HER-2/neu expression in ovarian clear cell carcinomas

HER-2 /neu is a 185-kDa glycoprotein and a transmembrane receptor with tyrosine kinase activity. Its overexpression is observed in 25-30% of primary breast carcinomas and is associated with a poor clinical prognosis. Recently, the U.S. Food and Drug Administration and the Japanese Ministry of Health, Welfare, and Labor approved the use of trastuzumab (Herceptin, Genentech, South San Francisco, CA) for the treatment of patients with metastatic breast carcinomas overexpressing HER-2 /neu. Results of clinical trials with Herceptin suggest that it may prolong the survival of patients with advanced metastatic breast carcinoma. Relatively little is known concerning the relationship between HER-2 /neu status and ovarian clear cell carcinoma. If HER-2 /neu overexpression status were demonstrable in ovarian clear cell carcinoma and a clinical correlation between overexpression and prognosis could be established, a rationale for clinical use of Herceptin for this tumor could be established. Our aim was to evaluate HER-2 /neu status in ovarian clear cell carcinomas. Fifteen ovarian clear cell carcinoma cases were immunostained for HER-2 /neu using HercepTest (DAKO, Glostrup, Denmark). Overexpression of HER-2 /neu was detected in only one case. Unlike in breast carcinoma, HER-2 /neu overexpression appeared to be uncommon in ovarian clear cell carcinomas. Herceptin may thus target only a small proportion of ovarian clear cell carcinomas and be of limited clinical value for treatment of this carcinoma.

Renin-producing serous cystoadenocarcinoma of the ovary: a case report

BACKGROUND

Only a few renin-producing ovarian tumors have been reported, and most such ovarian tumors have been sex cord/stromal tumors. Renin-producing ovarian epithelial tumors are quite rare.

CASE

A 46-year-old woman presented with hypertension and hypokalemia. Examinations of the patient revealed elevated plasma renin activity, hyperaldosteronism and a pelvic mass. Subsequently, a right ovarian tumor mass was resected. Microscopic observation of the tumor revealed a well-differentiated serous cystadenocarcinoma. Immediately after surgery, blood pressure, serum potassium, plasma renin activity and plasma aldosterone levels returned to normal ranges. RT-PCR analysis and immunohistochemical staining of this tumor indicated that it was producing renin.

CONCLUSION

This is the first report of a renin-producing ovarian serous cystadenocarcinoma.

Mesoderm layer and fibrous support tissues essential for embryological differentiation

Of the three germ layers, the mesoderm layer is the first to differentiate from the blastula and continues to lead the embryological differentiation while initiating the secretion of antagonistic duplication and maturation factors. After differentiation and while maintaining the secretion of duplication and maturation factors, the fibrous tissues that differentiated from mesoderm play an essential role in regulating the physio-mitotic conditions of functional tissues found in all histological organizations. Accordingly, some defects in mitotic interaction between the fibrous and functional tissues organized into structural units may give rise to various diseases such as carcinoma, sarcoma, leukemia, and fibro-multiplastic, myo-atrophic and neuroatrophic diseases. This defect in mitosis suggests the most important step in achieving eradication of these diseases.

Cancerous genetic peculiarities non-responsible for cancer development

Certain genetic peculiarities recently identified in cancer cells have generally been regarded as the abnormalities responsible for cancer development. However, these abnormalities may also be found in maturable cancer cells and are not limited only to the non-maturable type. As previously described by the authors, cancer tissue consists of two types of cancerous cells: maturable and non-maturable. The development of cancer may be dependent only on the non-maturable cancerous stem cells, not on the maturable type. Since the non-maturable cell may be solely responsible for carcinogenesis, the relevant genetic peculiarities that are also found in the maturable cancer cells should not be regarded as the abnormalities responsible for carcinogenesis.

[Basaloid-squamous carcinoma of the esophagus: report of a case]

We report herein the case of a 66-year-old man with basaloid squamous cell carcinoma (BSCC) of the esophagus. There are only 60 cases of BSCC of the esophagus previously reported in Japan. In our patient, endoscopic findings revealed a type 2 in the lower intrathoracic esophagus (Lt), and the tumor was intact with the aorta (T2). A biopsy suggested that it was adenosquamous cell carcinoma. An operation was done on June 11, 1996. With open thoracotomy, esophagectomy was performed with mediastinal lymphnode dissection by posterior mediastinal esophagogastrostomy. Histologically, the lesion of the tumor with ulceration was composed of BSCC, and other lesion was composed of typical squamous cell carcinoma (SCC). The immunohistochemical findings of the respected specimens led us to suspect that the basal-layer-type SCC had transformed into BSCC by undergoing differentiation and expansive proliferation. According to the prognosis, eventually the patient died of pneumonia due to methicillin resistant Staphylococcus aureus (MRSA) and candida 4 years and 9 months after the surgery.

Physio-mitotic theory and a new concept of embryological differentiation

According to the physio-mitotic theory described previously by the authors (10,11), general mitosis consists of two different types: essential duplication and converted maturation. In general embryological differentiation, progression for the most fundamental blastocysts of the three germ layers to the immature stem cells comprising functional organic tissues is dependent on the essential duplication mitosis. This mitosis replicates stem cells while gradually initiating latent cellularities whereas the converted maturation process merely amplifies these latent cellularlities by maturing the basic cells in differentiated functional end cells with a pre-determined life span. The differentiation from the three-germ layer to embryologically organized tissues is dependent on duplication mitosis while being regulated by interactions with maturation mitosis. Thus, the complicated embryonic differentiation must be established in each type of organic tissue. During the process, these two types of mitosiseach play an antagonistic role in the embryological development of the other. This is another application of the physio-mitotic theory.

Leukemia eradication and the effect of maturation factor

As described previously (1), the development of leukemia might be attributable to the deteriorated effect of a maturation factor on the relevant type of the leukemic leukocytes, rather than a certain cellular defect initiated in the individual leukemic leukocytes. Thus, the eradication of the leukemia should depend on re-establishing the effect of the maturation factor, rather than persistent destruction of individual leukemia leukocytes. The most powerful effect of the maturation factor may be exerted throughout the mitotic duplication process of the most immature fibro-blastocysts in an in vitro cell culture. Thus, to achieve leukemia eradication, this specific cell culture, which might indefinitely be duplicating the immature fibro-blastocysts in the lineage of leukemic leukocytes, should be investigated and developed. Additionally, a technical method of extracting the maturation factor for the maturation mitosis of leukemic leukocytes should be devised and developed in the future.

Physio-mitotic theory and a new concept of cancer development

In the physio-mitotic theory, general mitosis consists of two different types: maturation and duplication. While being co-regulated by mechanisms involving maturation and duplication factors, these two types of mitotic activities each play a respective role in the antagonistic histological development of the other. According to the theory of systematic organization, each type of organic tissue is always developed and established under certain physiological conditions. As an organoid tissue, cancerous tissue must also fundamentally develop according to that theory. Consequently, a new concept of cancer development should be devised based on the physio-mitotic theory.

Physio-mitotic theory and a new concept of leukemia development

In the physio-mitotic theory described previously by the authors (10), general mitosis consists of two different types: essential duplication and converted maturation. These two types of mitosis are regulated by mechanisms involving maturation and duplication factors, and each plays a role in the antagonistic histological development of the other.According to this theory, every kind of leukocyte is produced through mitosis in the bone marrow and migrates during cell turnover to the bloodstream. However, in leukemia a highly excessive number of leukocytes and leuko-blastocysts appear in the bloodstream. This excessive amount is greater than the physiological capability of cells in the bone marrow alone. Such an extremely large group of cells would not be produced without being dependent on an extremely high ratio of produced leukocytes to original stem cells. This extremely high ratio may be due to a systematic pathological deterioration of the mitotic maturation ability during the maturation process of the leuko-blastocysts. Consequently, restoration of the deterioration to the original mitotic maturation response of the normal leuko-blastocysts may be an essential event in achieving leukemia eradication, rather than persistent destruction of individual leukemic leukocytes.

The use of ionized iodine for cancer prevention and eradication

Using an ionized iodine compound, it may be possible to transmit a weak effect of the digestive enzymes from the duodenal lumen to the cytoplasmic structures beyond the cell membrane in general organic tissues. Povidone-iodine is easily obtainable at present, and may be the most suitable ionized material for the transmission of the enzymatic effects to body tissues. Consequently, to remove certain cellular byproducts accumulated abnormally in cancerous cytoplasm, and to achieve cancer prevention and eradication, a method of using povidone-iodine, as a conceptual model, should be devised and developed in the future.

[A case of ovarian cancer with metastatic tumor in the liver with paclitaxel and carboplatin systemic chemotherapy was very effective]

An 82-year-old woman was admitted to the Dept. of Obstetrics and Gynecology, Yamanashi Medical University to try to identify the origin of a liver metastatic tumor. CT examination revealed a small tumor located adjacent to the uterine cervix in a cul-de-sac. With biopsy using MR, it was clearly shown histologically that the origin of the tumor was the ovary. Systemic chemotherapy with paclitaxel and carboplatin was selected as the most reasonable treatment for this case because of the patient's age. After 6 courses of this chemotherapy, the tumor in the cul-de-sac disappeared and the tumor in the liver decreased markedly. Furthermore, no severe side effects were seen during this treatment. This result indicated that systemic chemotherapy with paclitaxel and carboplatin is effective and safe in cases of advanced ovarian cancer.

Periampullary choledochoduodenal fistula in ampullary carcinoma

Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma.

The novel untranslated exon "exon 0T" encoded between the exon 0 and exon 1 of the rat estrogen receptor alpha (ER alpha) gene

We have recently isolated two untranslated first exons, exon 0N and exon 0S, of rat estrogen receptor alpha (ER alpha) gene from the liver by use of 5'-rapid amplification of the cDNA ends (5'-RACE) method. In this communication, we further analyzed the 5'-untranslated region (UTR) of the ER alpha mRNA in rat anterior hypophysis in order to investigate the existence of the other 5'-untranslated exon(s) of rat ER alpha gene. Total RNA from the anterior hypophysis of 8-week-old female Wistar strain male rats was subjected to 5'-RACE with antisense primers located in exon 1 of the rat ER alpha gene and one of the positive clones (clone 35) was sequenced. The nucleotide sequence of clone 35 revealed the insertion of a previously unidentified exon (which we termed "exon 0T") between exon 0 (the first reported 5'-UTR form of rat ER alpha mRNA) and exon 1 of rat ER alpha mRNA. Analysis of rat genomic DNA indicated that exon 0T was located between exon 0 and exon 1 of rat ER alpha gene. We further investigated the distribution of ER alpha mRNA containing exon 0T in several brain regions and various peripheral tissues of 8-week-old male and female Wistar strain rats by use of reverse transcription-polymerase chain reaction (RT-PCR). The distribution of the ER alpha mRNA (0T-1) was essentially similar to that of ER alpha mRNA in which exon 0 was spliced onto exon 1 reported previously. These results indicate that (1) exon 0T is a novel untranslated exon of rat ER alpha gene which is located between exon 0 and exon 1 on rat genomic DNA, (2) exon 0T is inserted between exon 0 and exon 1 of ER alpha mRNA by alternative splicing, and (3) this alternative splicing may occur in tissues where the transcription of ER alpha gene is initiated from exon 0.

The multiple untranslated first exons system of the human estrogen receptor beta (ER beta) gene

In order to investigate the regulatory mechanism of the expression of the human estrogen receptor beta (ER beta) gene, we have analyzed the structure of the 5'-untranslated region of the ER beta mRNA in the normal uterine endometrium and liver using the 5'-rapid amplification of the cDNA ends method. The sequence analysis revealed the presence of the two isoforms of the ER beta mRNA containing the distinct 5'-untranslated regions. The genomic analysis revealed that the two isoforms of the message originated from the two distinct untranslated first exons, termed the exon 0K and exon 0N, which were spliced to the exon 1. We termed the two isoforms of the message the ER beta mRNA (0K-1) and ER beta mRNA (0N-1). We further analyzed the distribution of the ER beta mRNA (0K-1) and ER beta mRNA (0N-1) in the ejaculated spermatozoa, liver, uterine endometrium and myometrium, and peripheral leukocytes using the reverse transcription-polymerase chain reaction. The distributions of the two mRNA isoforms were different from each other. From these results, it is indicated for the first time that the expression of the human estrogen receptor beta (ER beta) gene is regulated, at least in part, by the multiple untranslated first exons and promoters system.

[A case of tuberculous endometritis detected by cytology of mass screening for gynecologic cancer]

A 55-year-old infertile woman was referred to our clinic for further investigation on extragenital tuberculosis, as tuberculous endometritis was strongly suspected by cytology of her vaginal smear carried out on the occasion of the mass examination for gynecologic cancer screening. Her vaginal smear revealed epithelioid cell clusters which are characteristic for tuberculosis, and cultures of her vaginal discharge were positive for M. tuberculosis consecutively. Moreover, she was exposed for tuberculosis infection from her father who died of active pulmonary tuberculosis when she was ten years old. Her tuberculin test was strongly positive, and her chest radiography showed no abnormality, but a small nodular shadow evaluated as primary focus of tuberculosis located beneath the pleura of the right lower lung field was confirmed by chest CT. In addition, calcification of her para-aortic abdominal lymphnode was detected by simple abdominal X-ray. Based on these data, she was diagnosed as tuberculous endometritis via abdominal cavity, and three antituberculous drugs, namely RFP, INH and EB, were administrated. The mycobacterial cultures of vaginal discharge converted to negative, and chemotherapy was terminated after 9 months treatment. A risk factor leading to the onset of gynecologic tuberculosis, in this case was an exposure to infection from her father. In order to evaluate risk factors relating to the development of gynecologic tuberculosis, bibliographic studies were made on 19 cases of tuberculous endometrites reported recently in Japan regarding their age, its pathogenesis and immuno-suppressive conditions, and the summarized results were as follows. 1. approximately 80% of them were elderly, namely 79% were above 50 years, 63% above 60 years, and 26% above 70 years. 2. 50% of them were caused by endogenous reactivation. 3. 25% of them were immuno-compromised host. It can be concluded that more than 70% of the patients with tuberculous endometritis had risk factors on the host side to develop tuberculosis.

Triterpene and flavanone glycoside from Rhododendron simsii

Antioxidative substances were isolated from the leaves of Rhododendron simsii. These were a triterpene and flavanone glycoside, together with the known matteucinol and two known benzoic acid derivatives. Their structures were characterized as 19,24-dihydroxyurs-12-en-3-one-28-oic acid and 7-O-beta-D-apiofuranosyl-(1-->6)-beta-D-glucopyranosylmatteucinol by spectroscopic analysis.

Lactate discrimination incorporated into echo-planar spectroscopic imaging

A technique for discriminating a lactate signal from overlapping lipid signals in (1)H spectroscopic imaging is presented. It is based on J-coupling between lactate protons and on the broad spectral bandwidth of lipid signal. Measurement parameters used in the technique are determined so that TE is separated from n/J (n: a natural number, J: J-coupling constant) enough to suppress the lipid signal at the time when the lactate signal is strongest. Data processing is used to calculate the lactate signal intensity from the reconstructed spectra. This technique enables lactate to be discriminated in a single measurement and enables spectra of other metabolites to be acquired simultaneously. However, it necessitates a homogeneous magnetic field, long TE, and supplementary lipid suppression. Discrimination of the lactate signal is demonstrated by applying lactate-discriminating echo-planar spectroscopic imaging (EPSI), which combines this discrimination technique with the standard EPSI, to rat focal cerebral ischemia models. Magn Reson Med 45:568-574, 2001.

Incidence survey of Kawasaki disease in 1997 and 1998 in Japan

OBJECTIVE

To describe the results of a nationwide epidemiologic survey of Kawasaki disease for the 2-year period 1997 and 1998.

DESIGN

We sent a questionnaire to all hospitals with 100 beds or more throughout Japan (2663 hospitals) requesting data on patients with Kawasaki disease. Study items included name, sex, date of birth, date of initial hospital visit, diagnosis, address, recurrence, sibling cases, gammaglobulin treatment, and cardiac lesion in the acute stage or 1 month after onset.

RESULTS

Of the 2663 hospitals, 68.5% responded, reporting 12 966 patients-7489 males and 5477 females. Of the total patients reported, 6373 (incidence rate of 108.0 per 100 000 children <5 years old) occurred in 1997, and 6593 (111.7) in 1998. More than one half of the patients (54.9%) were <2 years old and 81.6% were <4 years old. In males, the incidence rates of cardiac lesions were 27.2 in the acute stage and 10.1 a month after onset. In females, the rates were 16.7 and 5.2, respectively. The incidence rates of cardiac lesions were highest in the youngest age group (<6 months old) both in the acute stage and 1 month after onset. The rates decreased with increasing ages. Although frequency of giant aneurysms was not high at the acute stage, it did not decrease 1 month after onset.

CONCLUSION

The incidence rates have been steadily increasing for 11 years since 1987. The rate in 1998 was over 1.5 times higher than that in 1987. The age and sex distributions were identical in each survey. Although most of the cardiac lesions at the acute stage decreased to half or less 1 month after onset, giant aneurysms did not decrease and existed persistently after 1 month.

The novel isoform of the progesterone receptor cDNA in the human testis and detection of its mRNA in the human uterine endometrium

A novel isoform (termed isoform S) of the progesterone receptor (PR) cDNA (PR isoform S cDNA) which consists of a previously unidentified 5' sequence and exons 4-8 of the intracellular PR gene has been cloned from the human testicular cDNA library. The 5' sequence of the message was confirmed to be derived from a novel exon (termed exon S) by genomic cloning. The expression level of the PR isoform S mRNA was higher in the spermatozoon than in the uterine endometrium with a lower expression level of the PR isoforms B and A mRNAs in the spermatozoon than in the endometrium. These results implied that the PR isoform S which was possibly translated from the PR isoform S mRNA in the spermatozoon might be related to the cell surface membrane PR. Moreover, the PR isoform S in the uterine endometrium might play some physiological and/or pathogenic roles.

Capturing and toying with hyraxes (Dendrohyrax dorsalis) by wild chimpanzees (Pan troglodytes) at Bossou, Guinea

Chimpanzees (Pan troglodytes verus) were observed capturing and toying with western tree hyraxes (Dendrohyrax dorsalis, Order Hyracoidea) at Bossou, Guinea. An adolescent female carried one hyrax for 15 hr, slept with it in her nest, and groomed it. The captive was not consumed. Nearby adults ignored the hyrax. In another case, two adolescent males timidly inspected a small hyrax. These observations indicate that the chimpanzees at Bossou do not regard the hyrax as a prey animal, supporting the idea that lack of opportunity does not seem to be the only reason that chimpanzees do not consume an individual of a potential prey species.

Mismatch between lactate and the apparent diffusion coefficient of water in progressive focal ischemia

In this study, we examined mismatch in the area indicated by the normal apparent diffusion coefficient (ADC) of water and increased lactate in the early stage of focal cerebral ischemia. Five rats were subjected to permanent middle cerebral artery (MCA) occlusion. Diffusion-weighted echo planar imaging (DWEPI) and proton echo planar spectroscopic imaging (EPSI) were performed from 20 to 170 min after MCA occlusion, and lactate and N-acetyl asparate images were obtained by EPSI. Postmortem histological analysis was also performed. The areas of increased lactate and normal ADC were observed in the surrounding border zone of ischemia at approximately 20 min after MCA occlusion. This initial lactate in the border zone was significantly higher than that in the normal area, but lower than that in the ischemic core, which showed a reduction of ADC. However, this area was progressively involved in the ischemic core at 170 min without any treatment. The lactate-ADC mismatch in the initial period of ischemia may offer unique diagnostic information for ischemic tissue at high risk, followed by progressive involvement in the ischemic core without treatment. Considering that the accumulation of initial lactate in this area was not excessive, our findings may suggest that the lactate-ADC mismatch in the early period of ischemia indicates potentially salvageable tissue at high risk, requiring aggressive treatment.

Incidence rate of recurrent Kawasaki disease and related risk factors: from the results of nationwide surveys of Kawasaki disease in Japan

To investigate the incidence of recurrent Kawasaki disease, and to discuss some of the potential risk factors, data of the 13th and 14th nationwide surveys of Kawasaki disease in Japan were analyzed. To calculate the rate of recurrence, 10679 patients with 31501.9 person-years were observed. The mean observation period was 2.95 y. The rate of recurrence was 6.89 per 1000 person-years, with a high incidence within the 12 mo following the first episode.

CONCLUSION

The incidence was high among those under 3 y of age and those with cardiac sequelae during the first episode. None of the other factors affected the incidence.

Influence of sperm immobilization on onset of Ca(2+) oscillations after ICSI

Sperm immobilization prior to intracytoplasmic sperm injection (ICSI) is thought to be necessary for efficient fertilization. A variety of methods of sperm immobilization (pipetting, squeezing and piezo application) are currently employed in ICSI. The effect of differences in immobilization method on the timing of initial Ca(2+) oscillations of oocytes in ICSI was investigated. Motile spermatozoa were immobilized in eosin Y solution using pipetting, squeezing and piezo application. Complete staining of the sperm head was achieved after 220.7, 42.2 and 5.0 s respectively. Oscillations after ICSI were measured fluorometrically for each method. The onset of Ca(2+) oscillations was observed at 4.8 to 80.4 min after ICSI. Ca(2+) oscillations developed earlier with the piezo method (14.4 +/- 6.4 min) than other methods (pipetting, 43.1 +/- 20.2 min, P < 0.01; squeezing, 18.4 +/- 3.8 min, P = NS). The piezo method produced the earliest staining of the sperm head and may have caused the most damage to the sperm membrane. A more rapid onset of Ca(2+) oscillations was also observed with the piezo method. The method of sperm immobilization may be important for the rapid release of sperm factors that initiate oocyte activation. This study also showed that Ca(2+) oscillations develop earlier in human oocytes treated by ICSI than indicated in previous reports.

Naive chimpanzees' (Pan troglodytes) observation of experienced conspecifics in a tool-using task

The authors investigated the occurrence of naive chimpanzees' (Pan troglodytes) spontaneous observation of experienced conspecifics during a tool-use task entailing honey fishing. The chimpanzees were presented with 20 kinds of "tools" of which 12 kinds were usable. Six pairs of naive and experienced chimpanzees were brought to this honey-fishing situation. A total of 40 observation episodes occurred between the naive and experienced groups, 34 of which were from naive toward experienced individuals. Naive chimpanzees never observed their partners after their own success but did so after their own failure or before their first attempts. In addition, there were 10 cases in which naive individuals used the left-over tools of the experienced ones. Two factors for the transmission of tool use were clearly evident in this study: (a) spontaneous observation of an appropriate behavioral sequence and (b) enhanced environmental cues made by skilled individuals.

Use of leaves as cushions to sit on wet ground by wild chimpanzees

A new type of tool use, leaf cushion, by wild chimpanzees (Pan troglodytes verus) at Bossou, Guinea, was found. We report two cases: one is indirect evidence; the other is direct observation of a chimpanzee who used the tool. Both cases indicate that chimpanzees used a set of leaves as a cushion while sitting on wet ground. Chimpanzees at Bossou show various kinds of tool use, some of which are unique to the community. Most of these behavioral patterns are substance tool use for obtaining food, as at other study sites. The use of leaves as a cushion adds to the few instances of nonsubstance, elementary technology seen used by wild chimpanzees.

Anastomotic complications after bronchoplastic procedures for nonsmall cell lung cancer

BACKGROUND

Anastomotic complications associated with bronchoplastic procedures cannot be completely avoided despite the improvements made in surgical techniques and suture materials. Thus, the present study attempted to clearly define the significant factors influencing anastomotic complications.

METHODS

Between 1978 and 1998, 47 patients with primary nonsmall cell lung cancer underwent bronchoplastic procedures. The incidences of anastomotic complications were calculated according to each of the following clinical factors: primary site, age, pathologic type, pT factor, pN factor, pulmonary arterioplasty, surgical procedure, suture material, coverage of the anastomotic line, positive resection margin, and preoperative chemotherapy. The results were analyzed using univariate and multiple logistic regression analysis.

RESULTS

Anastomotic complications occurred in 8 patients. Four had anastomotic dehiscence and 4 had stenosis. Of these 8 patients, the resection margin was diagnosed as being positive in 6 patients. Three showed metastasis of the most distal mediastinal lymph node whereas the others had a residual tumor at the bronchial resection margin. According to multiple logistic regression analysis, only pN factor (p = 0.04) and positive resection margin (p = 0.02) had a significant influence on the complications.

CONCLUSIONS

Thus, pN2 patients, especially those with metastasis of the most distal mediastinal lymph node and patients with a residual tumor at the bronchial resection margin, have a significantly higher risk of anastomotic complications.

Extensively calcified hemangioma of the diaphragm with increased 99mTc-hydroxymethylene diphosphonate uptake

A 31-year-old woman visited an out-patient clinic, because of low-grade fever and general fatigue. She was referred to our hospital and admitted for examination of an abnormal shadow which had been found on the chest radiograph. She had experienced faint right lateral chest pain several times on the deep inspirations. Chest radiography showed a mass shadow with calcification in the right lower lung field on the mediastinal side. Chest radiographic computed tomography showed a 6x6 cm tumor in the right lung field. There were low-density areas with septae inside the tumor. Bone scintigraphy showed extremely high uptake of (99m)Tc-HMDP in the tumor. After surgical resection and pathological examination, we concluded that the tumor was an extensively calcified benign hemangioma of the diaphragm.

Established histological identity and cell destruction treatments for cancer

During cancerous cell turnover activity maintained by two types of mitosis, maturation and heteroduplication, cancer tissue consists of two types of cells, maturable and non-maturable. Most of the tissue is composed of maturable cells, which eventually disappear in the terminally matured cell phase. These cells do not participate in cell turnover activity or the organoid identity of cancer tissue. However, a small portion of the tissue is comprised of non-maturable cells, which replicate themselves endlessly, while producing maturable cells through each mitotic division in hetero-duplication mitosis. Thus, cell turnover activity and organoid identity are established in the cancer tissue. This organoid identity is solely responsible for carcinogenesis. Since most typical features of cancer are only detectable in maturable cells during maturation mitosis, cell destruction targeting these features should not be regarded as eradication. To eradicate cancer, the organoid identity of cancer, which is only established by heteroduplication mitosis, should clearly be recognized, and a new concept of cancer treatment based on destruction of the organoid identity should be devised in the future. This does not appear to be an insurmountable task.

Revascularization of canine cryopreserved tracheal allografts

BACKGROUND

We examined the blood supply of a cryopreserved tracheal allograft and its morphohistologic changes after transplantation.

METHODS

In each of 22 dogs, a five-ring tracheal segment was replaced by one of the following tracheal grafts: fresh autografts (n = 8), cryopreserved tracheal allografts (n = 8), or fresh allografts (n = 6). The cryopreserved tracheal allografts were preserved at -196 degrees C for 60 days. No immunosuppressant was given to any of the animals. All grafts were retrieved at 1 and 12 weeks and assessed by microangiography and histology.

RESULTS

The epithelial denudation and the revascularization of the transverse intercartilaginous arteries were recognized within 7 days as common to each of the three types of grafts. In the cryopreserved tracheal allografts, neither cartilage degradation nor graft shrinkage occurred at 7 days. However, the recanalized transverse intercartilaginous arteries completely disappeared at 12 weeks, and marked shrinkage occurred; the cartilage cells were accompanied by karyolysis and were significantly decreased in number (p < 0.05). Recanalization of the transverse intercartilaginous arteries was also demonstrated in the fresh allografts; however, necrosis abruptly occurred as a result of acute rejection responses.

CONCLUSIONS

Cryopreservation of a tracheal allograft provided sufficient reduction of the acute rejection responses, and blood supply to the cryopreserved tracheal allograft was established through the recanalized transverse intercartilaginous arteries within 7 days; however, subsequent chronic rejection responses resulted in occlusion of the transverse intercartilaginous arteries and atrophy.

gp100 mRNA is more sensitive than tyrosinase mRNA for RT-PCR amplification to detect circulating melanoma cells in peripheral blood of melanoma patients

Two different melanocyte-specific mRNAs are studied as markers for circulating melanoma cells in vitro using the human melanoma cell line G361 and in vivo using blood samples from Japanese melanoma patients at different clinical stages. These mRNAs encode tyrosinase, the most essential enzyme for melanin synthesis, and gp100, a melanosomal matrix glycoprotein recognized by monoclonal antibody HMB-45. We used reverse-transcription polymerase chain reaction (RT-PCR) to detect tyrosinase mRNA and gp100 mRNA in peripheral blood. Since melanocytes would not normally be present in peripheral blood, the detection of those transcripts should indicate the presence of circulating melanoma cells. RT-PCR detection of these two mRNAs was highly sensitive and specific. Our in vitro study showed that as few as 10 melanoma cells in 0.125 ml normal blood could be detected. In in vivo study, 130 blood samples from 55 melanoma patients gave positive and variably sensitive results, whereas no samples from healthy controls or patients with other cancers gave positive results. Tyrosinase mRNA was not detected in any of the melanoma patients. gp100 mRNA was detected in 12 of 55 melanoma patients, in none of five stage I patients (0%), in four of 26 stage II patients (15.4%), in one of six stage III patients (16. 7%) and in seven of 18 stage IV patients (38.9%). Thus gp100 mRNA is a more sensitive marker for detecting circulating melanoma cells compared with tyrosinase mRNA.

Successful repair of tracheal defect using gelatin-resorcin-formaldehyde-glue-reinforced fascia patch

We describe the case of a 63-year-old female who underwent repair of a membranous tracheal defect. The tracheal perforation occurred after subtotal esophageal resection, and was associated with empyema due to esophago-gastric anastomotic leakage. We employed a fascia patch reinforced with Gelatin Resorcin- Formaldehyde/Glutaraldehyde glue for the repair, as pedicle muscular flaps were not available due to thoracotomy and a pericardial patch was inadequate because of the empyema. Our method was uncomplicated and provided a satisfactory result.

Detection of circulating melanoma cells by RT-PCR amplification of three different melanocyte-specific mRNAs in a mouse model

Three different melanocyte-specific mRNAs are studied as potential markers for circulating melanoma cells in the serum of mice inoculated subcutaneously with B16F10 melanoma cells. These three mRNAs encode tyrosinase, tyrosinase related protein-2 (TRP-2) and Pmel17, proteins that are essential for the synthesis of melanin and are expressed specifically in melanocytes. We used reverse-transcription polymerase chain reaction (RT-PCR) to detect these three different melanocyte-specific mRNAs in the sera of B16F10 bearing mice. Since melanocytes would not normally be present in the blood, the detection of those transcripts should indicate the presence of circulating melanoma cells. RT-PCR detection of all three mRNAs was highly sensitive and specific. Our in vitro studies show that as few as 10 melanoma cells can be detected in 125 microl blood and that in vivo, melanoma cells can be detected in blood samples from B16F10 melanoma bearing mice. Of these three mRNAs, Pmel17 mRNA is the most sensitive marker for detecting circulating melanoma cells compared with tyrosinase mRNA and TRP-2 mRNA. Moreover, this mouse model might be useful for basic research of malignant melanoma patients with haematogenous metastasis.

Epidermal growth factor receptor expression correlates with poor prognosis in non-small cell lung cancer patients with p53 overexpression

To determine whether cancer patients with tumor suppressor gene abnormality survive for a shorter time when their growth was stimulated by growth factors, we examined 290 non-small cell lung cancer (NSCLC) specimens for p53 and epidermal growth factor receptor (EGFR) protein expressions using immunohistochemical staining. The distribution of cases by pathological stage of tumor was 155 cases of stage I, 30 cases of stage II, 96 cases of stage III and 9 cases of stage IV. Pathological types were 142 adenocarcinomas, 127 squamous cell carcinomas, 17 large cell carcinomas and 4 other types of malignancy. Immunohistochemical staining was performed on the formalin fixed, paraffin-embedded materials with monoclonal antibodies DO-7 and clone EGFR.133. positive staining for EGFR was seen in 124 (42.8%) cases. More EGFR positive cases were found in squamous cell carcinomas than in non-squamous cell carcinomas (p=0.0121). Staining for p53 protein was observed in 147 (50.7%) specimens. Multivariate proportional hazard model analyses revealed EGFR protein expression as a risk factor in the patients with NSCLC (p=0.0240). Patients negative for both EGFR and p53 survived for a longer period of time (p=0.0427).

Analysis of the phospholipid hydroperoxide glutathione peroxidase mRNA in the rat spermatozoon and effect of selenium deficiency on the mRNA

Phospholipid hydroperoxide glutathione peroxidase (PHGPx) is a selenium (Se)-dependent glutathione peroxidase. It is reported that the relative PHGPx mRNA levels are much higher in the testis than in the other tissues. We have analyzed the existence and structure of the PHGPx mRNA in rat sperm and the changes in the level of the PHGPx mRNA after feeding with Se-deficient diets. We used 8-wk-old male Wistar strain rats given Se-adequate feed (control group, n = 5) and Se-deficient diets with marginal levels of Se (0.03 ppm or less) (Se-deficient group, n = 5) for 4 wk. The existence and level of the PHGPx mRNA in the cauda epididymal sperm, testis, and liver from the Se-adequate rats were analyzed by the reverse transcription-polymerase chain reaction and the Southern blotting method. As a result, the existence of the PHGPx mRNA was demonstrated in the cauda epididymal sperm as well as in the testis and liver. Moreover, the subtype of the PHGPx mRNA in the rat sperm was the mitochondrial-type mRNA, which included a region corresponding to the mitochondrial transfer leader sequence. These results imply that the intracellular localization of PHGPx may be regulated by the transcription level. On the other hand, there was no significant difference between the control group and the Se-deficient group in the Se level of the cauda epididymal sperm and the level of the PHGPx mRNA. In conclusion, it has been demonstrated that the PHGPx mRNA exists in rat sperm for the first time. The analysis of the PHGPx mRNA in the sperm would be a useful tool for investigating the disfunction caused by the disorder of the level or structure of the PHGPx in the sperm.

Role of blood vessels in producing pathological changes in the brain with Alzheimer's disease

Vascular factors have been shown to be highly involved in the deposition of the amyloid beta-protein (A beta) in the brain of Alzheimer's disease (AD). However, the detailed mechanism remains unknown. Here, we showed that more numerous deposits of A beta 40 and A beta 42 in the brain were found in AD patients than in controls. Together with evidence of no difference in the level of A beta 40 and A beta 42 in sera between sporadic AD and controls, a certain dysfunction of the blood-brain barrier could induce an abnormal transport of A beta from sera to the parenchyma in AD. In addition, vascular A beta deposits and mature A beta plaques stained by Congo red in AD brains contained more A beta 40 than A beta 42, whereas Congo red-negative immature plaques mainly consisted of A beta 42. Our confocal laser scanning microscopy demonstrated an intimate relationship between A beta 40 and the vascular network. The amount of mature plaques but not that of immature plaques was reportedly correlated with the severity of dementia in AD patients. These results suggest that serum-derived A beta 40 and/or A beta 42 cause A beta 40 deposition in and around blood vessels through unknown but possible mechanisms such as (1) endocytosis of A beta 40, (2) selective transport A beta 40 and A beta 42 into blood vessels and the parenchyma, respectively, and (3) proteolysis of A beta 42 into A beta 40 induced by a putative carboxyl dipeptidase in blood vessels including vascular feet, which is involved in A beta fibrillation and cognitive deterioration in the patients. Therefore, the accumulation of A beta 40 associated with blood vessels may play a critical role in the development of AD.

Superficial undifferentiated small cell carcinoma of the esophagus showing an interesting growing pattern in histology

We report a case of superficial undifferentiated small cell carcinoma of the esophagus. The histology of the tumor was interesting; there was squamous cell differentiation within the epithelial layer and undifferentiated small cells growing within the submucosal layer. The tumor had a negative Grimelius reaction, suggesting no differentiation into a hormone-producing carcinoma known as an apudoma (Amine Precursor Uptake and Decarboxylation (APUD)). The serum levels of ACTH and calcitonin were within normal limits. As the patient was elderly and had a history of pleural tuberculosis causing poor pulmonary function, and owing to the fulminant nature of this carcinoma, he underwent blunt dissection of the esophagus by posterior mediastinal gastric pull-up. The patient recovered quickly and was able to be discharged with a good quality of life until the tumor recurred as a liver metastasis 6 months later.

[Neoadjuvant chemotherapy for esophageal cancer by administration of nedaplatin alone]

The possibility of safe implementation of neoadjuvant chemotherapy using nedaplatin (254-S) was investigated with the aim of improving the therapeutic results in advanced esophageal cancer patients. The subjects had usually undergone two courses of 254-S, 80 or 100 mg/m2, preoperatively, at intervals of 4 weeks. After chemotherapy, responses were evaluated, and resection was undertaken 4 weeks after the final administration. The subjects were 10 patients with untreated esophageal cancer. As a result of evaluation of responses of main lesions to chemotherapy, a partial response (PR) was observed in 3 patients, and a minor response 3, showing an efficacy rate of 30%. Pathological findings before treatment were determined by staining of a cell cycle marker (Ki-67). The 3 patients who were evaluated as PR (clinical efficacy) showed high rates of positivity for Ki-67 of 47.4%, 52.7%, and 86%, respectively. There were no serious complications and no death related to operation. The observations suggested that 254-S, which has little or no side effects including nephrotoxicity, can become the standard remedy for esophageal cancer instead of CDDP in future.

Comparative contractile effects of halothane and sevoflurane in rat aorta

BACKGROUND

Volatile anesthetic agents have been shown to have contractile effects in vascular tissues during specific conditions. This study compared contractile effects of halothane and sevoflurane in rat aorta treated with verapamil. This study also tried to elucidate the mechanism of the contraction.

METHODS

Endothelium-denuded rat thoracic aorta was used for recording of isometric tension and measurement of influx of 45Ca2+. All experiments were performed in the presence of verapamil. In recording of tension, rings were precontracted with a submaximum dose of phenylephrine, followed by exposure to halothane or sevoflurane. For measurement of influx of 45Ca2+, rat aortic strips were exposed to phenylephrine and then to additional halothane or sevoflurane. Influx of Ca2+ was estimated by incubating the strips in 45Ca2+-labeled solution for 2 min.

RESULTS

Halothane (0.5-4.0%) induced contraction in a dose-dependent manner, whereas sevoflurane (1-4%) had no effect on tension. Influx of 45Ca2+ was strongly enhanced by halothane at 1% and 2%, but only slightly at 4%, and was not affected by 1-4% sevoflurane. SK&F 96365, a blocker of voltage-independent Ca2+ channels, abolished contraction and influx of 45Ca2+ by 1% halothane. Depletion of Ca2+ from the sarcoplasmic reticulum with ryanodine or thapsigargin reduced the contraction induced by halothane at 4% but not that at 1% and 2%.

CONCLUSION

Halothane is suggested to cause contraction by enhancing influx of Ca2+ via voltage-independent Ca2+ channels at concentrations up to 2% and by inducing release of Ca2+ at 4%. Sevoflurane (1-4%) is devoid of these contractile effects.

Induction of apoptosis in bovine articular chondrocyte by prostaglandin E(2) through cAMP-dependent pathway

OBJECTIVE

Regulation of important biological processes such as proliferation and differentiation of articular chondrocytes is known to be mediated by prostaglandin E(2) (PGE(2)) in both normal and pathological states. Articular chondrocytes also undergo apoptosis, a biological phenomenon implicated in many physiological processes. Whether or not PGE(2) induces apoptosis in articular chondrocytes, however, is not known.

DESIGN

Bovine articular chondrocytes were cultured with or without PGE(2) for 24 h and amounts of fragmented DNA, which is a distinct characteristic of apoptosis, were measured by enzyme-linked immunosorbent assay. Also effect of cyclic AMP (cAMP), which is one of the intracellular downstream mediator of PGE(2), on chondrocyte apoptosis was investigated.

RESULTS

Administration of exogenous PGE(2) on bovine articular cartilage grown as a monolayer culture resulted in the induction of DNA fragmentation. This DNA fragmentation was accompanied with a marked dose-dependent increase in intracellular cAMP. Also cultured cells were treated with cAMP analogue, dibutyryl-cAMP or forskolin, a direct activator of adenylate cyclase, and the incidence of apoptosis in the chondrocytes was determined. As well as PGE(2), dibutyryl-cAMP and forskolin stimulated chondrocyte DNA fragmentation.

CONCLUSIONS

It is the first report that PGE(2) can induce articular chondrocyte apoptosis in vitro. It is also suggest that apoptosis of chondrocytes by PGE(2) is linked with cAMP-dependent pathway.

Expression of drug resistance-related genes in head and neck squamous cell carcinomas and normal mucosa

We examined the expression levels of mRNA for multidrug resistance 1 (MDR1), multidrug resistance-associated protein (MRP), human canalicular multispecific organic anion transporter (cMOAT), lung resistance-related protein (LRP), topoisomerase IIalpha, beta (Topo IIalpha, beta) and topoisomerase I (Topo I) genes in human head and neck squamous cell carcinoma (HNSCC) specimens and mucosa (HNM) specimens, to elucidate their roles in relation to the biological characteristics and drug resistance in vivo. Fifty-eight samples (45 head and neck carcinomas and 13 head and neck mucosa) obtained during surgical resection or biopsy from 38 patients were analyzed using the quantitative reverse transcription-polymerase chain reaction (RT-PCR) method. MDR1, MRP, LRP, Topo IIalpha, Topo IIbeta, and Topo I gene transcripts were detected in all the samples tested, but cMOAT mRNA was not detected in them. Comparisons of the expression levels in HNSCC with those in HNM showed that the Topo IIalpha gene expression level was higher in HNSCC than in HNM (P=0.0298). Moreover, the Topo IIalpha mRNA level was significantly higher in metastatic lymph node samples of HNSCC than in HNM samples (P=0.0205). There were no significant differences in the six genes' expression levels between samples exposed to platinum drugs and those not exposed to platinum drugs. These results suggest that it may be effective in anticancer therapy to use topoisomerase-targetting drugs against HNSCC, especially metastatic neck tumors, and that the expression of these genes in HNSCC is not associated with platinum drug exposure.

[Oral and dental health and oral and dental support of home patients--role of dental hygienist in the home service nursing station]

Home patients have few chances for going out, so communication with their family means a lot. Talking and eating are particular pleasures. Therefore, oral and dental health and oral and dental support are very important for home patients. A dental hygienist from our clinic visits and offers oral and dental health (oral care) and oral and dental support (oral rehabilitation) to home patients as part of a care plan with home care nurses. Moreover, as general conditions are closely related with oral function, maintaining oral and dental health and regular oral and dental support are very important in order to improve the quality of life (QOL) of home patients.

Progesterone receptor expression in the brainstem of the female rat

By using in situ hybridization and immunohistochemistry, the presence of neurons expressing progesterone receptor mRNA (PR mRNA) and progesterone receptor-like immunoreactivity (PR-LI) was examined in the brainstem and spinal cord of female rats. Neurons expressing PR mRNA and PR-LI were seen in the ventrolateral medulla, the parvocellular reticular formation and the nucleus of the solitary tract. PR mRNA, but not PR-LI, was seen in the hypoglossal nucleus, the inferior olive, the locus coeruleus and the parabrachial nucleus. No consistent labeling was present in the spinal cord. These findings show that progesterone receptors are expressed in brainstem areas involved in various functions, including autonomic regulation and pain modulation.

Gastric tumor induction by 1,2-dimethylhydrazine in Wistar rats with intestinal metaplasia caused by X-irradiation

Five-week-old male Wistar rats were X-irradiated with a total of 20 Gy in 2 equal fractions at a 3-day interval. 1,2-Dimethylhydrazine (DMH) solution was injected i.m. into the back musculature at a dose of 20 mg/kg body weight weekly for 10 weeks, beginning 20 weeks after the final irradiation. Twelve months after the initial carcinogen treatment, tumors in the fundus of the glandular stomach were observed in 5 of 23 animals receiving both X-irradiation and DMH treatment. No tumors of the glandular stomach were observed in the DMH and X-ray alone or nontreatment groups. It is concluded that the presence of intestinal metaplasia may increase sensitivity to the induction of gastric tumors by carcinogens like DMH.

Influence of concomitant miso or NaCl treatment on induction of gastric tumors by N-methyl-N'-nitro-N-nitrosoguanidine in rats

Six-week old male Sprague-Dawley (CD) rats were treated with 100 ppm N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) for 16 weeks in their drinking water with control, miso or sodium chloride (NaCl) supplemented diets. All animals were autopsied 12 months after the beginning of the MNNG treatment. Despite higher intake of MNNG in the high dose miso and NaCl groups, the total tumor incidences were decreased compared to middle and lowest values. The glandular stomach adenocarcinoma incidences in the 10% and 5% miso groups were significantly decreased as compared to those in the 2.2% or 1.1% NaCl groups, with the same concentration of NaCl.

[A case of tracheal fistula after operation for esophageal cancer]

We have experienced a case of mediastinal abscess and tracheal fistula after operation for esophageal cancer and successfully closed by using intercostal muscle pedicle flap. A 61-year-old male underwent esophagectomy for advanced esophageal cancer. On the 12th postoperative day, mediastinal abscess caused by leakage was detected, and drainage of the mediastinal and thoracic cavity was performed. On the 29th postoperative day, tracheal fistula was detected, and operation was performed in order to close the fistula by using of intercostal muscle pedicle flap. His postoperative course was fair and general condition was improvement, esophageal reconstruction using of free jejunal graft was performed and oral ingestion was started.

Localization of a locus responsible for the bovine chondrodysplastic dwarfism (bcd) on chromosome 6

A hereditary chondrodysplastic dwarfism caused by an autosomal recessive gene has been reported in a population of Japanese Brown cattle. Affected calves show an insufficiency of endochondral ossification at the long bones of the limbs. In the present study, we mapped the locus responsible for the disease (bcd) by linkage analysis, using microsatellite markers and a single paternal half-sib pedigree obtained from commercial herds. Linkage analysis revealed a significant linkage between the bcd locus and marker loci on the distal region of bovine Chromosome (Chr) 6. The bcd locus was mapped in the interval between microsatellite markers BM9257 and BP7 or BMS511 with a recombination fraction of 0.05 and 0.06, and a lod score of 8.6 and 10.1, respectively. A comparison of genetic maps between bovine Chr 6 and human Chr 4 or mouse Chr 5 indicates possible candidate genes including FGFR3 and BMP3 genes, which are responsible for human chondrodysplasias and associated with bone morphogenesis, respectively.