe, and Japan. However, the molecular mechanism of carcinogenesis is not yet well characterized. Frequent loss of heterozygosity (LOH) on chromosome 10q was reported in prostate cancer, and a candidate tumor suppressor gene, PTEN, was isolated on chromosome band 10q23.3. To investigate the genetic alterations of PTEN, we examined 45 primary prostate cancer specimens. LOH at the PTEN locus was observed in two (11.1%) of 18 tumors. However, no mutations were observed in any of the primary prostate cancers. These data suggest that mutation of the PTEN gene does not play a major role in prostate carcinogenesis of Japanese patients.

Structure of the murine secretory leukoprotease inhibitor (Slpi) gene and chromosomal localization of the human and murine SLPI genes

Secretory leukoprotease inhibitor (SLPI) is a serine protease inhibitor involved in antineutrophil elastase protection at inflammatory sites. To elucidate both the function and regulation of SLPI in vivo, we isolated and characterized the mouse Slpi gene. An entire 3-kb mouse Slpi gene fragment was sequenced, including an 0. 8-kb 5'-flanking region, the 2.2-kb Slpi gene, and a 0.1-kb 3'-flanking region. The mouse Slpi gene spans 2,222 base pairs containing four exons and three introns. All splicing borders between exons and introns are conserved as predicted by GT-AG rules. Using primer extension analysis, the transcription start site was located 20 nucleotides upstream from the methionine (ATG) initiation codon. At the defined transcription start site, the sequence TCA+1GAGC is present. These results indicate that both mouse and human genomic structure are highly conserved. Using fluorescence in situ hybridization, we confirmed that, consistent with the genomic similarity, the human SLPI gene is localized on chromosome 20q12-13. 2 and the mouse homologue on chromosome 2H, which are syntenic with each other.

Cell cycle regulation and differentiation in the human podocyte lineage

Mature podocytes are regarded as growth-arrested cells with characteristic phenotypic features that underlie their function. To determine the relationship between cell cycle regulation and differentiation, the spatiotemporal expression of cyclin A, cyclin B1, cyclin D1, the cyclin-dependent kinase inhibitors (CKIs) p27 and p57, and markers of differentiating podocytes in developing human kidneys was investigated by immunohistochemistry. In S-shaped body stage, Ki-67, a cell proliferation marker that labels the G1/S/G2/M phase, was expressed in the majority (more than 80%) of presumptive podocytes, along with cyclin A (approximately 20% of the Ki-67-positive cells) and cyclin B1 (less than 5% of Ki-67-positive cells) expression. Among these cells), cyclin D1 and CKIs were markedly down-regulated. At the capillary-loop stage, by contrast, CKIs and cyclin D1 were intensely positive in podocytes, whereas no Ki-67, cyclin B1, or cyclin A expression was seen. Moreover, double-immunolabeling and serial-section analysis provided evidence that CKIs and markers specific for differentiating podocytes, namely PHM-5 (podocalyxin-like protein in humans), synaptopodin (a foot process-related protein), and C3b receptor, were co-expressed at the capillary-loop stage. Podocytes were the only cells within the glomeruli that expressed CKIs at immunohistochemically detectable levels. Furthermore, bcl-2 (an apoptosis inhibitory protein) showed a reciprocal expression pattern to that of CKI. These results suggest that 1) the cell cycle of podocytes is regulated by cyclin and CKIs, 2) CKIs may act to arrest the cell cycle in podocytes at the capillary-loop stage, and 3) the specific cell cycle system in podocytes may be closely correlated with their terminal differentiation in humans.

Surveillance study for clinical stage I testicular seminomas and nonseminomatous germ cell tumors

BACKGROUND

Optimal therapy for stage I testicular tumors is still controversial. This study evaluated the efficacy of a surveillance policy for patients with testicular stage I seminomas and nonseminomatous germ cell tumors (NSGCT).

METHODS

From 1984 to 1996, 24 patients with stage I seminoma and 20 with stage INSGCT were followed after radical orchiectomy with tumor markers and imaging studies. All patients were followed for at least 2 years except for those who recurred within 2 years. Recurrent patients were treated with cisplatin-based chemotherapy.

RESULTS

The median follow-up periods for seminoma and NSGCT patients were 41 and 54 months, respectively. Recurrences were detected in 2 seminoma (8.3%) and 10 NSGCT (50%) patients. Eleven of the 12 recurrent patients (92%) were detected within 2 years after orchiectomy. The seminoma patients both recurred in the retroperitoneal lymph nodes, while 70% of the NSGCT patients recurred in the lung and/or retroperitoneal lymph nodes. The recurrent seminoma patients were treated with chemotherapy and are alive without disease for 1 7 and 24 months afterorchiectomy. One NSGCT patient died of cancer, but the other 9 recurrent NSGCT patients are alive without disease at 25 to 113 months after orchiectomy.

CONCLUSIONS

Surveillance alone is reliable for monitoring patients with stage I testicular seminoma and NSGCT. The majority of recurrences occurred within 2 years, necessitating intensive follow-up for 3 years. As the lung metastatic rates in NSGCT patients were high, a more accurate assessment for lung metastasis is desirable in these patients.

[Detection of PSA mRNA from the peripheral blood and pelvic lymph nodes in patients with prostatic cancer by means of reverse transcription-polymerase chain reaction (RT-PCR)]

BACKGROUND AND METHODS

To detect prostate cancer cells in the blood circulation and in the lymph nodes by RT-PCR methods, we examined two kinds of prostate specific antigens (PSA) primers and one prostate specific membrane antigen (PSM). PSa primer 1 was established by us, PSA primer 2 by Moreno et al and PSM primer by Israeli et al.

RESULTS

Both PSA primers were specific for expression of PSA mRNA because in 12 kinds of urogenital culture cells only LNCaP cells, which produce PSA, expressed PSA mRNA by RT-PCR, PSA 1 was more sensitive than PSA 2 for detection of PSA mRNA in the circulating cells since PSA mRNA was detected in the blood circulating cells in 5 cases of stage D2 prostate cancer using PSA primer 1 but in only one was using PSA primer 2. PSM mRNA was detected in all 12 types of urogenital cancer cells and in the blood circulating cells not of prostate cancer patients but also of renal, bladder, testicular cancer patients and normal volunteers. PSA 1 was used to detect PSA mRNA from the samples of fine needle aspiration biopsy (FNAB) of pelvic lymph node, and PSA mRNA was positive in 10 FNAB samples including not only all 6 cytologically positive and two cytologically class III cases but also 2 of 8 cytologically negative cases. RT-PCR for FNAB samples of all 15 cases of bladder cancer were negative for the detection of PSA mRNA.

CONCLUSION

Detection of PSA mRNA by RT-PCR in FNAB samples may be useful to diagnose pelvic lymph node metastasis and to furnish additional information for the cytological diagnosis of prostate cancer.

Adjuvant effects of fluoride on oral immunization of chickens

The present study was conducted to examine the antibody responses of chickens after oral immunization and the influence of sodium fluoride (NaF) on their immunological states. Bovine serum albumin (BSA) was used as an antigen, and the response was measured by enzyme-linked immunosorbent assays of serum samples, bile samples, and lachrymal fluids. Oral immunization of chickens with antigen alone hardly induced antibody responses in sera, bile samples or lachrymal fluids. Moreover, compared to control chickens, these orally immunized chickens exhibited a lower serum IgG response to subsequent parenteral immunization, suggesting that oral immunization induced immunological tolerance in chickens. A mucosal adjuvant, NaF, could abrogate oral tolerance and elicit an increase in antibody responses. Chickens, which received oral administration of antigen and NaF simultaneously, showed a significant rise in serum IgG antibody. Although there were variations among individual chickens and the titers were low, IgA antibodies were detected in bile samples and lachrymal fluids.

[Detection of urogenital malignant cells in the peripheral blood by nested RT-PCR using keratin 19 mRNA]

INTRODUCTION AND OBJECTIVES

It is reported that cytokeratin 19 (CK-19) mRNA is not expressed in the peripheral blood cells of the healthy subjects (Am. J. Pathol. 142: 1111. 1993). Detection of DNA fragments of CK-19 in the peripheral blood suggests the existence of epithelial malignant tumor cells. In this study, we detected CK-19 genes in peripheral blood of patients with urogenital malignancy, and thus clarified the possibility of understanding tumor expansion.

METHODS

Mononuclear cells were separated from the peripheral blood of 39 patients with urogenital tumor and 9 controls. Total cellular RNA was extracted according to the method described elsewhere. The CK-19 gene expression was investigated using nested reverse transcription polymerase chain reaction (nested RT-PCR) and confirmed by Southern Blotting. These results were compared to the clinical stages.

RESULTS

CK-19 mRNA was not detected in any of 9 controls. CK-19 mRNA was detected in 3 out of the 10 bladder cancer cases. Two had metastases and 1 had muscle invasion without metastasis. One of 6 urothelial cancer case of the upper urinary tract showed positive amplification, and had liver, bone and lymphnode metastases. After one course of chemotherapy, mRNA became negative. In prostate cancer cases, three among 7 were positive and all 3 cases had distant metastases. In renal, testicular and penile cancer cases, the positive ratio were 3/6, 1/8 and 2/2, respectively. All positive cases of renal and testicular cancer had distant metastases, but one case of penile cancer had no metastasis.

CONCLUSION

The detection of CK-19 mRNA in the circulating blood by nested RT-PCR makes it possible to detect micrometastasis, to evaluate therapeutic effects and to predict the prognosis.

Hemorrhagic type moyamoya disease

The clinical picture of hemorrhagic type Moyamoya disease was analyzed in 20 cases. Hematoma at the basal ganglia was noted in 40% of cases, intraventricular hemorrhage (IVH) in 30%, thalamic hemorrhage with ventricular rupture in 15% and subcortical hemorrhage in 5%. The location was undetermined in two cases (10%) due to bleeding in the pre-computed tomography (CT) era. The frequencies shown above were correlated well to previous reports. In magnetic resonance imaging (MRI) performed 1 year or more after IVH, the primary bleeding site was demonstrated at the lateral wall of lateral ventricle, in portion density weighted and T2 weighted images. MRI can detect the site of old bleeding points and its chronological change if the study is repeated. In a follow-up period of 6.2 years, 35% of the cases had rebleeding once or twice. The second bleeding occurred seven times and the third twice. IVH occurred five times and the most common, basal ganglia hematoma three times while thalamic hemorrhage once. As a result, the rate of good outcome was 60% after the first bleeding and 40% after rebleeding. The mortality rate was 5% after the first 25% after rebleedings. Factors related to rebleedings and their poorer outcome are sex (with women being more susceptible), massive ICH and early recurrence. Rebleeding worsened the outcome. Therefore, prevention of rebleeding is important. From a therapeutic viewpoint, although a close relation between rebleeding and untreated hypertension could not be established, blood pressure control is critical at the both acute and chronic stages. Bypass surgery for bleeding type of Moyamoya disease seems to be less promising than ischemic type, even though a definite answer may not be obtained from our small number of cases.

Internal iliac arterial infusion chemotherapy for rabbit invasive bladder cancer

BACKGROUND

Internal iliac arterial infusion (IA) chemotherapy has been used clinically for locally invasive bladder cancer, but there have been no experimental studies to actually demonstrate whether IA is more effective than intravenous infusion (i.v.) chemotherapy in this setting.

METHODS

We compared the effects of IA and i.v. using a rabbit invasive bladder cancer model. A 0.2 mL suspension containing 2 x 10(6) VX2 cancer cells was inoculated into the posterior submucosa of the bladder. Two weeks later the rabbits were divided into 3 treatment groups of 8 rabbits each: controls, a group treated with IA consisting of 10 mg/kg carboplatin and 1 mg/kg pirarubicin once a week for 3 weeks (days 14, 21, and 28), and the third treated with the same regimen intravenously.

RESULTS

All bladder tumors of the rabbits in the IA group decreased in size, and 3 of the tumors totally disappeared (37.5%). There was also no evidence of lung metastasis. All tumors in the rabbits in the i.v. treatment group increased in size (tumor volume of IA vs. i.v., P = 0.008) and 2 rabbits had lung metastases. All tumors of the control group increased in size and all rabbits had lung metastases. The concentrations of platinum and pirarubicin in the bladder tumors were significantly higher in the IA treatment group than those in the i.v. treatment group at time points from 5 to 10 minutes (P < 0.05) after drug infusion.

CONCLUSION

The antitumor effect of IA may be due to higher drug concentrations in the early stage after drug delivery, and the initial circulation of high concentrations of drugs may be the most important factor in suppressing tumor growth.

[Retrovesical leiomyosarcoma responsive to preoperative chemoradiotherapy: a case report]

A 70-year-old man with dysuria was referred to our hospital. Computed tomography scan and magnetic resonance imaging demonstrated a large solid tumor in the retrovesical space. Transurethral needle biopsy revealed leiomyosarcoma. Since the size of the tumor decreased markedly by intraarterial chemotherapy with cisplatin, methotrexate and pirarubicin, in combination with radiotherapy (40 Gy), surgical extirpation of the tumor was performed. Neither infiltration to the adjacent organs or lymph node metastasis was recognized. The patient had been free of recurrence for 12 months after operation.

Megakaryocytopoietic activity of a truncated variant of mouse thrombopoietin

Thrombopoietin (TPO) is a hemopoietic cytokine that specifically stimulates the growth and development of megakaryocytes. In addition to full-length TPO (corresponding to TPO-1), cDNAs of three truncated variants (TPO-2 to 4) have been isolated. However, whether or not these variants have biological activities has not been clarified presumably because of poor secretion into extracellular milieu. To examine the biological significance of the shortest variants, TPO-4, we prepared two fusion cDNAs of TPO-1 and TPO-4, each of which was combined with the finger-growth factor-kringle 1 (FGK1) domains of tissue plasminogen activator (tPA) as a tag and transfected them into baby hamster kidney (BHK) cells. An immunodetection assay for FGK1 antigen revealed that the amount of secreted TPO-4-FGK1 fusion protein was about 2% of that of TPO-1-FGK1. These fusion proteins after affinity purification had comparable activities on a molar basis in both megakaryocyte colony stimulating activity towards mouse bone marrow cells and growth promotion activity towards the TPO-responsive cell line UT-7/GM. These results indicate that the TPO-4 is biologically active in vitro, although its primary structure of the C-terminal half after the 111th amino acid residues is completely different from authentic TPO-1 due to frame shift.

Plasma chromogranin A in prostatic carcinoma and neuroendocrine tumors

PURPOSE

Chromogranin A is a good tumor marker for neuroendocrine cells. Whether plasma chromogranin A could be a useful marker for neuroendocrine differentiation of prostatic carcinoma and neuroendocrine tumors was investigated using an enzyme-linked immunosorbent assay.

MATERIALS AND METHODS

Plasma levels of chromogranin A were measured by enzyme-linked immunosorbent assay in 33 patients with prostatic carcinoma, 10 with benign prostatic hyperplasia (BPH) and 13 with neuroendocrine tumors (2 medullary thyroid carcinomas, 1 thymic carcinoid, 1 gastrin producing duodenal carcinoid, 3 nonfunctioning pancreatic endocrine tumors, 2 neuroblastomas, 3 pheochromocytomas and 1 carotid body tumor).

RESULTS

The normal level of chromogranin A from 40 healthy volunteers was 30 +/- 11 units per 1. (mean plus or minus standard deviation). Mean plasma chromogranin A in patients with BPH and prostatic carcinoma was 52.4 +/- 12.9 and 67.5 +/- 22.9 units per 1., respectively. All patients with neuroendocrine tumors, except 1 with a nonfunctioning pancreatic endocrine tumor, had elevated chromogranin A (mean 401 +/- 409 units per 1.). There were significant differences in plasma chromogranin A level between patients with BPH and neuroendocrine tumors (p < 0.01), prostatic carcinoma and neuroendocrine tumors (p < 0.01), and BPH and prostatic carcinoma (p < 0.05). Of the 33 patients with prostatic carcinoma 5 had elevated chromogranin A, only 1 of whom had elevated prostate specific antigen.

CONCLUSIONS

Chromogranin A is an excellent marker for neuroendocrine tumors, particularly nonfunctioning tumors, and measurement of chromogranin A is also useful to detect prostatic carcinoma in patients whose prostate specific antigen is not elevated.

Plasma chromogranin A in prostatic carcinoma and neuroendocrine tumors

PURPOSE

Chromogranin A is a good tumor marker for neuroendocrine cells. Whether plasma chromogranin A could be a useful marker for neuroendocrine differentiation of prostatic carcinoma and neuroendocrine tumors was investigated using an enzyme-linked immunosorbent assay.

MATERIALS AND METHODS

Plasma levels of chromogranin A were measured by enzyme-linked immunosorbent assay in 33 patients with prostatic carcinoma, 10 with benign prostatic hyperplasia (BPH) and 13 with neuroendocrine tumors (2 medullary thyroid carcinomas, 1 thymic carcinoid, 1 gastrin producing duodenal carcinoid, 3 nonfunctioning pancreatic endocrine tumors, 2 neuroblastomas, 3 pheochromocytomas and 1 carotid body tumor).

RESULTS

The normal level of chromogranin A from 40 healthy volunteers was 30 +/- 11 units per 1. (mean plus or minus standard deviation). Mean plasma chromogranin A in patients with BPH and prostatic carcinoma was 52.4 +/- 12.9 and 67.5 +/- 22.9 units per 1., respectively. All patients with neuroendocrine tumors, except 1 with a nonfunctioning pancreatic endocrine tumor, had elevated chromogranin A (mean 401 +/- 409 units per 1.). There were significant differences in plasma chromogranin A level between patients with BPH and neuroendocrine tumors (p < 0.01), prostatic carcinoma and neuroendocrine tumors (p < 0.01), and BPH and prostatic carcinoma (p < 0.05). Of the 33 patients with prostatic carcinoma 5 had elevated chromogranin A, only 1 of whom had elevated prostate specific antigen.

CONCLUSIONS

Chromogranin A is an excellent marker for neuroendocrine tumors, particularly nonfunctioning tumors, and measurement of chromogranin A is also useful to detect prostatic carcinoma in patients whose prostate specific antigen is not elevated.

[Study on the surgical treatment for pulmonary metastasis from renal cell carcinoma]

BACKGROUND

Pulmonary resection for metastatic renal cell carcinoma were studied to assess the indication of surgical management.

METHODS

Between January, 1981 and December 1994, 17 consecutive patients (14 men and 3 women) underwent complete pulmonary resection for metastatic renal carcinoma. Median age was 61 years (range, 45 to 73 years). Eleven were appeared lung metastasis after resection of primary tumor. Median time between nephrectomy and pulmonary resection was 32 months (range, 0 to 127 months).

RESULTS

There were no operative deaths. One patient had solitary metastasis, 4 had two, 2 had three, 2 had four, one had seven, one had eight and 6 had more than twenty-two. Segmental resection was performed in 12 patients, lobectomy in 2, lobectomy and segmentectomy in 3 and segmentectomy for total lobes in 3. Four patients had another site operation of renal metastasis, brain tumor resection, chest wall and ribs resection, contra-lateral adrenalectomy and contralateral partial nephrectomy. Median follow-up was 44 months (range, 10 to 129 months). The cause specific survival rate and disease free survival after pulmonary resection was 55 and 48 percent at 5 years and 27 and 14 percent at 10 years, respectively.

CONCLUSION

Pulmonary resection for metastatic renal cell carcinoma was considered effective in some selected slow-growing cases. Multiple and both lungs metastases is not contraindication and the patients under 10 metastatic focuses had good prognosis.

Endoscopic observation for detection and monitoring of N-butyl-N-(4-hydroxybutyl)nitrosamine--induced bladder tumor in rats

Recent advances in tumor carbohydrate biochemistry have demonstrated antitumor effects of locally administered GM3 ganglioside on mouse MBT-2 tumor. When intravesical therapy in N-butyl-N(4-hydroxybutyl)nitrosamine (BBN)-induced rat bladder tumor is attempted, it is essential to identify the tumor, to classify its size before therapy and to monitor the effect of the therapy. To establish a more reliable experimental therapeutic system, we assessed the development of BBN-induced rat-bladder tumor by endoscopic observation. BBN-induced bladder tumors in rats were observed serially using a 4.2-F flexible fiberscope. The endoscopic findings were compared with the histopathological findings. Intravesical tumor growth varied greatly between individual rats. The smallest change detected by endoscopy was a small edematous lesion histologically proved to be papilloma. The largest nodular lesion was determined to be a papillary, transitional cell carcinoma. This noninvasive method makes the BBN rat experimental system more reliable by allowing confirmation of tumor formation and classification of the tumor volume prior to therapy.

[Genetic diagnosis of pelvic lymph node metastasis in prostate cancer using aspiration biopsy samples]

We have developed a highly sensitive method to detect pelvic lymph node(LN) metastasis using reverse transcriptase-polymerase chain reaction(RT-PCR) with the primers specific for prostate-specific antigen(PSA) gene in combination with the fine needle aspiration biopsy(FNAB). The specimens were obtained from pelvic LN from 15 prostate cancer patients and 15 bladder cancer patients. The aspirated samples (0.05 approximately 0.1 ml) were used for detecting the fragment of PSA mRNA by RT-PCR and Southern blot analysis, and the rest of samples were submitted to conventional cytology. Expression of PSA gene was detected in 9 cases of FNAB samples including all 5 cytologically positive and further more 2 cytologically class III cases, and 2 of 8 cytologically negative cases. RT-PCR of FNAB samples from all cases of bladder cancer were negative for the detection of PSA gene. The sensitivity of PSA gene by RT-PCR was very high and could detect 10 degrees cancer cell. In conclusion, our study suggested that RT-PCR for detection of PSA gene in FNAB samples might become a new diagnostic tool for detection of small foci of prostatic cancer metastasis in LN and combination use of RT-PCR and cytology could greatly contribute to accuracy in diagnosis.

[Genetic diagnosis of pelvic lymph node metastasis using fine needle aspiration samples in prostate cancer]

We have developed a highly sensitive method to detect pelvic lymph node metastasis using the reverse transcriptase-polymerase chain reaction (RT-PCR) with primers specific for prostate-specific antigen (PSA) gene. Fine needle aspiration biopsy (FNAB) of pelvic lymph nodes was performed in 24 patients with prostate cancer. Each aspirated sample (0.05-0.1 ml) was divided into 2 parts; one for RNA extraction and RT-PCR to detect the fragment of PSA mRNA, and the other to smear on a slide glass for conventional cytology. The PSA gene was detected by RT-PCR in 11 FNAB samples which included not only all 6 cytologically positive and 2 cytologically class III cases but also 3 of 16 cytologically negative cases. The PSA gene was not detected by RT-PCR of FNAB samples in any of the 20 cases of bladder cancer. Thus RT-PCR for detection of the PSA gene in FNAB samples may be useful as a new diagnostic technique for detection of early lymph node metastasis in prostate cancer and an additional tool for cytological diagnosis of prostate cancer.

G(M3) inhibits murine MET-2 tumor invasion and growth

G(M3) has some important roles in cell-to-cell interaction and has proved to have an optimal concentration for fibronectin mediated cell adhesion. G(M3) content in murine bladder tumor (MBT-2) assessed by thin-layer chromatography was similar to human invasive bladder tumor. From glycolipid composition also, MBT-2 is considered as an appropriate model for human invasive bladder tumor. Anti-tumor effect of locally administered G(M3) On MBT-2 tumor was investigated. MBT-2 cells were injected subcutaneously into the right hind limb of CH3/HeSlc female mice on day 1. Tumor bearing mice were randomly placed on day 8 into G(M3) treatment, G(D3) treament, sialic acid treament and control groups. G(M3) was administered between tumor and fascia at 10 mu g in 0.1 ml, 1 mu g in 0.1 ml from day 8 to day 20 every other day, 7 times in total. Control group was given 0.1 mi of saline. G(D3) group was given 12.5 mu g of G(D3), and sialic acid group 2.5 mu g of sialic acid. The relative growth rates of control group, G(M3) 1 mu g group, G(M3) 10 mu g group on day 22 were 139+/-74, 56+/-39, 22+/-14, respectively, and statistically significant among these three groups (Mann-Whitney's U test p<0.01). There were no significant difference between control and G(D3) or sialic acid group. All of the 15 control mice had muscle invasion, however, of the 19 G(M3) 10 mu g administered mice, only 4 had muscle invasion. The incidence of muscle invasion between these 2 groups was statistically significant in chi(2) test (p<0.001). Locally administered G(M3) inhibited both invasion and growth of MBT-2 tumor. This mechanism could be explained by an important role of G(M3) in cell adhesion mediated by integrin and fibronectin interaction. These results may be applied to antiadhesion therapy of human invasive bladder tumor.

Two cases of closed dislocation of the interphalangeal joint of the thumb

Dorsal dislocation of the interphalangeal (IP) joint of the thumb is a rare injury, and closed dislocation without fracture is especially unusual. We present here two cases of closed dislocation of the thumb which were reduced by manipulation.

A case of dorsal dislocation of the proximal interphalangeal joint of the fourth toe

Dislocation of the interphalangeal joint of a toe is a rare injury, and when it does occur it usually involves the great toe. Dislocation of other toes without fracture is quite rare. We present here a case of dorsal dislocation of the proximal interphalangeal (PIP) joint which was reduced by manipulation.

Immunological detection of glycated proteins in normal and streptozotocin-induced diabetic rats using anti hexitol-lysine IgG

A polyclonal antibody specific for the Amadori compound, a product of an early stage of the Maillard reaction, was raised in rabbits by immunization with hexitol-lysine (1-glucitol-lysine or 1-mannitol-lysine) coupled with various carrier proteins. The affinity purified antibody has a high titre and preferentially recognizes the glucose adduct, in the presence of sodium borohydride, as judged on enzyme-linked immunosorbent assay as well as immunoblot analysis. The glycated proteins (Amadori products) in various tissues of normal and streptozotocin-induced diabetic rats were examined by immunoblot analysis. In diabetic conditions, kidney, liver, lens, brain and lung proteins are more susceptible to glycation than other tissue proteins. Heart, spleen, adrenal gland and muscle proteins exhibit similar extents of glycation in both normal and diabetic conditions. This is the first demonstration of a specific antibody against the Amadori compound being raised with a synthetic compound, and of the tissue distribution of glycated proteins in normal and diabetic conditions. The antibody was very useful for in vitro and in vivo experiments on the Maillard reaction.

[Clinical significance of proliferating cell nuclear antigen (PCNA) and argyrophilic nucleolar organizer region (AgNOR) in testicular tumors]

BACKGROUND

Proliferative potential of testicular tumor was assessed by immunohistochemistry using anti-proliferating cell nuclear antigen (PCNA) monoclonal antibody and silver staining of argyrophilic nucleolar organizer region (AgNOR), and the results were compared with clinical course.

METHODS

Fourty-five patients with testicular tumor and 10 normal testicles were investigated. All specimens were fixed with 10% buffered formaliun within 24 hours. The interval between patient's recognition of testicular swelling for the first time and the date for operation was designated as M (months), and the specimen weight was designated as g (gram). Growth rate of the primary tumor was estimated roughly by g/M.

RESULTS

PCNA positive rates in seminomas, non-seminomas and normal testes were 70.5 +/- 19.1% (mean +/- S.D.), 80.4 +/- 10.5% and 17.7 +/- 7.8%, respectively. PCNA positive rate in stage I seminoma (64.4 +/- 19.9%) was significantly lower than stage II and III seminoma (83.6 +/- 7.3%) (p < 0.05), but not significant between stage I non-seminoma and stage II, III non-seminoma. The mean numbers of AgNOR per nucleus in seminomas, non-seminomas and normal testes were 8.09 +/- 1.35 (mean +/- S.D.), 6.89 +/- 1.43, 4.18 +/- 1.60, respectively and significantly higher in testicular tumors than normal testes. There were, however, no significant difference between their clinical stages. Logarithmic significant correlation was observed between PCNA positive rate and the growth rate in primary lesion, but no correlation was found between mean number of AgNOR per nuclei and the growth rate. Of the 10 patients with stage I non-seminomas received surveillance policy, four relapsed. Of the 10 patients, 4 of the 6 patients with higher than 75% PCNA positive rate relapsed, whereas, none of the 4 patients with lower than 75% PCNA positive rate relapsed. There were no significant correlation between PCNA positive rate and number of AgNOR.

CONCLUSION

PCNA is more accurate indicator of growth potential in testicular tumor than AgNOR and may predict recurrence in stage I non-seminomatous testicular tumor patients followed by surveillance policy.